Byline: Phillip Zonkel Staff Writer
FIRST-TIME parents Catherine Snuggs-Saw-An and her husband, Lo-khem Saw-An, ache every day for the loss of their 4-month-old son, Zion.
``The grief feels like a broomstick is shoved into your stomach and coming out your back,'' Catherine says.
On June 14, Catherine, 26, dropped Zion off for his first day at child care. At 10:30 a.m., he was given a bottle and then went to sleep. His caregivers checked on him every 15 minutes, but sometime between noon and 1 p.m., Zion had stopped breathing.
When Catherine arrived at 1:15 p.m at the day-care facility to pick up her son, she was told he had just been rushed to the hospital and wasn't breathing. Child-care workers had attempted to contact Catherine at work but couldn't reach her. Their efforts to get hold of Lo-khem, 27, also were unsuccessful.
A friend drove an emotionally distraught Catherine to the nearby hospital. When they arrived, Zion already had been pronounced dead.
``When it's sudden and unexpected,'' Catherine says, ``it's catastrophic and devastating.''
``I still wake up at 3 or 4 in the morning like I used to to feed him. It's lonely,'' she says. ``It's so sad. I feel like I'm all by myself.''
Catherine, project coordinator with the Long Beach Health Department's African-American Infant Health Project, was confused. She practiced good prenatal care. Zion was in good health and had received all his immunizations. In fact, that afternoon Zion had a four-month checkup appointment with the doctor. What happened?
Doctors told the Bellflower couple that the preliminary finding was that Zion died from sudden infant death syndrome. (A final report takes four to six months to complete.)
SIDS is the sudden death of an apparently healthy baby under 1 year old that cannot be explained even after completion of an autopsy, death scene investigation and a review of the medical history of the infant and parents. One SIDS death occurs in the United States every three hours, 91 percent of them by the age of 6 months.
In Los Angeles County, 10 SIDS cases were reported in 2004, 13 in 2003 (this data is provisional and does not include cases from Long Beach and Pasadena).
SIDS was first described as an official cause of death in 1974. But SIDS is not a new disorder; historical records suggest that SIDS has been around at least 3,000 years. Until recently, however, people believed these babies died from suffocation either by getting tangled in their bedclothes or having someone roll over on them.
Most of the time, SIDS happens without warning. Parents or caregivers put a baby down to sleep at night or for a daytime nap. When they come back, sometimes as little as 20 minutes later, they find the baby has stopped breathing while sleeping. SIDS also has happened when a baby has been sleeping in a car seat or even in a mother's arms. (In California, 20 percent of SIDS deaths occur in child-care settings.)
The baby makes no sounds; SIDS happens quickly and quietly.
``It is devastating not only for the family but also for the pediatrician,'' says Dr. Alison Mann, a pediatrician affiliated with Encino-Tarzana Regional Medical Center and Cedars-Sinai Medical Center.
While Mann has not lost any patients to SIDS, she remains committed to reducing the disorder's health risks.
``I still think about it. We all want the best for our patients.''
Most of the time, SIDS babies seemed completely healthy prior to death. They are well-nourished, well-cared-for and have grown normally. Some might have had a mild cold, but the cold was not the cause of SIDS. Other babies have had some other minor illness, but nothing severe enough to make anyone think the baby might die, according to the California SIDS Program, a support, educational and risk reduction group run by the California Department of Health Services.
The cause of SIDS remains unknown, but the majority of SIDS babies are found on their sides or stomach, prompting, in 1994, the California Back to Sleep education campaign encouraging parents to place sleeping infants on their back. (Placing infants on their stomach or side to sleep is advised only if an infant's medical condition requires it.)
Some parents fear babies will aspirate or choke on their saliva if they sleep on their back, so they place them on their side. But since the American Academy of Pediatrics recommended in 1992 the back as the safest sleeping position, aspiration rates in infants have not increased, according to the California SIDS Program - and SIDS rates have decreased. In California, SIDS has declined by more than 50 percent.
Rachelle Parker, a nurse and mother of two boys from Playa Vista, closely follows the academy's recommendations.
``I don't put anything in the baby bed except for the fitted sheet and the swaddling blanket for the first two weeks,'' says the Cedars-Sinai nurse, who gave birth to her second son, David, on Jan. 6. ``I don't put stuffed animals in the bed; no pillows and no extra padding.''
