How to prevent sudden infant death syndrome

Until recently, the idea of ​​this syndrome was this: "Nobody knows why this happens, and parents can not prevent this".New research puts such gloomy statements in doubt. For parents who are concerned about such tragedies, we offer up-to-date information about this syndrome and, more importantly, ways in which you can reduce the risk.

Before proceeding further, we would like to make a warning: the following data are given in order to inform, and not to offend;instill optimism, and not scare. Having understood all the details of this terrible puzzle, parents will worry less. Knowing that they can become active participants in their own risk reduction program, they will not feel so helpless. We do not want to say that if you do not take all the precautions we recommend, your child may die, or that if you do everything as it is written, this can not happen. In addition, the syndrome of sudden child death is a rare phenomenon( see box "Facts about the syndrome of sudden child death").But our recommendations can reduce the risk for your child. They are based on the most recent studies of this syndrome, as well as on our own experiments. All risk reduction tips have been thoroughly studied, although some studies have not yet been completed. While new research has not helped us better understand and prevent this tragedy, we give you the most complete information known at the moment.

The basis of our risk reduction program

Our program to reduce the risk of sudden infant death syndrome is based on the following: taking certain precautions and choosing an approach to the child,

based on attachment, parents can reduce the risk of sudden infant death syndrome. Specifically, here are our recommendations:

1. Provide yourself with good prenatal care.

2. Do not smoke near the baby.

3. Place the baby on your back or on your side.

4. Breastfeeding.

5. Do not overheat the baby during sleep.

6. Provide your child with medical care.

7. Secure the place where your child sleeps.

8. Practice a child-centered approach based on attachment.

9. Put the child to sleep next to him.

Some of these recommendations may seem self-evident. The way it is. Others may seem new to you, so we will discuss each in detail. But to help you understand how we came to these recommendations, we would like to first tell how our understanding of this syndrome grew.

My own familiarity with this topic began in the early years of my pediatric practice. During the examinations, I usually asked young parents if they were worried about something."Syndrome of sudden child death," they answered."Why does this happen?"

"I do not know," I muttered.

Facts about the syndrome of sudden infant death(

)

Syndrome of sudden infant death( also known as sleep apnea syndrome, or death in a crib) is defined as the sudden death of a child under the age of one year, the cause of which remains unclear after a complete posthumousresearch, including autopsy, the study of the place of death and the medical map. In the United States, about one child out of five hundred is dying from the syndrome of sudden child death, usually between the ages of two and six months, and most often between the ages of two and four months. Ninety-five per cent of cases occur up to six months. Most often this tragedy occurs between midnight and 6 o'clock in the morning. Most often in December and January. Annually in the United States from the syndrome of sudden infant death kills about seven thousand children;this is the main cause of death in the age from one month to one year.

Although most of the victims of sudden children's death syndrome had no warning signs and no risk factors, in some children the risk of sudden childhood death syndrome is higher than that of others. These include:

• premature infants;

• children who had episodes of respiratory arrest( apnea) in the first weeks of life;

• Children whose lives were already under obvious threat( for example, there was already a stop of breathing, in which the child turned pale, turned blue and all limp);

• children whose mothers have had little or no antenatal care;

• children in families in difficult socio-economic conditions;

• younger brothers and sisters of a child who died from sudden infant death syndrome.

It should be noted that even for children belonging to these risk groups, the risk of dying from the syndrome of sudden infant death is not more than 1%.Syndrome of sudden child death is not caused by suffocation under blankets, vaccinations or because the child choked;and it's not contagious.

The cause of sudden infant death syndrome is unknown to date. There are many theories, but none is proved. Prevalence of the syndrome of sudden infant death as a violation of sleep. Studies indicate that children who are at risk of this syndrome are born with some physiological characteristics. Outwardly, these children seem healthy and behave just like any other children, but in fact these children at risk have an immature breathing regulation system. In the depths of the brain of each person there is a respiratory center, which is a high-precision control center, whose duties include receiving signals and regulating breathing. For example, the boiler of your heating system has an accurate control center that must turn on the boiler and turn it off when the temperature rises

or falls above or below a preset level.

