Cot death: a guilt trip too far

Is every parent's nightmare also their fault?

Brid Hehir

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Topics Politics

Sudden Infant Death Syndrome (SIDS) – more commonly known as cot death – has been a headline issue for a decade now, ever since the death of TV presenter Anne Diamond’s baby in 1991. Theories abound about the possible causes of cot death, but all seem to have a common theme: one way or the other, it’s the parents’ fault.

In October 2000 alone, two new theories were published linking parental behaviour to the risk of cot death. The first suggested that Helicobacter pylori, a bacteria that can cause stomach infections, could be transferred by the mouth or hands of carers through saliva. By kissing their babies or licking their babies’ dummies, parents could inadvertently be increasing their risk of cot death.

The second theory argued overheating could be a contributor to cot death. Parents – fathers in particular, who are not aware of the optimal room temperature for babies – could be putting their children’s lives at risk.

Despite this proliferation of scares and assertions, despite the £8 million spent by the Foundation for the Study of Infant Deaths (FSID) on research, nobody really knows what causes cot death. But that does not stop the Department of Health (DOH), the FSID and professionals from promoting unproven theories to parents, and the media from generating shock headlines.

The ‘Reduce the Risk’ and ‘BabyZone’ campaigns launched in 1991 and 1998 are good examples of this. These campaigns claimed that putting babies to sleep on their backs is an effective method of reducing cot deaths. Yet there is no explanation for the danger to babies of sleeping on their front. The theory raises more questions than answers – but it generates an ongoing anxiety among parents about how their babies are sleeping.

Parental smoking has also been blamed. It has suggested that cot deaths would be reduced by 61 percent if smoking were taken out of the equation. But again, evidence to justify this assertion is not offered. An association between smoking and cot death may exist, of course, but it is difficult to separate smoking from other causative factors. Despite the tenuous nature of these links, professionals are obliged to advise and even persuade parents to follow the campaign’s advice. Imagine the impact of this advice on a smoking parent, who lost their child to cot death.

These are only a few of the theories. Why do campaigns have such a resonance?

The incidence of cot death has not increased. In fact, the number of babies who actually die of cot death has fallen dramatically since it was first accepted as a certifiable cause of death in 1971. At that time there were around 1200 cot deaths in England and Wales. Since then the number has dropped by 75 percent to 286 babies in England and Wales in 1999 (0.45 per 1000 live births). Nor are the falling numbers explained by the impact of the ‘awareness-raising’ campaigns around cot death, as many campaigners often try to suggest: the decrease in cot death numbers started prior to campaigns beginning.

Our heightened sensitivity to cot death can partly be explained by the fact that, today, babies die from relatively little else. Infant mortality has fallen dramatically among all social classes in Britain: in 1900, 142,912 babies died in the first year of life in England and Wales, compared to 3390 in 1999. While 286 cot deaths per year might seem a small proportion of the total number of infant deaths, it is significant enough to have an impact: especially when journalists and campaigners manipulate the figures to make them seem greater than they actually are. The FSID, for example, suggests that cot death is a more common cause of child death than road traffic accidents. This is true: but only 236 young people under 19 died from road traffic accidents in 1997. The balance should not be ‘look how prevalent cot death is’, surely, but ‘look how rare death from road traffic accidents is’.

If there is one overwhelming reason why cot death campaigns gain such resonance, it is because they tap into pre-existing levels of parental anxiety and guilt. Today, parents seem to be less confident about their ability to bring up their children – despite the fact that children have never been healthier or safer, parents worry about the risks posed by diet, alcohol and drugs on the fetus, and crime and accidents on their children. These more general anxieties make parents more susceptible to cot death scares; and in highlighting the potential risks of certain forms of parental behaviour, campaigners play off more specific worries.

Given the lack of evidence and knowledge about cot death, the campaigns we see today are irresponsible and damaging. Just imagine the impact on a parent, who lost a child to cot death, of the ongoing speculation about what they could have done differently. And just think about the more general impact this has on parents of (currently) healthy babies, who are so fraught with fears about sudden death that they cannot relax and enjoy their babies. The campaigns about cot death cannot prevent the nightmares from happening, but they lead to too many sleepness nights.

Bríd Hehir is a contributor to Alternative Medicine: Should We Swallow It? (Hodder & Stoughton, 2002). Buy this book from Amazon (UK).

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