Orthodox crib death
The facts and the Fallacies
By: Dr. Sprott
Fallacy: To reduce the risk of cot
death, breastfeed your baby.
Breastfeeding does not reduce the risk of cot death, as the
following statistics demonstrate:
The breastfeeding rate in New Zealand has risen during recent
decades and is very high by international standards (over 90% of
newborns and 55% of babies aged six months). Yet up to 1995 the
New Zealand cot death rate was the highest in the world.
In the USA only 60% of newborns and 21% of babies aged six
months are breastfed. Yet in 1996 the USA cot death rate (0.75
deaths per 1000 live births) was less than half the New Zealand
The United Kingdom has a low breastfeeding rate (66% of
newborns, falling to 21% of babies aged six months), yet the
United Kingdom cot death rate is low (in 1999 only 0.57/1000).
While breastfeeding is good practice for nutrition and various
health reasons, it is not relevant to cot death prevention.
Fact (but only a
partial solution): To reduce the risk of cot death, sleep your baby
Face-up sleeping decreases the risk of cot death on mattresses
which are not wrapped for cot death prevention, but it is only a
The reason why face-up sleeping reduces the cot death risk is
simple: the gases which cause cot death (phosphines generated
from phosphorus, arsines generated from arsenic, and stibines
generated from antimony) are all more dense than air. They
diffuse away from a baby's mattress towards the floor, so a baby
sleeping face up is less likely to ingest them. However, the
protection afforded by face-up sleeping is limited.
Face-up sleeping is not very effective in preventing cot death
in cots, prams and carrycots 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 cot 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
cot 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 cot death
prevention. (However, for other reasons side sleeping is
To reduce the risk of cot death, don't smoke
during pregnancy or around your baby.
Smoking does not cause cot death, as recent history shows:
Smoking was very common in Britain in the 1930s and 1940s, yet
cot death was virtually non-existent. Smoking is prevalent in
present day Russia, yet cot death is rare in that region.
Furthermore, no cause-and-effect relationship between smoking
and cot 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 cot death. But it
does not follow that smoking is therefore a cot death risk
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 cot death occurs
much more frequently on re-used mattresses. A 1989 mattress
collection facilitated by British coroners showed that of some
150 cot death babies, about 95% had died on previously used
It is not smoking but the re-use of mattresses which causes the
high cot death rate among lower socio-economic families.
To reduce the risk of cot death, don't bed share with your baby
if you smoke or smoked during pregnancy. Sleep the baby in a
bassinet alongside your bed.
The risk posed by bed sharing 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 bed sharing results in a cot death risk if
the parents' mattress is not correctly wrapped for cot death
Placing a baby to sleep in a separate bassinet or cot alongside
the parents' bed does not protect a baby against cot death
unless the baby's mattress is correctly wrapped.
Keep baby's face clear at all times and place baby with feet to
the foot of the cot.
Keeping a baby's face clear may reduce the risk of cot death on
mattresses which are not wrapped for cot death prevention, but
the protection afforded is very limited.
Sleeping a baby with feet to the foot of the cot affords no
protection against cot 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).
Use a firm, clean fitting mattress, with no gap between the
mattress and cot sides.
While this advice may reduce the risk of injury in cots, it is
irrelevant to cot death prevention.
Any unwrapped mattress which contains the chemicals phosphorus,
arsenic and/or antimony can pose a cot 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 cot closely.
Tuck in bedding securely.
Tucking in bedding securely may reduce slightly the risk of
injury in cots, but it increases the risk of cot death on
unwrapped mattresses. This is because tight tucking in can lead
to increased temperature in a baby's cot; 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.
Don't put baby on a waterbed.
Certainly, waterbeds which are not wrapped for cot death
prevention can pose a cot 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
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 cot death
prevention, sleeping a baby on the bed poses no cot death risk.
Soft toys and bumpers are not recommended.
The presence of soft toys in a cot is irrelevant to cot death
Furthermore, if a baby's mattress is correctly
wrapped for cot death prevention, bumper pads pose no cot 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
cot, because they greatly impede ventilation. If bumper pads are
used, they should be positioned across the head of the cot and
part way down the sides.
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 cot 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 cot death
risk on wrapped mattresses and can increase the cot death risk
on unwrapped mattresses. Pillows, loose quilts and duvets should
not be present in a baby's cot.
THE MATTRESS ON WHICH A BABY SLEEPS IS CORRECTLY WRAPPED, THE
SITUATION IN RESPECT OF COT DEATH IS AS FOLLOWS:
The baby can sleep safely on any type or
age of mattress.
The baby can sleep safely on a waterbed.
Bumper pads can be used to prevent
There is no risk of cot death.