PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of bmjThe BMJ
 
BMJ. 1990 July 14; 301(6743): 85–89.
PMCID: PMC1663432

Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study.

Abstract

OBJECTIVE--To determine the relation between sleeping position and quantity of bedding and the risk of sudden unexpected infant death. DESIGN--A study of all infants dying suddenly and unexpectedly and of two controls matched for age and date with each index case. The parents of control infants were interviewed within 72 hours of the index infant's death. Information was collected on bedding, sleeping position, heating, and recent signs of illness for index and control infants. SETTING--A defined geographical area comprising most of the county of Avon and part of Somerset. SUBJECTS--72 Infants who had died suddenly and unexpectedly (of whom 67 had died from the sudden infant death syndrome) and 144 control infants. RESULTS--Compared with the control infants the infants who had died from the sudden infant death syndrome were more likely to have been sleeping prone (relative risk 8.8; 95% confidence interval 7.0 to 11.0; p less than 0.001), to have been more heavily wrapped (relative risk 1.14 per tog above 8 tog; 1.03 to 1.28; p less than 0.05), and to have had the heating on all night (relative risk 2.7; 1.4 to 5.2; p less than 0.01). These differences were less pronounced in the younger infants (less than 70 days) than the older ones. The risk of sudden unexpected death among infants older than 70 days, nursed prone, and with clothing and bedding of total thermal resistance greater than 10 tog was increased by factors of 15.1 (2.6 to 89.6) and 25.2 (3.7 to 169.0) respectively compared with the risk in infants of the same age nursed supine or on their side and under less than 6 tog of bedding. CONCLUSIONS--Overheating and the prone position are independently associated with an increased risk of sudden unexpected infant death, particularly in infants aged more than 70 days. Educating parents about appropriate thermal care and sleeping position of infants may help to reduce the incidence of the sudden infant death syndrome.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.2M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bacon CJ. Over heating in infancy. Arch Dis Child. 1983 Sep;58(9):673–674. [PMC free article] [PubMed]
  • Stanton AN, Scott DJ, Downham MA. Is overheating a factor in some unexpected infant deaths? Lancet. 1980 May 17;1(8177):1054–1057. [PubMed]
  • Stanton AN. Sudden infant death. Overheating and cot death. Lancet. 1984 Nov 24;2(8413):1199–1201. [PubMed]
  • Wailoo MP, Petersen SA, Whittaker H, Goodenough P. The thermal environment in which 3-4 month old infants sleep at home. Arch Dis Child. 1989 Apr;64(4):600–604. [PMC free article] [PubMed]
  • Lee NN, Chan YF, Davies DP, Lau E, Yip DC. Sudden infant death syndrome in Hong Kong: confirmation of low incidence. BMJ. 1989 Mar 18;298(6675):721–721. [PMC free article] [PubMed]
  • Nelson EA, Taylor BJ, Weatherall IL. Sleeping position and infant bedding may predispose to hyperthermia and the sudden infant death syndrome. Lancet. 1989 Jan 28;1(8631):199–201. [PubMed]
  • Eiser C, Town C, Tripp J. Dress and care of infants in health and illness. Arch Dis Child. 1985 May;60(5):465–470. [PMC free article] [PubMed]
  • Nelson EA, Taylor BJ. Infant clothing, bedding and room heating in an area of high postneonatal mortality. Paediatr Perinat Epidemiol. 1989 Apr;3(2):146–156. [PubMed]
  • Stothers JK, Warner RM. Thermal balance and sleep state in the newborn. Early Hum Dev. 1984 Jun;9(4):313–322. [PubMed]
  • Gilbert RE, Fleming PJ, Azaz Y, Rudd PT. Signs of illness preceding sudden unexpected death in infants. BMJ. 1990 May 12;300(6734):1237–1239. [PMC free article] [PubMed]
  • Stanton AN, Downham MA, Oakley JR, Emery JL, Knowelden J. Terminal symptoms in children dying suddenly and unexpectedly at home. Preliminary report of the DHSS multicentre study of postneonatal mortality. Br Med J. 1978 Nov 4;2(6147):1249–1251. [PMC free article] [PubMed]
  • de Jonge GA, Engelberts AC, Koomen-Liefting AJ, Kostense PJ. Cot death and prone sleeping position in The Netherlands. BMJ. 1989 Mar 18;298(6675):722–722. [PMC free article] [PubMed]
  • Prone or supine for preterm babies? Lancet. 1988 Mar 26;1(8587):688–688. [PubMed]
  • Wheldon AE. Energy balance in the newborn baby: use of a manikin to estimate radiant and convective heat loss. Phys Med Biol. 1982 Feb;27(2):285–296. [PubMed]
  • Fleming PJ, Levine MR, Goncalves A. Changes in respiratory pattern resulting from the use of a facemask to record respiration in newborn infants. Pediatr Res. 1982 Dec;16(12):1031–1034. [PubMed]
  • Orenstein SR. Effect of nonnutritive sucking on infant gastroesophageal reflux. Pediatr Res. 1988 Jul;24(1):38–40. [PubMed]
  • Orenstein SR, Whitington PF, Orenstein DM. The infant seat as treatment for gastroesophageal reflux. N Engl J Med. 1983 Sep 29;309(13):760–763. [PubMed]
  • Martin RJ, Herrell N, Rubin D, Fanaroff A. Effect of supine and prone positions on arterial oxygen tension in the preterm infant. Pediatrics. 1979 Apr;63(4):528–531. [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Group