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7 Tips To Keep Your Sleeping Baby Safe

I’m sure many of you have heard of SIDS, which is also known as cot death. SIDS is defined as the sudden unexpected death of an infant, which appears to happen during sleep, where the death can’t be explained even after an autopsy.

In the developed world, SIDS and suffocation are the most common cause of sudden unexpected infant deaths (an infant is a child under 1 year of age). Unfortunately, in South Africa, we don’t know the stats since most infants that die unexpectedly don’t undergo routine autopsies to identify cause of death.

You all probably know that back sleeping is the safest for your baby, but there are other additional ways you can reduce the risk of SIDS and other sleep-related causes of death. I have put together some tips in which to create a safe sleep environment for your baby from birth up until 1 year of age.

1. POSITION

Always place your baby to sleep on his or her back, for night sleeps AND naps. There is no evidence to prove that your baby is more like to choke if he or she vomits or regurgitates in this position, compared to a baby that sleeps in any other position. Placing your baby to sleep on their side is also not recommended, unless indicated for medical reasons by your practitioner.

Once your baby starts to roll, continue to place them to sleep on their backs but do not drive yourself mad by constantly repositioning them if they do roll over in their sleep. Once babies have mastered the art of rolling they can roll themselves right out of trouble if their breathing becomes difficult.

It’s important to also talk a little bit about flat head syndrome (plagiocephaly). Back sleeping is associated with this condition. Babies’ skulls are soft and constant pressure on the same spot can cause the head to change shape. You can avoid this deformity by repositioning your baby’s head to face opposite sides with each sleep.

2. SURFACE

Your baby should sleep on a firm flat surface. Not a soft surface like a couch, pillow or blanket. Babies should not sleep in car seats, baby swings and carriers either (this is not back sleeping). If your baby does fall asleep in one of these, it’s better to place them flat in their cot or bassinet as soon as possible. I spoke about recline angle and heads blocking airways in my post about car seat safety.

In addition to floppy heads its important to realise that a baby’s head is very large compared to their body. So if you elevate the head too much the airway can also become obstructed.

 

What happens to the airway when the head is elevated

 

3. BEDDING

It’s hard to avoid decorating your little one’s room when there are so many gorgeous accessories available. Just remember to remove all loose items from their beds before naps and bedtime. Such items are a potential entrapment, strangulation and suffocation hazard. Pillows, blankets, stuffed animals and even cot bumpers should not be in your baby’s bed whilst they sleep. There is no evidence to even prove that cot bumpers actually do prevent injury and infants don’t need pillows.

Please also be aware of mobiles. Depending on how high your mobile is your little one may be able to reach for it, as he or she gets older. Then the strings and other components could become a choking and/or strangulation risk.

4. LOCATION

This tip is debatable since there is mixed evidence in the literature. The American Academy of Pediatrics (AAP) recommends that your baby share your room but not your bed. This recommendation was introduced after many infants who co-shared died by either becoming trapped in the bedding or smothered by a parent.

Interestingly in African and Asian countries, this has not been seen. These countries, where co-sharing is the norm, actually have lower rates of sleep-related infant deaths than Western countries. Researchers suggest that co-sharing is actually protective because infants who sleep next to their parents are constantly stimulated. This stimulation keeps them in a more aroused state so they spend less time in deep sleep and are therefore at a lower risk of stopping breathing.

5. TEMPERATURE 

Your baby should not get too hot in their sleep. Dress your baby in only ONE extra layer than you would comfortably wear. A sleep sack is a safe option. No blankets please!

The room temperature should also be kept comfortable. Most baby monitors have a built in temperature function but if yours doesn’t, keep an indoor thermometer in the room and don’t let the temperature go higher than 22o Celsius.

6. PACIFIER

It has been shown that a pacifier reduces the risk of SIDS. You can try giving your baby a pacifier but only once breastfeeding has been well established (if you choose to breastfeed). The nipple can confuse your baby if given too early and you may then have problems with latching.

Remove dummy chains or strings before giving your baby a pacifier to sleep. Also, don’t stress if the dummy falls out during sleep (it most probably will), you don’t need to replace it.

Don’t force a dummy. It’s ok if your baby doesn’t like it, not all babies do.

7. FURNITURE

Now take a step back and look around your baby’s room. Make sure all electrical cables, window blind cords and any other potentially hazardous items within arms reach from the cot are removed.

