Cot Death Info

What is cot death ?
Cot death is also called SIDS — an acronym which stands for sudden infant death syndrome. Cot death isn't any one illness or disease. Rather, it's a diagnosis, given when an apparently healthy baby under the age of one dies without warning. When doctors and investigators can't pinpoint a cause after performing a full investigation including an autopsy, review of family and medical history and examination of the death scene, cot death is given as the cause.

Sadly, each year in the UK, around 350 babies die suddenly and unexpectedly. Most of them are under six months old. In 1991, the Foundation for the Study of Infant Deaths launched a campaign to reduce the risks of cot death. Since then the number of babies dying of cot death has more than halved. Nevertheless, cot death remains the leading kind of death in UK babies over one month old.

What causes cot death ?
No one knows for sure what causes cot death, but researchers around the world are working to understand more about the syndrome and they're learning more every day. What have they learned so far?

It's beginning to look as if cot death may result from more than one problem, or that several events must happen together for a cot death to occur. One suspected cause is an anatomical abnormality, possibly in the brain. The abnormality may lead to a failure in the way the baby breathes or controls blood flow to the body. Another possibility is that a developmental delay exists (that is, that proper breathing or blood flow control takes longer to appear in affected babies than in normal babies).

When babies with any of these problems are confronted with a challenge — such as sleeping on their stomach and rebreathing carbon dioxide, overheating, breathing cigarette smoke or momentary loss of blood pressure during sleep — they may be too vulnerable to survive. Some of the suspected causes of cot death are outlined below.

A defect in the brain stem
One medical researcher has identified an abnormality in the region of the brain stem which controls carbon dioxide sensing in some babies who have died of SIDS. Sleeping face down can trap carbon dioxide between the baby's face and the mattress, so the baby breathes in excess amounts of this deadly gas. Most babies will wake up when the levels of carbon dioxide get too high. But the brain-stem abnormality may prevent some babies from knowing when the gas has accumulated to a life-threatening level.

Abnormalities in blood pressure control
Other researchers have looked at the brain's ability to overcome blood pressure falls which occur normally during sleep in all infants. They suspect that some babies may die from an inability to recover from a sudden loss in blood pressure. That failure may result from the brain stem abnormality noted above, or an abnormality in other brain areas. The problem may be an inability to restore blood flow to critical organs (such as the heart), not a breathing failure. Sleeping on their backs may help babies by assisting certain brain areas in restoring blood pressure.

Developmental delays in a baby's defence system
The first year of life is a time of rapid growth and development. Babies are born with a primitive defence system known as the startle reflex (they pick their head up, kick and flail their arms) and later develop a more co-ordinated ability to move their body away from danger. Some researchers believe that some babies die because they simply aren't able to defend themselves against a life-threatening event such as being trapped under a blanket.

Neck artery constriction
When a baby sleeping on his stomach tries to move his face away from his bedding, he may inadvertently compress arteries in his neck, which can cut off blood flow to the brain, say researchers from Australia's University of Sydney and New South Wales Institute of Forensic Medicine. That, in turn, could damage the nerve centres which help to control involuntary functions such as breathing and, ultimately, lead to the baby's death. This is considered the weakest SIDS hypothesis by some experts because it does not explain the significance of certain risk factors such as ante- and post-natal smoking.

Which babies are most at risk ?
All babies under the age of one are at risk from cot death since doctors still have no way to pinpoint those with the most relevant abnormalities. Some children however, have a higher risk of cot death than the general population. Experts have identified these characteristics.

Any baby who:
• was born prematurely
• has a mother who smoked or took drugs during pregnancy or was under the age of 20 at the time of her first pregnancy
• is around a parent or caregiver who smokes
• was born to a mother who had poor or non-existent antenatal care
• is being bottle-fed (some evidence suggests that breastfeeding may reduce the risk of cot death)
• is a sibling of a baby who previously had a cot death
• is put down to sleep on her stomach
• suffered an apparent life-threatening event, especially a stoppage in breathing which made her pale, blue and limp

Boys are at slightly higher risk than girls. Low-birthweight infants, twins and other multiples are also at higher risk.