Similarly, the respiratory center located in the human brain is designed to maintain the oxygen level necessary for life in the blood. When the level of oxygen in the blood drops very low or the blood level of the carbon dioxide rises very high( what happens when a person stops breathing or holds his breath), the respiratory center automatically turns on and stimulates breathing. This protective mechanism normally works even when a person is in deep sleep. But for some children, for some unknown reason, breathing does not turn on automatically. In other words, some children who died from the syndrome of sudden infant death had disturbances in the awakening mechanism from sleep.

"Is there something we can do to prevent this?" - they persistently asked.

"Nothing I know about," I twisted.

Every time, at the end of this empty dialogue, I felt that I had let my parents down. Hands dropped because there is no way to reduce the risk. I experienced a special shock when I tried to comfort the parents who lost the child because of the syndrome of sudden child death. I grieved with them about their loss and grieved over my inability to explain why this happened and what they could do to prevent this tragedy from happening again. As a parent, I wanted to have a list of things that I could do to protect myself from the sudden infant death syndrome of my kids. As a pediatrician, I wanted to have a list that would be confirmed by research. And so I undertook to make such a list.

During the next ten years of

, I studied the most trustworthy studies of the syndrome of sudden infant death. Contrary to popular belief, this syndrome is not so mysterious. Quite a lot is known about the fact that this syndrome represents itself and what does not.

In these studies, two facts strike the eye: it happens in a dream, and this happens most often at the age of between two and four months. This syndrome may have different causes, but would not it be logical to assume that in most children this syndrome is a fundamental sleep disorder? And why exactly from two to four months? I set myself the goal of answering these questions. I found that researchers are divided into two groups: scientists and specialists who are studying the possible physiological characteristics of children who died from sudden infant death syndrome, and statistics that find out under what circumstances these tragedies occur and what are the risk factors. Although both of these approaches are necessary to solve the riddle, I felt that I needed another approach. I wanted to find out what impact parents can have on a child at risk, especially in high-risk situations( during sleep) and at high risk( the first six months).I wanted to fill this gap left by the researchers.

Since the syndrome of sudden infant death appears to be a sleep disorder, I wondered if the parent, in most cases the mother, could influence the speed of the awakening of her child by making changes in the organization of sleep. I put forward a hypothesis: Joint sleep can reduce the risk of sudden infant death syndrome.

Here is the first case that we learned to test this hypothesis. Near the child, a member of the high-risk group, a monitor was installed when he was sleeping in his crib. When the child was about three months old, the alarm signal due to the stop of breathing began to be heard with increasing frequency. But when the mother took the child to her bed and slept next to him, the alarm was silent. When the child was again moved to a separate place for sleeping, the siren reared again.

Nine Ways to Reduce the Risk of Sudden Infant Death Syndrome for Your Child

Based on recent studies of sudden infant death syndrome - including our own, - here are ways in which you can protect your child.

1. Provide yourself with a good prenatal care

Do everything to make your pregnancy go well, and provide yourself with a full prenatal care. From the syndrome of sudden infant death, studies have shown that children born to mothers who smoked during pregnancy and who took addictive substances, as well as those who did not receive good prenatal care, are more likely to die. Why these situations

Does the program give warning of sudden child death syndrome any results?

Of course, yes! In southern New Zealand, following a state educational program that advocated four methods of preventing sudden infant death syndrome( put the baby to sleep on your back or side, breastfeed, do not overheat the baby during sleep and do not smoke during pregnancy), the incidence of sudden syndromechild death fell by 80%.

are part of the risk factors, it is unknown, but most likely this is due to the chronic lack of oxygen in these children and an increased risk of premature birth.

2. Do not smoke near the baby

Studies show that smoking is a major risk factor, and all researchers agree that it increases the risk of sudden infant death syndrome. The risk is directly proportional to the child's exposure to cigarette smoke and the number of cigarettes smoked every day. Studies conducted in New Zealand indicate that the children of smoking mothers and fathers are seven times more likely to die from sudden child death syndrome. The mechanism of such a relationship is not yet fully understood. Probably, this combination of many factors. Children who are exposed to cigarette smoke are much more likely to have swelling of the respiratory tract. Recently, researchers have shown that children of smoking parents have certain chemicals in their blood that indicate that they are chronically short of oxygen.(On the effect of passive smoking on young children.)

