Gaming Disorder

What is a Video Game?

A video game is an electronic game that involves interaction with a
user interface to generate visual feedback on a video device such as a TV
screen or computer monitor.
With the Video Game Industry releasing more complex, realistic and
compelling video games designed to capture and hold the attention of
increasingly sophisticated gamers, this has led to video game addictions
affecting teens and young adults alike which made the World Health
Organization to classify and diagnose Gaming Disorder recently in the start
of 2018 as an official and classified disease.
What is Gaming Disorder?
Gaming disorder is a pattern of persistent or recurrent gaming
behavior online or offline, manifested by impaired control over gaming,
increasing priority given to gaming to the extent that gaming takes
precedence over other life interests and daily activities and continuation or
escalation of gaming despite the occurrence of negative consequences.

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 For gaming disorder to be diagnosed, the behavior pattern must be of
sufficient severity to result in significant impairment in personal, family, social,
educational, occupational or other important areas of functioning and would
normally have been evident for at least 12 months.
What causes Gaming Disorder on individuals?
Many different causes factor into gaming disorder or video game
addiction. One of the main reasons that video games can become so
addictive, however, is they are designed to be that way. Video game
designers, like anyone else trying to make a profit, are always looking for
ways to get more people playing their games. They accomplish this by
making a game just challenging enough to keep players coming back for
more but not so hard that the player eventually gives up. In other words,
success for a gamer often feels just out of reach. In this respect, video game
addiction is very similar to another more widely recognized disorder:
gambling addiction.
What are the signs of Gaming Disorder or addiction
problems on individuals?
As with any other addiction, video game addiction has warning signs.
It is important to know how to recognize these signs if you or someone you
care about is an avid gamer. According to the Illinois Institute for Addiction
Recovery, these symptoms can be both emotional and physical.
Emotional Symptoms of Gaming Disorder
Some of the emotional signs or symptoms of video game addiction
include:
 Feelings of restlessness and/or irritability when unable to play
 Preoccupation with thoughts of previous online activity or
anticipation of the next online session
 Lying to friends or family members regarding the amount of
time spent playing
 Isolation from others in order to spend more time gaming

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 Physical Symptoms of Gaming Disorder
Some of the physical signs or symptoms of video game addiction
include:
 Fatigue
 Migraines due to intense concentration or eye strain
 Carpal tunnel syndrome caused by the overuse of a controller
or computer mouse
 Poor personal hygiene

What are effects on individuals who were diagnosed

with gaming disorder?
Though most of the symptoms listed above have short-term effects,
they can lead to more severe long-term repercussions if not addressed
properly. For example, someone addicted to video games will often avoid
sleeping or eating proper meals in order to continue gaming. While the short-
term effects of this may include hunger and fatigue, it could eventually lead to
a sleep disorder or diet-related health issues. Similarly, those who isolate
themselves from others in order to play video games may miss out on family
events, outings with friends, or other events in the short-term.
Other long-term effects of video game addiction to consider are the
financial, academic and occupational consequences involved. Video games
and video game equipment can be very expensive, especially when factoring
in recurring costs such as the high-speed Internet connection required for
online multiplayer games. These games can also be very time-consuming,
leaving addicted gamers with less time to focus on their education or career.
Physical ailments can also affect individuals who spends large
amount of time using a computer or a game console. Carpal tunnel syndrome
may affect hands and wrists due to excessive time spent with gaming
equipment. Headaches, backaches, and dry eyes are additional problems
encountered. Weight issues may plague as well, due to the lack of physical
activity connected with this lifestyle.
Prevention
Prevention is beneficial to avoid the issues that accompany this
disorder. Instituting limitations on time spent playing video games may help
people avoid developing compulsions to playing these games. People can
consciously choose to pursue other activities, such as outdoor sports,
reading books, housework, or spending time with friends and family, instead
of playing video games.

