Traditional Advice about Babies and Crib Death

• Face-up sleeping is not very effective in preventing crib death in cribs, prams and carrycribs etc. which have enclosed sides, as these can cause gases to be trapped around a baby.
  
  
• It is not very effective against the danger of phosphine, as this gas is only slightly more dense than air. Any phosphine generated in a baby's crib is likely to be present in the air which a baby breathes, even if the baby is sleeping face up.

Face-up sleeping does not eliminate the risk of crib death. The risk is eliminated by separating the baby from the source of toxic gas using a gas-impermeable film which does not contain phosphorus, arsenic or antimony (and does not pose a risk of suffocation).

If a baby's mattress is correctly wrapped and the correct bedding used, sleeping position is irrelevant to crib death prevention. (However, for other reasons side sleeping is recommended.)

Fallacy: To reduce the risk of crib death, don't smoke during pregnancy or around your baby.

Smoking does not cause crib death, as recent history shows:

Smoking was very common in Britain in the 1930s and 1940s, yet crib death was virtually non-existent. Smoking is prevalent in present day Russia, yet crib death is rare in that region.

Furthermore, no cause-and-effect relationship between smoking and crib death has ever been established. In fact, they are simply socio-economic parallels. Put another way, smoking is more common among poorer people - and so is crib death. But it does not follow that smoking is therefore a crib death risk factor.

However, it is indisputable that along with having a higher rate of smoking, poorer people are also more likely to re-use mattresses. And it is also indisputable that crib death occurs much more frequently on re-used mattresses. A 1989 mattress collection facilitated by British coroners showed that of some 150 crib death babies, about 95% had died on previously used mattresses.

It is not smoking but the re-use of mattresses which causes the high crib death rate among lower socio-economic families.

Fallacy: To reduce the risk of crib death, don't bedshare with your baby if you smoke or smoked during pregnancy. Sleep the baby in a bassinet alongside your bed.

The risk posed by bedsharing does not arise from smoking - it arises from the mattress.

Adults' mattresses frequently contain the same chemicals and fungi as babies' mattresses and therefore can generate the same toxic gases. Thus all bedsharing results in a crib death risk if the parents' mattress is not correctly wrapped for crib death prevention.

However, bedsharing does not cause crib death if the parents' mattress is correctly wrapped for crib death prevention.

Placing a baby to sleep in a separate bassinet or crib alongside the parents' bed does not protect a baby against crib death unless the baby's mattress is correctly wrapped.

Misleading statement: Keep baby's face clear at all times and place baby with feet to the foot of the crib.

Keeping a baby's face clear may reduce the risk of crib death on mattresses which are not wrapped for crib death prevention, but the protection afforded is very limited.

Sleeping a baby with feet to the foot of the crib affords no protection against crib death. Any area on an unwrapped mattress where a baby sleeps is a potential source of toxic gas, since that is the area which becomes warm and moist (promoting the fungal activity which can cause gas generation).

Misleading statement: Use a firm, clean fitting mattress, with no gap between the mattress and crib sides.

While this advice may reduce the risk of injury in cribs, it is irrelevant to crib death prevention.

Any unwrapped mattress which contains the chemicals phosphorus, arsenic and/or antimony can pose a crib death risk. The risk can arise regardless of whether such a mattress is firm or soft, regardless of whether it is clean or soiled, and regardless of whether or not it fits the sides of the crib closely.

Misleading statement: Tuck in bedding securely.

Tucking in bedding securely may reduce slightly the risk of injury in cribs, but it increases the risk of crib death on unwrapped mattresses. This is because tight tucking in can lead to increased temperature in a baby's crib; and an increase in temperature of even a few degrees can cause the rate of gas generation to increase tenfold or more.

Overbedding must not be tucked in so securely that a baby cannot release the bedding for ventilation.

Misleading statement: Don't put baby on a waterbed.

Certainly, waterbeds which are not wrapped for crib death prevention can pose a crib death risk. This is for two reasons:

First, waterbeds are frequently made of PVC (polyvinyl chloride), a soft plastic which often contains phosphorus and antimony (which can generate, respectively, phosphine and stibine gases).

Secondly, waterbeds are frequently kept heated, which can cause increased fungal growth and hence increased gas generation.

However, if a waterbed is correctly wrapped for crib death prevention, sleeping a baby on the bed poses no crib death risk.

Misleading statement: Soft toys and bumpers are not recommended.

The presence of soft toys in a crib is irrelevant to crib death prevention.

Furthermore, if a baby's mattress is correctly wrapped for crib death prevention, bumper pads pose no crib death risk. In fact, they are to be recommended, as they reduce the risk of injury.

However, bumper pads should not be placed around all sides of a crib, because they greatly impede ventilation. If bumper pads are used, they should be positioned across the head of the crib and part way down the sides.

Fact: Pillows, loose quilts and duvets are not recommended.

Pillows, loose quilts and duvets can pose a very slight risk of suffocation or asphyxiation.

These items also pose a crib death risk. This is because they almost invariably incorporate a fill which contains phosphorus and antimony. Furthermore, they tend to be washed less frequently than other items of bedding, resulting in a greater likelihood of fungal activity.

Thus pillows, loose quilts and duvets can introduce a crib death risk on wrapped mattresses and can increase the crib death risk on unwrapped mattresses. Pillows, loose quilts and duvets should not be present in a baby's crib.

• Any sleeping position is safe.
  
  
• The baby can sleep safely on any type or age of mattress.
  
  
• Bedsharing can safely take place.
  
  
• The baby can sleep safely on a waterbed.
  
  
• Bumper pads can be used to prevent injury.
  
  
• There is no risk of crib death.
  
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