segunda-feira, 19 de outubro de 2009

Is sleeping with your baby dangerous?

Far from seeking to demonise parents, advice to always put sleeping infants in their cots is a lifesaver

To sleep with your baby? Or not to sleep with your baby? That is the question facing about 300,000 households across the UK after research suggested that sleeping with a parent increases the risk of cot death. 

The study, which found that just over half of cot deaths occurred when a child was sleeping with a parent, has sparked concern from some quarters that it demonises the parental bed. But that is not what the researchers intended. 

The study was led by the world’s greatest authority on cot death, Professor Peter Fleming from the University of Bristol. It was his team that in 1991 introduced the Back to Sleep campaign — where parents were urged to put their babies to sleep on their backs — which has been credited with saving the lives of as many as half a million babies worldwide.

Since the campaign was launched in the UK, the number of babies dying from cot death has plummeted by more than 75 per cent to about 300 babies a year. That is still 300 too many, but thanks to Fleming’s team there are probably 20,000 children and young people alive today who would not have been here had sleeping practices remained unchanged. So when they publish new findings we should listen. 

A couple of things are immediately clear from this latest study. First, sleeping with your baby if you are under the influence of drugs and alcohol is a recipe for disaster. And second, sleeping anywhere but the bedroom is particularly hazardous — snoozing with your baby on a chair, bean-bag or sofa may be tempting for a tired parent but should be avoided, even if you haven’t had a drink or taken any drugs. But what about in bed?

The parental bed may be safer than the sofa but is still more dangerous than having baby in his or her own cot. Accidents can happen to the most abstemious of parents and their young baby can overheat or suffocate. And if you do get into the habit of sleeping with your baby, will you always remember to put him or her in a cot when you have been out for a few drinks with friends, or after a dinner party at home? Probably not, which is one reason why the Foundation for the Study of Infant Deaths (FSID) suggests that the safest option is always to have them in a cot beside you instead.

No one is trying to demonise the parental bed, but the evidence shows that baby is safer in a cot.
But all this is only guidance; individual practice will eventually come down to parental choice. Healthcare professionals and the FSID are not trying to alarm parents (cot death is rare) or to be dictatorial, but are trying to ensure that the final choice is an informed one.
Here is a summary of the latest recommendations: 

1 Put your baby to sleep on his or her back.
2 Give up smoking and don’t let anyone smoke in your house. If both parents smoke, their baby is five times more likely to succumb to cot death.
3 Consider a dummy (research suggests that it can halve the risk of cot death) at night and when baby is napping during the day. Don’t force your baby to take it and don’t worry if it falls out when he or she goes to sleep. If your child is breastfed, don’t offer a dummy until he or she is four weeks old, by which time breastfeeding should be well established. Use the dummy until the child is six months old, when the risk of cot death recedes.
4 Don’t overdress your baby: no more than two light layers of nightclothes. Use a sheet and blanket and tuck both in firmly at the foot of the cot, making sure that baby’s head remains uncovered.
5 Place your baby with his or her feet at the bottom of the cot in a bedroom that is 16-20C (61-68F).
6 Ideally, he or she should sleep in a cot in the same room as you for the first six months. Do not share your bed with your baby if he or she was born prematurely, if either of you smoke, if you have been drinking or taking drugs that make you drowsy, or if you feel very tired (that is every night for most parents).
7 Avoid sleeping, however briefly, with a baby in a sofa or armchair.
8 If a young baby is unwell, seek medical advice promptly.
One unintended consequence of the Back to Sleep campaign has been an increase in the number of babies with “flat head syndrome”. Pressure on a malleable skull from lying in the same position can cause flattening of the back or side of the head, and US research suggests that about half of all babies are now affected to some degree. Most cases are trivial and of minor cosmetic concern only but parents still worry about it, and few are given advice on how to minimise flattening. These tips should help, particularly for the critical first six months of life when the growing skull is most susceptible to external pressures.
1 Continue to put your baby to sleep on his or her back to reduce the risk of cot death. Ensure that he or she spends plenty of time on his/her front during the daytime.
2 Never leave your baby in a car seat in the house. Put him or her on the floor instead.
3 Alter your baby’s position so that he or she is not always lying or looking in the same direction.
4 Alternate between arms when feeding your baby (natural for breastfeeding mums but not for bottle-feeders).
5 Seek advice from your GP or midwife if you are worried. Skull deformities that need aggressive intervention are rare.

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