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Cot death and sudden infant death syndrome (SIDS)
Cot death is when a baby under one year old dies suddenly and unexpectedly. If the death remains unexplained after detailed investigation the medical term is sudden infant death syndrome (SIDS). It’s also known as sudden unexplained death in infancy (SUDI)
About cot death
What happens after a cot death?
Causes of cot death
Reducing the risk of cot death
Living with cot death
Having another child
About cot death
Around 300 babies die suddenly and unexpectedly in the UK every year. Cot death can happen to any baby. But it’s more common in babies between one and three months, premature babies, and babies with a low birth weight. It’s also more common in baby boys.
Most cot death happens when a baby is asleep in their cot at night. However, it can happen wherever your baby is sleeping, such as when in a pushchair or even in your arms. It can also happen sometimes when your baby isn’t sleeping – some babies have died in the middle of a feed.
What happens after a cot death?
If your baby was one of twins, triplets or more, your other baby (or babies) will usually be taken into hospital for observation.
A thorough investigation will be carried out to try to find out why your baby died and to gather information that may help to prevent cot deaths in the future. This investigation is standard procedure in all cot deaths and doesn’t in any way imply suspicion or blame surrounding your baby’s death.
Many different people are involved in the investigation, including a coroner (an official who enquires into sudden, unexpected deaths), GPs, paediatricians (doctors who specialise in children’s health), social workers, police officers, health visitors and midwives.
When the full results from the investigation are available, a case discussion meeting, attended by all of the people involved in the investigation, will take place. This may be up to 12 weeks after the death of your baby.
You will be kept informed of the investigation procedure and progress at all times. At the end of the investigation, a doctor will usually discuss the findings with you.
If a specific cause of death is found, this will be registered on the death certificate. If the cause of death remains unexplained after the investigation, the death is usually registered as SIDS or SUDI. Sometimes the term ‘unascertained’ will be used.
Causes of cot death
Identified causes
Less than half of all cot deaths have a specific cause. Possible causes include a serious infection, an accident, or a previously unknown problem that your baby was born with (a congenital condition), such as a heart or lung problem.
SIDS
If no specific cause can be found to explain the death of your baby, it’s defined as SIDS or SUDI. Research has suggested that a number of different factors may be linked to SIDS. It’s believed that these factors don’t actually cause SIDS, but may make your baby more at risk. These factors include:
- placing your baby on their chest to sleep
- smoking in the same room as your baby
- allergies
- bacterial and viral infections
- unknown genetic conditions
- problems in the area of the brain that controls breathing
- an irregular heartbeat
- accidental suffocation
- overheating
Reducing the risk of cot death
A campaign to reduce the risk of cot death was launched in 1991 by the Foundation for the Study of Infant Deaths (FSID) and the Department of Health. The recommendations they made have helped to reduce the number of cot deaths reported every year in the UK by almost three-quarters.
Illness
- If your baby is unwell, seek medical advice promptly.
- If your baby has a high temperature, try to keep him or her cool.
Smoking
Exposure to cigarette smoke (during pregnancy or after the birth) is known to increase the risk of cot death. If a baby lives in a household in which one or more people smoke, it more than doubles the risk of cot death.
- Don’t smoke during pregnancy – this applies to both mothers and fathers.
- Don’t let anyone smoke in the same room as your baby – ask them to smoke outside.
- Don’t share a bed with your baby if you or your partner smokes.
Sleeping
For the first six months, the safest place for your baby to sleep is in a cot in your bedroom.
- Always lie your baby on his or her back to sleep.
- Place your baby with his or her feet at the foot of the cot to prevent them wriggling down under the covers.
- Don’t fall asleep with your baby while sitting or lying on a sofa or armchair.
- Don’t let your baby sleep with a pillow.
- Use a firm mattress with a waterproof cover for your baby’s cot.
- Always make sure that bedding is tucked in securely.
- Make sure your baby’s head isn’t covered with bedding.
