Reducing the Risk of Cot Death

What is cot death?

Cot death (Sudden Infant Death Syndrome or SIDS) is when a baby dies suddenly for no known reason. Cot death is uncommon. Most cases occur in babies under the age of five months.

What can I do to help prevent cot death?

Research has shown that the risk of cot death can be reduced. The things you can do fall into three main categories.

• Sleeping - learn the best way for your baby to sleep.
• Smoking - create a smoke-free home for your baby.
• Symptoms of illness - see a doctor if your baby appears unwell.

SLEEPING
The best way for your baby to sleep is as follows. Make sure that any child minders or babysitters know this too.

• Lie your baby on their back to sleep - not on their front or side. Cot death is more common in babies who are put on their front. Also, there is no evidence that babies who lie on their back will choke. (This unfounded worry was why it was common to put babies on their front in the past.) When your baby is able to roll over (aged about 5-6 months) it is safe for them to sleep in whatever position they like. The risk of cot death falls sharply at this age. Like adults they will toss and turn in their sleep and this is fine.
• Do not use a pillow - just a firm mattress that fits well into the cot.
• Use layers of sheets and thin blankets - rather than duvets, loose covers or a 'baby nest'. Do this at least until the baby is a year old. Duvets and loose covers are more likely to cover a baby's face. Also, using several thin layers allows you to put on or take off layers depending on the room temperature.
• Cover your baby up to their shoulders only - the head must be left uncovered. Tuck sheets and blankets under the sides of the mattress to stop them riding up onto the face.
• Lie you baby 'feet to foot' - that is, the baby's feet should be just touching the foot of the cot. This means they cannot slip further down the cot under the blankets.
• Temperature - babies need to be warm, but not too warm. Being too warm increases the risk of cot death. Have the room at a temperature that is comfortable for you. If your baby is sweating or feels hot then they are too warm. Do not place a baby's cot next to a heater or radiator, or in direct sunlight. Also, do not use water bottles, electric blankets, etc.
• Share a room with your baby - until they are at least six months old. A cot next to your bed is the best place for your baby to sleep.
• It is best not to share a bed with your baby when you sleep. There is a risk that you might roll over onto your baby when you are asleep, or the baby may get trapped under the bedclothes. Obviously, it is normal to feed and cuddle your baby when you are resting in bed but awake. However, when it is time for you to sleep, the best place for your baby is in a cot next to your bed. In particular, there is an increased risk of bedsharing if:
  • your baby is was born premature, had a low birthweight, or is less than 3 months old.
  • you or your partner are a smoker (even if you do not smoke in the home).
  • you are very tired or you are taking medication that can make you drowsy.
  • you have taken any alcohol or drugs.
• Do not fall asleep with your baby on a sofa, armchair, settee, etc. This has been shown to increase the risk of cot death.

In summary:

SMOKING
Create a smoke-free area around your baby. Cigarette smoke is a main 'risk factor' for cot death. Do not let anyone smoke in the same room as your baby. Smoking whilst pregnant also increases the risk of your baby having cot death. If at all possible, do not smoke when you are pregnant.

SYMPTOMS OF ILLNESS
Most cot deaths occur 'out of the blue' when the child is asleep. There are usually no symptoms to alert parents or carers that anything is wrong. However, sometimes an illness is not recognised and quickly gets worse. See a doctor if your baby appears unwell. Use your instincts - you know best if something is not right. The list below is also a guide to the main symptoms to look out for.

• Vomiting, especially bile (green) vomit.
• Takes less fluids (milk feed) and/or makes less urine than usual.
• High pitched or unusual cry.
• Drowsiness, floppiness or less responsive than usual.
• Wheezy, grunting, fast or difficult breathing.
• High fever or sweating a lot.
• Looks pale or blue.
• Blood in the nappies.
• Rash.

Enjoy your baby

Cot death is uncommon and becomes rare after the age of 5 months - about the time when babies are able to roll over and move a bit. Don't let worry of cot death spoil the precious time of getting to know your baby. But, the measures listed above reduce the small risk of cot death even further.

Further help and advice

Foundation for the Study of Infant Deaths (FSID)
Tel (Helpline): 020 7233 2090    Web: www.sids.org.uk
FSID funds research, supports bereaved families and promotes safe baby care advice.

© EMIS and PIP 2006   Updated: October 2006