Looking after our babies is a lot of work and we always need to be on call and think 2 steps ahead. But now that your little one is sleeping SAFELY, go and put your feet up and have a cup of coffee… or maybe go take a nap yourself!

RESOURCES

Cadematori, M.E., Piranian, M.A., Skrzypek, P.A. & Pron, A.M. (2016) Caregiver Compliance With Safe Sleep Guidelines. Newborn & Infant Nursing Reviews, [online] 16, pp. 122–125. Available from: https://www.sciencedirect.com/science/article/pii/S152733691630054X [Accessed: 26 September 2018].

Kibel, M.A., Molteno, C.D. & De Decker, R. (2005) Cot death controversies. Cot death. SAMJ, [online] 95 (11). Available from: http://www.samj.org.za/index.php/samj/article/viewFile/1881/1202 [Accessed: 26 September 2018].

Koren, A., Reece, S.M., Kahn-D’angelo, L. & Medeiros, D. (2009) Parental Information and Behaviors and Provider Practices Related to Tummy Time and Back to Sleep. Journal of Pediatric Health Care, [online] 24 (4), pp. 222-230. DOI: 10.1016/j.pedhc.2009.05.002 [Accessed 26 September 2018].

Miller, L.C., Johnson, A., Duggan, L. & Behm, M. (2011) Consequences of the “Back to Sleep” Program in Infants. Journal of Pediatric Nursing, [online] 26, pp. 364-368. Available from: https://0-ac-els–cdn-com.innopac.wits.ac.za/S0882596309002930/1-s2.0-S0882596309002930-main.pdf?_tid=dccfa213-e0d1-4850-beeb-18fd49b69dd5&acdnat=1537520788_cb816c0abb2f56d365e5a1b195a3ca24 [Accessed 26 September 2018].

How Safe Is Your Car Seat?

We all know how long it can take for a child to fall asleep. So when you reach your destination and your little one has finally fallen asleep you couldn’t feel more relieved. You wouldn’t dream of disturbing them by removing him or her from the car seat. Instead you do what is the most convenient, and move your child from your car into a pram chassis or straight into your home without ever moving them from the car seat.

Whilst car seats have saved many lives, they do have some hidden dangers. A study in 2015 found that out of all the sitting and carrying devices for young children, car seats were responsible for the most number of deaths. Hypoxia and suffocation from either poor positioning in the car seat or strangulation by the straps and buckles was the cause of death in all these cases.

HYPOXIA

This is when there is a loss of oxygen in the blood which reduces the amount of oxygen reaching the tissues. When there is an extreme loss of oxygen a child will suffocate.

The developing brain is very sensitive to a decrease in oxygen. Loss of oxygen can cause brain injury and result in a range of developmental problems as well as seizures.

POSITIONING

The position of your car seat is important. The Recline Angle of a rear-facing car seat is critical and an angle between 30-45o from the vertical is recommended. A recline angle more than 45o offers very little protection in the event of a crash.

A newborn or young infant’s head is heavy and the neck muscles are weak. If the recline angle becomes less and the car seat more upright, the head will flop down and obstruct the airway. A newborn should therefore be positioned in the lowest possible position, which still offers crash protection. As babies grow their neck muscles get stronger and the angle of the car seat can become more upright since their head and neck control improves.

 

The recline angle of a rear-facing car

 

A number of studies have looked at the level of oxygen in an infant’s blood whilst in their car seat. A level of oxygen less than 90% is considered dangerous. It was shown that children’s oxygen levels dropped as far down to 83.7% when in incorrectly positioned car seats. The authors also found that the longer the child remained in the car seat the lower the oxygen level would drop.

Another study found that a child in a correctly placed rear-facing car seat is still at risk of suffocation. The vibration produced by a car could cause newborns and young children’s head and shoulders to fall forward, despite correct use of the straps and buckles. This risk was also similar for both term and preterm infants.

Some specialists recommended that young babies spend no more than 30 minutes to an hour in a car seat at a time. If a long journey is unavoidable it may be wise for someone to sit in the back with your child to keep an eye out.

STRAPS AND BUCKLES

Always make sure your child is properly securely in a car seat. If the straps are too loose a child can easily slip or even wriggle down far enough to become strangled by the straps. If the child falls lower down in the seat the child may also suffocate from an obstructed airway if the head falls onto the chest.