Don’t share a bed with your baby if you or your partner:
- have been drinking alcohol
- have taken medication that makes you drowsy
- are very tired
Dummies
There is some evidence to suggest that giving your baby a dummy when you settle him or her to sleep may help to reduce the risk of cot death. However, more research in this area is needed before official recommendations can be made regarding the risks and benefits of using dummies.
If you’re breastfeeding, don’t introduce a dummy until around one month and try to reduce the use of a dummy gradually when your baby is around six to 12 months to prevent dental problems.
Breastfeeding
Babies who are breastfed are less likely to die from cot death than babies who have only ever received formula milk.
Temperature
Keep your baby at the right temperature.
- The ideal room temperature for your baby is 18°C (a range of 16 to 20°C is acceptable).
- Keep your baby’s head uncovered.
- Feel your baby’s abdomen (tummy) to check if he or she is the right temperature. If it’s hot or your baby is sweating, take off some bedding or clothing. It’s normal for babies to have cool hands and feet.
- Always take off your baby’s outdoor clothes when you come inside, even if this means waking him or her up to do so.
- Don’t let your baby sleep with a hot water bottle or electric blanket, next to a radiator, heater or fire, or in direct sunshine.
- Don’t use duvets or quilts if your baby is under 12 months.
- Baby sleeping bags are an alternative to blankets and sheets. Make sure you get the right size and thickness and know what clothes your baby should wear underneath. Always check the manufacturer’s recommendations to ensure that your baby doesn’t overheat.
Baby breathing monitors
There is no evidence that breathing or movement monitors help prevent cot death and they should only be used on the guidance of a doctor. They can provide a false sense of security and increase anxiety.
Living with cot death
Even after taking as many precautions as possible, babies can and do still die from cot death. You will often have many different emotions, including overwhelming feelings of guilt and anger. Family and friends can be a valuable source of help and comfort at this difficult time. They can also help in practical ways, for example with looking after other children, preparing meals and doing shopping.
Dedicated charities, support groups and associations can provide advice and help to families affected by cot death. It may also help to talk to a counsellor who specialises in helping people cope with grief.
Your GP or health visitor can help you find a suitable counsellor or support group in your area.
Having another child
The decision to have another child after losing a baby to cot death isn’t an easy one. You will know if and when you’re ready and when it’s the right time for you.
Care of the next infant (CONI) schemes are available in many areas. They offer advice, support, increased monitoring for your new baby and frequent check-up visits. Ask your GP or midwife if there is a CONI scheme in your area. If there isn’t, your local health authority may run its own equivalent scheme and will be able to offer you additional support during your pregnancy and after the birth of your new child.
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.
I have lost a child to cot death before and am now pregnant again. Is it likely I will lose another child to cot death?
I have just lost my baby to cot death and have been told that a post-mortem examination must be done. Why? What might this involve?
Is it safe to use second-hand baby equipment such as mattresses and sleeping bags?
I have lost a child to cot death before and am now pregnant again. Is it likely I will lose another child to cot death?
It’s very rare for cot death to occur twice in the same family. Occasionally an inherited disorder, such as a heart problem, may cause more than one baby to die unexpectedly.
Explanation
If a cause of death was established for the baby you lost previously, talk to your doctor or midwife about any tests or precautions that may be appropriate during your pregnancy and after your new baby is born.
Your midwife will be able to offer you extra support and advice throughout your pregnancy. Ask if there is a suitable support programme in your area which might be able to offer additional support and information.
Care of the next infant (CONI) is a programme that was set up and is jointly funded by the Foundation for the Study of Infant Deaths (FSID) and local health services to support families who have been bereaved by cot death as they prepare for their next child. The CONI programme is available in 194 centres across the health services in England, Wales and Northern Ireland. The Scottish Cot Death Trust provides services with healthcare professionals across Scotland.
During your pregnancy and after the birth of your baby, the CONI programme can offer the following services.
- Regular (weekly) visits from an experienced health visitor until your new baby is six months old, or two months older than the baby you lost.
- Diaries to note down your concerns and any symptoms you notice in your baby that you may be worried about. You can then discuss your diary with your health visitor at regular meetings. This may help identify any problems or reassure you that all is well.
