‘How’s your little brother?’, I asked a recent older brother. ‘How’s he behaving? ‘All right’, he answered, looking annoyed. ‘But he only knows how to eat and sleep, eat and sleep, eat and sleep ... all day’.
Luckily for this little "dethroned prince" at least this little brother did not cry too much, because the truth is that a newborn baby spends most of its time sleeping and then spends the rest of the time eating and crying, in varying proportions depending on how lucky we are. Sleep is very important for the baby's development, but it is also a time when the baby is especially vulnerable.
It is called sudden infant death or crib death, when a baby under 12 months of age dies suddenly, usually while sleeping and for unknown causes, even after in-depth investigation. It is an exceptional circumstance, but it is the most frequent cause of death in babies during the first year of life in developed countries.
The incidence of sudden infant death varies widely in different countries without a clear geographic or socioeconomic pattern. In Spain the incidence is around between 0.3 and 0.4 per thousand live births but there are few studies on this problem in our country.
For many years it has been known that there are a number of factors associated with higher or lower risk of sudden infant death. Many of these factors, genetic in nature, like the age of the parents or the sex of the baby cannot be changed, but others can.
In 2014 the Spanish Pediatric Association published recommendations for the prevention of sudden death, but recently, at the end of 2016, the American Pediatric Society reviewed these risk factors and published new recommendations for the prevention of sudden infant death, which are summarized as follows:
Put the baby down to sleep on his back until one year of age. Always. Every time he goes to sleep. Sleeping on their back does not increase the risk of choking, even in babies who regurgitate a lot or have reflux.
When sleeping, on their back – always.
Placing them on their side is unsafe and is not recommended.
Sleeping on a firm surface. The mattress should be firm and should be protected by a tight-fitting sheet, with no other bedding or soft objects in the crib. This includes pillows, blankets, "crib bumpers", toys, etc.
Use lightweight bedding, do not allow the baby to overheat.
Breastfeeding, especially if it is the only method used, but also if it is partial, help protect against sudden death.
Breastfeed
The baby should sleep in the parents' room, near the bed during the first year of life. The AAP does not recommend that the baby sleep in the same bed as the parents, i.e., co-sleeping. Taking into account that co-sleeping is a common practice in some families, it is important to know the real risks of this practice. Co-sleeping involves a significant increase in the risk of sudden death in the following cases:
- If the baby is less than 4 months old
- If one of the parents smokes, or if the mother smoked during pregnancy
- If one of the parents is excessively tired or under the effects of sedatives, like medication, alcohol or narcotic substances
- If the bed is shared with other children
- If you sleep on a soft surface like a sofa, a waterbed or an old mattress
In the parents room during the first year.
Co-sleeping? Yes, but safely.
Co-sleeping cribs can be an option.
The pacifier is a something that protects from sudden death. It can be used once breastfeeding is well established, without ribbons or chains that can become entangled around the neck or hooked on soft toys, which should be avoided inside the crib. If it falls out once the baby is asleep, it need not be replaced.
A pacifier to sleep if breastfeeding is well established.
Smoking during pregnancy or smoking in the home or in the family car are risk factors for sudden death, as well as the consumption of alcohol or drugs during pregnancy. This risk is even more important if you share the bed with the baby.
Do not smoke.
Avoid overdressing the baby. There is no recommended room temperature, although you should dress the baby with a layer more than an adult needs to feel comfortable, checking for signs that he/she is hot, like sweating or if you notice the body hot around the chest.
Do not overdress the baby.
Monitoring of the pregnancy by a doctor and vaccinating children are ways of protecting against sudden death.
No accessory, mattress or crib advertised as protection against sudden death has proven its effectiveness. Neither have cardiorespiratory monitors for domestic use.
Dr. Gloria Colli
Head of the Pediatrics Service at Hospiten Estepona