But the campaign has not been as effective in African-American communities; African-American infant deaths from SIDS are more than twice the rate of white infants.
``Black infants are more likely to be placed on their stomachs,'' says SIDS researcher Dr. Henry Krous, director of pathology at Children's Hospital San Diego. ``The Back to Sleep campaign has been less effective in reaching the black population.''
The cause of SIDS may still remain unknown, but ongoing research is starting to answer some questions.
In 1994, a groundbreaking paper called ``Triple Risk Hypothesis'' examined SIDS findings. The researchers came to the conclusion that three factors working in conjunction contributed to a SIDS death: an infant's developmental stage from 1 to 6 months (when SIDS is most prevalent), SIDS risk factors (sleep position, prenatal and post-natal smoking, body temperature during sleep, etc.) and an abnormality in the baby's brain tissue.
``There's a general agreement that these three variables interacting with one another are critically important to SIDS,'' Krous says.
At this stage, a baby's physiology evolves, Krous explains. The infant essentially changes from being an organism breathing through a placenta to a baby breathing air on its own.
``There's something wrong with the development of particular structures in the brain pertaining to the baby's control of respiration during sleep,'' Krous says of SIDS babies.
Those developmental structures, he says, are related to the brain stem, which tells the body how often and how deep to breathe and how fast the heart should beat, whether someone is awake or asleep. The brain stem of SIDS babies might not be able to respond to changes in the environment.
When babies sleep, their breathing is not regular. Babies have pauses in their breathing, and oxygen levels rise and fall, Krous explains. A small number of babies do not wake up from sleep to protect themselves from low oxygen, which might occur as a baby stops breathing. This inability to rescue himself or herself from a breathing pause is related to SIDS.
``The routine postmortem exam will not demonstrate these findings,'' Krous says. ``They require very sophisticated techniques that only a few laboratories in the world are doing.''
Krous says research is under way examining the relationship between these three factors in the hope of understanding SIDS.
Even though SIDS is a natural cause of death, not knowing the reason behind it still wreaks havoc on parents.
``You don't anticipate losing your children, especially for no reason,'' says Kevin Butler, president of the Southern California SIDS Foundation. ``It's extremely difficult to deal with.''
Since Zion's death, Catherine has become pregnant with the couple's second child. Their daughter is due in March.
Lo-khem tries to balance those jubilant emotions with the sadness he still has for Zion.
``It's still hard. Some days are harder than others. I still cry a lot,'' he says. ``Some things will remind you of time with your son, and it will hit you and trigger the emotions. Sometimes it's something as simple as seeing a flower or seeing a sign for day care.''
For more information
--The California SIDS Program, (800) 369-7437
--The Southern California SIDS Foundation, (800) 974-3752 or www.californiasids.com
Get the facts about SIDS
--In 2002, SIDS was the No. 5 cause of death among infants and the No. 2 cause of death for infants from 1 month to 1 year old.
--Male babies are more likely to die from SIDS than female babies, 57 to 47 percent.
--In 2002, 91 percent of SIDS deaths happened by 6 months of age.
--The rate of African-American infant deaths from SIDS is more than twice that of whites.
Source: California SIDS Program
Reducing risk to your baby
--Always place your baby on his or her back to sleep, even for naps.
--Place your baby on a firm mattress, such as in a safety approved crib.
--Remove soft, fluffy bedding and stuffed toys from your baby's sleep area.
--Make sure your baby's head and face remain uncovered during sleep.
--No smoking around the baby.
--Do not let your baby get too warm during sleep.
--Talk with child-care providers, grandparents, baby sitters and all caregivers about SIDS risks.
Source: California Back to Sleep Campaign
CAPTION(S):
3 photos, 3 boxes
Photo:
(1 -- cover -- color) ON THE COVER: Rachelle Parker and son David. A nurse at Cedars-Sinai Medical Center, Parker puts her baby to sleep on his back.
David Sprague/Staff Photographer
(2) Catherine Snuggs-Saw-An with a picture of Zion. ``I still wake up at 3 or 4 in the morning like I used to to feed him. It's lonely.''
Jeff Gritchen/Staff Photographer
(3) Zion was in good health and had received all his immunizations when SIDS struck.
Box:
(1) For more information (see text)
(2) Get the facts about SIDS (see text)
(3) Reducing risk to your baby (see text)
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