NEVER

  • Never place your baby in a car seat on a soft surface such as a bed or couch. This type of surface could cause the recline angle to change resulting in your child’s head falling forward and obstructing the airway.
  • Never loosen or unbuckle any straps if you do decide to keep your baby in a car seat outside of the car. A child can wriggle and slip down far enough to be strangled by the straps and even fall out of the car seat altogether.
  • Never leave an infant or young child unsupervised in a car seat if they are asleep or even if they are awake.
  • Never place your baby in a car seat on an elevated surface such as a table. A baby can wriggle enough to cause the seat to move and fall off the surface.
  • Never place your baby in a car seat on the floor without looking at the recline angle. Some car seats may become more upright when placed on the floor.

Always make sure your car seat is installed correctly. Most car seats come with a built-in indicator that allows you to see if the seat is installed at the proper angle.

Read the manual carefully and if in doubt contact the local manufacturer or distributor. You can also contact Julie at Precious Cargo (www.preciouscargo.co.za) to book a professional car seat installation.

RESOURCES

Arya, R., Williams, G. and Kilonback, A. et al. (2017) Is the infant car seat challenge useful? A pilot study in a simulated moving vehicle. Arch Dis Child Fetal Neonatal Ed, [online] 102, pp. 136-141. Available from: https://fn.bmj.com/content/fetalneonatal/102/2/F136.full.pdf [Accessed 13 September 2018].

Batra, E.K., Midgett, J.D. and Rachel Y. Moon (2015) Hazards Associated with Sitting and Carrying Devices for Children Two Years and Younger. The Journal of Pediatrics, [online] 167, pp. 183-187. Available from: http://dx.doi.org/10.1016/j.jpeds.2015.03.044 [Accessed 13 September 2018].

CPSBestPractice (2018). Rear-facing restraint recline angle. [image] Available at: https://sites.google.com/a/umich.edu/cpsbestpraci/resources/rear-facing-child-restraints [Accessed 14 Sep. 2018].

NHS (2016) Warning over babies sleeping in car seats. [online] Available from: https://www.nhs.uk/news/pregnancy-and-child/warning-over-babies-sleeping-in-car-seats/ [Accessed 13 September 2018].

Rholdon, R. (2017) Understanding the Risks Sitting and Carrying Devices Pose to Safe Infant Sleep. Nursing for Women’s Health, [online] 21 (3), pp. 225-230. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28599744 [Accessed 13 September 2018].

The Dangers of Party Balloons

We recently celebrated my daughter’s two-year birthday and, of course, decorated the house with balloons. No children’s birthday party is complete without balloons and although they are very popular with kids, they can also be extremely dangerous. Which is why I wanted to do a post on the potential dangers of balloons:

CHOKING HAZARD

Children can choke on balloons if they breathe them in whilst trying to blow them up. This happens when a child takes in a deep breath before inflating the balloon and accidently sucks the balloon back into his or her mouth. A child can also choke if they swallow deflated balloons or pieces of popped balloons they may chew on. If a balloon pops in a child’s face the child can also inhale the balloon pieces as they fly through the air.

Latex is a dangerous material to choke on as it can fit tightly in the throat and cause a complete airway obstruction very quickly. Whilst foil balloons are usually blown up with helium they can also become a choking hazard if deflated balloons or broken pieces are swallowed. There was a widely reported incident in 2016, where a three-year-old suffocated after putting the foil balloon over her head.

BURSTING HAZARD

Balloons can pop without warning. They can pop if children play with them roughly or if little children chew on them. Poor quality balloons can also pop more easily even if they aren’t being rough-handled. Children can also trip over balloon strings and fall onto the balloons popping them. If balloons pop near a child’s face they can cause serious damage to the eyes as well as cuts to the face.

STRANGULATION HAZARD

This may be an overlooked hazard. The colourful strings and ribbons that are tied to balloons can become a strangulation hazard as children become tangled.

ALWAYS KEEP IN MIND

  • Keep uninflated balloons away from children
  • Do not let children blow up balloons
  • Inflated balloons should be kept out of reach of children
  • Children should never play with inflated balloons
  • Always supervise children when inflated balloons are around
  • Throw away deflated and popped balloons immediately
  • Throw away balloon strings immediately when balloons deflate and pop

In the United States the Child Safety Protection Act requires a warning to be placed on any latex balloon or toy containing a latex balloon. This warning states that children under eight years of age are at risk of choking or suffocating on uninflated or broken balloons. Similarly, in the EU, children under the age of eight are actually legally banned from blowing up balloons without adult supervision.

