Breastfeeding And Cot Death
Breastfeeding is one of many factors that can help protect babies from sudden infant death syndrome - SIDS or cot death.
Breastfeeding certainly doesn't guarantee protection, but there are several reasons why it may be important. Researchers think risk factors can have a cumulative effect. Known and suspected risk factors are listed below.:
Cot Death Risk Factors1. Mother being a smoker This is the most important, especially in the first weeks of life. If you are a smoker, you may multiply your baby's risk of SIDS by fivefold. Having a father who smokes multiplies the risk too, but only by one-and-a-half times. A study by US researchers suggests that breastfeeding reduces the risk of SIDS in babies of non-smokers but not in those of smokers.
2. The baby sleeping on his tummy European research (2004) attributed nearly one in two deaths from SIDS to this. Put your baby on his back to sleep - remember, 'Back to Sleep'.
3. Overheating The danger comes from being wrapped up too warmly and/or being in too hot a place - there's no need for a baby to be in a room warmer than 18ºC . However, being too warm during sleep seems to be a problem only for babies who sleep on their tummies, though this isn't advisable anyway.
4. Mild infection Some seemingly healthy babies seem to have an unusually powerful response to infection.
5. Being pre-term
6. Formula-feeding - Most studies record a higher risk of SIDS in formula-fed babies* (see below)
7. Post-natal depression At least two studies have found that having a depressed mother triples the risk of SIDS.
8. Being a boy. Three boys succumb to SIDS to every two girls. Fewer boys are breastfed than girls and breastfed boys are generally breastfed for fewer months than girls, which might help explain the gender factor if there really is a link between SIDS and formula-feeding.
9. Lower socio-economic group. This is probably significant only because of its association with other risk factors.
10. An inherited factor An identical twin of a baby that succumbs to SIDS is at higher risk, suggesting a genetic factor may be involved.
A European study in 2004 found the mother's consumption of alcohol was significant, but only if she shared her bed with her baby all night.
12. Sleeping in a separate room .
If a baby who is in another room becomes distressed because he can't breathe, then unless he cries or makes some other loud noise his mother is less likely to know than if he's in her bedroom. Though some mothers sense intuitively when their baby is distressed, wherever he is. Having your baby nearby means you are readily alerted by his sounds or movements and can pick him up immediately if he is distressed. A European study in 2004 attributed roughly 36 per cent of SIDS cases to the baby sleeping in a separate room. A New Zealand study in 1996 suggested that room-sharing with a parent reduced the risk of SIDS, so the researchers recommended that babies should sleep in the same room as their parents for at least six months.
13. Co-sleeping (bed-sharing)
Until recently SIDS was thought to be more common in babies who slept with their mother only if she or her partner were smokers. Indeed, if you smoke, it's unwise to share your bed with your baby.
However a 2004 European study attributed about 16 per cent of SIDS cases to bed-sharing though if the mothers were non-smokers the risk was very small, and significant only in the first eight weeks. There was no indication of how the babies were fed, which could be important because formula-feeding mothers probably aren't primed to be as sensitive as breastfeeders to a baby's needs when co-sleeping, so might not wake if their baby became breathless or otherwise distressed. Also, there was no record of where co-sleeping occurred, which is important because babies who co-sleep on a sofa have a higher risk of SIDS than babies who co-sleep in bed.
14. Food sensitivity
It's been suggested that SIDS may, in some babies, result from a sudden overwhelming response to a foreign protein. Cows' milk protein is by far the commonest foreign food protein babies meet, and formula-feds consume a huge amount.
16. Viral infections
Another theory is that a baby succumbs to SIDS because he is unable to cope with a viral infection. Breast milk helps protect babies against some viral infections.
17. Inability to cope with long gaps between feeds
Babies who succumb to SIDS tend to have had a relatively long gap (more than six hours) between their last feed and the time of death. If this is important, it may be significant that successfully breastfed babies have more frequent feeds than formula-fed babies, especially early on, and especially at night.
18. Frequent sucking
Dummy sucking has been reported to protect against SIDS. This is possible because it helps keep the mouth and throat muscles active and 'toned', so keeping the airway well open. The researchers suggest that if this is confirmed, a dummy could halve the number of SIDS deaths.
It's possible that frequent breastfeeding might have the same protective effect as a dummy.
As I said above, Breastfeeding certainly doesn't guarantee protection, but there are several reasons why it may be important!
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*Most studies record a higher risk of SIDS in formula-fed babies.
Scandinavian research (2002) found that babies breastfed for less than one month were five times more likely to die from SIDS.
Japanese research (2002) found that breastfeeding helped protect against SIDS.
A UK study (1995) failed to find that formula-feeding was a significant risk factor. Breastfed babies had a lower risk of SIDS but were also more likely than formula-fed babies to have a non-smoking mother and a father in employment, to have been born at term, and to sleep on their back, all of which are protective. However, the researchers considered only a small number of babies, and said larger studies might be able to distinguish a small risk from formula-feeding.
In 1995 a New Zealand team criticised this UK work, claiming the statistics were misinterpreted and were actually similar to those of other large, well-controlled studies showing that breastfeeding halves the risk of SIDS. The UK researchers replied that their results still didn't suggest that breastfeeding had a strong independent protective effect. They also claimed that after extensive adjustment for maternal smoking, prematurity and sleeping position, only one published study showed that breastfeeding offered significant protection.
A New Zealand study (1993) found that babies who died of SIDS were less likely to have been breastfed, and those that were breastfed were breastfed for fewer weeks, and were less likely to have been exclusively breastfed. Babies not still being breastfed on discharge from hospital were nearly twice as likely to succumb to SIDS. The conclusion was that breastfeeding had a significant association with a lowered risk of SIDS and this seemed to persist for several months.
New Zealand research (1991) suggested three factors were particularly important: the baby sleeping on his tummy, a parent being a smoker, and not being breastfed. Breastfed babies in this study were one third less likely to succumb to SIDS than those who were formula-fed.
A large US study (1988) reported that SIDS was twice as likely in babies formula-fed from birth.
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