May 2018 2nd Edition

Steps to prevent cot death

Written by: Silisapso Nyanda

The cause of Sudden Infant Death Syndrome is not fully understood, there are a number of things parents or caregivers can do to reduce the risk.

There are steps that parents can take to try and prevent Sudden Infant Death Syndrome (SIDS) - also known as cot death - which is the sudden, unexpected and unexplained death of an apparently healthy baby.

According to neonatal specialist Dr Natasha Rhoda, from the Groote Schuur Hospital in the Western Cape, the chance of a baby dying from SIDS can be minimised and sometimes avoided.

“While there are unique features associated with the syndrome, there are no diagnostic features that can be attributed to a SIDS death,” Dr Rhoda said.

She explained that SIDS is only diagnosed as a cause of death after all other possible causes have been investigated and ruled out.

“SIDS is diagnosed after a thorough investigation, including a complete autopsy. There is also a review of the child’s medical and clinical history. A death scene investigation, which includes thorough investigation of the sleep environment, bedding and position, is also part of the investigation,” she said.

Dr Rhoda, who is researching SIDS for her doctoral studies, said SIDS is typically associated with sleep and is presumed to have happened during sleep or in the phase between sleeping and waking up.

“Approximately 95 percent of SIDS deaths occur in the first six months of life, with a peak in infants aged between two to four months,” she confirmed.

SIDS deaths increase

Dr Natasha O’Connell, a paediatrician from the Western Cape’s Khayelitsha District Hospital, said the hospital recorded an increase in suspected SIDS deaths last year.

“We had seven children under one year who died from suspected SIDS in 2018. This is more than previous years. However, data on SIDS deaths for the entire Khayelitsha area and Cape Town is not currently available,” said Dr O’Connell.

Dr Rhoda said that Statistics South Africa found that 0.6 percent of infant deaths were reported as SIDS in 2015. “In low and middle income countries we do not have any reliable or accurate data for SIDS rates. Few studies exist. We don’t know the SIDS rates in South Africa because we do not have the full resources to perform autopsies and investigations in all sudden and unexpected deaths. So, we can’t accurately diagnose SIDS country-wide,” she said.

A new child death review system will investigate all unnatural deaths of children younger than 18.

Preventing cot death

There are ways to minimise the risk of SIDS.

“Do not allow infants to sleep on their tummies or on their sides because this has a 15 times increased risk of SIDS,” Dr Rhoda said.

An unsafe sleeping environment, such as overheating, soft bedding or bed sharing are also high risks said Dr O’Connell.

Parents should use firm bedding and avoid soft surfaces, like mattresses and sheepskin, because there is a risk that the surface depresses under the weight of the infant which may result in choking, overlaying or overheating. Infants should also not sleep on a couch or sofa.

The exposure of a child to cigarette smoke increases the risk of SIDS up to five times. Infants should be in a smoke-free environment and mothers should stop or reduce smoking during pregnancy and at home.

SIDS education underway

Khayelitsha District Hospital and all surrounding clinics and hospitals offer general antenatal education and support for all pregnant women, including  information about the first 1 000 days of a baby’s life and side-by-side campaigns which are run by the National Department of Health.

According to Dr O’Connell, these campaigns promote breastfeeding and community care workers focus on supporting at risk mothers, like teenagers, during the antenatal period. Community workers also visit all new mothers and babies at home, within the first two weeks after birth, to offer general education and breastfeeding support.

According to Dr Rhoda, South Africa can learn lessons from the high-income countries like America, Australia and the United Kingdom where the SIDS rate has decreased over the past two to three decades to between 0.2 and 0.5 per 1 000 live births.

“This dramatic reduction of 30 to 35 percent in the SIDS rate was largely due to the safe sleeping campaigns that these countries ran nationally,” she confirmed.   

For more information about SIDS, visit the Western Cape Department of Health’s website at: 
Side by Side website at:

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