3. Put the child to sleep on the

back or on the side

Common sense says it is safer to put children to sleep on their stomachs. This proven

is based

time advice on the fact that if a child spews up or it vomits, the fluid in this case will leak out of the mouth under the influence of gravity, whereas if the child is lying on his back, this fluid can swirl to his throat and the child will breathe it into his lungs. However, new studies put this council in doubt. First, according to researchers of the syndrome of sudden infant death, it is extremely unlikely that a child will choke on a vomiting mass when he sleeps on his back. In addition, in the late 1980s, a wave of retrospective studies overwhelmed the world( mostly from New Zealand, Australia, and the United Kingdom), who pointed out that children who sleep on their stomachs may experience more sudden child death syndrome than children who are asleepon the back or side. Initially, these studies were not too impressive for the scientific community, but the press inflated these discoveries and betrayed their wide publicity. Flicked fat headlines, advising parents not to put children to sleep on their stomachs. And suddenly, about a miracle, whether by mere coincidence, or for any other reason, the infant mortality rate from the syndrome of sudden child death in the countries where the results of these studies were published fell by 50%.Other researchers of the sudden infant death syndrome were still restrained and cautious and did not rush to forbid parents to put children on

Children who need to sleep on their stomachs

Be sure to consult your doctor if your child does not have any medical indications to ensure thatput him to sleep on his stomach. needed to sleep on the abdomen:

• Preterm infants during their stay in the hospital;sleep on the abdomen increases the efficiency of breathing in premature infants.

• Children suffering from gastrointestinal reflux;These children are best placed on their stomachs by raising their heads by thirty degrees.

• Children with pathologically small jaw bones or other anatomical anomalies of the respiratory tract.

belly, as history shows, the number of deaths from the syndrome of sudden child death is always temporarily reduced after any publications that draw attention to this problem.

Why, if you put children to sleep on their backs or sides, this can reduce the risk of sudden infant death syndrome, it is unknown. One theory states that children in this case are much less likely to overheat. When children lie on their sides or back, the internal organs are more open, and it is easier for them to give off excess heat than when the children lie on their stomachs. It is also possible that when a child sleeps face down, he can press his head into a soft surface that forms around his face a pocket in which carbon dioxide accumulates. As a result, the child breathes his own exhaled air. I would like to calm my parents and assure them that they should not in any way conclude from this that if they put their child to sleep on their stomachs, he will surely die. Studies only point to the statistical increase in danger.

Put children on your back or on your side? One of the reasons that some reputable experts prefer lying on their back is a concern that children who are laid to sleep on their side can roll onto their stomachs. But from our experience we can say that usually children turn from side to back, and not to the stomach, perhaps because the outstretched hand serves as a barrier and prevents them from rolling onto the stomach. We found that in the first months our children sleep best on their sides. When you put the child to sleep on his side, stretch his lower arm forward so that the child has less opportunity to roll on his stomach.

4. Breastfeeding

The newest studies confirm what I have always guessed: children who are breastfeeding die from the syndrome of sudden child death less often. One study in New Zealand found that children who are breastfed die from this syndrome three times more often. Older studies in this country also indicate that children who are breastfeeding suffer sudden infant death syndrome less often. Even the rude calculations carried out by the National Institute for Child Health and Human Development in the United States indicate that children who died from the syndrome of sudden child death were given a much lower incidence of breastfeeding, and if they were still breastfeeding, they were weaned earlier.

How breastfeeding can reduce the risk of sudden infant death syndrome is not known, but in my opinion, a combination of the following factors plays a role here. Due to the infection-killing substances contained in breast milk, the child has less inflammation of the upper respiratory tract( acute respiratory diseases), because of which the nose may be blocked and breathing difficult;due to hypoallergenic milk in the respiratory tract may be less swelling;numerous substances contained in breast milk that affect physiological processes, so-called factors, are absent in artificial mixtures. In addition, it is possible that breast milk contains substances that affect the child's sleep cycles and allow him to wake up more easily under circumstances that threaten his life. The hormone progesterone, for example, is a respiratory stimulant, and studies have shown that in children receiving breastfeeding, the level of this hormone in the blood is higher.

