Find out more about cot death
What are the risks when your baby sleeps?
Which babies belong to the risk tarket group?
What are the principal measures to prevent cot death?
What is the influence of the sleeping environment of the baby for the risque of cot death?
What other factors increase the risks when your baby sleeps?
1. What is cot death?
Cot death is the sudden and unexplained death of an apparently healthy baby of between two weeks and one year, peaking between two and four months. It always happens unexpectedly and almost always during sleep. After a thorough examination, it proves impossible to find the cause of death.
Experts consider cot death as a diagnosis of exclusion, when no cause of death (e.g. a physical anomaly) is found through a detailed medical examination. Apart from cot death, there is also near-miss cot death or apparent life-threatening event (ALTE).
There are no accurate figures about the frequency of cot death as a post mortem is not always performed after the suspicious death of a baby. Moreover, the criteria determining cot death may differ from one country to another.
How do you detect the risk of cot death? You can feel your baby's neck or feet to check whether it is too hot. If they feel pleasantly lukewarm, there is no problem. If, however, they really feel hot, your baby's body temperature is above normal. A baby who sweats is always too hot. Cold hands, however, are not unusual. A study about cot death in the UK has shown that mothers of babies that died from cot death were worried that their babies were too cold and thus carefully tucked them in.
2. What are the risks when your baby sleeps?
No one knows exactly why and how cot death occurs. There are no hereditary factors or disease patterns. It is generally assumed that cot death is caused by external factors combined with the baby's sensitivity to the risk factors.
The main risks of cot death are impeded breathing (i.e. suffocation) and situations in which heat stress or heat congestion may arise. Breathing in air that has already been breathed out (rebreathing) is also hazardous because it leads to a shortage of oxygen, diminishing consciousness and consequently a possibly fatal outcome. Passive smoking by the baby is also a crucial factor which considerably increases the chances of cot death.
3. Which babies belong to the risk target group?
- Premature or pre-term babies
- Neonates whose brother or sister died of cot death
- Children in whom ALTE has been diagnosed
- Children who have great difficulty in waking up
- Children of mothers with drug or alcohol abuse
- Infants with congenital anomalies of the face which may impede respiration
- Children with anomalous sleep study results
- Children displaying risk symptoms while asleep (e.g. excessive perspiration, snoring, long breathing pauses, heart rate disorders, etc.).
Children at risk are referred by their doctor to a specialised centre for further examination.
4. What are the principal measures to prevent cot death?
We wish to point out that the causes of cot death are still not 100% clear.
However, scientific studies have highlighted a number of risk factors which undeniably have a negative effect on sleeping babies. These risks can be reduced if you take the following preventive measures.
Always put a baby to sleep on its back. You should absolutely avoid putting it on its stomach or side. These positions should be avoided for a number of reasons. Babies will fall asleep sooner on their back if they are put to sleep in this position right from the start.
From the age of three months, however, your child may turn itself from back position to stomach position. Even though you put him on his back, in his sleep your baby may unconsciously roll over onto its stomach. Moreover, the risk of cot death is highest in children who sleep on their stomach for the first time. Try to avoid this by letting your baby play on his tummy now and again when he's awake. But only under the constant watchfulness of an adult. Medici and experts recommend laying your baby in different positions. This is ideal for your baby to learn to tilt his head up, crawl and sit. When your baby is sleeping, absolutely avoid him laying on his tummy!
If your baby turns himself onto his stomach while sleeping on an AeroSleep mattress cover, he will be able to continue breathing unobstructedly. The air can maximally circulate through our 3D structure and AeroSleep reduces the risk of suffocation.
Smoking increases the risk of lifelong damage to health and of cot death. Nicotine impedes the function of particular heart receptors which accelerate the heart rhythm. This slows down the response in the event of a shortage of oxygen, e.g. when the baby is asleep. For this reason, smoking is prohibited during and after pregnancy, which applies to mum and dad. Learn more how you can avoid contact between your baby and smoking.
The consumption of alcohol and drugs by the mother also increases the risk of cot death.
- Make sure the baby does not get too hot
The baby must not get too hot so as to prevent the risk of heat congestion. This applies not only when they are asleep but also when awake. Pay particular attention to the combination of clothing, ambient temperature and bed products used.
Click here to read things you should do before putting your child to sleep.
If in spite of these measures your baby does get too hot (e.g. when it has a fever or in high summer temperatures) and it sleeps on an AeroSleep mattress cover, he will be better able to keep his body temperature under control. The air can maximally circulate through our 3D structure: the hot air from the body is discharged and fresh air is supplied from the surroundings. In this way, AeroSleep reduces the chance of overheating and heat congestion.
- The bedding must guarantee a safe sleeping environment
Always use a safe bed with safe bedding. Avoid all material in which the baby may suffocate or where it can get stuck.
We recommend several safety requirements for a cot.
Always stay near your baby. Preferably keep your baby in your room for the first six months, where it should sleep in a separate cot. Also make sure that the baby sleeps near you during the day. Through your natural vigilance, you will in this way notice sooner if something is wrong. If possible keep this up until the child can easily turn around by itself (about six months).
