Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
There is currently no way to predict which infants are at risk for SIDS. SIDS
has been linked to certain infant-specific and sleep-environment factors.
Therefore, observing the following precautions has reduced the risk of SIDS for
many infants.
Sleep position and the local sleep environment: Educate babysitters,
day-care providers, grandparents, and everyone who cares for your baby about
SIDS risk and the importance of observing the advice offered in the "Back to
Sleep" Campaign.
Sudden infant death syndrome (also known as SIDS) is defined as the sudden,
unexpected death of an infant younger than 1 year of age. If the child's death remains
unexplained after a formal investigation into the circumstances of the death
(including performance of a complete autopsy, examination of the death scene,
and review of the clinical history), the death is then attributed to SIDS.
Sudden infant death is a tragic event for any parent or caregiver.
SIDS is suspected when a previously healthy infant, usually younger than 6
months of age, is found dead following a period of sleep. In most cases, no sign of
distress is identifiable. The baby typically feeds normally prior to being
placed in for sleep. The infant is then discovered lifeless, without pulse or
respiration. Cardiopulmonary resuscitation (CPR) may be initiated at the scene,
but evidence shows a lack of beneficial effect from CPR. The cause of death
remains unknown despite a careful review of the medical history, scene
investigation, and autopsy.
SIDS is rare during the first month of life. Risk
peaks in infants 2-4 months of age and then declines.
About 90% of SIDS deaths
occur in infants younger than 6 months of age.
What is the cause of SIDS?
The cause (or causes) of SIDS is still unknown. Despite the dramatic decrease
in the occurrence of SIDS in the United States and worldwide in recent years,
SIDS remains one of the leading causes of death during infancy beyond the first
30 days following birth. It is generally accepted that SIDS may be the result of
multiple interacting factors.
Infant development: A leading hypothesis is that SIDS may reflect a delay
or abnormality in the development of nerve cells within the brain that are
critical to normal heart and lung function. Research examinations of the
brainstems of infants who died with a diagnosis of SIDS have revealed a
developmental delay in formation and function of several serotonin-binding nerve
cell pathways within the brain. These pathways are thought to be crucial to
regulating breathing, heart rate, and blood pressure responses during awakening
from sleep.
The hypothesis is that certain infants, for reasons yet to be
determined, may experience abnormal or delayed development of specific, critical
areas of their brain. This could negatively affect the function and connectivity
to regions regulating arousal during sleep.
Arousal, in this context, refers
to an infant's ability to awaken and/or respond to a variety of physiological
stimuli. For example, a child sleeping facedown (prone) may move his or her face
into such a position so that the nose and mouth are completely obstructed. This
may alter the levels of oxygen or carbon dioxide in the infant's blood.
Normally, these changes would trigger arousal responses, prompting the infant to
move his or her head to the side to relieve this obstruction.
Other protective
responses to stressful stimuli may be defective in infants who are vulnerable
to SIDS. One such reflex is the laryngeal chemoreflex which arises from nerve
cell pathways located in the back of the throat (pharynx) and within the voice
box (larynx) and upper airway. This reflex regulates changes in breathing, heart
rate, and blood pressure when portions of the airway are stimulated by fluids
like saliva or regurgitated stomach contents. Having saliva in the airway may
activate this reflex, triggering swallowing responses which help to keep the
airway clear. When an infant is in the facedown position, the rate of swallowing
is decreased. Protective arousal responses to these laryngeal reflexes are also
diminished in active sleep when infants are in the facedown sleep position.
Rebreathing stresses: When a baby is facedown, air movement around the
mouth may be impaired. This can cause the baby to re-breathe carbon dioxide that
the baby has just exhaled. Soft bedding and gas-trapping objects, such as
blankets, comforters, waterbeds, and soft mattresses, as well as stuffed or
plush toys are other types of sleep surfaces that may impair normal air movement
around the baby's mouth and nose when positioned facedown.
Hyperthermia (increased temperature): Overdressing, using excessive
coverings, or increasing the air temperature may lead to an increased metabolic
rate in these infants and eventual loss of breathing control. However, it is
unclear whether the increased temperature is an independent factor or if it is
just a reflection of the use of more clothing or blankets that may act as
objects obstructing the airway.
Even though the specific cause (or causes) of SIDS remains unknown,
scientific efforts have eliminated several previously held theories. We now know
the following about SIDS:
Apnea is a term that describes the clinical situation in which a person's
breathing stops spontaneously. Apnea associated with prematurity and apnea which
occurs during infancy are felt to be clinical conditions that are distinct from
SIDS. Infants with apnea may, in some cases, be managed with electronic monitors
prescribed by doctors that track heart rate and respiratory activity. Apnea
monitors will not prevent SIDS.
SIDS is neither predictable nor preventable.
Infants may experience episodes termed apparent life-threatening events (ALTE).
These are clinical events in which young infants may experience abrupt changes
in breathing, color, or muscle tone. Common causes of ALTE include viral
respiratory infections (RSV), gastroesophageal reflux disease, and seizures;
however, no definite scientific evidence links ALTE as events that will lead to
SIDS.
SIDS is not caused by immunizations or bad parenting.
Sleep apnea is defined as a reduction or cessation of breathing during sleep. The three types of sleep apnea are central apnea, obstructive apnea (OSA), and a mixture of central and obstructive apnea. Central sleep apnea is caused by a failure of the brain to activate the muscles of breathing during sleep. OSA is caused by the collapse of the airway during sleep. OSA is diagnosed and evaluated through patient history, physical examination and polysomnography. There are many complications related to obstructive sleep apnea. Treatments are surgical and non-surgical.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
A number of vital tasks carried out during sleep help maintain good health and enable people to function at their best. Sleep needs vary from individual to individual and change throughout your life. Not getting enough sleep can hurt memory performance, health, and your mood.
Respiratory syncytial virus (RSV) is a highly contagious viral infection. Symptoms include fever and nasal congestion and discharge. Treatment focuses on supportive care.
Good parenting helps foster empathy, honesty, self-reliance, self-control, kindness, cooperation, and cheerfulness, says Steinberg, a distinguished professor of psychology at Temple University in Philadelphia. It also promotes intellectual curiosity, motivation, and desire to achieve. It helps protect children from developing anxiety, depression, eating disorders, antisocial behavior, and alcohol and drug abuse.
Hyperthermia is the overheating of the body. Heat-related illnesses like heat stroke, heat exhaustion, heat cramps, heat rash, and sunburn are all hyperthermia conditions. Treatment of these conditions depends upon the condition, environment, and circumstances. Heat stroke is a medical emergency, and may result in death if not treated promptly. Heat exhaustion may lead to heat stroke if not treated properly.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
Smoking during pregnancy increases the risk of miscarriage or stillbirth, low birth weight or premature birth, and more. Secondhand smoke also increases your baby's risk of developing lung cancer, heart diseases, emphysema, asthma, allergies, and SIDS.
If your health isn't enough to make you
quit smoking, then the health of your
baby should be. Smoking during pregnancy affects you and your baby's health
before, during, and after your baby is born. The nicotine (the addictive
substance in cigarettes), carbon monoxide, and numerous other poisons you inhale
from a cigarette are carried through your bloodstream and go directly to your
baby. Smoking while pregnant will:
Lower the amount of oxygen available to you and your growing baby.
Increase your baby's heart rate.
Increase the chances of miscarriage and stillbirth.
Increase the risk that your baby is born prematurely and/or born with low
birth weight.
Increase your baby's risk of developing respiratory (lung) problems.
The more cigarettes you smoke per day, the greater your baby's chances of
developing these and other health problems. There is ...
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