For first time parents it becomes truly vexing when they are sent to home from birth center. Having no prior experience, they start receiving advices from grandparents, friends and neighbors. But whom to trust? The worst nightmare for “newly born parents” is SIDS.
Sleep is one of the perplexing issue for new parents. Babies don’t sleep like the rest of us and many are born with their days and nights completely reversed. So parents have to wake up many times during night for these night-owls to make sure everything is ok. While many parents may think that placing the baby on his stomach or side will let him have a sound sleep during night, but placing on his back is the best and safest position.
Pediatrics worldwide recommend that infants should be placed on their back as it reduces the risk of Sudden Infants Death syndrome (SIDS) and sudden unexpected death in Infancy (SUDI). SUDI is a broad term that includes SIDS and other fatal sleeping accidents. Sometimes the baby may start rolling from his back to his stomach on its own, that’s completely safe. However, place the baby on his back at the start of the night.
What is SIDS?
SIDS, also known as cot death or crib death is the unexpected death that happens to a child of less than one year of age. It usually occurs between 00:00 hours to 09:00 hours and is related to sleep patterns. There is no struggle or noise produced and hence death remains unexplained even after autopsy. An infant sleeping on his stomach gets less oxygen to breath as he is re-breathing the air from the small pocket of bedding assembled around his nose which contains more of carbon dioxide breathed out. A healthy baby with no prior illness goes to sleep and never wakes up.
Recent findings also suggest that SIDS death is also related to poor development of brain cells in certain regions of brain in underdeveloped babies. The network of brain cells involved in waking up the child when life-threatening situation arises and develops during mid-gestation. When such babies with underdeveloped cells encounter challenges to their well being, they may fail to wake up. It is not possible to found out which baby’s brain cell network is underdeveloped, so pediatrics suggest that all infants be placed on their back as it is the safest position.
Who are at risk?
Infants more than one month old but less than six months and are born prematurely (born before 39 weeks of gestation) are at more risk. Male child are at more risk than girls and so are twins or triplets. African American babies and American Indian babies are at more risk up to two three times higher than national average. However, parents of all newborn should follow safe sleeping patterns to reduce risk of unexplained sleeping deaths.
Safe sleeping tips
- Firm sleeping surface: Avoid placing the baby on soft sleeping surfaces such as pillows, quilts and fluffy mattresses. It is safest to use a firm crib mattress covered by a sheet. Don’t add a second mattress or any padding. Also avoid baby sleeping on couches and makeshift bedding as his head may get covered by pillows or he may be in danger of getting wedged between mattress and the wall.
- Back sleeping: The safest position for healthy babies is to put them to sleep on their back. Back sleeping position also avoids the possibility of choking and vomiting which might result if he sleeps on his stomach or by his side. Till the baby attains 1 year of age and is able to find his comfortable position, he should be lied on his back.
- Standard cribs: Cots built to strict safety standards should be used. It should be devoid of lead paint, wide gaps such that the baby may get stuck and too low sides that the baby may climb over.
- Clutter free crib: Avoid stuffed toys while sleeping as it may block his airway if he buries his face in it. Try to avoid bumpers. Crib bumpers should be thin and firm and securely attached to the crib. Crib should be clutter free to avoid any danger.
- No smoking: Avoid smoking during pregnancy and also in the vicinity of the newborn. Apart from parents, others such as day care providers and visitors should avoid smoking in the house. Passive smoking is strongly related to infant death caused by SIDS. Nicotine alters neuro development in infants.
- Room sharing: Let your infant sleep in the same room, but not in the same bed. Place his cot near your bed and far away from air-conditioners and heaters. Avoid overheating and room temperature should be comfortable.
- Breast feeding: Breast-feeding lowers the risk of SIDS. However, breast-fed babies should still follow safe sleeping practices.
- Pacifiers: You can offer a pacifier at sleep time. Don’t force it, if your baby doesn’t want it or it falls out of the mouth. Pacifiers help keep the airways open through mouth. Wait for 4-5 weeks if you are breast-feeding to well establish it. However, research shows that pacifiers don’t affect breast feeding which is a common misconception.
- Others: Make sure baby’s head don’t get covered while sleeping. Bed sheets should be tucked in securely so as not to cover baby’s head. A one-piece sleeper can be used with fitted neck and armholes. Zipper allows the bag to be closed. Extra layering can be done with a sleep sack. Make sure that the baby’s head remain uncovered as it might cause over-heating.
Down-sides of back sleeping
Infants have a soft skull. Lying on the same spot give rise to cases of misshapen skull. Back of the skull may become flat over a prolonged time and is called positional plagiocephaly. It rarely requires surgical intervention and there is no neurological problem associated with it. It is more of a cosmetic concern and it gets better without any medical help as the child spends more time upright and less sleeping typically y the age of two years.
It becomes severe when the child approaches about two years of age and the asymmetry does not resolve. Health insurance policies also do not cover such cases if there is no fatal risk associated with it. So parents have to take preventive measures for this problem. Always put babies on back to sleep. You can alter the tilt to left or right when the baby is sleeping. When awake, keep the baby off the back of their head and should also spend some time on their stomach. Sometimes pressure distributing helmets can be used, though there is not much favor for it from the pediatrics. If the baby refuses to sleep on his back, then he can be made to sleep by his side though it does not reduce the risk of SIDS.