Nicotine is a highly potent neuromuscular blocking agent that induces respiratory arrest in all ages by peripheral block at the diaphragm (not CNS). Deaths occur rapidly, typically within 30 min, even from minute amounts (in one 1936 case, a 6-year-old who had ingested snuffbox scrapings). [Franke FE, Thomas JE. The treatment of acute nicotine poisoning. JAMA. 1936;106(7):507–512. doi:10.1001/jama.1936.02770070003002.]

This is important because tobacco smoke exposure is a well-known SIDS risk factor. Younger children, especially infants, would be most vulnerable to nicotine toxicity compared to older children. We hypothesized that nicotine absorption from household tobacco smoke in sleeping infants with diaphragm fatigue causes SIDS respiratory arrests by reducing the DCC threshold (perhaps by worsening fatigue).

Any thoughts or suggestions? Alternative mechanisms?

It's perplexing that no one appeared to look into this despite so much effort and resources poured into SIDS since the 1990's.