I cannot imagine anything worse than losing a child. The heartache and grief must be overwhelming for parents and whanau, and I suspect the pain never truly goes away.
Tragically though, this is exactly what more than 30 families in New Zealand face every year, as a result of Sudden Unexplained Death in Infancy (SUDI, formerly known as SIDS).
SUDI refers to the death of an infant under 12 months of age, without any immediately obvious medical reason. It usually occurs while the baby is sleeping. Although there have been dramatic reductions in the rates of SUDI since the 1980s, largely due to the success of public awareness campaigns such as the Back to Sleep one, New Zealand still has one of the highest rates in the developed world, with Maori babies being sadly over-represented in the statistics.
We know that there are some babies who are more at risk of SUDI than others. These include babies who are born prematurely or have very low birth weights. There are also thought to be other unusual genetic factors that play a part, including abnormalities in the baby’s arousal system, but unfortunately these factors are not only hard to identify, but in all likelihood are impossible to modify.
Thankfully however, there are other risk factors that we can do something about. These include:
Babies should sleep on their backs. Sleeping prone (or on their front) is thought to increase the risk of SUDI between 4 and 13 times. Since this correlation was noted, encouraging parents to put babies to sleep lying on their backs has led to a dramatic reduction in SUDI rates.
Overheating your baby, or their room, by using too many clothes or blankets, can place them at risk of SUDI. The ideal temperature for a baby to sleep at is 18-22 degrees, but if like me you don’t possess a thermometer, general advice would be to wrap your infant in one more layer than you would wear yourself.
MATTRESSES AND MATTRESS PROTECTORS
Don’t use an old or “adult” sized mattress for your baby. Likewise, avoid soft bedding such as quilts, pillows or sheepskins under the sheet, unless they are specifically designed for babies – they increase the risk of SUDI by obstructing the airway or overheating your baby. Mattresses should be well fitted, leaving no gaps between the edge of the mattress and the edge of the cot. Mattress protectors are also a risk and should be avoided until children are older.
Feeding from the breast is protective for babies, even if it’s just for the first few weeks of their life. This isn’t an option for everyone though, and some hospitals have access to wonderful “milk banks” where babies can be bottle fed donated breast milk, offering them the same protection against SUDI.
CIGARETTE SMOKING DURING PREGNANCY
Exposure to cigarette smoke in the womb is known to increase a baby’s risk of SUDI.
Babies who are fully immunised are at lower risk of SUDI: despite beliefs to the contrary, a series of robust studies over the past 20 years have repeatedly shown the correlation between fully vaccinated babies and lower rates of SUDI.
The last, but certainly not the least, “modifiable” risk factor is bed sharing. We know that adults sleeping in the same bed as an infant greatly increases the risk of SUDI. This risk is even higher if the adult has been drinking alcohol. Medical experts strongly encourage parents to put their babies to sleep in a separate cot, next to their bed if possible. However, in many Maori and Pacific families, it is the cultural norm to have the baby sleep with you in bed. This is thought to be the main reason why, despite the overall drop in rates of SUDI, until recently Maori babies were still at around five times the risk compared to European babies.
Over the last few years though, the increased use of “portable infant beds” has provided something of a breakthrough – these beds are based on the design of the Maori wahakura, a portable infant bassinet hand-woven from flax.
These beds are designed to be used anywhere, but can also be safely brought into the adult’s bed, if parents choose to bed-share with their baby. Increased demand for wahakura has driven the development of Pedi-Pods – based on the same design as wahakura, but far less time-consuming to make. They are made from recycled polypropylene (the bottom of a clothes-basket in fact), and come with a well-fitted mattress and bedding.
Both wahakura and Pedi-Pods are part of the Safe Sleep programme, implemented in 2010. Since that time, we have seen a 29 per cent reduction in the rate of SUDI, most markedly amongst Maori infants – a huge and exciting achievement. For more information, visit www.safekids.nz or www.whakawhetu.co.nz, or ask your GP, practice nurse or midwife to refer you to your local Safe Sleep programme.
* Cathy Stephenson is a GP and a medical forensic examiner.