When putting newly-born babies to sleep, most mothers prefer having them lie on their tummies instead of their backs. The observation is that babies in this position sleep much longer with limited distractions.
Unfortunately, several findings reveal that those who succumb to a rare disorder during sleep, do so in this resting position.
Dr Tharcisse Ngambe, a pediatrician at King Faisal Hospital describes this type of death as sudden infant death syndrome (SIDS).
“It occurs in seemingly normal babies who are less than a year old during their sleep. This anomaly continues to puzzle medical professionals around the world because there are no theories to explain it,” says Ngambe.
Since most babies die from their cribs, SIDS is sometimes referred to as ‘crib death’
The pediatrician explains that much as findings are not conclusive, certain practices like having infants lie on their tummy during sleep increase pressure on the stomach a factor that could be behind this sudden death.
“Pressure exerted on the stomach causes regurgitation or throw-back on vomiting. This kind of reaction could cause aspiration of stomach contents into the lungs that eventually suffocates the baby,” explains Dr Ngambe.
Babies with birth defects more prone
Available research shows that SIDS is common in babies between 1 and 12 months of age and most registered deaths occur between 2 and 4 months of age.
However, mothers who don’t access proper healthcare during pregnancy, smokers or those involved in multiple births such as twins are likely to encounter this syndrome more frequently.
Also, certain features at birth are leading signs towards the possibility of SIDS.
“Premature and babies born with low birth weight are highly susceptible to this syndrome,” explains, Dr Rachna Pande, a specialist in internal medicine at Butaro Hospital.
She adds that sometimes such infants experience malfunction in some parts of the body including the brain which controls sleep patterns.
“As a result, sleep and arousal may not have developed adequately to trigger waking up and there is increased risks in prematures and those born below normal weight,” she adds.
Other studies reveal that the idea of parents preferring soft mattresses and covering for their newborns is a risk factor for inadequate air supply of which asphyxia is more likely during sleep.
According to US-based Mayo Clinic, placing babies face-down on a fluffy comforter or a waterbed can block an infant’s airway while draping a blanket over a baby’s head is equally risky.
Swaddling babies increases the risk of SIDS in babies according to a recent study published in the Journal of Pediatrics.
Researchers found that increased risk for the syndrome was greatest for swaddled babies but in all cases, the sleep position matters. The increase in risk was greatest for swaddled babies placed to sleep on their front, less for those put down on their side and still less for back sleepers.
During sleep, part of the nervous system is inactive, the eyes are closed, the postural muscles relaxed and consciousness is practically suspended.
Dr Rachna further warns that babies who sleep with their parents stand high chances of being rolled over during sleep and such a death would correspond to SIDS.
“Even those who sleep with soft toys or objects lying around are prone to SIDS. If one is on the same bed with one or more parents, there is a potential risk of them rolling over in sleep and accidentally suffocating the baby,” warns Pande.
In fact some societies for long considered sleeping with babies a bad omen just to prevent the occurrence of these sudden deaths.
Lying on the back safer
Much as babies are delicate, Dr Ngambe explains that in any sleeping position children should have a normal coughing reflex when something enters the wrong side of the air pathway.
“Even when they swallow something in another pathway, children are supposed to cough in such an unfortunate event unless there are problems in the brain which are associated with coordination,” he explains.
When infant’s sleep facing down, they become more stable although lying on the back is safer.
For the same reason, mothers always want babies to lie on the tummy just to sleep longer, a practice, Dr Ngambe believes, only offers stability and adequate ventilation but limited safety.
“In such a position, babies would have all their four limbs on the ground, they cannot roll over and again the ventilation is improved. When you look at the anatomy of the lungs, the biggest portion is at the back of the chest compared to the front where there are other organs,” elaborates Ngambe.
Over 3,500 deaths due to SIDS are estimated annually in the developed world. However, figures are likely to be higher in Sub-Saharan Africa.
While confusion surrounds SIDS and sudden cardiac arrest, Dr Nathan Ruhamya, a cardiologist at King Faisal Hospital, explains that the two are totally different.
“Like in most cases, living a sedentary lifestyle, smoking, alcoholism and strenuous activities, among others, are the known causes of sudden cardiac arrest and in such a situation, we are able to warn people because the predisposing factors are now especially in adults. SIDS is however a case for infants,” explains Dr Ruhamya.
The causes over SIDS remain largely unknown but sometimes acute respiratory tract infections can block breathing of a baby in sleep. Other studies suggest that SIDS is influenced by genetics across family lines.
EXPERTS SHARE TIPS
Solange Mutangana, a nurse
Some cases of sudden death syndrome in infants are brought about by an infant being born with low weight. Pregnant women should make sure to eat healthy, take all the prenatal vitamins that are required and attend all antenatal visits. Parents should ensure that they check their infants frequently when they take them to sleep.
