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Babies - Cot death: how to reduce the risk

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Cot death, or sudden infant death syndrome (SIDS), is the sudden unexpected death of an apparently well baby between birth and the age of two.

Although cot death is the most common cause of death in young babies, it's rare and the risk of your baby dying from cot death is small.

The exact cause of cot death is unknown, but you can take precautions to reduce the risks.

The Department of Health and the Foundation for the Study of Infant Deaths (FSID) provide the following advice.

To reduce the risk of cot death:

  • Place your baby on their back to sleep, in a cot in a room with you.
  • Do not smoke in pregnancy or let anyone smoke in the same room as your baby.
  • Do not share a bed with your baby if you have been drinking alcohol, if you take drugs or if you are a smoker.
  • Never sleep with your baby on a sofa or armchair.
  • Do not let your baby get too hot.
  • Keep your baby's head uncovered. Their blanket should be tucked in no higher than their shoulders.
  • Place your baby in the feet to foot position (with their feet at the end of the cot or pram).

Breastfeeding

Breastfeeding your baby reduces the risk of cot death. Breast milk gives babies all the nutrients they need for the first six months of life and helps protect them from infection. It's natural to have questions or need some extra support to breastfeed successfully. Your midwife, health visitor or GP can help.

Sleeping position

Always place your baby in the feet to foot position (with their feet at the end of the cot or pram). Put your baby on their back to sleep to reduce the risk of cot death. Healthy babies placed on their back to sleep are not more likely to choke while they are asleep. It is normal for babies to roll over on their own when they get to about five or six months old. At this age, the risk of cot death falls significantly. If your baby is under five months and you find them asleep on their side or front, gently turn them over. But don't feel that you need to check on them all the time when they are asleep.

Bedding

Your baby should sleep in a cot in the same room as you for the first six months. Their mattress should be:
  • clean, 
  • firm, 
  • flat,
  • well fitted,
  • waterproof, and 
  • covered with a single sheet.

Use sheets and lightweight blankets, but do not use duvets, quilts, pillows or similar thick bedding.

Babies whose heads are covered by bedding are at an increased risk of cot death. To prevent your baby wriggling down under the covers, place them so that their feet touch the bottom of the cot or pram. Tuck the covers in so they can't slip over your baby's head.

Put your baby in their cot before you go to sleep, especially for the first three months after birth.

Smoking

Smoking in pregnancy increases the risk of cot death. That includes passive smoking from partners too. It's best not to smoke at all. Babies exposed to tobacco smoke after the birth are also at an increased risk of cot death. It's best not to let anyone smoke in your home. If you smoke, don't share a bed with your baby.

Temperature

Don't let your baby get too hot as this can increase the risk of cot death. Babies can get too hot if they have too much bedding or if the room is too warm. If your baby is sweating or their tummy feels hot to touch, take off some of the bedding. Don't worry if your baby's hands and feet are cool as this is normal. Remember that babies don't need hot rooms. Keep the room at a temperature that is comfortable for you to sleep in. This is usually about 18°C (65°F).   Your baby should never sleep:
  • with a hot water bottle or electric blanket, 
  • next to a radiator, heater or fire, or in direct sunlight.

Using a dummy

It's possible that using a dummy at the start of any sleep period reduces the risk of cot death. However, the evidence is not strong and not all experts agree that dummies should be promoted.

If you're breastfeeding, do not give your baby a dummy until they're one month old. This will help ensure the dummy does not affect your baby's breastfeeding routine.

Don't worry if your baby's dummy falls out while they're sleeping, or if your baby doesn't want to use a dummy. Not all babies like dummies. Never force your child to use one if they don't want to.

Medical Review: November 23, 2009

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