Can it all be in the very nature of breast milk? Gastro-oesophageal reflux( also known as gastroesophageal reflux) may increase the risk of sudden infant death syndrome. The throwing of milk from the stomach into the upper respiratory tract can provoke a reflective stopping of breathing. In children receiving breastfeeding, gastroesophageal reflux disease is observed less frequently. Could it be that the children receiving breastfeeding are better coordinated by the mechanism of swallowing and the mechanism of breathing? It is known that children who are breastfeeding suck and swallow differently than children who are on artificial feeding. Children who receive breastfeeding also usually suck more often than children who receive a bottle. Thus, they may have more practice in coordinating the mechanism of sucking and the mechanism of breathing. Finally, children who receive breastfeeding, especially if they sleep at night next to their mother, have other cycles of sleep, more often wake up to take their breasts, and usually sleep on their side, facing their mother. Maybe their sleep is also healthier and safer? The impact of

on breastfeeding on mother's sleep and the influence of the breast milk itself on the physiology of the child is poorly understood;further research in these areas, I hope, sooner or later shed light on the riddle of sleep apnea syndrome.

5. Do not overheat the baby during sleep

Children who are overheated during sleep are at a higher risk. Be especially careful not to overheat the baby if it is sleeping next to you. The body of the parent is a source of heat. If you put the baby in such a way as to put one to sleep, and then, at night, take him to your bed, respectively, change it. Studies have shown that mortality from sudden infant death syndrome is higher in countries where children are warmly wrapped up compared to those countries where children are covered easily and freely and where the rooms are heated according to the weather. Signs of overheating: sweat, damp hair, sweating, rapid breathing, restless sleep and sometimes a rise in body temperature. Both overheating and hypothermia have a harmful effect on respiration.

6. Provide your child with medical care

Although the sudden infant death syndrome does not bypass any social stratum, the death rate from this syndrome is higher among children belonging to socially-economically disadvantaged groups of society. If you are overworked and under constant stress due to financial problems and your opportunities to give the child the necessary maternal care are limited, seek help from your doctor and the social protection service. Studies have shown that the higher the parenting skills in dealing with the child, the lower may be the death rate from the syndrome of sudden infant death. One interesting study, conducted in Sheffield, England, confirmed that mothers can be the best ambulance service for their children. Researchers divided a very large number of children at risk into two groups. Immediately after birth, one group received weekly visits to a nurse's home from a state medical facility. Mothers in this group were taught how to treat a child, how to feed, how to conduct hygienic procedures and to recognize when a child is sick. In the second group, mothers received no special attention. In the second group, the number of children who died from the syndrome of sudden infant death was three times higher.

7. Secure the place where your child sleeps

Remember that almost all children who died from the syndrome of sudden child death died in a dream.

If you put a child to sleep on a mattress in your bed, put it on the back or on its side. The mattress must be firm. Observe the same caution when traveling or spending the night in a new place.(See also "How to share sleep without risk" and "Safety in the crib.")

8. Practice a child-centered approach to attachment

Maybe we pay for abandoning the approach to children that provided us with survivalfor millennia? I am sure, and this is confirmed by studies that three key elements of a parental approach based on attachment - breastfeeding on demand, sleeping together and carrying the baby in the arms or in a bag - organize the physiology of the child and develop sensitivity in the parents. In the first months of life, the child's central nervous system and the mechanism of breathing regulation are still immature, and they lack debugging, as well as the cycle of waking sleep. Parental affection provides comprehensive regulation to the child's physiological systems, and this is also transferred to his respiratory mechanism.

Earthbound parents, like radar, feel their children. Once, when I was sitting at home at my desk and writing, I was called to the reception room to inspect a five-month-old child who had a stop in breathing. The child and parents were visiting friends. It was time for sleep, and the mother put the child in the master bedroom on the second floor. The gathered were noisy having fun, when quite unexpectedly the alarm sounded inside the mother. She suddenly thought: "My child is very sensitive to noise. Why does not he wake up? I'd better go check it out. "She found him pale and lifeless. She began desperately to call her husband, who brought the child back to life, making him artificial respiration. Now the child is alive and feels great.

9. Put the child to sleep next to him

That's where the heated debate begins. Does joint sleep reduce the risk of sudden child death syndrome, or does it increase, or does not change anything? We are sure that if you put your child with you, you can reduce the risk. However, some researchers hold the opposite opinion. Such cases, when parents crushed their child, are almost always associated with abnormal circumstances, for example, if the mother is under the influence of narcotic drugs or alcohol, or too many children in one bed, or the precautions that we mentioned in paragraph 7 were not takendeaths in children's

What about children's monitors?

