Promoting safe baby care 

Information from the Foundation of Sudden Infant Death

Parents make decisions on safe baby care, for example about where to sleep their new baby and what bedding to buy, at different times. It is vitally important for childbirth educators and midwives to target all parents with relevant aspects of “reduce the risk of cot death” message during the pregnancy. This should be followed up by the childbirth educator after the birth and again by the well baby clinic sister in the early weeks. It is essential that professionals do not assume that someone else has done the basic education and make sure the messages are understood by parents.

What is cot death? 

Sudden infant death syndrome (SIDS) is defined as the sudden unexpected death of an infant less than one year of age, with onset of the fatal episode apparently occurring during sleep that remains unexplained after a thorough investigation, including performance of a complete autopsy and review of the circumstances of death and the clinical history.

Cot death statistics 

More than 312 babies die suddenly and unexpectedly every year in the UK.  Since parents and carers have been following the risk reduction advice, the number of babies dying has fallen by over 70%.

Key facts

 2004 to 2008:

• The unexplained infant death rate for boys was over 1.4 times higher than the rate for girls

• 65% of all unexplained infant deaths occurred in babies aged less than 3 months

• 28% of unexplained infant deaths occurred over the winter period, whereas 21% occurred over the summer

2008:

• 75% of all unexplained infant deaths occurred among babies born with a normal birth weight (2,5kg and over)

• The cot death rate was highest for babies of mothers aged under 20 at the time of the child’s birth (1.07 per 1,000 live births)

How can you reduce the risk of cot death?
• 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 at birth.
• 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.

Is cot death on the decline?

The rate remained fairly constant at about 2 per 1 000 live births from 1971 to 1988, and then began to decline. The rate has fallen by around 70% since the advice on “reducing the risk of cot death” campaign was launched in 1988. However more than 300 babies died suddenly and unexpectedly in the UK in 2007 making cot death the largest kind of death in babies over one month old.

How does the cot death rate compare with other countries?
It is similar to countries such as France, Norway and Sweden. The rate is lower in the Netherlands and Japan, but higher in New Zealand, Australia and the USA. 

What is the usual age for cot death?
Cot death is uncommon in babies less than a month old, but rises to a peak during the second month. The risk then diminishes as the baby grows older. Nearly 90% of cot deaths have occurred by six months, and very few occur after a year.

Keep an eye on your baby's room temperature 

Babies who get too hot are at an increased risk of cot death. They can get too hot because the room is too hot or because they have too much bedding or clothing. 

 
How to protect your baby.

1. Babies do not need hot rooms, all night heating is rarely necessary. Keep the room at a temperature between 16-20ºC.  18ºC is just right
2. Adults find it difficult to judge the temperature in the room, so use a room thermometer in the rooms where your baby sleeps and plays
3.  When you check your baby, if they are sweating or their tummy feels hot to the touch, take off some of the bedding. Don't worry if their hands or feet feel cool, this is normal
4. Use lightweight blankets or a baby sleeping bag. If your baby feels too warm, reduce the number of layers or use a lower weight baby sleeping bag. In warm summer weather, your baby may not need any bedclothes at all. Do not use a duvet, quilt or pillow for babies under 12 months
5. Even in winter, babies who are unwell and feverish need fewer clothes and bedclothes
6. Babies need to lose excess heat from their heads. Make sure their head cannot be covered by the bedclothes by sleeping them 'feet to foot' (with their feet to the foot of the cot) so they don't wriggle down under the covers or using a sleeping bag
7. Babies should never sleep with a hot water bottle or electric blanket, or next to a radiator, heater or fire, or in direct sunshine
8. When it's warm, you can cool the room where your baby sleeps by closing the curtains and opening the windows during the day. Offer your baby plenty to drink, and in very hot weather, sponge them down regularly with tepid water.  Use a fan but do not place it directly onto your baby
9. Remove hats and extra clothing as soon as you come indoors

10.  A car can become very hot in the summer. Avoid direct sunlight on your baby. In winter, keep the heating low, and remove your baby's outdoor clothing while travelling in the car

The sleep environment

Many studies have shown that bed sharing increases the risk of SIDS in certain circumstances, especially if the mother is a smoker. One recent UK publication (funded by FSID) found that this risk was absent, or too small to measure, if mother was not only a non-smoker but had not used alcohol or other drugs. However, information on maternal drug and alcohol use was not available for most of the other studies that have addressed this problem, which leads to the current recommendation that the safest place for an infant to sleep for the first six months is in a cot in the parents’ room. (At least four studies have shown that sleeping the baby in a cot in a separate room approximately doubles the risk).

