Tizzie Hall responds to FSID (PART 4)

Some mums have noted that comment moderation is in place on Tizzie Hall's own website - therefore I have reproduced an excerpt of her post with a link to the rest, you are welcome to comment here :)

Thank you Prof Haycock

July 30th, 2011

I would like to thank Prof Haycock for taking the time to respond to the questions posed by Analytical Armadillo in concerns to my bedding advice. My official response is below. 
FSID believes that it is vital that all parents are offered safe sleep advice which is supported by independent, peer-reviewed scientific research. Babies are all very different so it is important for parents to be aware of their baby’s temperature by feeling their tummy or the back of their neck – not their hands or feet – and if they do feel hot they should remove a layer.
Here is our advice:
1. Babies do not need hot rooms and all night heating is rarely necessary.  Keep the room at a temperature between 16-20ºC.  18ºC (65ºF) is just right.  20 degrees is what I recommend in Australia and other areas on this side of the world and after a recent trip to the UK and Ireland I will now be recommending 18 degrees for that side of the world. My advice is consistent with FSID guidelines.
2. Adults find it difficult to judge the temperature in the room, so use a room thermometer in the rooms where your baby sleeps I always recommend my parents measure the room temperature with a room thermometer to establish the ambient temperature of the room. I recommend a room thermometer in my online store.
Taken from my bedding guide –
“ I suggest having a baby’s room cooled to 22 degrees centigrade in summer (if you are using air conditioning), or warmed to 20 degrees centigrade in winter. If you do not have hydronic heating, I suggest you use an oil-filled column heater. I do not advise using ducted heating in a baby’s room due to the dust it blows around. A good way of keeping an eye on the temperature is to use a room thermometer.” Please note:  to clarify one point above, I have found that if you set your air-conditioning to 22 degrees when trying to cool a room it gives a actual room temperature of 20 degrees.
My advice is consistent with FSID guidelines.
3. When you check your baby, if they are sweating or their tummy feels hot to the touch, take off some of the bedding or clothing. Don’t worry if their hands or feet feel cool, this is normal. I clearly state in my bedding this exact same thing. Here is the direct quote - 
Please note: Using the above guides, you will still need to watch your individual baby and adjust the bedding if your baby appears too hot or cold. Here are a couple of pointers to tell if your baby is too hot or cold. 
Signs of a baby who is too hot might include:
• the baby will be waking and moaning,
• having a sweaty back
• having sweaty or wet clothes.
• Shallow, rapid breathing
Signs that your baby is too cold might include:
• Moving all around the cot
• Never laying still
• Rolling on to their tummy
• Catnapping in the day, or
• Waking from 4am (but more often 5am)
You might also need to adjust the recommended bedding depending on the humidity level where you live as well.
The sheets and blankets in your child’s cot should be made from cotton or bamboo.
Tips:
• Never tuck a sleeping bag in under the mattress because this will restrict your little one’s movement and is dangerous.
• The most important rules to remember to protect your little one from SIDS are to have a totally smoke-free pregnancy and environment for your baby, and to always place a baby in the safe sleeping position on their back to sleep
• Toddlers over 18 months appear to be better at controlling their own body temperature while they sleep so might need less bedding.
• To see how I set a cot up with bedding please visit my BLOG February 2010
My recommendations are consistent with FSID guidelines.
 4. Use lightweight blankets or a baby sleeping bag. If your baby feels too warm, reduce the number of layers or use a lower tog baby sleeping bag. In warm summer weather, your baby may not need any bedclothes at all. Do not use a duvet, quilt or pillow for babies under 12 months. 
I am confused by the word “or” used here; “Use lightweight blankets or a baby sleeping sack” My confusion comes because research I have read by Monique P L’Hoir states “ we hypothesized that turning prone is prostponed when a sleeping bag was used, and even more so if the baby was tucked in with a blanket as well.” This statement is in line with what my observations have shown. Although I have also seen that if more lightweight bedding is used this may delay the baby rolling to their tummy for even longer. I can’t help but wonder here if it is FSID who are suggesting a sleeping bag or bedding or if it is the sleeping bag companies suggesting this….
For the research see information heading 134s COT DEATH AND SLEEPING SACKS the very last line states “we hypothesized that turning prone is prostponed when a sleeping back was used, and even more so if the baby was tucked in with a blanket as well.” http://www.ispid.org/fileadmin/user_upload/textfiles/SIDSI2006finalabstractbook.pdf
My recommendations is to use layers of lightweight 100% cotton or bamboo blankets and watch your baby for signs of being too hot or too cold as stated above. From my bedding guide–
 “So why not just add more clothing under the sleeping bag and then eliminate the need for blankets? The reason I recommend using bamboo or cotton blankets along with a safe sleeping bag, and not normally using more than two layers of clothing underneath the sleeping bag, is because I feel more than two layers under a sleeping bag causes a risk of its own. You might for example, as advised by some sleeping bag manufacturers, add extra layers under your baby’s sleeping bag. Then, when you go in to check your little one at night and discover he feels too hot, you may decide not risk lifting him to remove some clothing layers because you are scared of waking him. You and I would like to think we would put safety first, but it’s important to remember that some nights we might feel too tired to risk waking our sleeping baby. In my opinion this is a far more dangerous situation than using bamboo or cotton blankets that can be added and removed as needed. On the other hand, if you found your baby was too cold without enough layers under his sleeping bag you might just grab the nearest thing – for example a quilt or polyester blanket – and throw it over your baby. A safer approach is to have the correct safe bedding at hand and educate the people who are around your baby at sleep times about how to put your little one to bed safely. My advice is consistent with FSID recommendations.
5. Even in winter, babies who are unwell and feverish need fewer clothes and bedclothes. Currently I do not have this warning in my bedding guide but as a result of this blog I have now realised that some parents are confused how to dress their babies and what to cover them with when unwell so I will be adding a paragraph to explain that less bedding and clothing is needed when a baby is unwell. My advice will be updated to include this FSID recommendation.
6. Babies need to lose excess heat from their heads. Make sure their head cannot be covered by the bedclothes by sleeping them ‘feet to foot’ (with their feet to the foot of the cot) so they don’t wriggle down under the covers.
Taken from my safe bedding guide –