If your child has any signs indicating a danger of sudden child death syndrome, your doctor may advise you to purchase a home-grown baby monitor - a device the size of a small box that monitors the heartbeat and breathing of the child during sleep and includes a siren ifthere are any deviations from the norm. If at birth there is any indication that the child is at risk( for example, he was born prematurely or had episodes of stopping breathing) or he had frightening stops of breathing in the first months, the child may undergo a check called a pneumogram. This special check is performed either in the ward for the newborn or at home. It is painless and consists of attaching wires to the baby's skin that record changes in the heartbeat or the rhythm of breathing.

Monitoring is usually refused between the ages of seven and twelve months, depending on the maturity of the child's respiratory system and the number of real anxieties. Parents should know that children's monitors usually cause severe anxiety. Frequent false alarms caused by technical problems. That's why monitors are only recommended for children in risk groups. Part of the home monitoring program is to instruct parents on resuscitation and simple methods of restoring normal breathing, which are usually a simple shaking or waking up of the child. Although the monitors are not flawless, this device can reduce the risk of sudden infant death syndrome for a particular child.

cribs, held in New Zealand in view of many of these precautions, also attributed joint sleep to risk factors, and these findings penetrate the press that frightens parents and makes them believe that if they let their child sleep in their bed, thenwill endanger his syndrome of sudden child death. Can a completely natural approach to a night's sleep, practiced for centuries, suddenly become unsafe? The only worthwhile lesson that stands out from this

is, in our opinion, to extract - not to forbid parents to sleep with their children, but to teach them how to do it correctly, without risk. Convincing studies indicate that children who are at risk of sudden infant death syndrome have a decreased rate of awakening from sleep. From this it follows that anything that can help a child to wake up easier, or the mother's sensitivity to her child during sleep can reduce the risk. This is the case when you are sleeping with your child.

As a joint sleep reduces the threat of sudden infant death syndrome

In the very first months of life, the child spends most of the night in an active sleep - a condition from which the child comes out or from which it is easiest to awaken. This condition can "protect" the child from stopping breathing. From one to six months, during the most severe fears of sudden infant death syndrome, the duration of active sleep decreases as a percentage, and the duration of a calm, or deep, sleep increases. This is called maturity sleep, and this milestone development parents are always waiting with impatience - now the child can sleep the night away. It's a good news. However, there is concern that if a child begins to sleep more deeply, the risk of sudden infant death syndrome may increase. Somewhat calms the fact that when the baby starts to sleep more deeply, its compensatory cardiopulmonary adjustment system becomes more mature, and by six months the respiratory centers work much more reliably and resume breathing if it stops. But the period from one month to six months, when the sleep becomes deeper, and the compensatory mechanisms are still not well established, is the vulnerability period, , during which children are most at risk of sudden child death syndrome. Joint sleep solves the problem of this period.

Mom -metron

Imagine what happens when mom and her baby sleep side by side. Place the baby next to the warm body, and this person will act as a "breathing metronome", setting the rhythm for the baby's respiratory movements, which is so important in these vulnerable first months of life when the child's automatic breathing mechanism is still immature. The sleeping couple is, as we call it, in harmony with sleep. Mother sleeps like a child, until the child is ripe to sleep, like an adult. For both members of this pair, the sleep stages are changed synchronously, perhaps not a second per second, but synchronously enough so that they both feel the presence of each other and influence each other's physiology without interfering with each other's sleep. Thanks to this mutual sensitivity, the presence of the mother reduces the threshold of awakening in the child, thereby protecting the child in the event that the respiratory arrest occurs.

Even when a child who was sleeping next to his mother died from sudden infant death syndrome( and there were such cases), the mother was less scared of remorse because she was close. This organization of night sleep does not mean that the

mother is expected to be a guardian angel all night long during the first six months or that she is a bad mother if she chooses another option. This deprives parents of the night of joy and fills them with horror. We are only talking about forgetting about the norms that society is imposing on us, and doing what we think most natural and right. And do not be afraid that you will never be able to put a child to sleep alone or that you need to go to bed early every night, as soon as the time comes to lay the baby. The time in which the syndrome of sudden child death takes place most often - after midnight. Do not forget, the sudden infant death syndrome is a relatively rare phenomenon, and this section is only meant to answer the question "Can I do anything to reduce the risk of sudden infant death syndrome for my child?"

