The two words that strike fear into the hearts of all new parents, cot death remains a mystery. It is, thankfully, rare and there is plenty of advice for parents on how they can reduce the risks even further.
What is it?
Cot death or SIDS (sudden infant death syndrome) is a term used to describe the death of an infant which cannot be explained. If no reason for the death can be found following a post mortem, an examination of the place where the baby died and a thorough review of the baby's medical history, then SIDS will be cited as the cause.
It occurs most commonly while babies sleep – usually at night, but sometimes during naps in the daytime – and 90% of deaths occur during the first six months.
By the time a baby is one year old, the risk of cot death is greatly reduced. Very very rarely, it can occur after the age of 12 months.
It is simply not known what causes cot death, although research is constantly being undertaken. We know that boys are at a slightly higher risk (around six out of 10 cot deaths occur in boys) as are premature babies and those born with a low birth weight. Babies whose mothers smoked during pregnancy are considerably more likely to die of SIDS.
What can I do?
Because there is no definitive reason why some babies die of SIDS, there is no definitive answer as to how it can be prevented. However, research over the years has revealed a number of risk factors and, as such, there are many things parents can do to reduce the likelihood of cot death occurring.
The Foundation for the Study of Infant Deaths (FSID) and the NHS web page are both valuable resources, but here are some of the key points to be aware of:
Babies exposed to tobacco smoke in utero are four times more likely to die of cot death – and those who are exposed to a continually smoky environment after birth are eight times more likely to die than those in a smoke-free home. Even if you don't smoke yourself, you should never allow anyone to smoke in your house or near your baby.
You might love the idea of co-sleeping, but the safest place for your baby to sleep during their first six months is in their own cot or crib, in your room. Certainly, you should never sleep with your baby in your bed if you have been drinking alcohol, smoking, taking drugs or taking any medication that could make you sleep heavily.
You should always lie your baby on their back when they go to sleep. It is not absolutely clear why this might make a difference, but it may be because it reduces the chances of them inhaling poor-quality air (air they have already exhaled, which is therefore depleted of oxygen and laden with carbon dioxide).
When you lay them down, make sure their toes are touching the bottom of the cot, to prevent them from wriggling down underneath the blankets. Babies should not sleep with covers over their heads or faces.
As soporific as a snoozing baby on your chest can be, don't fall asleep with your little one on the sofa – always put them into their cot to sleep. At around four or five months old, your baby will probably start rolling over. Turn them back on to their back before you go to bed if you can do so without disturbing them too much – but don't fret and keeping turning them all night. By the time your baby is this age, and able to move around their cot, they are already at a decreased risk of SIDS.
Babies who get too hot are more at risk of cot death. The best room temperature for a baby is between 16°C and 20°C – ideally, 18°C. Invest in a room thermometer so you can check that your home, particularly the bedroom, is not too hot or too cold. Don't place your baby's cot near a radiator or a heater.
Babies younger than 12 months should not have duvets/quilts and pillows – a sheet and cellular blankets are perfect because you can add or take away layers to keep them comfortable.
Be aware of your baby's temperature. You'll probably be able to tell if your baby is too hot just by looking at them: if their face is pink or flushed, or if they have damp hair, remove a layer and perhaps reduce the room temperature to cool them down. If you are not sure if they your baby is too hot, feel the skin on their tummy or back – you'll know if it feels warmer than usual.
SIDS does not always occur at night time, so when you come inside from the cold, remove your baby's outer clothing, hat and gloves, even if you think it might wake them.
Breastfeed if you can
Breastfeeding seems to reduce the risk of cot death and breast milk contains all the nutrients and antibodies your baby needs. However, breastfeeding is not always possible – so don't beat yourself up about it.
Use a dummy
Several studies have shown that giving a baby a dummy when they go to sleep may help reduce the risk of cot death. It's not entirely clear why a pacifier might help, but it could be because the bulk of the dummy's handle prevents babies suffering from a lack of oxygen if, for example, their faces accidentally become covered by blankets, or it might be because the sucking action helps to improve the development of babies' airways.
If you do consider using a dummy, don't introduce it until breastfeeding has been fully established, perhaps after a month or so – and if your baby doesn't like the dummy, don't try to force them to use it. If their dummy falls out once they are asleep, there's no need to replace it.
Immunise your baby
Babies who are immunised appear to have increased protection from the risk of cot death.
Help and support
The FSID has a fantastic website detailing various measures you can take to further reduce the risk of cot death. They also offer a helpline, which is open to people who have been bereaved, as well as parents seeking safety advice. The number is free, call 0808 802 6868, or email firstname.lastname@example.org