• The most important rules to remember to protect your little one from SIDS are to have a totally smoke-free pregnancy and environment for your baby, and to always place a baby in the safe sleeping position on their back to sleep

And taken from my SIDS article – http://www.saveoursleep.com.au/reading/free/sids.asp Which can be found under ‘Free Reading’ on my website –
Make sure your baby’s face and head stay uncovered while your baby is sleeping. A good way to ensure this is to put your baby’s feet at the bottom of the cot so that she can’t slip down underneath the bedclothes. Tuck in bedclothes securely so they can’t become loose. Never put quilts, doonas, duvets, pillows, lambskins or cot bumpers in a cot or under the sheet covering the mattress.
My grandmother says I should put a hat on my five-week-old baby to make him sleep better. What do you think? This is a question posed to me which is on my website and my answer to the question is below – this FAQ is also in my book.
I have heard this a few times and believe it to be a very dangerous old wives’ tale. You should most definitely not put a hat on your baby to help him sleep as this could cause your baby to overheat and will increase the risk of SIDS. If your baby is too hot and needs to cool down, he will need to be able to lose that heat through his head. You may put a hat on your baby if you are outdoors in cold weather, but take it off once inside.
My advice is consistent with FSID guidelines.
 7. Babies should never sleep with a hot water bottle or electric blanket, or next to a radiator, heater or fire, or in direct sunshine. I do not recommend any of these things but do not state this in my bedding guide. My advice will be updated to include this FSID recommendation.
8. When it’s warm, you can cool the room where your baby sleeps by closing the curtains and opening the windows during the day.  Offer your baby plenty to drink, and in very hot weather, sponge them down regularly with tepid water.  Use a fan but do not place it directly onto your baby. I concur as stated in my bedding guide.
My advice is consistent with FSID guidelines.
9. Remove hats and extra clothing as soon as you come indoors or enter a warm bus, train or shop, even if it means waking your baby. I have shown an example above where I also recommend this. My advice is consistent with FSID guidelines.
10. A car can become very hot in the summer. Avoid direct sunlight on your baby.  In winter, keep the heating low, and remove your baby’s outdoor clothing.  A thermometer may be helpful. I believe we have addressed this above. I will add the point about babies getting hot in cars to my SIDS article.  My advice is consistent with FSID guidelines
Research Evidence:
The most important publication implicating over-wrapping of babies as a risk factor for SIDS is the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) report ¹ which had a very large dataset. Some of the data in the report had been published before. ^2-4 In the chapter Thermal Environment and Arrangement of Bedding the authors state
 “For both the usual sleep and last/reference sleep, the SIDS infants were wrapped significantly more warmly than the control infants. The difference in the distribution of tog values remained significant when adjusted for socio-economic status. Notably twice as many SIDS infants put down for the last/reference sleep were covered by 10 tog or more bedding, and three times as many were found this way compared to the control infants.” – I do not, for the majority, recommend covering with 10 tog or MORE of bedding. So therefore my recommendations I believe are consistent with FSID guidelines. I recommend in my guide 6 layers of 0.6 tog blankets which is 3.6 tog plus a doubled over sheet of 0.4 tog totalling 4.0 tog and a maximum of 16 layers at 0.6 tog with is 9.6 tog include the doubled over sheet at 0.4 tog which is 10 tog. I note the above statement is 10 or more so I will adjust my maximum layers for a baby over 4 months sleeping in a cot to 15 layers as 16 layers equals 10 tog. I would like to point out that if the above study was undertaken on baby’s 3 months and under, which I suspect it was then I do not recommend more than 12 layers for baby in cot and 10 layers for a baby in moses basket – total 6.4 tog and 7.6 tog respectively (including doubled over sheet calculated to .4 tog) I also strongly advise my parents to begin with my recommended bedding, not my maximum bedding and watch their baby’s for signs of being too hot or too cold and add or remove the bedding as needed. My advice is 99% consistent with that of the current research outlined here  and I will adjust the maximum layers for a baby over 4 months sleeping in a cot to 15 layers of my recommended blankets.
To Note: You may argue that the ‘standard blanket layer’ is 1.5 to 2.0 tog however it is my belief that this average would have been achieved by evaluating the broad range of blankets on the market – cotton, bamboo, wool, polyester, polar fleece etc. I have not been able to find an answer to ‘what is the average tog of a cotton or bamboo blanket?’ so therefore I can only go with what the range of blankets I recommend have been tog tested too. I have made it clear in my bedding advice as taken from my bedding guide – “The sheets and blankets in your child’s cot should be made from cotton or bamboo”
 CESDI indicated that worrying about overheating might actually be protective:
“Significantly more control than index mothers worried about their baby getting too hot, suggesting a protective effect…”
It was the mothers of the SIDS infants who worried most about their baby being too cold:
27.8% of the mothers of SIDS infants compared to 15.8% of controls. I would argue that parents following my routines and advice could be more aware of the dangers of both overheating and underheating than parents not following my advice because of the emphasis and importance I stress in bedding and setting up a safe sleeping environment. I would argue that you would find my parents would be monitoring their babies on a very regular basis.


CONTINUES HERE: http://blog.saveoursleep.com/2011/07/30/thank-you-prof-haycock/#respond


You can read Contradictions in Tizzie Hall's response to FSID HERE