COT DEATH OR SIDS

Sadly, eight babies die suddenly and unexpectedly every week in the UK from cot death or SIDS (Sudden Infant Death Syndrome). It's a dreadful thought and one that it is common for new parents and parents-to-be to become a little paranoid or anxious about. What usually helps is to know some of the facts around the topic and most importantly know the latest advice on how to reduce the risks of cot death or Sudden Infant Death Syndrome.

• What is cot death or SIDS?
• Which babies are at risk?
• Can I reduce my baby's risk of cot death?
• Is it safe to sleep with my baby?
• What about dummies and daytime naps?
• Should I use a sleep/breathing/ apnoea monitor?
• When is SIDS no longer a risk?
• Should I follow older family advice or the guidelines?
• What should I do if become paranoid about cot death?
• Where to find out more

The term cot death is often a label used to describe any death of a baby where a cause of death isn't initially found. You may also hear it called 'sudden unexpected death in infancy' (SUDI). If after a postmortem and other tests no cause of death can be found the death would usually be registered as 'sudden infant death syndrome' (SIDS).

Despite the term cot death the deaths do not only occur in the cot they can also occur in any place where a baby goes to sleep such as in a pram or a moses basket. It can also occur at any time not only at night as some people imagine.

Unfortunately all babies are at risk of cot death and therefore it is important that we all follow the precautions to reduce the risks. Some babies however are at greater risk. This includes babies that were born premature, or had a birth weight below 2.5kg or 5 ½ lbs. Research has also shown that the babies born to younger mums (under 20 years) are also at greater risk. Babies who are exposed to cigarette smoke both in the womb, if the mother smoked in pregnancy, and once they are born, are at dramatically increased risk.

Yes there are steps that you can take to reduce the risks of cot death. The Foundation for the Study of Infant Deaths (FSID), the UK's leading charity working to prevent sudden deaths and promote health, along with the Department of Health recommend you take the following steps.

• Cut smoking in pregnancy - fathers too! And don't let anyone smoke in the same room as your baby.
• Place your baby on the back to sleep (and not on the front or side).
• Do not let your baby get too hot, and keep your baby's head uncovered.
• Place your baby with their feet to the foot of the cot, to prevent them wriggling down under the covers.
• Never sleep with your baby on a sofa or armchair
• The safest place for your baby to sleep is in a crib or cot in a room with you for the first six months
• It's especially dangerous for your baby to sleep in your bed if you (or your partner):
- are a smoker, even if you never smoke in bed or at home - have been drinking alcohol - take medication or drugs that make you drowsy - feel very tired; - or if your baby: - was born before 37 weeks - weighed less than 2.5kg or 5½ lbs at birth - is less than three months old.
• Don't forget, accidents can happen: you might roll over in your sleep and suffocate your baby; or your baby could get caught between the wall and the bed, or could roll out of an adult bed and be injured.
• Settling your baby to sleep (day and night) with a dummy can reduce the risk of cot death, even if the dummy falls out while your baby is asleep.
• Breastfeed your baby. Establish breastfeeding before starting to use a dummy.

It is important that you follow this advice both for daytime naps and night-time sleeps. Don't change what you do just because it is a daytime nap. The risks are still there and you should not allow your baby to sleep somewhere unsafe such as on a pillow, sofa or beanbag.

You can read more about these steps and their importance on the FSID website and order or download their leaflet Reduce the risk of cot death both from the FSID or Department of Health website

Many new mums (and some dads) like to have their babies in bed with them to reduce the need to get up in the night for feeding or comforting the baby. Whilst it can be lovely to have the baby so close it is not without its own risks. The safest place for the baby to be, in their first six months, is in a cot or crib in a room with you day or night. If there is room for the cot or crib next to the bed this can make life just as easy to get the baby up to feed or comfort and then put the baby back to sleep in their own cot. The risks are that the baby could fall out of the bed when you are asleep, either parent could roll and suffocate the baby, the baby could become trapped between the gap between the mattress and the wall, or headboard if they wriggle upwards, or the baby could slip under the covers of the bed and overheat that way. Remember that pillows and duvets are not to be used in a cot for a baby under a year old and yet these are both usually found on an adult bed. As stated above the risks are even greater and bedsharing is especially dangerous if either parent smokes, has been drinking alcohol or is very tired - which of course many new parents are.

Some recent research found that babies who were given a dummy to go to sleep with were less likely to die of cot death than babies that were not given a dummy to sleep with. This was found to be the case for both daytime and night-time sleeps.

The advice regarding dummies from FSIDs is that:

Settling your baby to sleep with a dummy - even for naps - can reduce the risk of cot death.

• If breastfeeding, do not begin to give a dummy until your baby is one month old to ensure breastfeeding is well-established.
• Don't worry if the dummy falls out while your baby is asleep, and don't force your baby to take a dummy if he or she doesn't want it.
• Never coat the dummy in anything sweet.
• Stop giving the dummy between six and twelve months of age.

Some parents believe that these monitors will prevent cot death but sadly they don't. They are designed to sound an alarm if breathing movements have not been detected for a set period of time. Sadly babies can and have still died whilst on such a monitor. The advice is still to follow the steps to reduce the risks of cot death and to have the cot in your own room for the first six months.

Babies who do die of cot death are most likely to be under the age of six months although sadly it can occur after this age, although it is rare beyond six months.

Sometimes it can be very difficult if you are getting conflicting advice from other family members, particularly your own mother or your partner's mother. They may say such things as "you always slept on your side and you were fine". In answer to this you can point out that since the advice has changed and babies have been sleeping on their backs cot death rates have reduced by 75% since the Reduce the Risk Campaign was launched in 1991. Explain that you are following the latest advice based on current research and ask that they support you and follow the same advice if they are looking after the baby.

Whilst it is a difficult topic to think about some parents do become particularly anxious about it to the point where they don't fully enjoy the first few months with their baby. This is very sad as you want to be able to appreciate getting to know your new baby and not be fearful of this not very common incident. By simply following the steps and ensuring you reduce the risks you can relax and know you are doing everything you can to protect your child.

If you do find yourself particularly fearful firstly remember that due to your sensitivity about the topic you are probably fully aware of the precautions and are making sure that you are following them and therefore you are reducing the risks. If you find that you are losing sleep through worrying or you, or those close to you, are worried that your anxieties are becoming extreme, discuss your fears with your GP, midwife or health visitor. You may need to talk your fears through with a counsellor or someone who can show you how to keep your worries in proportion and help you to enjoy your new baby.

You can find more information and have further questions answered at the FSID's website you can also contact their helpline on 020 7233 2090 or helpline@fsid.org.uk

• A little life, not a little loss.A mum writes about coping with losing a baby
• In need of support, someone to share your worries with? There are lots of parents on babyworld's forums in similar positions. We have several Support forums eg Lossing a baby, Feeling Down that you need to be registered for in order to view. Click here to find the right forum for you.