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 Parents should provide ongoing supervision and limits on the time
children spend playing video games to prevent compulsions from starting. It
may also help to talk about the fact that the action in video games can go on
for a long time, but the games can always wait for the next playing
opportunity.
Behavioral therapy can help a gamer move past the addiction.
Therapy can help the compulsive person refocus thoughts and energy on
different activities instead of gaming. If a gamer has been immersed in an
extensive gaming community, spending time with other people who are also
playing video games, it may be necessary to change the gamer’s physical
environment for a period of time to institute new habits and thought
processes. A residential treatment facility could provide this temporary
environment to help a person move past video game compulsions.
Medication: Are there drug options for Gaming
Disorder?
Treatment for gaming disorder can come in many forms, including
different types of therapy or 12-step programs. Certain medications may
even be able to inhibit addictive behaviors.
Drugs: Possible Options
Bupropion is one medication that has been used recently to treat this
type of disorder. The drug works in a way that changes the brain’s chemistry
and helps to decrease cravings for video game play. Though it has proven to
be fairly effective, this option may not be for everyone. Others may choose to
medicate only when absolutely necessary, treating the symptoms as they
occur. For example, a gamer suffering from migraines may take medication
for headaches. Likewise, an addict suffering from sleeplessness may turn to
sleeping pills.
Medication Side Effects
When you take any form of medication, especially when self-
medicating, it is very important to read all directions and follow dosage
instructions carefully. Even over-the-counter medications can result in
dependency and therefore should not be taken for long periods of time
unless it is recommended by a medical professional.

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 Bupropion, though often helpful, is not for everyone. Some possible
side effects include:
 Drowsiness
 Dry mouth
 Excessive sweating
 Itching
 Fever

Antidepressant Drug Addiction, Dependence and

Withdrawal in Online Addicts
Due to the evident link between video game or Internet addiction and
depression, it is not surprising that many addicted gamers take
antidepressant medication to help with the symptoms. Though most
healthcare professionals consider this type of medication to be safe and
effective, it also comes with its own set of risks and side effects. One factor to
consider before beginning antidepressant medication is that it may be difficult
to stop taking it. It is common to experience withdrawal symptoms, including
anxiety, irritability, nausea and dizziness. In more serious cases, it is possible
to experience depression as a symptom of withdrawal from the medication.
This depression can be even more severe than the original depression,
leading the patient to believe that the illness has returned.

Medication Overdose
According to the National Safely Council, unintentional overdose is
responsible for more deaths among Americans between the ages of 35 and
54 years old than motor vehicle crashes. When taking any medication for
addiction or any other problem, it is important to take only the amount
prescribed.

Depression and Gaming Disorder

Two recent studies concerning the ties between video game addiction and
depression showed an alarming correlation between the two. If you suffer
from both conditions, it’s important to seek help at a treatment facility that can
address both issues. If you attempt to treat the video game addiction without
treating the underlying depression, the addiction is more likely to recur.

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Dual Diagnosis: Gaming Disorder and Substance Abuse
Because gaming disorder has been linked to depression, sleeplessness and
an overall lack of concern for one’s own health, it is not surprising that
substance abuse is also a problem for many gamers suffering from this
compulsive disorder. For those suffering from video game addiction as well
as substance abuse, proper treatment is imperative to recovery.

Should all people who engage in gaming be concerned

about developing gaming disorder?
Studies suggest that gaming disorder affects only a small proportion of
people who engage in digital- or video-gaming activities. However, people
who partake in gaming should be alert to the amount of time they spend on
gaming activities, particularly when it is to the exclusion of other daily
activities, as well as to any changes in their physical or psychological health
and social functioning that could be attributed to their pattern of gaming
behaviour.

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 Auto-Brewery
Syndrome

What is Auto-Brewery Syndrome?

Auto-brewery syndrome, also known as intestinal candida infection or gut
fermentation syndrome, might be a fascinating condition to read about – but
it’s an absolutely miserable experience if you have it. This odd digestive
disorder results in a feeling of being intoxicated all the time, or being in a fog,
where it becomes extremely difficult to concentrate on even the simplest of
tasks.

It is a rare medical condition in which intoxicating quantities of ethanol are

produced through endogenous fermentation within the digestive system.

Claims of endogenous fermentation of this type have been used as a

defense against drunk driving charges.

One case went undetected for 20 years.

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It has also been investigated, but eliminated, as a possible cause of sudden
infant death syndrome.

