Protecting the older baby
Condition of development
Sudden infant death is a condition of development. Young babies (<5 months) are especially sensitive to how they are positioned when they sleep. As their breathing develops and their jaw joint forms, positioning risks lessen. However these positioning risks do not completely go away.
An older baby is more able to change position and this developmental progress, in terms of increased mobility, presents the older baby with a different form of positioning risk. By their own movements, they may get into asphyxia-generating situations due to getting underneath loose or bulky bedding or, in an effort to free themselves, become tangled in coverings. This can lead to overheating, airway obstruction, or accidental suffocation.
Simultaneous and co-existing risks
Tummy sleeping interacts with other risks. As does smoking. For example, it is more dangerous for babies who become prone, or babies who are smoke-exposed, if they also are exposed to covers over the head, being unwell, wintertime, a soft sleeping surface, sleeping in another room, are swaddled or overwrapped. A vulnerable baby may be older when they meet their first asphyxia challenge and have multiple risks to contend with all at once.
An update on the profile of sudden infant deaths can be found in the Fifth Report of the Child and Youth Mortality Review Committee to the Minister of Health. This document reports on SUDI mortality in New Zealand for 359 babies who died in the five years between 2003 and 2007. The report can be downloaded here.
Peak age of death
Eighty per cent of SUDI deaths in this period were of babies aged less than five months with 40% of babies aged between 1 and 3 months. This peak age is younger than in the past, and prevention in recent years has focused, quite appropriately on protecting the younger baby. Yet 20% of babies were older than 5 months and accounted for an average of 13-15 babies per year.
What this means for education
We need to be vigilant, in our education, about protection for the older baby. We need to apply safe sleep principles to babies under one year and not just under 6 months. One quarter of sudden infant deaths are of babies found with their heads under bedclothes (a 17 fold increase in risk over having a clear face). Equally concerning is the evidence for a 10 fold increase in risk if babies sleep in rooms separate from sleeping parents. There is an interaction between these two risks, with babies in separate rooms more likely to be found with covers over their heads.
Development must not be restrained.
Babies will move. Parents need to make the sleeping place safe for their older babies. No pillows, infant sleeping bags instead of bedding, or lightweight and firmly tucked bedding may help. While every effort must be made to protect older babies from asphyxia risks such as getting tangled in or underneath bedding, the evidence suggests that babies sleeping in the same room as parents for their first year of life has the best chance of alerting a parent in time should this happen.