Facts supporting our sleep hypothesis

Parental certificates. For many years of pediatric practice I was amazed many times by stories of many parents about their sensitivity when they are sleeping next to the child. Many mothers told me: "I wake up just before my child wakes up;I feed him with breast, and we both fall asleep again. "For many parents, there is no doubt that there is a mutual feeling of the friend's

presence and mutual sensitivity when they are sleeping with their child. It is this that led me to this hypothesis. Purists will argue, saying that these are just anecdotes, but I have long learned to appreciate the wisdom of a mother with a strong intuition, no less than the most high-tech scientific methods.

Our personal experience. We measured more than fourteen years with our babies in our bed( and sleep with their four-month-old daughter, Lauren, now).When I watched our lovely babies with whom we shared a dream, I was always amazed at how sleeping children are automatically attracted to the mother. Usually they sleep face to face with their mother and spend most of the night on their side. Does not more physiological processes occur than the eye can see? Perhaps the position face to face allows the mother's breathing to stimulate the child. I found that when I lightly breathe on my child's cheek, he takes a deep breath. Is there a sensor in the nose that perceives the breath of another person and stimulates the breathing of the child? Then, one more observation: when our child sleeps next to the mother, he stretches out his hand from time to time, touches Martha, takes a deep breath and falls asleep again. In general, both sides feel each other, without interfering with each other.

Our experiments. Seven times we measured Lauren's pulse for a long time, oxygen level in the blood, respiratory movements, airflow and watched sleep cycles in two places: one night when she was sleeping next to Martha, and the other night when she was sleepingin another room. The equipment did not cause the child any anxiety or unpleasant sensations, and Lauren serenely slept throughout all our experiments. Our research clearly demonstrates mutual sensitivity. When Lauren slept next to Martha, her physiology and breathing underwent a positive change. The oxygen level in her blood was higher during co-sleeping.

Researchers from the University of California, studying this hypothesis of joint sleep on mother-child pairs in the sleep laboratory, found a certain synchronism of the change in sleep cycles. Our experiments and experiments of other researchers are still too far from the final stage to draw conclusions concerning the prevention of sudden infant death syndrome, but even now we can confidently conclude: the presence of a mother sleeping next to the child does affect its physiology.

Sleep cycle studies - wake in infants. Experiments have shown that children who sleep next to their mother, especially if they receive breastfeeding,

wake up more often than children who are in other conditions. In one study, the researchers compared the sleep cycle of waking in children in different situations. In group one, children were given breastfeeding at first request during the day and night and slept next to their mothers. In group two, children received breastfeeding, but mothers were determined to wean the baby early and put their children to bed separately. In the third group, children had neither breastfeeding, nor sharing sleep with their mother. Children, mothers who were breastfed and put to sleep next to themselves, woke more often and slept for shorter periods of time;those children who received breastfeeding, but did not sleep with their mothers, slept longer;and those children who did not receive breastfeeding and slept far from their mothers, slept the longest. Could it be that the children who sleep alone train themselves early to bed too long and too deep?

Mortality rate from the syndrome of sudden infant death in countries where mothers traditionally sleep with their children. The death rate from sudden infant death syndrome is the lowest among people whose parents traditionally put their children to sleep next to each other, but this level may increase if representatives of these

peoples are changing the cultural environment. For example, the death rate from sudden infant death syndrome is low in Asian immigrants arriving in the US, but a recent study in California showed that the longer the groups of these immigrants live in the United States, the higher their mortality rate from this syndrome, because, perhaps representatives of these peoples adopt a more distant approach to the child.

From the above facts, draw your conclusions. If there were fewer baby cots, would there be fewer deaths in baby cots?

Of course, I do not want to assure my parents that the above precautions will protect their child from sudden child death syndrome by 100%.The best that we can hope for is to do everything possible to reduce the risk. In this case, if the child still perishes from this syndrome, for parents it may be some comfort to feel in the depths of their hearts that they have done everything in their power to prevent this tragedy.