usage and SIDS prevention. The AAP (2005) considers the usage of pacifiers to help prevent SIDS, in partnership with strict guidelines. The AAP (2005) and Li et al. (2006) recommends that pacifiers should be delayed for the first month of life, when SIDS probability is lowest and once breastfeeding has been firmly established. These guidelines also advocate that pacifiers be used for all sleep episodes and must not be coated in any sweet solution (such as honey or sugar) as to prevent confusion with breastfeeding and reduce the incidence of paediatric dental problems. As pacifier usage can be linked with oral colonization such as Candida, parental education in pacifier cleaning is vital and pacifier usage should not exceed the first year of life, due to the increased risk of Otitis Media. Studies have also identified that when pacifiers are used they should be introduced at the moment of sleep and they should not be re-introduced if it falls out of the infant’s mouth, nor should the infant who refuses a pacifier be forced to take one.
Recent studies have suggested that
breastfed infants have an increased awakening response, compared to formula-fed babies during sleep. Research has revealed conflicting results, with some studies identifying a protective effect of breastfeeding to prevent SIDS whereas others have not. Nonetheless, breastfeeding is highly beneficial for the mother and infant and should be promoted for many reasons.
SLEEPING ENVIRONMENT It has been well documented that infants must sleep in the supine position and there is overwhelming evidence, which links the prone and side lying positions to SIDS. The supine position is recommended for all healthy infants, except those with craniofacial anomalies and gastro- esophageal reflux. Research continues to suggest that healthcare professionals are reluctant to recommend the supine position instead of the side lying position, due to the perceived risk of aspiration. Research within the FSID (2009) has clearly identified no evidence to link aspiration of vomit to the supine sleeping position and highlights that there is no documented evidence of adverse effects of normal infants lying supine. The AAP (2005) clearly identifies soft
mattresses, cot bumpers, the presence of soft toys; pillows, duvets and sheepskins are strongly associated with SIDS and thus are not recommended to be within the infant’s sleeping environment. If sheets are to be used, they must be tucked into the bottom of the cot, with the sheet not extending above the chest of the infant. Such campaigns as ‘Back To Sleep’ promote the philosophy of ‘Feet To Foot’ (where the infant lies at the bottom of the cot) to prevent the infant from sliding under the covers and preventing potential over heating or suffocation. Head coverings, such as hats are highly discouraged when sleeping, as this practice has been linked to overheating and SIDS. With regards to
room temperature, air conditioning must remain between 16-20o
C and the infant
must feel warm to the touch. Bed sharing continues to be as
controversial as pacifier usage in the prevention of SIDS. The WHO (1998) recommends co-sleeping to promote breastfeeding and enhance maternal-infant bonding. However, epidemiological studies have identified that bed sharing can be hazardous under certain conditions (i.e. multiple bed sharing, or when the bed sharer is overtired). The AAP (2005) guidelines and continuing research from Europe and North America clearly recommend that the safest place for the infant to sleep is in it’s own crib/cot in the same room as the parents for the first six months of life.
SECONDARY CAREGIVERS The secondary caregiver philosophy in the UAE is a popular concept and is highly utilized. Parents must be aware that there is strong evidence to suggest that the incidence of SIDS increases when an infant is cared for by nannies, babysitters or unregulated nurseries (AAP 2005). Why these infants are at higher risk is unclear, however research is beginning to link these practices to the secondary caregivers being unaware of the importance of SIDS prevention, especially lacking knowledge of the supine sleeping position in a safe environment. European research has suggested that education of secondary caregivers is just as important as parental education.
CONCLUSION The incidence of SIDS remains unclear in the UAE, however we as healthcare professionals must not show complacency in educating and empowering parents on the risks and protective factors associated with SIDS. SIDS continues to be a major problem that mandates continued interdisciplinary efforts to find the ultimate resolution. As professionals we are in a privileged position to offer correct, unbiased, up to date and clear information, enabling parents to make informed choices for the wellbeing of their child. ■
AH
REFERENCES References available on request (
magazine@informa.com)
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