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.