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Avoid SIDS: say no to tummy sleeping and these other risk factors

We’ve all heard by now how dangerous it can be to put your baby to sleep on his tummy. Tummy sleeping has been associated (along with other factors) with Sudden Infant Death Syndrome (SIDS), and since the 1990s, healthcare professionals have advised parents to stop putting their babies on their tummies to sleep, and the incidence of SIDS has decreased by a whopping 50 percent. However, in developed countries SIDS still remains the leading cause of death for infants aged one month to one year.

Back sleeping

Parents started putting their babies to sleep on their backs and another problem arose: positional plagiocephaly, or flat head syndrome. Because babies’ skulls are soft and pliable, if they spend too much time lying or sitting with the backs of their heads resting against a surface, such as in a cot or car seat, the shape of their skulls can actually change. In some severe cases babies have to wear helmets to relieve the pressure on one part of their skull!

In some severe cases babies have to wear helmets to relieve the pressure on one part of their skull

In some severe cases babies have to wear helmets to relieve the pressure on one part of their skull

American doctors were in favor of back sleeping until very recently. It was felt that a large portion of the population would not buy wedges to keep their baby in the side-sleeping position, and the baby could easily roll over from his side onto his tummy, therefore increasing the incidence of SIDS once again. It was therefore felt that the back position would be safer. Flat head syndrome has now changed that advice in favor of side sleeping.

In Europe and South Africa, parents have been advised to practice the side position for some time. Those of us who know a little bit about anatomy will know that this is without doubt the safest position for your baby.

Side sleeping

When you are on your side, as long as you are breathing, the airway is maintained (or kept open) because the tongue is lifted off the back of the throat. This is the case even if your baby should lose consciousness, let’s say in the case of a febrile convulsion, for example.

If a baby is on his back and for some reason loses consciousness, his tongue will fall back and can close the airway and the baby will then stop breathing.

If a baby is on his back without elevation of the back and the head and he vomits, the vomit can flow down his trachea (airway) and into his lungs. If there is mucus in his vomit, as is common with babies, this could be thick enough to block his airway if he were on his back. If the baby were sleeping on his side, the solid matter would simply drain out of his mouth.

This is the case even if your baby should lose consciousness, let’s say in the case of a febrile convulsion, for example.

This is the case even if your baby should lose consciousness, let’s say in the case of a febrile convulsion, for example.

The American Heart Association and the Resuscitation Council of South Africa teach us to turn a breathing but unconscious patient into the “recovery position” (a side-lying position) so that he can continue breathing and so that his airway won’t be blocked by vomit. This advice is obviously intended for a very compromised patient who may have had a seizure, heart attack or stroke. But if we do that for a compromised patient, surely we should do the same for our new babies and ensure they are slept in the safest position possible?

A wedge is imperative! You can get inexpensive wedges from any baby store. They consist of two triangles, one long and one short, with a piece of Velcro in the middle to adjust the width. The baby needs to be very snug between the two wedges. Don’t worry about room to move your baby has been very happy in a small space in your tummy for a long time. Babies are secure in a snug space. Remember to alternate between putting your baby to sleep on his left and right side though, to avoid a flattened face!

A wedge is imperative! You can get inexpensive wedges from any baby store.

A wedge is imperative! You can get inexpensive wedges from any baby store.

A breathing monitor is a wonderful invention which gives you peace of mind that if anything goes wrong, causing your baby to stop breathing, you will be alerted immediately. A breathing monitor should be used until two years of age, as SIDS can occur up to that age. However, education goes hand in hand with a reliance on modern-day technology. It is pointless to use a monitor if you don’t know how to do CPR on your baby. Make sure you have attended an infant CPR course for optimum safety.

There are other factors that can contribute to or reduce SIDS, too. Be aware of the following:

Dummies

This is a controversial topic as some breastfeeding experts feel dummy use can interfere with breastfeeding. Many mothers manage to breastfeed successfully even though they are giving their baby a dummy, though.

When the baby has a pacifier in his mouth, the tongue is pushed down and held in position which therefore prevents it slipping back and occluding the airway. This even happens when he is sleeping, which is the most vulnerable time for SIDS. The Maternal and Child Health Journal (Vol 16 issue 3) found that “pacifier use at sleep time decreases SIDS”. A population-based case control study in California found pacifiers reduced the risk of SIDS for every category of maternal and infant factor examined, e.g. for breastfed babies as well as formula-fed babies.

When the baby has a pacifier in his mouth, the tongue is pushed down and held in position which therefore prevents it slipping back and occluding the airway.

When the baby has a pacifier in his mouth, the tongue is pushed down and held in position which therefore prevents it slipping back and occluding the airway.

It was also found that with dummy use, the incidence of SIDS was reduced even if the parents allowed their babies to sleep prone (on their tummies) or with soft, fluffy bedding or practiced bed-sharing. The research found that pacifiers used at sleep times may reduce the risk of SIDS by as much as 90 percent. The American Academy of Pediatrics’ task force on SIDS recommends parents use dummies at sleep times.

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