• By Kevin Mount
  • Posted on Monday 18th February, 2008

Cot death syndrome haunts parents who already struggle

The specter of Sudden Infant Death Syndrome (SIDS) still terrifies some new parents. They make multiple cot-side visits each night to be sure their babies still breathing. Some even buy breathing alarms – although there’s no evidence that they do anything to prevent SIDS. Most parents’ fears are unjustified according to Tony Risdon, a prominent forensic pediatric pathologist in the UK. In a recent article in the London Daily Mail [Middle class parents worry needlessly about cot death], he maintains that SIDS is "not something that happens to middle-class families any more”. The majority of deaths occur among the “underclass” and are associated with huge social problems. “If every parent followed the advice on safe sleeping environments and so on, the problem would probably disappear.” A recent study of all babies (excluding twins) born in Denmark between 1973 and 1998 tends to support Risdon’s claim. Using data collected routinely by the Danish government, Sarah A. King-Hele and colleagues at the University of Manchester UK found that children of parents who had been admitted to institutions because of mental health problems were twice as likely as other children to die of SIDS. When both parents had been previously admitted for psychiatric reasons, children were particularly at risk. Having parents admitted for alcohol- or drug-related disorders also increased children’s risk.The researchers note that it’s not clear why children of parents with a history of mental illness appear to be more vulnerable. Possible reasons include prenatal alcohol exposure, exposure to smoke (smoking is common among those with psychiatric illness), or parents’ neglect to ensure a safe sleeping environment for their children.According to the Daily Mail article, most middle-class families are aware of the dangers of smoking around their babies, sleeping with their babies, and putting them to sleep on their tummies. Parents living in poverty or coping with mental health problems might lack this information or be too stressed and disorganized to use it. Thus the Manchester researchers suggest that clinicians should take care to make sure that parents with mental health problems are aware of the standard advice about preventing SIDS.• The catastrophic effects of the bad advice of putting babies to bed on their fronts rather than their backs were summarised in an article in the Journal of Epidemiology in 2005, which reported on a study by researchers at the UK Institute of Child Health. As well as estimating that the mistake may have been responsible for 12 avoidable cot deaths a week for two decades, it said “systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10,000 infant deaths in the UK”. [See: Dr Spock’s advice blamed for cot deaths.]• Summary of “Risk of Sudden Infant Death Syndrome With Parental Mental Illness” by Sarah King-Hele, Kathryn Abel, Roger Webb, Preben Mortensen, Louis Appleby, and Andrew Pickles in Archives of General Psychiatry, Volume 64, Issue 11, pp1323-1330, November 2007.

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