- Weight charts to help you to keep track of your baby’s growth and development.
- Room thermometers to make sure that your baby’s room (and any other room in which your baby sleeps) is at the correct temperature (16 to 20°C).
- Movement (breathing) monitors that will alert you if your baby stops moving (breathing) for a certain period of time. However, there are mixed views on the usefulness of these monitors – for example, they may give a false sense of security or heighten anxiety.
I have just lost my baby to cot death and have been told that a post-mortem examination must be done. Why? What might this involve?
Losing a baby to cot death and being told that a post-mortem examination must be done can be very upsetting. However, it’s important to remember that this is a standard procedure in this situation. A post-mortem will involve a number of examinations and tests, which will aim to help establish why your baby died.
Explanation
National guidelines make it a requirement for all health authorities to fully investigate cot death cases.
After a cot death, a specially trained police officer and a paediatrician will usually visit the place where it happened and talk to you to find out the circumstances of your baby’s death (for example, the place and time) and to learn about the medical history of your baby and your family. Other people who have had contact with your baby (such as midwives, health visitors and GPs) may also be asked for information. A post-mortem examination will be ordered by the coroner and performed by a specially-trained pathologist (a doctor who specialises in establishing causes of death).
The main aim of a post-mortem is to establish whether there was an identifiable cause of your baby’s death, such as a bacterial or viral infection or a problem with one of your baby’s organs (for example, the heart, lungs or brain).
A post-mortem will usually be carried out within 48 hours of your baby’s death. The detailed results of a post-mortem may not be available for many weeks due to the time it takes to carry out all of the laboratory tests. However, this doesn’t mean that you will have to wait this long before you can hold a funeral. You can arrange this as soon as the post-mortem itself has been completed.
A pathologist will carry out a detailed external and internal examination of your baby and look for any signs of disease. He or she will take samples of your baby’s blood, urine and some small tissue samples (such as liver and kidney) for future examination. You may be asked permission for samples of brain tissue to be taken – this is often the most important source of information and can therefore be one of the most useful parts of a post-mortem.
New examination techniques are being developed by scientists all the time. It’s possible that by looking at tissue samples from many babies using these new techniques, a better understanding of the causes of cot death, and how to prevent it, may be found.
It’s important to remember that post-mortems are carried out in all cases of unexpected death and your baby will be treated with the utmost care, respect and dignity at all times. A post-mortem is the most likely way to find out why your baby died. However, sometimes, despite a detailed post-mortem and investigation, the exact cause of death will remain unknown.
Is it safe to use second-hand baby equipment such as mattresses and sleeping bags?
Ideally, buy a new mattress for a new baby. It’s been shown that there is a link between the use of second-hand mattresses and cot death. Sleeping bags (new or second-hand) are safe to use as long as they are the right size for your baby and the right thickness for the temperature of the room in which your baby sleeps.
Explanation
The link between second-hand mattresses and cot death is most apparent with mattresses which come from another household (for example, bought second-hand or given to you second-hand). However, there is still an increased risk of cot death if you re-use a mattress which was bought brand new for an older child in your own home.
It’s been suggested that bacterial infections may play a role in cot death. Staphylococcus aureus (S. aureus) is a type of bacteria that has been identified as a possible cause of cot death in several studies. S. aureus has been found in used mattresses but it’s not yet known whether the presence of this bacteria in used mattresses could be a direct cause of cot death.
Ideally, buy a new mattress for a new baby. However, if you need to re-use a mattress only do so if:
- the mattress was made with a waterproof covering
- the mattress cover is in good condition – no tears, splits or holes
- the mattress is firm, doesn’t sag anywhere and fits the cot without any gaps
- you clean and dry the mattress thoroughly before use
A second-hand baby sleeping bag is a safe alternative to traditional cot bedding (sheets and blankets) as long as:
- it’s washed thoroughly before use
- it doesn’t have a hood
- it’s the right size for your baby (in particular it should have the right-sized opening at the neck)
- it’s the right thickness (has the appropriate tog rating for the time of year)
- your baby has the appropriate clothing on underneath
As with other forms of bedding, it’s important to make sure your baby doesn’t overheat and that his or her head remains uncovered. If you’re buying a second-hand sleeping bag, it’s important to know what age range it’s for and what tog rating it has. It’s also important to know what clothing your baby should wear when using it, such as a vest alone or a vest and pyjama top. There are different recommendations about clothing depending on the tog rating of the sleeping bag and the temperature of the room in which your baby is sleeping. This information should be on the manufacturer’s website.