What causes Auto-Brewery Syndrome?

One gastrointestinal organism, Saccharomyces cerevisiae, a type of yeast,
has been identified as a pathogen for this condition.

A variant occurs in persons with liver abnormalities that prevent them from
excreting or breaking down alcohol normally. Patients with this condition can
develop symptoms of auto-brewery syndrome even when the gut yeast
produces a quantity of alcohol that is too small to intoxicate a healthy
individual.

Gut fermentation syndrome is typically associated with an accumulation of

yeast inside the intestines. Yeast can build up to the point to where just
having a soda, or introducing sugar into the body in some other manner, can
trigger a reaction that can rival a major alcohol bender.

Symptoms of Auto-Brewery Syndrome

The effects of the disease can have profound effects on everyday life. As
well, the recurring side effects of excessive belching, dizziness, dry mouth,
hangovers, disorientation, irritable bowel syndrome, and chronic fatigue
syndrome can lead to other health problems such as depression, anxiety and
poor productivity in employment. The random state of intoxication can lead to
personal difficulties, and the relative obscurity of the condition can also make
it hard to seek treatment.

How can Auto-Brewery Syndrome affect individuals who

have it?
It is known that the syndrome has been used to waive DUI charges — like
most recently for this New Yorker whose blood alcohol level was 0.4 but she
had none of the usual symptoms of intoxication, even though she had
ingested alcohol earlier that day. She also carried out most of her daily
activities normally, even with high levels of alcohol in her system.

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On the other hand, there was another case where the carrier experience the
effects of auto-brewery syndrome differently:

Cases involving the yeast Candida albicans and Candida krusei have popped
up in Japan, and in 2013 Panola College Dean of Nursing Barbara Cordell
documented the case of a 61-year-old man who had frequent bouts of
unexplained drunkenness for years before being diagnosed with an
overabundance of Saccharomyces cerevisiae, or brewer's yeast, the same
yeast used to make beer.

Diagnosing Auto-Brewery Syndrome

The best way to know is to buy a DOT approved breathalyzer and test your
blood alcohol concentration (BAC) when you feel drunk. Now, if you’ve been
drinking, it doesn’t count, of course, but if you haven’t had anything to drink,
and your BAC is elevated, there’s definitely a problem.

If you are trying to prove you have ABS to someone else, like law
enforcement, your family, etc., it may be a little harder. A primary provider
(MD, Nurse Practitioner, DO, etc.) would need to admit you to a hospital for a
24 hour observation without alcohol and try and re-create the triggers that
cause the drunkenness, such as a high carbohydrate diet (sugar, pasta, corn
or your particular triggers). A breathalyzer may be used and/or blood would
be drawn every few hours to document a rise in blood alcohol levels if it
happens. Some people report episodes only every few days so it may or may
not happen in the hospital. Prior to the hospital challenge, a detailed history
should be taken and stool samples should be sent for yeast testing and
identification.

Other symptoms of yeast overgrowth include itchy, flaky skin, toe fungus,
athlete’s foot, dandruff and other signs. Many people with ABS experience
gastric upset such as nausea, vomiting, bloating, belching, and/or gas.

Treatment for Auto-Brewery Syndrome

The treatment for auto-brewery syndrome is a change in diet requiring low
carbohydrates and high protein. Sugar is fermented into alcohol, and a diet
that effectively lowers sugars also lowers the alcohol that can be fermented
from it. Anything that causes an imbalance between the beneficial and
harmful bacteria in the gut can help increase the chance that fermentation in
the gut will develop. This can include not only antibiotics, but also
overindulgence in sugars and carbohydrates. Watching what you eat could
lower the risk of gut fermentation syndrome, and taking probiotics could
further protect you by increasing the number of good bacteria in your system.

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It can happen to anyone
In severe cases, the body of someone with gut fermentation syndrome
produces so much alcohol that he or she can quickly become legally drunk –
without having a sip of beer or liquor. In fact, one woman in New York was
actually pulled over because a police officer suspected her of drunk driving,
but her case was later thrown out because she was diagnosed with the
condition.

