THE SUDDEN INFANT DEATH SYNDROME

IN 1950, when Keith Bowden published in this journal an article entitled "Sudden Death or Alleged Accidental Suffocation in Babies"," he reflected in this title the prevailing medical and lay opinion of the likely cause of the sudden unexpected death of a previously well infant. Bowden went on to describe 40 cases of sudden infant deaths. In most of these there had been a story from the parents that the child had been unwell shortly before death, and the post-mortem findings in most instances supported a diagnosis of infection. These findings, together with observations made on healthy sleeping infants, who were easily able to push aside covering bed clothes and to adjust their posture if their face should become obstructed by a mattress or a pillow, led him to the conclusion that infection was the likely cause of death in these babies. The First International Conference on the Causes of Sudden Death in Infancy, held in 1963, recognized the need for identification of this problem (which has sometimes been colloquially called "cot death") and suggested the term "sudden death syndrome" (SDS). During the next few years, the publication of many epidemiological studies has enabled a "profile" of the child at risk to be built up. This profile applies to any of the affluent "westernized" societies. The child is usually a male infant, aged between one and seven months, living in overcrowded substandard housing in a city centre; he is likely to have been born prematurely to a young mother, who has bottle fed him. The risk is greater in the winter months, especially if he has a mild respiratory tract infection. There are many other factors potentiating this risk-being a twin, belonging to a minority racial group and the presence of a pillow or another child in the cot, to mention a few. The story of sudden infant deaths cannot be entirely explained on the basis of poor housing, poverty and bottle feeding, as a sudden infant death may occur amongst households where none of the above-mentioned risk factors are found to apply. Death may occur amongst