Fulgence Kamali, a medic at Ruhengeri Hospital
The sleeping environment for infants should be organised and not stuffy. Soft and comfy beddings should be avoided because it is easy for infants to suffocate in them and die suddenly. Besides, ensuring that the infant has a safe sleeping environment which is warm is ideal.
Esperance Akayezu, a practitioner at Gikondo Hospital
Sudden infant death syndrome normally occurs in infants below one year. For this reason, parents should avoid making their infants sleep while facing down. At this age, a baby may not be able to inhale enough oxygen in this position, which can lead to sudden death. First time mothers should seek advice from experts on how to take care of their infants.
Iba Mayale, a gynecologist
Parents should not sleep with their infants in the same bed; rather, they should keep them close but in a separate bed. This can help to prevent sudden infant death syndrome where the infant may get trapped in the beddings and suffocate. Breastfeeding the baby well is vital and reduces the chances of sudden deaths.
Aline Gihoza, a medical student at UR’s College of Medicine and Health Sciences
Infants should be put to sleep on their backs. This reduces the chances of unnecessary suffocation and ensures safe sleep. Parents should not let their babies to sleep in a very hot room. An infant should not be dressed in many clothes and shawls when sleeping.
WHAT YOU CAN DO TO PREVENT SIDS
- Place your baby to sleep on his back for every sleep. Babies up to 1 year of age should always be placed on their backs to sleep during naps and at night. However, if your baby has rolled from his back to his side or stomach on his own, he can be left in that position if he is already able to roll from tummy to back and back to tummy. If your baby falls asleep in a car safety seat, stroller, swing, infant carrier, or infant sling he should be moved to a firm sleep surface as soon as possible.
- Place your baby to sleep on a firm sleep surface. The crib, bassinet, portable crib, or play yard should meet current safety standards. Check to make sure the product has not been recalled. Do not use a crib that is broken or missing parts, or has drop-side rails. Cover the mattress that comes with the product with a fitted sheet. Do not put blankets or pillows between the mattress and the fitted sheet. Never put your baby to sleep on a chair, sofa, water bed, cushion, or sheepskin.
- Keep soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation out of the crib. Pillows, quilts, comforters, sheepskins, bumper pads, and stuffed toys can cause your baby to suffocate. Note: Research has not shown us when it’s 100% safe to have these objects in the crib; however, most experts agree that after 12 months of age these objects pose little risk to healthy babies.
- Place your baby to sleep in the same room where you sleep but not the same bed.Keep the crib or bassinet within an arm’s reach of your bed. You can easily watch or breastfeed your baby by having your baby nearby. Babies who sleep in the same bed as their parents are at risk of SIDS, suffocation, or strangulation. Parents can roll onto babies during sleep or babies can get tangled in the sheets or blankets.
- Breastfeed as much and for as long as you can. Studies show that breastfeeding your baby can help reduce the risk of SIDS.
- Schedule and go to all well-child visits. Your baby will receive important immunizations. Recent evidence suggests that immunizations may have a protective effect against SIDS.
- Keep your baby away from smokers and places where people smoke. If you smoke, try to quit. However, until you can quit, keep your car and home smoke-free. Don’t smoke inside your home or car and don’t smoke anywhere near your baby, even if you are outside.
- Do not let your baby get too hot. Keep the room where your baby sleeps at a comfortable temperature. In general, dress your baby in no more than one extra layer than you would wear. Your baby may be too hot if she is sweating or if her chest feels hot. If you are worried that your baby is cold, infant sleep clothing designed to keep babies warm without the risk of covering their heads can be used.
- Offer a pacifier at nap time and bedtime. This helps to reduce the risk of SIDS. If you are breastfeeding, wait until breastfeeding is going well before offering a pacifier. This usually takes 3 to 4 weeks. It’s OK if your baby doesn’t want to use a pacifier. You can try offering a pacifier again, but some babies don’t like to use pacifiers. If your baby takes the pacifier and it falls out after he falls asleep, you don’t have to put it back in.
- Do not use home cardiorespiratory monitors to help reduce the risk of SIDS. Home cardiorespiratory monitors can be helpful for babies with breathing or heart problems but they have not been found to reduce the risk of SIDS.
- Do not use products that claim to reduce the risk of SIDS. Products such as wedges, positioners, special mattresses, and specialized sleep surfaces have not been shown to reduce the risk of SIDS. In addition, some infants have suffocated while using these products.
What expectant moms can do
- Schedule and go to all prenatal doctor visits.
- Do not smoke, drink alcohol, or use drugs while pregnant and after birth. Stay away from smokers and places where people smoke.
- Remember Tummy Time: Give your baby plenty of “tummy time” when she is awake. This will help strengthen neck muscles and avoid flat spots on the head. Always stay with your baby during tummy time and make sure she is awake.