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Cot Death

Sudden Infant Death Syndrome (SIDS)

What and Why?

‘Is he all right?’ is the first thing a new mother wants to know about her baby. A few in every hundred are not quite perfectly formed, though most of these will lead completely normal lives unhindered by their birthmark. A few in every thousand have more serious defects which will handicap them to some extent and may involve many visits to doctors and hospitals during their childhood. Apart from this tiny minority, the answer comes back, ‘He’s fine’.

Occasionally however, the defect is too subtle to be seen. An underweight baby may have been retarded in his growth at all stages so that no one organ is actually malformed — they are all too small and contain too few cells. That leaves most of them with reduced overall power for living and perhaps a few with defective or unbalanced metabolism. This may weaken their primal adaptive systems right from the start, opening them up to serious mistakes in their early weeks and months of life which threaten their survival.

Unfortunately the possibilities do not end there. Western culture has undermined the intimacy with his mother that should sustain and reassure a baby throughout his infancy. Despite the pleas of Leboyer, many babies are still born roughly into glaring lights and clashing noise, up-ended, slapped and probed vigorously with an unkind plastic tube. Most are taken away to be weighed, cleaned up and checked soon afterwards. Some are then "cot nursed’ in the mistaken belief that a technically trained nurse can care better for a weak or injured baby than his emotionally-attuned mother. A baby who is frightened and cries a lot is usually put away in a nursery to give the mother some peace, rather than given to her in bed to suckle and comfort. All these habits undermine bonding and breast feeding and are easily taken home by parents anxious to bring up their baby loved but unspoiled.

The result is that your baby is removed from you just when he most needs your presence. An infant who cannot feel his mother’s warmth and movement — nor hear, taste, smell or see her — has no means of knowing that she still exists. Nothing could undermine him more completely than this. Obviously that is not your intention: you accept in good faith the management you are taught by people you believe know better than you do. It is dreadfully upsetting to realize that well-intentioned caring may bring him to the edge of despair.

A few babies every year actually go past that point. Subtle birth defects or utter hopelessness break down their immunity completely and without warning they are discovered dead in their cots. There is no illness to account for it. Many theories have been offered none of which explains more than a minority of cases. Yet there are enormous variations between ethnic groups, and deliberate attempts to look after especially vulnerable babies and stressed parents dramatically reduce the number of these tragedies. It should not be difficult to prevent the vast majority of them; we have only to realize their connections with the worst in Western attitudes to baby care.

 

What can I do?

Advice to maintain and maximise health

1. Take preparation for pregnancy seriously. Never produce a baby casually or resentfully.

2. Begin in pregnancy to be friends with your baby, knowing that his communications are wide open. Talk to your medical attendants about your plans and fears for the delivery and make very clear what you would prefer to happen. On the day, father can oversee the implementation of your plans — adapting them to medical advice but not letting that overwhelm your aspirations.

3. Avoid injected drugs during your labour if you can, so that both you and baby are alert to experience the moment of birth. Hold him then and keep him with you unless one of you urgently needs medical attention. You are the one to vitalize, comfort and console a tired or shocked infant, not an incubator!

4. Suckle him as soon as he shows interest and breast feed exclusively.

5. Get home from hospital as soon as you can.

6. Do not be afraid to have him in bed with you — all night if you would like to and have the room. Feeding him in the night is then much easier and he is continuously reassured with your presence. Unless you are drunk or drugged, the risk that you will suffocate him during your sleep is tiny compared with the risk of cot death.

7. Even if you put him to sleep in a cot, keep that near your bedside until he is weaned. Do not banish an infant to a separate room unless you are desperately tired yourselves — a dangerous state of affairs that needs lots of support from relatives and friends.

8. Get a sling or baby-carrier and make a habit of carrying your baby around with you for a lot of the time. All babies prefer movement and a changing scene, especially attached to mother. In shops and among crowds it is safer, virtually proof against cross-infection and much less frightening for him than the unfriendly sight of people’s towering bodies. He will be much more alert, contented and confident for this kind of handling and correspondingly more fun to be with.

9. Do not rush to wean him from your breast, not even with the occasional solids or bottle of cowsmilk when you are out (see Infancy). He will indicate clearly enough when he is ready for that step, usually around five to seven months of age. Since this moment marks the end of infancy it deserves to be waited for, then savoured and celebrated. Do not rush your baby into childhood.

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