However, children as old as 10 years have been found, on autopsy, to have suffocated from a balloon, which makes it difficult to define what age is actually safe for kids to handle balloons.

I think its important to stress to your kids that party balloons are not toys. They are purely for decoration and should always be properly secured and disposed of after use.

RESOURCES

CPSC (2012) CPSC Warns Consumers of Suffocation Danger Associated with Children’s Balloons. [online] Available from: https://www.cpsc.gov/s3fs-public/5087.pdf [Accessed 6 September 2018].

Francis, P.J. & Chisholm, I. H. (1998) Ocular trauma from party balloons. British Journal of Opthalmology, [online] 82 (2). Available from: https://bjo.bmj.com/content/82/2/203.1 [Accessed 6 September 2018].

Meel, B.L (1998) An Accidental Suffocation by a Rubber Balloon. Medicine, Science and the Law, [online] 38 (1), pp. 81-82. Available from: https://doi.org/10.1177/002580249803800113 [Accessed 6 September 2018].

Does Your Child Need a Tetanus Shot or Not?

I’ve had parents often come into the emergency room after their child has taken a tumble asking for a Tetanus vaccine, which is why I felt the need to write a post explaining what Tetanus is and why we need to vaccinate our kids.

WHAT IS TETANUS?

Tetanus is a disease commonly known as lockjaw. It is caused by the bacteria, Clostridium tetani and can be fatal. The toxin from the bacteria affects the nervous system and causes severe painful muscle spasms, which can interfere with the ability to breathe. Currently there is no cure for Tetanus and treatment is mainly symptomatic until the effects of the toxin wear off. Complete recovery can take up to several months.

WHERE IS THE BACTERIA FOUND?

Clostridial spores can be found everywhere. They are found in soil, dust and animal faeces (including humans). Once the spores enter a wound they grow into mature bacteria, which produce the powerful toxin. Clostridium tetani is found worldwide.

WHAT ARE THE SIGNS AND SYMPTOMS OF TETANUS?

Signs and symptoms of tetanus can appear anytime from a few days to a few weeks from infection:

  • Spasms and stiffness of jaw muscles (hence the name lockjaw);
  • Spasms and stiffness of the neck muscles;
  • Difficulty swallowing;
  • Spasms and stiffness of other body muscles, commonly the abdominal muscles;
  • Other constitutional symptoms such as fever, sweating and palpitations.

TETANUS VACCINATION

I won’t go into too much detail regarding the various combination vaccines as there are many and every country has its own recommendations. A copy of the latest South African immunisation schedule can be downloaded from my resources page. The WHO recommends an initial 6-dose schedule to achieve tetanus immunity.

1. Primary vaccination

Three primary doses of the vaccine are recommended in childhood starting from 6 weeks.

2. Booster vaccination

Three booster doses are recommended prior to adolescence. Booster vaccines are then recommended every 10 years thereafter.

TETANUS-PRONE WOUND

  • This is any wound that has been contaminated with material that could contain tetanus spores;
  • This is any wound that is deep;
  • This is any wound that is dirty;
  • This is any wound that contains a foreign body.

Note: any wound can be tetanus-prone – cuts, scrapes, burns, animal (including human) and insect bites.

WHEN TO SEE A DOCTOR

It is recommended you see a doctor if:

  • Your child has a tetanus-prone wound and has not had a booster vaccine in the last 5 years;
  • Your child has a minor, clean wound and has not had a booster vaccine in the last 10 years;
  • Your child has a wound and you cannot remember when their last booster vaccine was.

RESOURCES

CDC (2018) Tetanus. [online]. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html#contraindications [Accessed 30 August 2018].

WHO (2018) Tetanus vaccines: WHO position paper, February 2017 – Recommendations. Vaccine. [online] 36 (25). Available from: http://dx.doi.org/10.1016/j.vaccine.2017.02.034 [Accessed 30 August 2018].

WHO (2018) Tetanus. [online]. http://www.who.int/ith/vaccines/tetanus/en/ [Accessed 30 August 2018].

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