The research from Bristol and Warwick University claims the safest place for baby to sleep for the first six months is in a cot next to the parent’s bed. We completely agree with this statement and it is something we have been recommending to parents since the start of this blog over a year ago.

However, when the tabloids published this story they did not go into enough detail. On closer inspection of the study it is apparent that the extremely high correlation between cot death and co sleeping was observed in a high-risk group. This high-risk group consisted of young, socially-deprived mothers who smoked and many of whom had taken alcohol or drugs at the time of the tragic cot death. In the group studied, there were also many cases where the mother had fallen asleep on the sofa with her baby.

What this study shows therefore is that these risk factors (alcohol, drugs, smoking and falling asleep on the sofa) are lethal when combined with co sleeping. It does not necessarily show that informed cosleeping is much more dangerous than the cot, although there have been studies in the past that have claimed this to be the case.

The study also included a control group which comprised of randomly selected SIDS cases (not just high-risk ones). In this group, 20% of the deaths were associated with a cosleeping arrangement and this control group also had a far lower percentage of alcohol/drug-related risk factors involved. Furthermore, only 1% involved cosleeping on a sofa.

I want to make it clear that I am not advocating cosleeping, I am just trying to give people an objective description of the study and I still stand by my position that the safest place for baby to sleep in the first six months is in a cot next to the parent’s bed.

Although the rate of Cot Death is decreasing in the UK, according to the FSID there are still more than 300 cases a year. The increase in education about the known risk-factors is playing a large part in the declining figures and if you are in any doubt about what you can do to reduce the risk then please read our post on SIDS.

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Research has proved that infants who sleep in their own room in the first six months are twice as likely to die from SIDS (formerly called cot death) than those who share their parents’ bedroom. (FSID’s Editorial Team, 2007). I strongly advise you therefore to have baby sleeping in your room for the first six months.

However, the choice of whether you want to share a bed with your baby or put him in a cot next to the bed is ultimately for you to decide on your own. The reason I stated that a cot in the parents’ room is generally the safest place to put baby to sleep is because there are certain medically-agreed, risk factors that can make co-sleeping much more dangerous than cot sleeping. Experts agree that you should never share a bed with your baby if:

• The baby is under three months old
• The baby was premature or less than 2.5kg
• You or your partner are smokers (even if you don’t smoke at home)
• You have been drinking alcohol or have taken medications that make you drowsy.
• You are very tired.

If the above rules are followed I have not found conclusive evidence to recommend cot-sleeping over sharing a bed or vice-versa. The fact that the research is contradictory tells us that there is no hard and fast, right or wrong answer and the unfortunate truth is that tragic accidents can happen in any scenario. Fortunately, these accidents are very rare.

To help you make an informed decision, I will discuss the pros and cons of co-sleeping in my next post.

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Sudden Infant Death Syndrome is where a child (usually under one year) dies suddenly, for no known medical reason, in their sleep.

Thankfully, the rates of SIDS are falling. In 1991 SIDS hit 1 in 1000 infants.  Nowadays, the figure is closer to 1 in 2000. I believe the reduction is due to new parents becoming increasingly more educated about the main risk factors that are usually associated with this condition. With more and more studies being conducted on SIDS, hopefully, the number of instances will continue to fall.

So what do we know about SIDS?

Most cases of SIDS (around 75%) happen when the infant is less than four months old. After this period the risk falls dramatically. Premature babies are at a higher risk with the risk rising according to the degree of prematurity (Lavin, Glaser 2007).

Babies and infants exposed to cigarette smoke have been found to have a higher risk of SIDS, with some studies indicating the risk is five times greater than babies not exposed to the cigarette smoke.

In which ways can we dramatically decrease a child’s risk of SIDS?

1.  The golden rule is to put your baby to sleep on his back.

This has been the most influential discovery in reducing the number of deaths from SIDS and you should ensure you always follow it. There has been concern by some parents who followed this rule but awoke to find their baby had rolled himself over onto his side or front. Doctors generally agree that this type of occurrence should not warrant an elevated cause for concern. They feel that if the baby was able to roll over unassisted, he should also have the mobility to get out of an uncomfortable or stressful position should one occur. However, if you discover that your baby has rolled over onto to his front, I would still help him onto his back again just to be on the safe side.

2. Ensure the baby’s home is smoke free. Even smokers who light up outside of the house increase the risk of SIDS. Kicking the habit is obviously the safest thing you can do but if you can’t do this, ensure that smoke is banned from the house and that no smoker shares a bed with the baby.

3. Ensure the baby has the right bedding. Never let your baby sleep with a pillow, stuffed animal or any type of fluffy bedding. Just use a firm mattress and a tight fitting sheet in the crib or bassinet. If it’s especially cold you could simply dress baby in warmer, well-fitted clothing or add another suitable sheet or blanket.

4. Don’t fall asleep with your baby while sitting or lying on the sofa.   There has been strong evidence that links this with an elevated risk of SIDS.  There is also the danger that you could potentially roll over and suffocate him and the danger of him getting trapped down the side or back of the cushions.

5. Sucking a dummy may reduce the risk. Some studies have shown this to greatly reduce the risk of SIDS, although experts are still examining the research before making a recommendation.

6. Don’t overheat the baby’s room. Ensure the temperature is comfortable but not too warm.

Room Temperature	Amount of bedding
12°C	Sheet plus four or more layers of blankets
14°C	Sheet plus three or four layers of blankets
16°C	Sheet plus three layers of blankets
18°C	Sheet plus two layers of blankets
20°C	Sheet plus one or two layers of blankets
22°C	Sheet plus one layer of blankets
24°C	Sheet only
Source: Department of Health www.doh.gov.uk  Bedding guidelines for babies wearing a nappy, vest and babygro

•  
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    • Try to keep room temperature between 16 and 20°C – the ideal temperature is 18°C. Get a thermometer to check the temperature.
    • Use the right amount of bedding for the temperature of the room (see table above).
    • When you check on your baby, if your baby is sweating or their tummy feels hot, take off some of the bedding.  It’s normal for babies to have cool hands and feet.
    • Don’t let your baby sleep with a hot water bottle, an electric blanket, next to a radiator, heater or fire or in direct sunshine.
    • Don’t use duvets, quilts or pillows if your baby is less than one year old.
    • Don’t put too many clothes on your baby.
    • Take off the baby’s outdoor clothes as soon as you get inside.

(BUPA’s Health Information Team, 2006).

7.  Co-Sleeping & SIDS.  This is such a controversial and ongoing debate and so I think it deserves it’s own section which I’ll complete in the next few days (when finished, you will be able to select it from the ‘category’ list to the right-hand side of the page).  In short, despite the list of suggested benefits of co-sleeping, I feel strongly enough to advise you against it.  There have been many studies that show it increases the risk of SIDS and there is also a strong risk of the parent rolling over and squashing or suffocating their baby.  I know a parent who the latter tragically happened to and she wanted me to help convey as strongly as possible that co-sleeping poses a very real, life-shattering danger.  However, I will be examining all the evidence objectively in my next blog.

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Well that concludes my initial blog on SIDS.  As with all the topics, I would very much like you to respond with any comments, questions, experiences, suggestions, revisions and opinions you may have. 

References

Lavin, S Glasser (2007). “Baby & Toddler Sleep Solutions.” Wiley Publishing, Inc.

Bupa’s Health Information Team (2006). “Sudden infant death syndrome (SIDS).” Available from: http://hcd2.bupa.co.uk/fact_sheets/html/sids.html (09/10/07)

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