Positioners ban shines spotlight on Sids

The ban imposed by the Dubai Municipality on sleep positioners last week again highlighted the issue of sudden infant death syndome (Sids), the most common cause of death for babies aged between one month and six months old.

The precautionary ban was introduced following an international warning from the US Food and Drug Administration (FDA) and the Consumer Product Safety Commission (CPSC), which received reports of 12 babies having suffocated in these positioners over the past 13 years. There were also dozens of reported non-fatal cases of babies being found in potentially dangerous positions within or near the sleep positioners - flat mats and mats with side bolsters or an inclined wedge - which are often marketed to reduce the risk of Sids.

Parents have been warned not to place any positioners, pillows or quilts in a baby's cot and to ensure babies are placed on their backs to sleep. Such measures can drastically reduce the risk of their babies succumbing to this mysterious syndrome. "The single most beneficial measure to prevent Sids is the supine sleeping position (sleeping on the back)," confirms Dr Maurice Khoury, a paediatrician at the Advanced Cure Diagnostic Centre in Abu Dhabi. "Putting the baby to sleep on the side or using sleep positioners is a false reassurance: the baby rolls from side to stomach and becomes wedged against the side of the device or between the device."

The condition does not just affect babies in cots. Infants have been known to die suddenly while in car seats or even, tragically, in their parents' arms. To understand what cot death is, is to understand what it is not. If a cause of death can be ascribed to an infant after a post-mortem, it is not Sids. As Jean Simons of the Foundation for the Study of Infant Deaths (FSID) explains: "Sids is a diagnosis of exclusion. If absolutely nothing can be found that would contribute to a baby's death, it is Sids. We don't know why the babies die; we just know that they stop living.

"It's a bit of a misnomer 'cot death'," she adds. "It is simply that babies under a certain age spend the majority of their life in a cot or carry cot. Babies are much more likely to be asleep the younger they are." Since it was founded in 1971, FSID has spent around £10 million (Dh59m) researching the causes and risk factors associated with cot death, and their findings have helped to save the lives of thousands of babies. FSID and paediatricians recommend reducing these risk factors rather than relying on products such as movement monitors and sleep positioners, as Simons explains: "You can't actually prevent Sids occurring just by vigilance, you just have to do all the things we know make babies less vulnerable to cot death. Monitors don't prevent cot death - we don't know why the babies die, but we do know with great certainty the factors that contribute to the risk. There are some risks and situations that make a baby more vulnerable to cot death. Low birth-weight babies, or babies born prematurely, and certain environmental practices make babies more vulnerable to cot death."

So what actions should parents take to minimise these known environmental risk factors? The main actions are set out, left, but the key thing to remember, explains Simons, is "place your baby on his or her back to sleep, in a cot, in a room with you, and do not smoke during pregnancy or let anyone smoke in the same room as your baby". Ensuring young babies do not overheat is another important factor. In a hot country such as the UAE, Khoury recommends a room temperature of 21-22°C. He adds: "It is important not to overdress the child. Any child whose clothes feel damp when they wake up is considered to be overdressed."

In the past, there has been some concern that the recommendation that babies sleep on their backs has led to an increase in plagiocephaly, or "flat head syndrome". "Plagiocephaly is a common finding in children. It is usually of no consequence and is merely a cosmetic issue," explains Khoury. "After the age of six to eight months the infant acquires significant mobility, which allows it to change sleeping position many times during his sleep. At this period, the risk of Sids is extremely low and the infant has acquired significant protection mechanisms. The change in sleeping position allows for correction of plagiocephaly. Hair growth covers up the rest."

Once breastfeeding is established, settling a baby to sleep with a dummy can also reduce the risk of cot death, as Simons explains: "It has been shown that settling a baby to sleep with a dummy is a protective factor and research is ongoing to try to find out why, but we do know that the results are consistent." This doesn't mean that widespread dummy use is recommended, however: "Just use it to settle to sleep and just for the first six months," Simons advises.

Far from living in fear of this tragic and unexplained cause of death, the condition is, thankfully uncommon. "Most of the babies who die are cared for in an environment where there is more than one risk factor present," says Simons. "It is becoming ever rarer for a baby to die from Sids."