You must have heard many horror stories of SIDS or ‘cot deaths’ and may be terrified that a similar thing could happen to your precious newborn. The AAP recently developed updated guidelines in 2016 to supplement the last statement from 2005. All parents of infants should adopt these guidelines in their entirety.

Sudden Infant Death Syndrome is the leading cause of death in infants between one month and twelve months in developed countries. It is nowhere near being the leading cause in our country, but that may be due to several factors:

• Infections are prevalent in our country, and infections claim many of our babies.
• Many infant deaths are not recognized as SIDS because investigations into a sudden unexplained death are superficial at best.

Where should my child sleep?

A crib is the safest place for the child to sleep. While we all would love to cuddle up with our sweet baby (and I am sure if the child could express it, she would too!), we must realize that there is a great disproportion in the sizes of the parents and the baby. There is a real, though small, risk that the tired and sleeping parent could potentially roll over onto the child and smother the child, leading to the lamentable case of SIDS.

“But that is impossible, Doc; even in my sleep, I would immediately sense my child’s position and never, ever put my child at such a risk!”

While your parental instincts are appreciated and undoubtedly exist, one of the most significant contributors to a high incidence of SIDS unquestionably is ‘bed sharing.’ So remember:

“Share your room but not your bed.”

Ensure that the child’s crib is near your bed. This will help you, as a mother, take care of your child well by alerting you to her needs whenever she cries or needs a feed. Remember to put the child back in the crib after taking care of the child (feeding, changing nappies, etc.).

In any case, never share the bed with the child, especially if:

1. The child is less than three months of age.
2. Either of the parents is or has been a smoker.
3. The mother is exhausted and may fall into a deep slumber.
4. The person has been using medications (painkillers, anti-depressants) or substances (alcohol, etc).
5. The person sleeping with the infant is not a parent, including siblings.
6. The infant sleeps with multiple persons in the same bed.
7. The baby sleeps on soft surfaces like a water bed, armchair, sofa, couch, or old lumpy mattress.
8. Soft bedding like pillows, heavy blankets, quilts, and comforters are on the bed.

When I feed my baby, I pick up my baby from the crib and then feed the baby on my bed. Is that OK?

Feeding the baby on your bed is fine if you remember to put the baby back in the crib after s/he finishes feeding. Try to feed in a sitting position on the bed. It is improbable that you will fall asleep when you are sitting, but it is all too possible to fall asleep while you are feeding in the lying position.

What type of mattress should I use?

A firm mattress is vital for your baby’s sleep environment. Avoid soft, velvety sleeping materials (pillows, quilts, comforters, even if covered by a sheet), as the tiny baby can easily become entangled in a soft, fluffy mattress where depressions have formed. Remember, it’s a myth that the tender skin of the baby requires only soft mattresses, or else the baby will be uncomfortable. A firm mattress provides the necessary support and safety for your little one’s sleep.

The size of the mattress is also essential. It should be a tight fit in the crib without gaps between the sides and the mattress, where the baby can be entrapped.

Doctor, we put the AC on at night when we sleep, and my baby feels cold. What type of blanket should I use to cover her, and how many should I use?

Please do not use any blankets on your child! Similarly, avoid any soft, cuddly toys or loose objects you may have. They must not be kept in the crib when the child is sleeping. They may get displaced and be a source of potential asphyxiation. You may put a reasonable amount of layered (two at the most) clothing on the child to keep her warm. It is far better to adjust the temperature of your AC so that the child is not uncomfortable in any way.

My child likes to sleep on her belly. Is this OK?

An unqualified NO! The child should sleep on his back all the time until one year of age. Sleeping in the prone position or even sideways is one of the most significant risk factors for SIDS. Even in children with gastroesophageal reflux, do not place the baby in a prone position or with the head end up when the child is asleep because of the risk of the child sliding down to a position that may interfere with the child’s breathing.

If the infant has started rolling over from supine to prone and vice versa, allow the child to sleep in the position she assumed.

It is even more important to keep the sleeping child supine in preterm infants. This position should be encouraged when the child is stable and reaches 32 weeks post-menstrual age. Supine sleep should be started when the child is in the NICU itself before discharge.

However, there is a vital role in the so-called ‘tummy time,’ where you allow the baby to lie on the tummy when awake and playful. This also helps to build strong neck and back muscles.

Sleeping on the side is neither safe nor advised.

Can I put a rubber sheet or mattress cover under the bedsheet to protect the mattress from stool and urine?

Sure! But do remember:

• The sheet should be thin and should snugly fit the mattress.
• There should be no overhanging wires or cords dangling over the crib since the child may get entangled.
• Do not use sitting devices like car safety seats, strollers, swings, infant carriers, or infant slings for sleeping babies at home. If the baby is in the infant sling, ensure that the infant’s head is up and above the fabric, the face is visible, and the nose and mouth are clear of obstructions.
• If the baby falls asleep in a sitting device, pick her up and put her in the crib or other appropriate flat surfaces.

CARE DURING PREGNANCY

• • Regular prenatal care is known to reduce the risk of SIDS significantly

• • No Smoking! Either by the mother herself or by others around her.

• • No Alcohol or Substance Abuse!

BREASTFEEDING

Breastfeeding has a protective effect against SIDS. If you exclusively breastfeed your child, the effect is even more significant.

PACIFIERS

• • Pacifiers protect against SIDS and should be given as the child falls asleep.

• • Start with pacifiers only after breastfeeding is firm; otherwise, there may be ‘nipple confusion,’ and the baby may not breastfeed.

• • Offer pabreastfeednap time and bedtime.

• • After the child falls asleep, remove the pacifier if it has fallen out of the mouth.

• • Do not force a pacifier on the child if she does not want it.

• • Do not attach soft toys or threads to the pacifier or dangle it around the baby’s neck.

VACCINATIONS

Keeping up with routine vaccinations has a protective effect against SIDS. Please do not skip vaccinations.