The scariest thing about gut fermentation syndrome is that it can strike
anyone, regardless of age, gender, or medical history. Children have even
been diagnosed with the condition. One girl developed it at the age of 13;
another was diagnosed when she was only 3 years old.

Gut fermentation syndrome sufferers will typically complain that they are tired
all the time, which is completely understandable, considering what they
experience on a daily basis.

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How can diet affect gut fermentation syndrome?
A diet high in carbohydrates can have a profound effect on triggering a bout
of drunkenness due to gut fermentation syndrome. In one study performed in
2010, a 61-year-old man suffering from the condition was given a high-carb
meal. His blood was drawn before the meal to establish a baseline blood
alcohol content level, and was then checked every two hours. He was also
given a Breathalyzer test every four hours. At one point during the study, his
blood alcohol level shot up to .12 percent. If he had been behind the wheel,
he could have easily been pulled over for a DWI.

Interestingly, researchers also linked this man’s condition to antibiotics he

had received six years earlier. They believed that the antibiotics destroyed so
many bacteria in his lower intestine that it allowed the Saccharomyces
cerevisiae yeast in his body to explode in numbers, contributing to his
condition. They gave the man an anti-fungal medication to lower the amount
of yeast in his system. He was then given probiotics to help replenish his
supply of intestinal bacteria. According to the study, the treatment lasted for
two and a half months and he was symptom-free afterward.

Anything that causes an imbalance between the beneficial and harmful

bacteria in the gut can help increase the chance that fermentation in the gut
will develop. This can include not only antibiotics, but also overindulgence in
sugars and carbohydrates. Watching what you eat could lower the risk of gut
fermentation syndrome, and taking probiotics could further protect you by
increasing the number of good bacteria in your system.

If you do take antibiotics as well as probiotics, you should take them at

different times in order for the probiotic to be able to work. Taking the
probiotic at least two hours later will help ensure it will be able to do its job. A
good rule of thumb is to take the antibiotic after you eat dinner, and then take
the probiotic before you go to bed.

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The mystery continues
This is not to suggest that laying off of carbs and antibiotics will automatically
cure gut fermentation syndrome – far from it, in fact. Scientists still don’t
know exactly why this problem occurs, and they have yet to develop a
reliable way to address it.

Thankfully, gut fermentation syndrome is extremely rare. One of the only

ways to get an accurate diagnosis involves a lengthy hospital stay. The
patient will typically be isolated from others to ensure he or she is not
consuming alcohol; tests will be performed on gut microbes and enzymes.
Blood alcohol content levels will be checked on a regular basis as well.

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 Sudden Infant Death
Syndrome

What is 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 less than one year of age.
Diagnosis requires that the death remains unexplained even after a thorough
autopsy and detailed death scene investigation. SIDS usually occurs during
sleep. Typically death occurs between the hours of 00:00 and 09:00.There is
usually no evidence of struggle and no noise produced.

The exact cause of SIDS is unknown. The requirement of a combination of

factors including a specific underlying susceptibility, a specific time in
development, and an environmental stressor has been proposed. These
environmental stressors may include sleeping on the stomach or side,

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overheating, and exposure to tobacco smoke. Accidental suffocation from
bed sharing (also known as co-sleeping) or soft objects may also play a role.
Another risk factor is being born before 39 weeks of gestation. SIDS makes
up about 80% of sudden and unexpected infant deaths (SUIDs). Other
causes include infections, genetic disorders, and heart problems. While child
abuse in the form of intentional suffocation may be misdiagnosed as SIDS,
this is believed to make up less than 5% of cases.

The most effective method of reducing the risk of SIDS is putting a child less
than one year old on their back to sleep. Other measures include a firm
mattress separate from but close to caregivers, no loose bedding, a relatively
cool sleeping environment, using a pacifier, and avoiding exposure to
tobacco smoke. Breastfeeding and immunization may also be preventive.
Measures not shown to be useful include positioning devices and baby
monitors. Evidence is not sufficient for the use of fans. Grief support for
families affected by SIDS is important, as the death of the infant is sudden,
without witnesses, and often associated with an investigation.

