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By Vivienne Fouché
SIDS, also known as cot death, is the leading cause of death in the
developed world for babies between 1 month and 1 year old. It’s the
diagnosis that is given when a baby under 1 year dies suddenly and
an exact cause of death can’t be found after a complete legal and
medical investigation. It is devastating, not least because it
generally happens without warning in a seemingly healthy infant.
According to US statistics, SIDS most commonly affects babies
between the ages of 2 to 4 months, with 90% of cases occurring in
infants under 6 months. It occurs most frequently during cold
weather months. These parameters are similar for countries around
the developed world.
Researchers have learned a great
deal about SIDS in the past three decades but not enough to answer
“What causes SIDS?” At this stage, there are guidelines for lowering
an infant’s risk of developing SIDS – but there’s no guaranteed way
to prevent a cot death.
Some experts believe that SIDS
happens when a baby with an underlying abnormality - for example, a
brain defect that affects breathing – sleeps tummy down, or is faced
with an environmental challenge such as secondhand smoke during a
critical period of growth. But frustratingly, other experts have
published studies that contradict this hypothesis.
Supporters of the “brain
defect-breathing” theory pinpoint a possible abnormality in the
“arcuate nucleus”, which is a part of the brain that may help to
control breathing and awakening during sleep. If a baby is breathing
stale air and not getting enough oxygen, his brain usually prompts
him to wake up and cry, which compensates for the lack of oxygen.
But a problem with the arcuate nucleus could deprive the baby of
this reaction and put him at greater risk for SIDS.
This theory links into the idea that
stomach sleeping can increase an infant’s risk of “rebreathing” his
own exhaled air, particularly if he is sleeping on a soft mattress
or with bedding, stuffed toys or a pillow near his face. It’s
believed that eventually, this lack of oxygen could contribute to
SIDS.
Some researchers have also suggested
that stomach sleeping puts pressure on a child’s jaw, narrowing the
airway and hampering breathing.
One area where all scientists and
researchers are in agreement is that mothers should avoid smoking,
drinking or using drugs while pregnant and avoid exposing a baby to
secondhand smoke. Infants of mothers who smoked during their
pregnancy are three times more likely to die of SIDS than those with
mothers who were smoke-free.
 And exposure to secondhand smoke
after your baby is born is believed to double his risk of succumbing
to SIDS.
Some researchers also suggest that a
baby who gets too warm could go into a deeper sleep, making it more
difficult
to awaken.
Scientists continue to study the
brain, nervous system, immunity, infant care, sleep and genetics in
search of answers.
The “Back to sleep” campaign,
launched in the US in 1994 by the American Academy of Pediatrics (AAP),
the US Public Health Service, the Association of SIDS and Infant
Mortality Programs and the SIDS Alliance, has helped reduce deaths
from SIDS by at least between 40% and 50% (estimates vary).
In 1992, the AAP began recommending
that all healthy infants younger than 1 year be put to sleep on
their backs, because of strong evidence that stomach sleeping might
contribute to the incidence of SIDS. They also warn that placing an
infant to sleep on his side increases the risk that he might roll
over onto his tummy while sleeping.
Many parents aren’t aware that up to
20% of SIDS deaths also happen in daycare settings. It’s crucial
that your daytime babysitter continues your own night time routine,
putting your child to sleep on his back. Several studies have also
shown that if a child is used to sleeping on his back and is then
put down on his tummy, his risk of SIDS rises significantly – which
may explain the high rate of SIDS in daycare settings.
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Have your baby sleep on his back on
a firm, flat mattress Look for a mattress with big ventilation holes
in it, which allegedly helps prevent the build-up of carbon dioxide.
There are also other products on the market that help position your
baby on his back when he’s falling asleep
-
Don’t let your baby sleep on a soft
surface Quilts, duvets, sofas, waterbeds, beanbags and other soft
surfaces are all unsafe
-
Don’t put soft toys in his cot
and ensure that bedding doesn’t creep up over his head. Position your
baby so
he is lying with his feet touching the end of the cot, so he doesn’t
move down the bed and get trapped under the covers
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Some experts recommend that you
avoid using a blanket and keep your baby in a warm room. But if
you’re uncomfortable with this, use a thin blanket, tuck it around
the mattress and cover your baby’s arms and chest
-
Swaddling is another option, because
it can help your baby sleep more comfortably on his back. A
“wearable blanket” – a sleeveless garment that’s closed at the
bottom like a bag – is also an option
-
Avoid overheating your baby Signs
that he might be overheating include sweating, damp hair, heat rash,
rapid breathing, restlessness and fever. Keep the room temperature
around 20˚C
-
Watch humidity levels Strike a happy
balance between air that isn’t too dry or humid
-
Don’t use cot bumpers while your
baby is tiny If you must use them, ensure they are thin and firm.
