Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS), also known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age.

SIDS remains the leading cause of infant death in many developed countries. There are around 2,700 babies who die from cot death every year in the US – and around 300 in the UK.

Cot death occurs when a seemingly healthy infant – under 12 months of age – dies in their sleep with no cause of death established in a post-mortem investigation. Although many risk factors are known to increase the risk of cot death – such as maternal smoking and bed sharing – nobody is exactly sure why it happens.

The incidence of SIDS is higher in male infants as compared with female infants, with a ratio of 60 male deaths to 40 female deaths.

The American Academy of Pediatrics now recommends that infants be put to sleep on their back instead of on their side or stomach. While this has reduced the incidence of SIDS somewhat, it certainly has not eliminated it.

Contents

The allostasis hypothesis

Allostasis is defined as "the process of achieving equilibrium through fluctuating neuroendocrine responses to physical and psychological stressors." Professor Eran Elhaik (2016) has postulated a hypothesis, based on allopathic (stress) load that may explain the cause of SIDS. According to Elhaik:

We postulate that while low-level stress can stimulate adaptation, prolonged and repetitive iatrogenic stressful, painful, or traumatic experiences during prenatal, perinatal, neonatal, and postneonatal development constitute allostatic overload and are risk factors for SIDS. Due to their total dependence, the infant’s ability to allostatically regulate exposure to stressors is severely constrained, which increases their vulnerability to disease and premature death. Due to their difficulties in maintaining homeostasis and inability to escape/avoid iatrogenic or non-medically nociceptive exposure, infants are vulnerable to toxic stress with preterm infants being the most vulnerable.

Elhaik lists infant stressors such as:

• maternal smoking
• maternal caffeine consumption
• preterm births
• non-urgent pediatric surgeries
• neonatal circumcision

Elhaik lists stressors from non-therapeutic neonatal circumcision as:

• intense pain
• bleeding
• shock
• sepsis
• circulatory shock
• hemorrhage

that can result in death. He points out that post-operative circumcision pain can last for 10-14 days.

Elhaik lists skin breaking procedures such as heel sticks and seasonal respiratory viral infection as additional stressors.

Elhaick observes that the SIDS rate in the UK where the NHS does not perform non-therapeutic circumcision is 0.38 per 1000 as compared with the US rate of 0.55 per 1000 where most male infants are circumcised.

Evidence of association with circumcision

Elhaik (2019) published data from 15 countries and 40 U.S. states to provide evidence of an association between non-therapeutic neonatal circumcision and SIDS.

Elhaik found great variation in the SIDS mortality rate. Of the 15 countries studied, The Netherlands, where the Dutch do not practice infant circumcision, was the lowest at 0.06 per 1000 births, while the United States where non-therapeutic infant circumcision is commonplace had the highest at 0.82 per 1000 births.

Elhaik reported that the incidence of SIDS in states where Medicaid pays for non-therapeutic circumcision is higher than that of states where Medicaid does not pay for non-therapeutic circumcision.

See also

• Circumcision risks: Post-operative risks A-Z

External links

• Ehaik, Eran (11 January 2019). Neonatal circumcision could increase the risk of sudden infant death syndrome in babies – new research, /theconversation.com/, The Conversation. Retrieved 8 July 2020.

• (11 January 2019). Circumcision linked to SIDS, Doctors Opposing Circumcision. Retrieved 4 July 2020.