At what age is the risk of cot death highest ?
Cot death is most common between one and four months of age, with 90 per cent of cases in babies under six months, though babies are still considered at risk up to the age of one year. Cot death occurs most often during sleep (but not always), usually between the hours of 10pm and 10am — the usual hours of extended sleep. Also, cot death is more common during winter.

How can I reduce my baby's risk of cot death ?
You can do a number of things to decrease your baby's risk, but at present there's no way to prevent cot death. Here are the most important steps to take.

Put your baby to sleep on her back

This is the single most important thing you can do to help protect your baby. The Foundation for the Study of Infant Deaths estimates that the 'Reduce the Risk' public awareness campaign has saved nearly 1,000 babies' lives a year in the UK since it began in 1991. Putting your baby on her side (with one arm outstretched so she can't roll onto her face) is safer than tummy-down, but still not as good as placing your baby on her back to sleep. Research shows that placing your baby on her stomach to sleep doubles your baby's risk of cot death. Also, put her with her feet at the end of the cot so she can't wriggle too far down under the blankets. If you have any questions about your baby's sleep position, talk to your midwife or health visitor.

Don't smoke during pregnancy and don't allow smoking around your baby

Women who smoke cigarettes during or after pregnancy put their baby at increased risk of cot death. Recent studies have found that the risk of cot death rises with each additional smoker in the household, with the numbers of cigarettes smoked a day, and with the length of the infant's exposure to cigarette smoke. Keep the air around your baby smoke-free.

Use firm, flat bedding

Several studies have linked soft sleeping surfaces to an increased risk of cot death. Always put your baby to sleep on a firm, flat, clean and well-fitting mattress with no pillow, fluffy blanket or sheepskin under her. The outside of the mattress should be waterproof, like PVC and covered with a single sheet. Waterbeds, beanbags, baby nests and other soft surfaces are all unsafe for a baby to sleep on. The use of cot bumpers neither increases nor decreases the risk of cot death. However, cot bumpers should be removed before your baby can get on her hands or knees so that she can't use the cot bumper as a lever for climbing out of the cot.

Avoid overheating your baby

Too warm a room, too much bedding, or bedding that can cover the baby's head are associated with an increased risk of cot death. Keep the room your baby sleeps in at a comfortable temperature (around 64 degrees F / 18 degrees C). Signs that your baby may be overheated include sweating, damp hair, heat rash, rapid breathing, restlessness, and fever. Feel your baby's tummy or neck to see if he is getting too hot or too cold, but not his hands or feet because it is normal for them to feel cold anyway.

For bedding, use a sheet and cellular blankets rather than a duvet, or a well-fitted baby sleeping bag. Prevent your baby wriggling down under the covers by placing his feet at the foot of the cot or pram. Make the covers up so that they reach no higher than your baby's shoulders. Tuck any sheets or blankets in securely so they cannot slip up over his head. If your baby's too hot, remove a blanket, if he's cold, add one. Do not use duvets, quilts, bedding rolls or pillows.

Breastfeed your baby if you can
Research shows breastfed babies are less at risk from cot death.

Take your baby for regular check-ups
Babies who are up to date on their immunisations are less at risk from cot death. If your baby is unwell, seek medical advice promptly.

Can sharing a bed with my baby help reduce the risk of cot death ?
Some experts believe that co-sleeping (when your baby sleeps in your bed) reduces the risk of cot death. This advice is based on studies which show that co-sleeping alters the baby's sleep patterns (making them lighter) and allows mothers to respond more quickly to changes in their baby's breathing and movements. But no research proves that bed sharing decreases the risk of cot death, and one recent study shows that co-sleeping with a baby who is less than eight weeks old may actually increase the risk.

The Foundation for the Study of Infant Deaths recommends that babies sleep at night in a cot next to their parents' bed for the first six months.

The best advice is to talk to your health visitor about bed sharing and never let your infant sleep with you if you regularly take drugs or drink alcohol. Napping on a sofa with your baby is also known to increase the risk of cot death, so it's advisable to put her in a separate cot or bouncy chair if you are feeling sleepy.

We ofcourse recommend that you use the BABYSENSE II baby monitor