About cot death

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.

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. 

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 specialisedcentre for further examination.

Cot death and the sleeping environment of the baby

  • Sleep furniture

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

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.
  • Nightclothes

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.

  • Toys

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. 

What is near miss cot death?
This refers to a child who on waking up:

  • is blue or pale in the face
  • breathes superficially
  • may be found unconscious and with lowered blood pressure.

These children certainly belong to the risk group and are at a greater risk of eventual cot death.

Are there physical causes in babies which increase the risk of cot deat?

Scientists assume that a baby's sensitivity to the risk factors of cot death is caused by the still insufficiently developed function of the respiration centre in the brain. When a baby breathes insufficiently or briefly stops breathing, the brain is not activated by the shortage of oxygen or the excessive amount of carbon dioxide in the blood. The aim should therefore be to make it as easy as possible for the baby to breathe properly. There must be no impediment to his ability to breathe freely. This is why experts recommend avoiding anything that could cause physical suffocation (soft mattress, thick duvet, pillow and cuddly toys in bed, cot surrounds, etc.).

Incidence of cot death

The total number in cot deaths per year is quite high in the Flemish Region: in 2006, 0.46 in 1 000 live-born babies died of cot death. This figure was much higher up to 2000 (e.g. in 2000, it was 0.69 per 1 000 live births). However, the figure dropped thanks to increased attention and prevention. The lowest level was in 2005, when it was 3.3 per 1 000 live-born. This means that after a decrease over four consecutive years, the number rose again slightly in the Flemish Region in 2006.* In Belgium as a whole, the average number of cot deaths in recent years has been about 70 a year, or 0.7 per 1 000 live-born babies. 
These figures are perhaps difficult to judge, and it may be helpful to compare them with the figure in neighbouring countries.
* Source: Het Kind in Vlaanderen 2007 [Children in Flanders in 2007], published by Kind &Gezin.

Research into cot death

Some babies are more susceptible to cot death than others. This can be tested through a professional sleep study conducted at a clinic. Such studies are carried out on babies between ages 6 and 8 weeks.
The study makes it possible to find out in what stage of sleep the child displays breathing problems. This provides important information about neurological parameters during sleep. This includes measuring heart rhythm, respiratory movements, brain activity, eye movements, muscle activity and oxygen in the blood. 

If the results are positive, the parents receive a sleep monitor to take home for the baby.  This device is connected with an electrode which is glued to the baby's abdomen. The device, which in this way checks the child's breathing and heart beat, triggers an alarm if these functions deviate too much from the standard values. 
A few months after using the sleep monitor, a second cot death test is carried out. If the result is negative, the sleep monitor is no longer necessary.
The sleep study provides a record at a given moment and is not a screening instrument. It therefore does not contribute to preventing cot death. All it does is reveal something about the baby's susceptibility to such a fatal event.

Possible dangerous situations in which you should ask your doctor for advice:

  • The body temperature of children under the age of six months is above 38°C or below 36°C and there are no identifiable reasons for this change in temperature.
  • A sudden change in behaviour: your child is unusually calm or excited.  
  • The child vomits or refuses to eat.
  • Your child displays breathing difficulties or looks very pale.