Orthodox crib death prevention
advice: The facts and
the Fallacies
By: Dr. Sprott
Fallacy:
To reduce the risk of cot death, breastfeed your baby.
Breastfeeding does not reduce the risk of cot death, as the
following statistics demonstrate:
The breastfeeding rate in New Zealand has risen during
recent decades and is very high by international standards
(over 90% of newborns and 55% of babies aged six months).
Yet up to 1995 the New Zealand cot death rate was the
highest in the world.
In the USA only 60% of newborns and 21% of babies aged six
months are breastfed. Yet in 1996 the USA cot death rate
(0.75 deaths per 1000 live births) was less than half the
New Zealand rate (1.8/1000).
The United Kingdom has a low breastfeeding rate (66% of
newborns, falling to 21% of babies aged six months), yet the
United Kingdom cot death rate is low (in 1999 only
0.57/1000).
While breastfeeding is good practice for nutrition and
various health reasons, it is not relevant to cot death
prevention.
Fact (but only a partial solution): To reduce the
risk of cot death, sleep your baby face up.
Face-up
sleeping decreases the risk of cot death on mattresses which
are not wrapped for cot death prevention, but it is only a
partial solution.
The reason why face-up sleeping reduces the cot death risk
is simple: the gases which cause cot death (phosphines
generated from phosphorus, arsines generated from arsenic,
and stibines generated from antimony) are all more dense
than air. They diffuse away from a baby's mattress towards
the floor, so a baby sleeping face up is less likely to
ingest them. However, the protection afforded by face-up
sleeping is limited.
Face-up sleeping is not very effective in preventing cot
death in cots, prams and carrycots etc. which have enclosed
sides, as these can cause gases to be trapped around a baby.
It is not very effective against the danger of phosphine,
as this gas is only slightly more dense than air. Any
phosphine generated in a baby's cot is likely to be present
in the air which a baby breathes, even if the baby is
sleeping face up.
Face-up sleeping does not
eliminate the risk of cot death. The risk is eliminated by
separating the baby from the source of toxic gas using a
gas-impermeable film which does not contain phosphorus,
arsenic or antimony (and does not pose a risk of
suffocation).
If a baby's mattress is correctly wrapped and the correct
bedding used, sleeping position is irrelevant to cot death
prevention. (However, for other reasons side sleeping is
recommended.)
Fallacy: To reduce the risk of cot death, don't smoke
during pregnancy or around your baby.
Smoking
does not cause cot death, as recent history shows:
Smoking was very common in Britain in the 1930s and 1940s,
yet cot death was virtually non-existent. Smoking is
prevalent in present day Russia, yet cot death is rare in
that region.
Furthermore, no cause-and-effect relationship between
smoking and cot death has ever been established. In fact,
they are simply socio-economic parallels. Put another way,
smoking is more common among poorer people - and so is cot
death. But it does not follow that smoking is therefore a
cot death risk factor.
However, it is indisputable that along with having a higher
rate of smoking, poorer people are also more likely to
re-use mattresses. And it is also indisputable that cot
death occurs much more frequently on re-used mattresses. A
1989 mattress collection facilitated by British coroners
showed that of some 150 cot death babies, about 95% had died
on previously used mattresses.
It is not smoking but the re-use of mattresses which causes
the high cot death rate among lower socio-economic families.
Fallacy: To reduce the risk of cot death, don't bed
share with your baby if you smoke or smoked during
pregnancy. Sleep the baby in a bassinet alongside your bed.
The risk
posed by bed sharing does not arise from smoking - it arises
from the mattress.
Adults' mattresses frequently contain the same chemicals and
fungi as babies' mattresses and therefore can generate the
same toxic gases. Thus all bed sharing results in a cot
death risk if the parents' mattress is not correctly wrapped
for cot death prevention.
Placing a baby to sleep in a separate bassinet or cot
alongside the parents' bed does not protect a baby against
cot death unless the baby's mattress is correctly wrapped.
Misleading statement: Keep baby's face clear at all
times and place baby with feet to the foot of the cot.
Keeping a
baby's face clear may reduce the risk of cot death on
mattresses which are not wrapped for cot death prevention,
but the protection afforded is very limited.
Sleeping a baby with feet to the foot of the cot affords no
protection against cot death. Any area on an unwrapped
mattress where a baby sleeps is a potential source of toxic
gas, since that is the area which becomes warm and moist
(promoting the fungal activity which can cause gas
generation).
Misleading statement: Use a firm, clean fitting
mattress, with no gap between the mattress and cot sides.
While this
advice may reduce the risk of injury in cots, it is
irrelevant to cot death prevention.
Any unwrapped mattress which contains the chemicals
phosphorus, arsenic and/or antimony can pose a cot death
risk. The risk can arise regardless of whether such a
mattress is firm or soft, regardless of whether it is clean
or soiled, and regardless of whether or not it fits the
sides of the cot closely.
Misleading statement: Tuck in bedding securely.
Tucking in
bedding securely may reduce slightly the risk of injury in
cots, but it increases the risk of cot death on unwrapped
mattresses. This is because tight tucking in can lead to
increased temperature in a baby's cot; and an increase in
temperature of even a few degrees can cause the rate of gas
generation to increase tenfold or more.
Overbedding must not be tucked in so securely that a baby
cannot release the bedding for ventilation.
Misleading statement: Don't put baby on a waterbed.
Certainly,
waterbeds which are not wrapped for cot death prevention can
pose a cot death risk. This is for two reasons:
First, waterbeds are frequently made of PVC (polyvinyl
chloride), a soft plastic which often contains phosphorus
and antimony (which can generate, respectively, phosphine
and stibine gases).
Secondly, waterbeds are frequently kept heated, which can
cause increased fungal growth and hence increased gas
generation.
However, if a waterbed is correctly wrapped for cot death
prevention, sleeping a baby on the bed poses no cot death
risk.
Misleading statement: Soft toys and bumpers are not
recommended.
The
presence of soft toys in a cot is irrelevant to cot death
prevention.
Furthermore, if a baby's
mattress is correctly wrapped for cot death prevention,
bumper pads pose no cot death risk. In fact, they are to be
recommended, as they reduce the risk of injury.
However, bumper pads should not be placed around all sides
of a cot, because they greatly impede ventilation. If bumper
pads are used, they should be positioned across the head of
the cot and part way down the sides.
Fact: Pillows, loose quilts and duvets are not
recommended.
Pillows,
loose quilts and duvets can pose a very slight risk of
suffocation or asphyxiation.
These items also pose a cot death risk. This is because they
almost invariably incorporate a fill which contains
phosphorus and antimony. Furthermore, they tend to be washed
less frequently than other items of bedding, resulting in a
greater likelihood of fungal activity.
Thus pillows, loose quilts and duvets can introduce a cot
death risk on wrapped mattresses and can increase the cot
death risk on unwrapped mattresses. Pillows, loose quilts
and duvets should not be present in a baby's cot.
IF THE MATTRESS ON WHICH A BABY SLEEPS IS CORRECTLY WRAPPED,
THE SITUATION IN RESPECT OF COT DEATH IS AS FOLLOWS:
-
The baby can sleep
safely on any type or age of mattress.
-
The baby can sleep
safely on a waterbed.
-
Bumper pads can be
used to prevent injury.
-
There is no risk of
cot death.
