Sleep baby on the back from birth, not on the tummy or side 2. Sleep baby with head and face uncovered 3. Keep baby smoke free before birth and after 4. Provide a safe sleeping environment night and day 5. Sleep baby in their own safe sleeping place in the same room as an adult care-giver for the first six to twelve months 6.
Safe sleeping recommendations target known risk factors associated with SUDI. Where studies specifically define the population as SIDS, this specific term will be used to describe the study findings. Definitions Gastro-Oesphageal Reflux GOR is the effortless regurgitation or spitting up of gastric stomach contents into the oesophagus food pipe with or without effortless regurgitation and vomiting 1.
For example, when the GOR causes poor weight gain or complications such as oesophagitis or respiratory signs. This requires medical assessment before a diagnosis of GORD is made 1, 2. Regurgitation in children is defined as the passage of refluxed contents into the throat, mouth or from the mouth. It is a characteristic sign of reflux in infants but is not diagnostic of GORD 1.
Regurgitation in infants is normal. Key Points Babies with GOR should be placed to sleep on their back from birth on a firm, flat mattress that is not elevated 5.
In babies with GOR, the risk of sudden death when baby is in the tummy or side sleeping positions outweighs any benefits of tummy or left side positioning of babies 6.
Elevating the sleeping surface for back sleeping babies does not reduce GOR and is not recommended 5, 7.
If a baby is in an elevated cot, further hazards may be introduced into the sleeping environment. When elevated, babies are more likely to slip down the cot and become completely covered by bedding, or if a pillow is used to elevate the baby pillows become a suffocation hazard 5.
If for a rare medical reason a baby must be slept in a position other than the back position, medical staff should advise the parents in writing and provide information about the other ways parents can reduce the risk of SUDI. Medical assessment is required for a diagnosis of GORD 2. Non-nutritive sucking using a pacifier or dummy has no effect on acid or non-acid GOR and thus can be used in preterm infants with GOR symptoms 5.
Elaboration of the key points: It is usually mild and self-resolving.
These products have not been researched and, like other soft products in the cot, may create a suffocation risk 5. Use the baby monitor review to find the right monitor. Also a heavier weight and a non-slip bottom seems very important.
GOR is a normal physiological process occurring several times per day in healthy babies both term and preterm and is normally cleared by swallowing 9, The great majority of children with the more serious GORD are over one year of age 2. Most GOR can be managed by educating and reassuring parents that it will resolve by itself without treatment or medication. Medical attention is recommended if vomiting is very frequent and growth should be monitored using parent-held records.
Babies who are breastfed have less GOR 11, 12 Eliminate smoking. Eliminating environmental tobacco smoke ETS is important for many baby health outcomes. In adults, cigarette smoking is a common cause of gastro-oesophageal reflux, and ETS from parental smoking may also be a cause of GOR in babies Two critical systematic reviews of the literature suggest that thickening of feeds is helpful in reducing the signs of GORD 7, Results show that frequency of regurgitation and vomiting is reduced and increasing weight gain can be achieved by thickening feeds.
Pacifiers dummies used for non-nutritive sucking have no effect on acid and non-acid GOR and thus can be used in preterm infants with GOR Sleeping baby on the back provides airway protection 6. The back sleeping position is safer for babies with GOR as babies can protect their airways when placed on the back compared with babies placed to sleep on the tummy or side Figure 1 6,9, The American Academy of Pediatrics advises that the back sleeping position be recommended in the treatment of gastro-oesophageal reflux for mild to moderate cases 5.
The tummy and side sleeping positions significantly increase the risk of sudden infant death for babies under six months of age 5, 6.
Elevating the cot during sleep is not recommended In a critical review of the literature elevating the head of the cot in the supine position does not reduce GOR 7. It may cause the baby to slide down to the foot of the cot into a position that might compromise breathing. Elevating a baby during feeding and tummy time While props in the shape of a wedge may provide an aid during feeding, and tummy time while the baby is under supervision, they should never be used during sleep or when baby is awake and not being watched by an adult.
These products have not been researched and, like other soft products in the cot, may create a suffocation risk 5. The medical practitioner should also provide information about the child care practices that reduce the risk of sudden infant death.
GOR Medications in preterm and term infants should be carefully evaluated especially in the high risk preterm population as there is uncertain evidence of efficacy and potential harms 20 Figure 1 Figure 1: Anatomy of infant larynx in the prone and supine position When prone the esophagus food pipe is above the laryngeal opening, thus high reflux or postnasal secretions have direct access to stimulation of receptors around the laryngeal opening leading to laryngeal chemoreceptor reflex LCR apnoea breathing stops.
When supine the food pipe is below the laryngeal opening and the piriform fossae provide a temporary reservoir with protection from LCR stimulation. Thus both the anatomy and physiology predispose the infant to activation of the LCR when prone 6, 9, In Australia, between and there were 5, babies who died suddenly and unexpectedly.
But, it is not a good idea to try and keep her on the back with a baby sleep positioner. The product does not have a kite mark, CE mark or Lion safety mark either. In most of these cases, the babies suffocated after rolling from their sides to their stomachs.
For further information visit the Red Nose website at rednose. This information statement was first posted in Most recently updated December View the references for this article here.
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