Cot death/Sudden Infant Death Syndrome (SIDS)
ParentsCentre's expert Dr Stuart Flanagan continues his series of articles by outlining some guidelines on how to avoid cot death/Sudden Infant Death Syndrome. Dr Flanagan is an experienced physician who also works as a contributor and medical adviser for a number of BBC projects - you can download his biography at the bottom of this page. He is writing monthly articles for the site, including bedwetting, immunisation, discussing contraception with teenagers, acne in adolescence and common diseases in childhood.
Current guidelines on reducing the risk of cot death
The term 'cot death' is one that fills all parents with fear and anxiety, and represents one of the most devastating events for any parent. In this article, I will be looking at the some of the potential causes of Cot Death and the current guidelines for parents on reducing the risks.
Cot death is the term most people use for Sudden Infant Death Syndrome (SIDS). This term was first proposed in 1969, although its definition has been modified in subsequent years. SIDS is defined as "sudden unexpected death of an infant less than one year of age, with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history."
This means that SIDS is essentially a diagnosis by exclusion. In other words, when all other possible causes have been ruled out, the unexplained death of the infant is termed SIDS.
This carefully worded definition is helpful for gathering statistical evidence and clarifying scientific research into the condition. But of course, the unexplained nature of the death often leaves parents feeling guilty, frustrated, cheated and anguished.
Babies at risk
Some 90 per cent of cot deaths occur at the age of six months or less. Babies most at risk are thought to be those among poorer families and those where the mother smokes. There is also an increased risk in those babies who have had a sibling lost to SIDS. Other risks include premature birth, low birth weight and babies put to sleep on their stomach.
Causes of SIDS
There have been no clear causes of SIDS identified, although several have been proposed. Many theories suggest that the affected baby may have problems with temperature control or regulation of breathing. When the child is faced with a situation when breathing may become difficult, or overheating may become a problem, they may be too vulnerable to survive. Most children will grow out of these problems as they develop, but of course it is difficult to identify those children who may be particularly vulnerable.
Scientists are still researching these and many other theories, and it's most likely that several of these factors combine to cause SIDS.
Prevention
A three-year study by the Confidential Enquiry in Stillbirths and Deaths In Infancy (CESDI) led to a recent update on the guidelines for prevention of cot death.
'Back to Sleep'
Since the early 1990s, parents have been advised to place their babies on their backs when laying them down to sleep - the 'Back to Sleep' position. This has shown to significantly reduce the risk of cot death. Indeed, since the well-publicised 'Back to Sleep' campaign was launched in 1991, the rate of cot deaths in the UK has fallen by 70 per cent - the equivalent of 12 babies per week.
At around five to six months your child may start to roll around in bed - if you find them lying on their front, gently turn them onto their back again. While your child is awake it is perfectly safe for them to play on their front, and in fact this will help them with muscle development.
Stop smoking - both mums and dads
Research has shown that mothers who smoke during pregnancy put their child at an increased risk of cot death compared with those that don't. This also holds for mothers who smoke after pregnancy. Indeed, your child's risk of SIDS increases with length of exposure to cigarette smoke - so both Mum and Dad should stop smoking and prevent baby being exposed to other smokers.
Keep baby at a comfortable temperature
Overheating is an important risk factor in SIDS. A room that is too warm, or a cot with excess bedding, can easily overheat your baby. Keep your baby's room at a comfortable temperature (around 18oC).
Use single sheets or a comfortably fitting baby sleeping bag for bedding. Avoid pillows, duvets and quilts. If you swaddle your child, do so with light materials - don't use additional bedding, and keep your child's head uncovered.
Watch out for signs of overheating - your baby's hands and feet will usually be cooler, so check the tummy to gauge temperature. Signs of overheating are sweating, rapid breathing, agitation, and a feverish brow.
Add or remove blankets if your child is too cool or too hot. Never put your baby to bed with a hot water bottle or electric blanket, and don't place them too close to a radiator in the room.
Keep baby's head uncovered
Babies lose excess heat from their heads, so always make sure your child's head is uncovered before they go to sleep. Place your baby at the foot of the cot so that they can't wriggle down under the sheets. Tuck the sheets securely at the level of the shoulders. This way, your child will be comfortable without slipping under the sheets.
Bed sharing
Since 2004, the FSID has advised that bed sharing with babies aged eight weeks or less could put them at increased risk of SIDS. Indeed, around 135 babies die from cot death every year after sharing their parents' bed all night. This may be due to the child overheating or having restricted head movement.
There is a significantly increased risk if a parent is a smoker, has been drinking or taking medication or drugs or is excessively tired. The current advice is for baby to sleep in a cot in the parents' room for the first six months.
Never sofa-share
The recent CDESDI update showed some alarming figures for parents who fall asleep with their babies on the sofa. There has been a four-fold increase in infants dying in this way in recent years. The advice is that the sofa is not a safe sleeping environment - always place them back to sleep in their cot.
See a doctor if your baby is unwell
Be alert for any signs or symptoms that your baby may be seriously unwell. These include:
- a less responsive child
- persistent agitation
- a weak, simpering cry
- grunting breaths
- poor oral intake
- poor urinary output
- feverish and sweating
- floppiness
- avoidance of the light
- a new rash
- seizure or fits always require medical attention
You know your baby best - if they show any of the above symptoms, or just do not seem their usual self, seek medical help.
Breastfeeding
Babies who have been breastfed may be at a slightly lower risk of cot death.
Immunisation
Babies who have immunised according to the current vaccination guidelines have been shown to be at a lower risk of cot death.
Overall, remember that if you follow the advice above, the risk of your baby suffering SIDS is much reduced.
Dr Stuart
Flanagan's biography
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