Rates of SIDS vary nearly tenfold in developed countries from one in a

thousand to one in ten thousand. Globally it resulted in about 19,200 deaths
in 2015 down from 22,000 deaths in 1990. SIDS was the third leading cause
of death in children less than one year old in the United States in 2011. It is
the most common cause of death between one month and one year of age.
About 90% of cases happen before six months of age, with it being most
frequent between two months and four months of age. It is more common in
boys than girls.

Definition
SIDS is a diagnosis of exclusion and should be applied to only those cases in
which an infant's death is sudden and unexpected, and remains unexplained
after the performance of an adequate postmortem investigation, including:

1. An autopsy (by an experienced pediatric pathologist, if possible);

2. Investigation of the death scene and circumstances of the death;
3. Exploration of the medical history of the infant and family.

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After investigation, some of these infant deaths are found to be caused by
accidental suffocation, hyperthermia or hypothermia, neglect or some other
defined cause.

Australia and New Zealand are shifting to the term "sudden unexpected
death in infancy" (SUDI) for professional, scientific, and coronial clarity.

The term SUDI is now often used instead of sudden infant death syndrome
(SIDS) because some coroners prefer to use the term 'undetermined' for a
death previously considered to be SIDS. This change is causing diagnostic
shift in the mortality data.

In addition, the U.S. Centers for Disease Control and Prevention (CDC) has
recently proposed that such deaths be called "sudden unexpected infant
deaths" (SUID) and that SIDS is a subset of SUID.

Age

SIDS has a 4-parameter lognormal age distribution that spares infants shortly
after birth — the time of maximal risk for almost all other causes of non-
trauma infant death.

By definition, SIDS deaths occur under the age of one year, with the peak
incidence occurring when the infant is at 2 to 4 months of age. This is
considered a critical period because the infant's ability to rouse from sleep is
not yet mature.

Risk factors
The cause of SIDS is unknown. Although studies have identified risk factors
for SIDS, such as putting infants to bed on their stomachs, there has been
little understanding of the syndrome's biological process or its potential
causes. The frequency of SIDS does appear to be influenced by social,
economic, and cultural factors, such as maternal education, race or ethnicity,
and poverty. SIDS is believed to occur when an infant with an underlying
biological vulnerability, who is at a critical development age, is exposed to an
external trigger. The following risk factors generally contribute either to the
underlying biological vulnerability or represent an external trigger:

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Tobacco smoke

SIDS rates are higher for infants of mothers who smoke during pregnancy.
SID correlates with levels of nicotine and derivatives in the infant. Nicotine
and derivatives cause significant alterations in fetal neurodevelopment.

Sleeping

Placing an infant to sleep while lying on the stomach or the side increases
the risk. This increased risk is greatest at two to three months of age.
Elevated or reduced room temperature also increases the risk, as does
excessive bedding, clothing, soft sleep surfaces, and stuffed animals.
Bumper pads may increase the risk of SIDS due to the risk of suffocation.
They are not recommended for children under one years of age as this risk of
suffocation greatly outweighs the risk of head bumping or limbs getting stuck
in the bars of the crib.

Sharing a bed with parents or siblings increases the risk for SIDS. This risk is
greatest in the first three months of life, when the mattress is soft, when one
or more persons share the infant's bed, especially when the bed partners are
using drugs or alcohol or are smoking. The risk remains, however, even in
parents who do not smoke or use drugs. The American Academy of
Pediatrics thus recommends "room-sharing without bed-sharing", stating that
such an arrangement can decrease the risk of SIDS by up to 50%.
Furthermore, the Academy recommended against devices marketed to make
bed-sharing "safe", such as in-bed co-sleepers.

Breastfeeding

Breastfeeding is associated with a lower risk of SIDS.It is not clear if co-

sleeping among mothers who breastfeed without any other risk factors
increased SIDS risk.

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Pregnancy and infant factors

SIDS rates decrease with increasing maternal age, with teenage mothers at
greatest risk. Delayed or inadequate prenatal care also increases risk. Low
birth weight is a significant risk factor. In the United States from 1995 to
1998, the SIDS death rate for infants weighing 1000–1499 g was 2.89/1000,
while for a birth weight of 3500–3999 g, it was only 0.51/1000. Premature
birth increases the risk of SIDS death roughly fourfold. From 1995 to 1998,
the U.S. SIDS rate for births at 37–39 weeks of gestation was 0.73/1000,
while the SIDS rate for births at 28–31 weeks of gestation was 2.39/1000.

