Neurological DisordersNeurological DisordersPSY 417PSY 417

SchuetzeSchuetze

Diagnosing Neurological ProblemsDiagnosing Neurological Problems

Structural ImagingStructural Imaging Functional ImagingFunctional Imaging

Computerized Axial Tomography Computerized Axial Tomography (CAT Scan)(CAT Scan)

Magnetic resonance Imaging (MRI)Magnetic resonance Imaging (MRI)

Positron Emission Tomography Positron Emission Tomography (PET Scan)(PET Scan)

Inject radioisotopes in bloodInject radioisotopes in blood Attracted to areas of tissue that are Attracted to areas of tissue that are

metabolically activemetabolically active

PET ScanPET Scan

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Diagnosing Neurological ProblemsDiagnosing Neurological Problems

Structural ImagingStructural Imaging Functional ImagingFunctional Imaging

Computerized Axial Tomography Computerized Axial Tomography (CAT Scan)(CAT Scan)

Magnetic resonance Imaging (MRI)Magnetic resonance Imaging (MRI)

Positron Emission Tomography Positron Emission Tomography (PET Scan)(PET Scan)

Inject radioisotopes in bloodInject radioisotopes in blood Attracted to areas of tissue that are Attracted to areas of tissue that are

metabolically activemetabolically active

PET ScanPET Scan

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Computerized Axial Tomography Computerized Axial Tomography (CAT Scan)(CAT Scan)

Magnetic resonance Imaging (MRI)Magnetic resonance Imaging (MRI)

Positron Emission Tomography Positron Emission Tomography (PET Scan)(PET Scan)

Inject radioisotopes in bloodInject radioisotopes in blood Attracted to areas of tissue that are Attracted to areas of tissue that are

metabolically activemetabolically active

PET ScanPET Scan

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Magnetic resonance Imaging (MRI)Magnetic resonance Imaging (MRI)

Positron Emission Tomography Positron Emission Tomography (PET Scan)(PET Scan)

Inject radioisotopes in bloodInject radioisotopes in blood Attracted to areas of tissue that are Attracted to areas of tissue that are

metabolically activemetabolically active

PET ScanPET Scan

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Positron Emission Tomography Positron Emission Tomography (PET Scan)(PET Scan)

Inject radioisotopes in bloodInject radioisotopes in blood Attracted to areas of tissue that are Attracted to areas of tissue that are

metabolically activemetabolically active

PET ScanPET Scan

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

PET ScanPET Scan

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

UltrasoundUltrasound

Large hemorrhage in left ventricular

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Electroencephalogram (EEG)Electroencephalogram (EEG)

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

EEG WavesEEG Waves

EpilepsyEpilepsy

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

EEG WavesEEG Waves

Unresponsive neonateUnresponsive neonate Grade IV Grade IV

Intraventricular Intraventricular HemorrhageHemorrhage

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Areas to be EvaluatedAreas to be Evaluated

Mental StatusMental Status Awareness and interaction with the Awareness and interaction with the

environmentenvironment

Motor Function and BalanceMotor Function and Balance Sensory ExaminationSensory Examination ReflexesReflexes

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

ReflexesReflexes

Inborn automatic responses to particular Inborn automatic responses to particular form of stimulationform of stimulation Gradually disappear over 1Gradually disappear over 1stst 6 months 6 months

probably due to increase in voluntary controlprobably due to increase in voluntary control Reflexes index health of nervous systemReflexes index health of nervous system Week or absent reflexesWeek or absent reflexes Overly exaggeratedrigid reflexesOverly exaggeratedrigid reflexes

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

ReflexesReflexes

EyeblinkEyeblink MoroMoro CrawlingCrawling BabinskiBabinski Palmar GraspPalmar Grasp

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Evaluation of Cranial NervesEvaluation of Cranial Nerves I Olfactory Nerve ndash identification of smellsI Olfactory Nerve ndash identification of smells II Optic Nerve - eyeII Optic Nerve - eye III Oculomotor ndash pupil of eyeIII Oculomotor ndash pupil of eye IV Trochlear ndash movement of eyesIV Trochlear ndash movement of eyes V Trigeminal ndash ability to feel faceV Trigeminal ndash ability to feel face VI Abducens ndash movement of eyesVI Abducens ndash movement of eyes VII Facial ndash tastes smilingVII Facial ndash tastes smiling VIII Acoustic - hearingVIII Acoustic - hearing IX Glossopharyngeal - tasteIX Glossopharyngeal - taste X Vagus - swallowing X Vagus - swallowing XI Accessory ndash moving shouldersneckXI Accessory ndash moving shouldersneck XII Hypoglossal ndash movement of tongueXII Hypoglossal ndash movement of tongue

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Cerebral PalsyCerebral Palsy

Motor problems due to brain damage that Motor problems due to brain damage that occurs before during or after birthoccurs before during or after birth

Often due to anoxiaOften due to anoxia General symptoms muscular General symptoms muscular

incoordination posturalbalance problems incoordination posturalbalance problems secondary impairmentssecondary impairments

Not progressiveNot progressive Hypertonia versus hypotoniaHypertonia versus hypotonia

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Cerebral Palsy ndash Affected SitesCerebral Palsy ndash Affected Sites

Hemiplegia ndash one side of bodyHemiplegia ndash one side of body Paraplegia ndash lower extremitiesParaplegia ndash lower extremities Quadriplegia ndash all extremitiesQuadriplegia ndash all extremities Diplegia ndash all extremitiesDiplegia ndash all extremities Monoplegia ndash one extremityMonoplegia ndash one extremity Triplegia ndash three extremitiesTriplegia ndash three extremities

