19 May 2012
Cot death: Reducing the risk (Medical students)
Back to sleep
The baby should always be placed back to sleep with the feet touching the foot of the cot.
Parents should be reassured that there is no increased risk of choking.
To avoid plagiocephaly, the baby should be placed on the abdomen (‘tummy to play’) several times a day when awake.
Grandparents and other carers should be told clearly that the baby should always be placed to sleep on the back. Unaccustomed prone sleep increases the risk of SIDS by as much as 18-fold.
Sleep in cot
The baby should sleep in the parents’ room for at least the first six months. The baby’s cot (not the parents' bed) is the safest place for the baby to sleep.
A firm mattress should be used, covered with a sheet. The baby should not sleep on soft things such as cushions, blankets and sheepskins. The cot should be uncluttered with soft-toys, comforters, pillows and other objects.
Overheating is an important risk factor. Babies should not be overdressed or wrapped in blankets. Sweating, damp hair and a heat rash are signs of overheating. Air-conditioners and fans can be used, and the room should be well ventilated. The room temperature should feel comfortable for a lightly-dressed adult. Lightweight blankets can be used (up to the baby’s chest) to keep the baby warm, but not duvets, quilts or pillows until the baby is one year old.
Mothers should not smoke in pregnancy. No-one should be allowed to smoke near the baby.
A recent review article on the associations of breastfeeding on various child and maternal outcomes found that a history of breastfeeding was associated with a reduction in the risk of SIDS (by 36%), as well as a decrease in risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma in young children, obesity, type 1 and 2 diabetes, childhood leukaemia and necrotizing enterocolitis.
There is some evidence that dummies may reduce the risk of SIDS. Some parents choose to give their child a dummy. It should be given when the infant is placed down to sleep, and it should not be reinserted once the infant falls asleep. The dummy should be cleaned and replaced regularly, and it should not be coated with any sweet solution. For breast-fed infants the dummy should be delayed until 1 month to ensure that breastfeeding is firmly established. The use of the dummy should be discontinued between 6 and 12 months.
Devices to maintain sleep position have not been tested sufficiently to show efficacy or safety, and should not be used. Electronic home monitoring of selected infants (e.g. infants with Apparent Life Threatening Event, ALTE) may be used. Unfortunately there is no evidence that home monitors are effective to prevent SIDS.