Attach them firmly to the cot and ensure no strings are dangling
inside the cot
-
Don’t smoke or use drugs while
pregnant
-
Get proper prenatal care and
nutrition
-
Don’t expose your baby to
second-hand cigarette smoke
-
Limit your baby’s exposure to
illness and infection in other people
-
Breastfeed Researchers believe that breastmilk may help prevent babies getting infections that increase
the
risk of SIDS
-
Dummies have been linked to a lower
risk of SIDS As per AAP recommendations since October 2005, try
putting your baby to sleep (at bed time and during naps) with a
dummy during his first year – but if he rejects it, don’t force it.
And if the dummy falls out while he’s sleeping, don’t reinsert it.
Don’t coat the dummy in anything sweet and sterilise it regularly.
If you’re breastfeeding, wait until your baby is at least a month
old so that breastfeeding is well-established first.
A study published in the British
Medical Journal in December 2005 reported that the use of a dummy
was associated with a reduced risk of SIDS, especially when there
were other known risk factors involved.
The study was carried out by
researchers at the Kaiser Permanente research foundation in
California. It focused on interviewing the mothers or carers of 185
infants who had died of SIDS, and a number of randomly selected
non-SIDS affected families. The study found that, after adjusting
for known risk factors, the use of a dummy during sleep was
associated with a 90% reduced risk of SIDS compared to infants
without a dummy.
The study also showed that thumb
sucking appeared to have a protective influence. The authors suggest
firstly that the dummy’s handle might help keep the baby’s nose and
mouth clear of covers and soft bedding and secondly that the sucking
action might help improve the upper airway flow.
Some people believe you shouldn’t
take your baby to bed with you during his first few months: your bed
has lots of soft bedding, which ups the risk factors for SIDS. It’s
also easy for your baby to become overheated while sharing your bed.
Then again, others believe that
co-sleeping allows a mother to be in tune to changes in her baby’s
breathing and movements and that as long as the parents don’t smoke
or allow the baby to lie on his tummy, bed sharing could lower the
risk of SIDS.
If you do decide to co-sleep, it’s
probably best to wait until your baby is over 2 months old and make
sure that your mattress is firm and flat and fits tightly against
the wall.
The AAP discourages bed-sharing, but it does recommend
having your baby in the same bedroom as you. British researchers
have found that when a baby is in his own cot in his parents’ room,
his risk of SIDS is lower.
Some parents are
concerned about positional plagiocephaly, a condition in which
babies develop a flat spot on the back of their heads from spending
too much time lying on their backs. This condition – otherwise known
as “flat-head syndrome” – has become more common worldwide since the
introduction of the Back to Sleep campaign. It’s fairly easily
treated, if discovered early enough, by changing your baby’s
sleeping position frequently
and allowing for more “tummy time” while
he’s awake.
-
Babies born to teenage mothers are
more at risk of SIDS
-
If your baby is sleeping on his tummy, he is
more likely to overheat, have pauses in his breathing and re-breathe
the air he has just exhaled
-
Covering your baby’s head while he’s
sleeping may cause a rise in brain temperature and your baby’s
respiratory control centre might be affected by this. If in doubt,
talk to your doctor
-
Most babies have slightly irregular breathing
in their first weeks of life and may have short pauses for a few
seconds before normal breathing begins. If your baby’s colour looks
normal while he’s sleeping (not pale, blue or very red) then he’s
probably fine
-
SIDS sometimes occurs together
with respiratory and gastro
intestinal infections
-
The AAP says there is no increased risk of
choking for healthy infants who sleep on their backs. But for
infants with chronic gastric reflux or certain upper airway
malformations, sleeping on the stomach may be the better option. In
this case it’s critical to consult your child’s doctor to determine
the best sleeping position for your baby.
As a final caution, the Dr Sears
team say: “Especially in the first six months, avoid sleep trainers
who advise you to let your baby cry it out… Sleep-training done
before their cardiopulmonary control mechanisms are mature enough to
handle prolonged deep sleep could be risky… For some infants
sleeping lighter and for shorter stretches may be the safer way.”
Resources:
www.askdrsears.com
www.babycentre.co.uk
www.nichd.nih.gov/health/topics/Sudden_Infant_Death_Syndrome.cfm
www.aphroditewomenshealth.com
www.news-medical.net
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