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Cerebral Palsy ndash TypesCerebral Palsy ndash Types

Spastic muscles contract when stretchedSpastic muscles contract when stretched Athetoid limbs flailAthetoid limbs flail Ataxia loss of coordinationAtaxia loss of coordination MixedMixed

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

SeizuresSeizures Abnormal electrical discharges in cerebral Abnormal electrical discharges in cerebral

neuronsneurons Imbalance between excited versus Imbalance between excited versus

inhibited neuronsinhibited neurons Epilepsy recurrent seizuresEpilepsy recurrent seizures 3 Categories3 Categories

Partial activation of one area of brainPartial activation of one area of brain Generalized activation of entire brainGeneralized activation of entire brain UnclassifiedUnclassified

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Types of SeizuresTypes of Seizures

Tonic ndash rigid muscle contractionTonic ndash rigid muscle contraction

Clonic alternate contractionrelaxation of musclesClonic alternate contractionrelaxation of muscles

Tonic-clonicgrand mal contraction followed by Tonic-clonicgrand mal contraction followed by clonic activityclonic activity

Myoclonic sudden brief shock-like muscle Myoclonic sudden brief shock-like muscle contractionscontractions

Atonic sudden reduction in muscle toneAtonic sudden reduction in muscle tone

Infantile poor long-term prognosisInfantile poor long-term prognosis

Febrile tonic-clonic from high feverFebrile tonic-clonic from high fever

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Traumatic Brain InjuryTraumatic Brain Injury

Physical SymptomsPhysical Symptoms Cognitive SymptomsCognitive Symptoms Behavioral SymptomsBehavioral Symptoms

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Neural Tube DefectsNeural Tube Defects

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Spina BifidaSpina Bifida

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Other Neural Tube DefectsOther Neural Tube Defects

AnencephalyAnencephaly MicrocephalyMicrocephaly HydrocephalyHydrocephaly

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Shaken Baby SyndromeShaken Baby Syndrome

Approximately 50000yearApproximately 50000year 25 die25 die

Mental retardationMental retardation Cerebral PalsyCerebral Palsy

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Sudden Infant Death Syndrome (SIDS)

10487081048708 The sudden death of an infant under 1 year The sudden death of an infant under 1 year of age which remains unexplained after a of age which remains unexplained after a thorough case investigation including thorough case investigation including performance of a complete autopsy performance of a complete autopsy examination of the death scene and review examination of the death scene and review of the clinical historyrdquo of the clinical historyrdquo ndash

Willinger Willinger 1991

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Characteristics of SIDSCharacteristics of SIDS

Peak incidence 2 to 4 months of agePeak incidence 2 to 4 months of age Slight male predominanceSlight male predominance More prevalent in cold winter monthsMore prevalent in cold winter months Not considered genetic or hereditaryNot considered genetic or hereditary Not due to suffocation aspiration abuse Not due to suffocation aspiration abuse

or neglector neglect

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Characteristics of SIDSCharacteristics of SIDS

Leading cause of postneonatal death (28 to Leading cause of postneonatal death (28 to 364 days of age)364 days of age)

Occurs suddenly without warning often Occurs suddenly without warning often during periods of sleepduring periods of sleep

Occurs during critical development periodOccurs during critical development period

Triple-risk hypothesisTriple-risk hypothesis

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

What Causes SIDSWhat Causes SIDS

Triple-Risk ModelTriple-Risk Model

SIDSExogenous Stressors

Vulnerable Infant

Critical Development

Period

Some infants are born vulnerable with certain brain stem abnormalities that make them susceptible to sudden death during a critical developmental period once an exogenous stressor or environmental

challenge is presented

Source Filiano JJ Kinney HC Biology of the Neonate 1994

bulloverheatedbullexposed to second-hand smokebullentrapment from stuffed animals or pillowsbullenvironmental challenge

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Risk Factors for SIDSRisk Factors for SIDS

Prone sleep positionProne sleep positionPreterm birthPreterm birthLBWLBWNolate prenatal careNolate prenatal careMaternal smoking during pregnancyMaternal smoking during pregnancyETS exposureETS exposureYoung maternal ageYoung maternal ageSingle marital statusSingle marital statusSoft beddingSoft beddingCo-sleeping (possibly)Co-sleeping (possibly)Infections (possibly)Infections (possibly)

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

ldquoldquoBack to Sleeprdquo CampaignBack to Sleeprdquo Campaign

1992 ndash American Academy of 1992 ndash American Academy of Pediatricians (AAP) recommendation Pediatricians (AAP) recommendation

1994 ndash National public education 1994 ndash National public education campaign beginscampaign begins

Prone sleep position drops from 62 in Prone sleep position drops from 62 in 1993 to 20 in 19981993 to 20 in 1998

SIDS incidence has fallen 30-50SIDS incidence has fallen 30-50

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

Mortality Rates Due to SIDS US 1980-Mortality Rates Due to SIDS US 1980-20012001

02468

1012141618

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000

Year

Rate

per

100

000

live

birt

hs

AAP Position

Statement

Back to Sleep

Campaign

initiated

Change to ICD-10

Codes

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94

SIDS mortality rates by race of motherSIDS mortality rates by race of mother

0

50

100

150

200

250

300

350

1989 1990 1991 1995 1996 1997 1998 1999 2000 2001 2002

Year

Rat

e pe

r 10

000

0 liv

e bi

rths

Am IndianAlaska Native

Black non-Hispanic

White non-Hispanic

SIDS ndash Sudden Infant Death SyndromeSOURCE CDCNCHS National Vital Statistics System Linked Birth-Infant Death data set Data not available for 1992-94