Anemia has also been linked to SIDS (note, however, that per item 6 in the
list of epidemiologic characteristics below, extent of anemia cannot be
evaluated at autopsy because an infant's total hemoglobin can only be
measured during life. SIDS incidence rises from zero at birth, is highest from
two to four months of age, and declines toward zero after the infant's first
year. Baby boys have a ~50% higher risk of SIDS than girls.

Genetics

Genetics plays a role, as SIDS is more prevalent in males. There is a

consistent 50% male excess in SIDS per 1000 live births of each sex. Given
a 5% male excess birth rate, there appears to be 3.15 male SIDS cases per
2 female, for a male fraction of 0.61. This value of 61% in the US is an
average of 57% black male SIDS, 62.2% white male SIDS and 59.4% for all
other races combined. Note that when multiracial parentage is involved,
infant race is arbitrarily assigned to one category or the other; most often it is
chosen by the mother. The X-linkage hypothesis for SIDS and the male
excess in infant mortality have shown that the 50% male excess could be
related to a dominant X-linked allele, occurring with a frequency of 1⁄3 that is
protective of transient cerebral anoxia. An unprotected male would occur with
a frequency of 2⁄3 and an unprotected female would occur with a frequency
of 4⁄9.

About 10 to 20% of SIDS cases are believed to be due to channelopathies,

which are inherited defects in the ion channels which play an important role
in the contraction of the heart.

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Alcohol

Drinking of alcohol by parents is linked to SIDS. One study found a positive

correlation between the two during New Years celebrations and weekends.
Another found that alcohol use disorder was linked to a more than twofold
risk.

Other

There is a tentative link with Staphylococcus aureus and Escherichia coli.

Vaccinations do not increase the risk of SIDS; contrarily, they are linked to a
50% lower risk of SIDS.

A 1998 report found that antimony- and phosphorus-containing compounds

used as fire retardants in PVC and other cot mattress materials are not a
cause of SIDS. The report also states that toxic gas can not be generated
from antimony in mattresses and that babies suffered SIDS on mattresses
that did not contain the compound.

A set of risk factors SIDS has been identified with: seasonality: winter
maximum, summer minimum; increasing SIDS rate with live birth order; low
increased risk of SIDS in subsequent siblings of SIDS; apparent life-
threatening events (ALTE) are not a risk factor for subsequent SIDS; SIDS
risk is greatest during sleep.

Differential diagnosis
Some conditions that are often undiagnosed and could be confused with or
comorbid with SIDS include:

 medium-chain acyl-coenzyme A dehydrogenase deficiency (MCAD

deficiency);
 infant botulism;
 long QT syndrome (accounting for less than 2% of cases);
 Helicobacter pylori bacterial infections;
 shaken baby syndrome and other forms of child abuse;
 overlaying, child smothering during carer's sleep

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For example, an infant with MCAD deficiency could have died by "classical
SIDS" if found swaddled and prone with head covered in an overheated room
where parents were smoking. Genes indicating susceptibility to MCAD and
Long QT syndrome do not protect an infant from dying of classical SIDS.
Therefore, presence of a susceptibility gene, such as for MCAD, means the
infant may have died either from SIDS or from MCAD deficiency. It is
currently impossible for the pathologist to distinguish between them.

A 2010 study looked at 554 autopsies of infants in North Carolina that listed
SIDS as the cause of death, and suggested that many of these deaths may
have been due to accidental suffocation. The study found that 69% of
autopsies listed other possible risk factors that could have led to death, such
as unsafe bedding or sleeping with adults.

Several instances of infanticide have been uncovered where the diagnosis

was originally SIDS. Estimate of the percentage of SIDS deaths that are
actually infanticide vary from less than 1% to up to 5% of cases.

Some have underestimated the risk of two SIDS deaths occurring in the
same family and the Royal Statistical Society issued a media release refuting
this expert testimony in one UK case in which the conviction was
subsequently overturned.