Baby sleeping bags

• If you wish to use a sleeping bag for your baby make sure it's designed for regular use at night (i.e. not one designed for camping)
• It should be with arm holes but sleeveless, without a hood, and it should be an appropriate size to prevent your baby from sliding down into the bag
• To make sure your baby doesn't become too hot choose a lightweight bag. Sleeping bags are available in Summer, Spring/Autumn and Winter weights
  • Check if your baby is too hot by feeling down the side of its neck or its tummy. If it is hot to the touch, or if they are sweaty - remove layers, if cold - add layers and if luke warm do nothing
  • Remember that what the baby needs will vary greatly according to the temperature of the room. If it is very warm, they may need no more than a vest and a nappy underneath
  • A great way to access your baby’s needs is to use a strip thermometer that provides the temperature of the room with a guide to what your baby should be wearing. A baby in Durban would probably never need more than a spring/autumn bag, but if they lived in Mooi River, they would probably need a winter weight bag during the colder months. It is also so dependent on the house. A thatched house tends to be far draftier and colder. A house with double volume ceilings in the bedrooms also tend to be colder. An older house with thicker walls and a flat roof stays far warmer. Equally, a baby room with under floor heating or wall panels would be unlikely to drop lower than 16 degrees, in which case a winter sleeping bag would never be needed. The key is to never use additional blankets with a sleeping bag. Rather change the weight of the sleeping bag or add more layers to your baby inside the sleeping bag. Additional blankets just get kicked off, so if they are wearing a summer bag in winter, they are still going to wake up cold, and equally they can then start to kick them off, posing a risk once again and defeating the whole point of the sleeping bag

For more information see www.fsid.org.uk

Babies prefer routine and they tend to sleep better when they are in familiar environments with smells and things they recognise.

Whilst in the womb, a baby is lulled to sleep by his mother’s heart beat and he feels safe because he is tucked in tightly, a feeling we then replicate with the use of swaddling when our baby is first born. The continuation of this feeling of security helps your baby to sleep well, which then helps you set up a routine that works for the whole family (including a good night’s sleep for all!)

Once your baby no longer wants to be swaddled (at about 8-10 weeks old), baby sleeping bags provide a wonderful way to continue the feeling of safety and security that swaddling provides, and helps to establish good sleeping patterns that work flexibly with our every day busy lives.

When your baby gets to about nine months of age, having slept in a sleeping bag for a few months already, he will instantly recognise his sleeping bag, and he will know that it is safe to sleep and time to sleep. He has established that it forms part of his sleep routine. So, even if you are on holiday and aren’t able to bath him at the same time as normal, feed him in the same chair you always do, or lay him in his own cot, you are able to travel with one essential item that he will recognise and find calming, which provides him with the ability to fall asleep more easily on his own.

This sleep solution makes travelling with your baby, or taking him to friends for dinner, so much more practical and easier to face.

The relationship your baby forms with his sleeping bag is one from which he derives huge comfort and security, which means you can go anywhere in the world, and if your baby has his sleeping bag, he will sleep well. (and so will you....)

Your baby can use a sleeping bag from 4kg (Dizzy Dots offers one with a removable swaddle that you can use from birth), and they are available in different sizes and seasons right up to 3 years of age.

Tips when buying a sleeping bag for your baby:

• Choose a simple and fuss-free design with an easy-to-use zip system that doesn’t expose your baby’s chest when undone (you don’t want to wake your baby up – just get to the nappy area)
• Is it 100% cotton? Very important, so your baby’s skin is able to breathe at night!
• Ensure that you have the right size sleeping bag and that your baby’s head is bigger than the neckline of the sleeping bag when fitted.
• The thickness of the sleeping bag must appropriate for the time of year.
• Never use a fleece sleeping bag or a sleeping bag with sleeves or a hood – your baby needs to get rid of excess heat when necessary.
• Use a thermometer in your baby’s room to check the temperature easily.
• Don’t stop using a sleeping bag in Summer – you may struggle to get your baby used to it again come Winter when you really need it. Plus, it protects your baby from mosquitos!

Getting a toddler or older baby into a sleeping bag for the first time:

If you are trying to get your one year old to sleep in a sleeping bag, but aren’t sure if he is going to take to it, then try putting him in and zipping only the top 10cm of the zip up, leaving his feet out, so that he doesn’t feel constricted. Once asleep, simply pop his feet into the bababag and zip him up. You won’t have to do that for much more than a 3 or 4 nights before he gets used to being snug and warm all night long!

Choosing your first feeding spoon:

When first introduced to solids, your baby is generally also going through teething, and therefore the gums can be extremely sensitive. Using a hard tip spoon, therefore, may be uncomfortable against his or her gums, so try and find the softest spoon you can.

Babies tend to look around at every noise whilst being fed, which is challenging with any spoon, but choosing soft tip spoon makes it that much easier, so that when your baby moves his head to look at the cat running past,  you won’t catch his mouth with the spoon.