Further information
- Foundation for the Study of Infant Deaths (FSID)
0808 802 6868
www.fsid.org.uk
- Scottish Cot Death Trust
0141 357 3946
Sources
- Reduce the risk of cot death. Scottish Cot Death Trust, 2011. www.scottishcotdeathtrust.org
- Sudden infant death syndrome. eMedicine. www.emedicine.medscape.com, accessed 17 November 2010
- Advice for professionals. Foundation for the Study of Infant Deaths (FSID). www.fsid.org.uk, accessed 17 November 2010
- Statistical bulletin: Unexplained deaths in infancy, England and Wales. Office for National Statistics, August 2010, www.statistics.gov.uk
- What is cot death? Scottish Cot Death Trust. www.scottishcotdeathtrust.org, accessed 17 November 2010
- Looking after your baby. Foundation for the Study of Infant Deaths (FSID). www.fsid.org.uk, accessed 17 November 2010
- The Royal College of Paediatrics and Child Health and the Royal College of Pathologists. Sudden unexpected death in infancy. A multi-agency protocol for care and investigation. 2004. www.rcpch.ac.uk
- Postnatal care: Routine postnatal care of women and their babies. The National Collaborating Centre for Primary Care, 2006, www.nice.org.uk
- Weber MA, Klein NJ, Hartley JC, et al. Infection and sudden unexpected death in infancy: A systematic retrospective case review. Lancet 2008; 371(9627):1848–53.
- Allergic reactions and SIDS. Foundation for the Study of Infant Deaths (FSID). www.fsid.org.uk, accessed 17 November 2010
- Reduce the risk of cot death (2009 edition). Department of Health, March 2009. www.dh.gov.uk
- Passive smoking and children: A report by the tobacco advisory group of the Royal College of Physicians. Royal College of Physicians, March 2010, www.rcplondon.ac.uk
- Pacifier (dummy) use and sudden infant death. Bandolier. www.medicine.ox.ac.uk, accessed 22 November 2010
- Vennemann MM, Bajanowski T, Brinkmann B, et al. Does breastfeeding reduce the risk of sudden infant death syndrome? Pediatrics 2009; 123(3):406–10. doi:10.1542/peds.2008-2145
- The pregnancy book. Department of Health, 2009, www.dh.gov.uk
- Next infant support programme. Scottish Cot Death Trust. www.scottishcotdeathtrust.org, accessed 17 November 2010
- Working together to safeguard children: A guide to inter-agency working to safeguard and promote the welfare of children. Hm Government Department for Children Schools and Families, 2010, www.education.gov.uk
- Guidelines on autopsy practice. Scenario 8: Sudden unexpected deaths in infancy (SUDI). Royal College of Pathologists, 2005, www.rcpath.org
- Tappin D, Brooke H, Ecob R, et al. Used infant mattresses and sudden infant death syndrome in Scotland: Case-control study. BMJ 2002; 325:1007. doi: 10.1136/bmj.325.7371.1007
- Re-use of mattresses in relation to cot death. Department of Health. www.dh.gov.uk, published 9 February 2007
- Goldwater PN. Sterile site infection at autopsy in sudden unexpected deaths in infancy. Arch Dis Child 2009; 94:303–7. doi:10.1136/adc.2007.135939
Related topics
- Antenatal care
- Bereavement
- Breastfeeding
- Depression
- Fever in children
- Planning for pregnancy
- Stages of pregnancy
- Ways to stop smoking
Published by Bupa’s Health Information Team, April 2011.
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