Please note never to sleep with your baby in the same bed. This is because an adult bed is more likely to cause cot death than a baby bed. Click here to find out why.
Even when you take these precautionary measures into account, it remains important to know how you can recognize the risks of cot death. Read here how you can detect potentially dangerous situations.
5. Cot death and the sleeping environment of the baby
The child's cot must allow a maximum of ventilation in order to prevent heat congestion. How do you choose a good cot? Remember the following tips when buying a cot for your baby.
Preferably choose a mattress with good back support. Just like adults, your baby needs optimum support in the back. This is certainly important, bearing in mind how many hours during the night and day your baby sleeps. How do you choose a good mattress? Remember the following tips when buying a mattress for your baby.
Apart from the baby's cot, there are several other pieces of furniture where you would put your baby to sleep from time to time. But are all of these places safe? Click here to get an overview of unsafe sleep furniture.
Bedding refers to all material under which or, on top of which or, inside which babies are put to sleep such as sheets, covers, duvets, sleeping bags, pillows, etc. Bedding should meet the following requirements:
- Insulate heat and allow water vapour and air to permeate
- Every sheet and cover should be made up short and taut so that the child does not end up underneath the covers.
- A towel is not suitable as bedding.
- A sleeping bag with holes for the baby's arm and neck adapted to the baby's size is a safe choice. It helps to prevent the child from turning on its stomach.
- Do not use a pillow for a baby younger than two years. Also remove any cherry pit pillows, electric blankets and similar from the cot.
- Bed edge protectors and bolsters (fabrics for decoration, for protection against drafts or protection in general) are risky as they might impede breathing. If you nevertheless use them, make sure they are air permeable and cannot be pulled loose.
- Nor is a sheepskin safe because it does not let any air through at all if the child happens to lie on it with its face down.
Choose clothes that cannot cause heat congestion. In particular, do not cover the head in any way.
You are advised never to put your baby to sleep with a cap on its head.
Nor should there be any ribbons, bibs, etc. in the place where you put your baby to sleep as your child could be choked by them.
- Do not leave any toys in the baby's cot while it is asleep and make sure that the baby cannot reach any toys. Also any toys suspended above the cradle should be removed as soon as the child becomes very mobile (from 5 to 6 months).
- If you want, let your child go to sleep with a cuddly toy but never allow it to sleep with one. The baby may end up with his head under or against it and suffocate as a result. Especially when a cuddly toy or cloth becomes damp with saliva, vomit or other fluid, its air permeability diminishes and it will have the same choking effect as a pillow.
6. What other factors increase the risks when your baby sleeps?
- Age
Cot death occurs in particular in children under the age of six months, with a peak between two and four months. - Gender
Cot death occurs about twice as often in male babies.
- Prematurity
Prematurity increases the chance of cot death because it is reversely proportionate to birth weight and length of pregnancy. The lower the birth rate and the shorter the pregnancy, the higher the chance of cot death.
- Sleep rhythm
Try to respect the child's life rhythm and follow a regular time schedule. This ensures that the child does not get too little sleep which may also increase the risk of cot death.
- Breast feeding
Breast feeding is recommended as the gold standard to reduce baby mortality in the post-natal and post-neonatal period.
However, breast feeding is currently not considered a significant preventive factor against cot death.
- Medication
Medicines with a sleep-inducing side effect should be avoided. They may cause a baby to sleep too deeply.
Give your baby a medicine only if the doctor advises you to do so because for many medicines it is insufficiently known what their effect is on small children.
If you are breast feeding, you should also avoid these medicines because you pass them on via your breast milk.
Vaccination, infections and ALTE have no risk-enhancing effect on cot death.
- Season
Cot death occurs more often in winter. Nevertheless, we recommend dressing your child in accordance with the ambient temperature in the room where he sleeps and not on the basis of the outdoor temperature. Even if it is very cold outside, the temperature inside the room may be much higher, e.g. as a result of heating.
Air the child's room as much as possible. Where appropriate, use a fan.
- Rest and regularity
Babies are sensitive to disruptions in rest. It is better to avoid restless situations (travel, staying with other people, moving house, etc.) during the child's first year. They can easily upset a baby, leading to disturbed sleep. This is why it is important to keep an even closer eye on the child in such situations.
A baby also experiences a sudden change in the environment as stressful, causing a change in its sleep pattern. It therefore appears that the chance of cot death during day care is higher, in particular during the first days.
- Stay on the same altitude
At high altitudes or during air travel, there is lower oxygen tension. Babies still have foetal haemoglobin, making them tolerate relative oxygen decreases. However, long exposure to low oxygen tension may increase the risk of cot death.
This is often linked with the young age of the parents, a low level of education, single parenthood, etc.
These elements together may be responsible for an increased risk of cot death. Moreover, it has been noted that the safety recommendations are less heeded among this group of parents.
Unfortunately it is impossible to guarantee complete safety because babies remain vulnerable. The risk that something suddenly happens to a baby can never be completely excluded. However, if the above advice and tips are followed, the chance of particular possible risks of cot death becomes much smaller.
Never hesitate to ask your doctor for medical advice. You should do this in any case if you think there is something wrong with your baby, if you have any doubts or questions, or in the following possibly threatening situations.