Prevention
A number of measures have been found to be effective in preventing SIDS
including changing the sleeping position, breastfeeding, limiting soft bedding,
immunizing the infant and using pacifiers. The use of electronic monitors has
not been found to be useful as a preventative strategy. The effect that fans
might have on the risk of SIDS has not been studied well enough to make
any recommendation about them. Evidence regarding swaddling is unclear
regarding SIDS. A 2016 review found tentative evidence that swaddling
increases risk of SIDS, especially among babies placed on their stomachs or
side while sleeping.

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A plot of SIDS rate from 1988 to 2006

Sleep positioning

Sleeping on the back has been found to reduce the risk of SIDS. It is thus
recommended by the American Academy of Pediatrics and promoted as a
best practice by the US National Institute of Child Health and Human
Development (NICHD) "Safe to Sleep" campaign. The incidence of SIDS has
fallen in a number of countries in which this recommendation has been
widely adopted. Sleeping on the back does not appear to increase the risk of
choking even in those with gastroesophageal reflux disease. While infants in
this position may sleep more lightly this is not harmful. Sharing the same
room as one's parents but in a different bed may decrease the risk by half.

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Pacifiers

The use of pacifiers appears to decrease the risk of SIDS although the
reason is unclear. The American Academy of Pediatrics considers pacifier
use to prevent SIDS to be reasonable. Pacifiers do not appear to affect
breastfeeding in the first four months, even though this is a common
misconception.

Bedding

Product safety experts advise against using pillows, overly soft mattresses,
sleep positioners, bumper pads (crib bumpers), stuffed animals, or fluffy
bedding in the crib and recommend instead dressing the child warmly and
keeping the crib "naked."

Blankets or other clothing should not be placed over a baby's head.

Sleep sacks

In colder environments where bedding is required to maintain a baby's body

temperature, the use of a "baby sleep bag" or "sleep sack" is becoming more
popular. This is a soft bag with holes for the baby's arms and head. A zipper
allows the bag to be closed around the baby. A study published in the
European Journal of Pediatrics in August 1998[64] has shown the protective
effects of a sleep sack as reducing the incidence of turning from back to front
during sleep, reinforcing putting a baby to sleep on its back for placement
into the sleep sack and preventing bedding from coming up over the face
which leads to increased temperature and carbon dioxide rebreathing. They
conclude in their study, "The use of a sleeping-sack should be particularly
promoted for infants with a low birth weight." The American Academy of
Pediatrics also recommends them as a type of bedding that warms the baby
without covering its head.

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Vaccination

A large investigation into diphtheria-tetanus-pertussis vaccination and

potential SIDS association by Berlin School of Public Health, Charité –
Universitätsmedizin Berlin concluded: "Increased DTP immunisation
coverage is associated with decreased SIDS mortality. Current
recommendations on timely DTP immunisation should be emphasised to
prevent not only specific infectious diseases but also potentially SIDS."

Many other studies have also reached conclusions that vaccinations reduce
the risk of SIDS. Studies generally show that SIDS risk is approximately
halved by vaccinations.

Management

Families who are impacted by SIDS should be offered emotional support and
grief counseling. The experience and manifestation of grief at the loss of an
infant are impacted by cultural and individual differences.

Epidemiology

Globally SIDS resulted in about 22,000 deaths as of 2010, down from 30,000
deaths in 1990.[74] Rates vary significantly by population from 0.05 per 1000
in Hong Kong to 6.7 per 1000 in American Indians.

SIDS was responsible for 0.54 deaths per 1,000 live births in the US in
2005.[29] It is responsible for far fewer deaths than congenital disorders and
disorders related to short gestation, though it is the leading cause of death in
healthy infants after one month of age.

SIDS deaths in the US decreased from 4,895 in 1992 to 2,247 in 2004.[76]

But, during a similar time period, 1989 to 2004, SIDS being listed as the
cause of death for sudden infant death (SID) decreased from 80% to
55%.[76] According to John Kattwinkel, chairman of the Centers for Disease
Control and Prevention (CDC) Special Task Force on SIDS "A lot of us are
concerned that the rate (of SIDS) isn't decreasing significantly, but that a lot
of it is just code shifting".

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