Preventing Cot Death and using baby car seats safely.

A neonatal nurse recently developed "Best practice" guidelines for the prevention of Cot Death while travelling and using car safety seats.Michelle Clark, neonatal unit sister at Doncaster Royal Infirmary, produced information to raise parents’ awareness of the risk of car seat cot death, due to a dearth of materials in this area. She spent two years researching the subject, studying findings from various sources, including New Zealand and the Foundation for Sudden Infant Death. Now Ms Clark has developed guidance for parents to help minimise the risk of car seat cot death and her work has been recognised by the national special care baby charity Bliss, which is publishing it on its website and in its information booklet for parents.

Key findings from Ms Clark’s work include:

Young babies may experience respiratory (breathing) problems if placed in a sitting position or car seat. A newborn baby’s reflex to keep its head held up is not fully developed, meaning the head flops down and restricts the airway. It is always best to keep a young baby on their back wherever possible.
Car seats should only be used to transport babies in cars, and other sitting baby equipment should only be used once the baby is strong enough to support their own head. (usually about 6/7 months)

Car seats are designed to keep babies safe while travelling, not as a main sleeping place. The research recommends that frequent breaks are taken on long journeys to get the baby out of the seat, even if this involves waking the baby up.
The same applies when bringing the baby into the home if they have fallen asleep in the car seat. The baby’s warm outdoor clothing should be taken off, even if this involves waking the baby.

If the baby is due a sleep, they should be taken out of the car seat and put into a cot or crib; the safest place for a baby to sleep is on a firm, flat mattress - a car seat does not meet this requirement. Worryingly, it has been found that some babies were spending hour after hour in car seats, ie during the journey, transferring the car seat in a travel system pram, and once home allowing the baby to continue sleeping in the car seat rather than waking the baby up and placing in them in a cot or crib.

All the advice suggests that babies should not spend longer than possible in a car seat, especially whilst sleeping.
1) So, stop your baby from scrunching up and over, keep an eye on their neckline.
2) Make sure the car seat you buy is age appropriate and correctly fitted.
3) Be sure grandparents and carers know how to fit the car seat and watch them practice.
4) When ever possible, babies travelling in a car seat should be observable by a responsible adult.
5) If you are a lone driver driving a significant distance use service stations to stop and check on your baby.
6) Babies find it difficult to regulate their temperature and quickly overheat. When in the car, remove any headgear the baby is wearing as they lose excess heat through their head.
7) Think about what baby is wearing, for example, thick snowsuits. It may be cold outside, but cars can heat up quickly. Natural materials will help the baby’s body with heat rather than nylon, polyester, and other man-made fabrics.

Swaddling.

Swaddling is the art of wrapping a baby or infant so that they are held firmly in cloth binding. This is a practice that has been carried out through the ages since biblical times. Originally swaddling was a method of restricting the movement of the child, and was thought to encourage strong, straight growth of the child's limbs. The degree of swaddling, which used to involve several different bindings altered in about the 17th century when it was decided that this was too restrictive a practice. Since then swaddling has been refined to the wrapping of the infant in a single piece of cloth or a shawl.

Many cultures still swaddle children until they are independantly mobile. In the west we swaddle newborn babies but some people think that swaddling should be discontinued at 8 or 12 weeks. There is no evidence to suggest that this is good practice, in fact the research completed in 2002 and 2005, and quoted in Pediatric journals, suggests that swaddling has a rich variety of benefits for the child and for the parents.

Swaddling a newborn makes the baby feel secure. While in mothers womb only limited movement was possible, baby was confined by mothers womb and abdominal muscles. Swaddling gives the baby the sensation of being held. Surrounded by the deep pressure of a breathable wrap, only baby's head is left free. This "holding", without physical contact, allows baby to relax and sleep on his/her back. The startle reflex, which causes baby to abruptly open arms and swing unco-ordinated hands and arms, can result in an unswaddled baby hitting themselves and can waken an otherwise settled baby.

Swaddling calms a fussy baby because it makes baby feel secure. One well recognised Pediatrican points out that this is one of the "four S's which calm and settle babies!" Today many mums are discouraged from maintianing swaddling after 12 weeks on the grounds that after this time swaddling impacts on a childs growth and motor development. Again, there is no evidence to back up this eroneous claim.

Swaddling has the following positive benefits;-

1) Swaddled babies sleep longer and better. Startles are reduced, there are fewer awakenings during deep sleep, and there are shorter arousals during REM sleep.

2) Swaddled babies are kept at a warm temperature without the risk of loose bedding covering their face and head.

3) Swaddling reduces fussiness and may even help eliminate colic.

4) Swaddling keeps baby sleeping on his/her back which is recommended for the prevention of Sudden Infant Death.

5) Swaddling is associated with increased awareness of environmental auditory stress, so although baby sleeps longer and deeper baby is also more alert to danger.

6) Swaddling makes it impossible for baby to scratch themselves or jerk their limbs and wake themselves by the unco-ordinated limb movement.

As babies grow stronger and more mobile they will wriggle free of the swaddle but there is no evidence that swaddling will inhibit a childs development in any way. Of course, as the child grows swaddling should only be done for naps and night sleep. The rest of the time baby should be able to use their limbs freely and experience the world.

As recently as July of this year researchers were being quoted as having further evidence of the benefits of swaddling even in older children. It is never too late to swaddle although some children do take a little time to get used to this if it has been discontinued earlier.