Cot Death: Sudden Infant Death Syndrome (SIDS)
What is cot death?
Cot death (sudden infant death syndrome) is a comparatively rare and mysterious malady which kills 1200 babies in this country each year. A seemingly healthy infant is put to bed and then dies in its sleep, for no apparent reason. Cot death usually affects babies between 1-5 months old and is rare in babies over six months old.
It is slightly more common in boys, second children, during the early hours of the morning, at weekends and in the winter months, again, for reasons that are unknown.
What causes cot death?
There is no single known cause of cot death, nor is there agreement about whether it is one disease or a collection of disorders.
Many theories have been put forward, including poor antenatal care, low birth weight, lung or heart disorders, and sleep apnoea, a disorder in which the sleeper stops breathing and sometimes does not start again. Another suggestion is that cot death may be due to a lack of a special chemical which prevents the air sacs in the lungs from collapsing.
Some scientists believe cot death may be due to a subtle brain abnormality. The problem may lie in the brain stem, which controls breathing and heart rate, or in the areas of the brain that control sleep patterns or learning processes.
Some researchers are also investigating the role of brain centres that control functions such as the tongue muscles or the regulation of body heat.
One theory is that, just as babies learn other actions, such as clearing their throats, they need to learn to defend themselves against respiratory distress. Some babies may not learn how to struggle for breath when they begin to suffocate, or the area of the brain controlling the tongue may be defective, in which case death may occur when the tongue falls back during sleep and muscles do not react to clear the airway.
Why some babies have this abnormality is unknown. Some researchers believe that it may be related to exposure to certain substances.
For example, cot death is much more common among infants whose mothers smoke, which has led to one theory that maternal smoking, before and after the baby's birth, may affect brain development.
What can I do myself?
There is no way to accurately pinpoint babies who are at risk from cot death, although some risk factors have been identified, including low birth weight and mothers who smoke.
However, it is important to keep these risks in perspective. For example, many babies who succumb to cot death had a cold or viral illness in the preceding week or so. But the vast majority of babies who have colds do not then suffer cot death.
Parents of newborn babies should follow the latest advice. In particular it is recommended that babies are laid down to sleep on their backs, or on their sides with the lower arm forward to stop them rolling over. There is no evidence that babies may vomit and choke on their back.
Some babies who are receiving treatment for a particular condition may need to be nursed on their stomachs. In that case your doctor, nurse or midwife will advise.
Pregnant women and parents of newborn babies may wish to discuss risk factors with their doctors. Reassuring the parents is important, especially if there has already been a cot death in the family. Where appropriate, the doctor may recommend using a home monitor.
This can be used to track the breathing pattern of an infant who is thought to be susceptible. The monitor sounds an alarm when the infant's breathing becomes irregular while sleeping. So far, the use of such monitors has not reduced the incidence of cot death.
If cot death has occurred in a family you know, the most important thing is to give comfort and support. You can also suggest they seek support from the family doctor, or other parents who have faced the same experience.
You should also explain that the parents can expect a visit from the police. This is routine and does not imply blame. The police should be considerate and sensitive. There will also be an autopsy to try to establish cause of death.
How can I reduce the risk of cot death
As the cause of cot death is unknown, there is no certain way to prevent it. However, the Department of Health has suggested measures which may reduce the risk. If you are worried about following this advice for any reason, speak to your doctor or health visitor: □ Babies should be placed on their backs for sleeping, or on their sides with the lower arm forward to prevent them rolling over. This also applies to babies who have been sleeping on their stomachs. However, if the baby finds it difficult to adjust to the new position and does not settle, it is not recommended that you insist on the change. Once babies are able to roll themselves over in their sleep it is safe to let them adopt whichever position they prefer.
- Babies should be kept warm, but not too warm. Do not use a duvet or baby nest which can be too warm and may cover the baby's head. Instead, use lightweight blankets which can be added to or removed as necessary. The temperature of the baby's room should be such that you feel comfortable in it.
- Do not smoke. In particular, never smoke near the baby. This also applies to visitors.
There is no evidence that baby monitors make any difference in preventing cot death, while false alarms may make parents more anxious rather than reducing their anxiety.
If you and your doctor decide it may help to have a monitor to detect lapses in your baby's breathing, make sure you are trained in the correct technique for administering cardiopulmonary resuscitation to an infant.