SUMMARY The thermal insulation of clothing and wrapping (tog value), room temperature, and body temperature was measured for 3-4 month old infants sleeping in their home cots under conditions chosen freely by parents during a cold winter. We found that ambient temperature averaged 18-4°C when infants were put down, but fell by an average of 4-4°C during the night. Minimum room temperature correlated with outside temperature, but most rooms were heated to some degree; smaller babies were kept in warmer rooms. The tog value of clothing before putting the baby down averaged 5-1, supplemented by 9-6 tog units of wrapping in the cot-a 188% increase for a 4-40C drop in temperature.Total tog of clothing and wrapping correlated negatively with minimum room temperature; smaller born babies tended to be more heavily wrapped. Despite the large increase in insulation in the cot, most babies maintained normal body temperatures.Over the last couple of decades there has been a substantial increase in the variety of items for clothing and wrapping of babies, and a rise in the number of homes with central heating. There are few reports, however, of the thermal consequences of the way in which parents now clothe and wrap their babies. 1 Recent reports of raised core temperature in some sudden infant deaths,2 and subsequent retrospective analysis of clothing and wrapping,3 have suggested that 'over wrapping' may be a contributory factor, but is not clear how 'over wrapping' can be defined as we have no precise information about either the range of normal parental behaviour or how it affects infant thermoregulation.In this study we report data on the room temperatures to which normal 4 month old infants were exposed at home during the night, the extent to which they were clothed and wrapped, and the factors that parents took into account in deciding the appropriate combination of room heating and coverings for sleeping babies during a cold British winter. Subjects and methodsInformation on a random sample of normal, full term, singleton babies was collected at birth, and permission obtained from parents for the body temperature to be monitored for one night during sleep between the ages of 3-4 months. At this time each child was visited at home, weighed, skin fold thickness measured, and information obtained on feeding pattern and the recent health of the baby. Three thermistor probes were securely attached to the baby: (a) at the centre of the forehead; (b) on the abdomen 3 cm to the left of the umbilicus; and (c) into the rectum 5 cm from the anal margin.
SUMMARY Rectal, skin, and ambient temperatures were continuously recorded overnight from 3-4 month old normal infants in their home cots under conditions of room temperature and wrapping chosen freely by parents. It was found that rectal temperature was above 37°C when infants were put down, but fell rapidly to 36-4°C within one and a half hours, then stabilised for a few hours before rising steadily. This pattern was tied more closely to the time of putting down than time of day. The extent and rate of temperature fall did not correlate with any feature of the thermal environment. We also found that skin temperature changed much less than rectal temperature over the night, and for the first two hours in the cot there was no relation between skin and rectal temperature. There is therefore a well organised, endogenous rhythm of temperature in 4 month old infants.At some time during the first year of life, infants develop rhythmical changes in certain body functions based on a 24 hour cycle,' whereby activities are at a peak during daytime wakefulness and decline during nightime with sleep.2 Body temperature, in line with other functions, tends to fall during the night and rise during the day to levels predetermined endogenously. 4 It is possible, however, that other factors in a home environment-for example, ambient temperature, quality of clothing, or infection-might influence body temperature to produce variation that might modify the normal circadian rhythm. Recently the findings of raised core temperature at necropsy in children who died suddenly have led to suggestions of fatal hyperpyrexia during sleep,6 although it is unlikely that postmortem findings accurately reflect the temperature state of live babies. We studied the pattern of core temperature during sleep in babies at the age of peak incidence of sudden deaths with relation to the home conditions that may significantly alter that pattern. Subjects and methodsInformation on a random sample of 98 normal, full term, singleton babies was collected at birth, and permission obtained from parents for the body temperature to be monitored for one night during sleep between the ages of 3-4 months. At this time each child was visited at home, weighed, skin fold thickness measured at the mid forearm region, and information obtained on feeding pattern and the recent health of the baby. Three thermistor probes were securely attached to the baby: (a) at the centre of the forehead; (b) on the abdomen 3 cm to the left of the umbilicus; and (c) into the rectum 5 cm from the anal margin. A fourth probe was fixed at the cot side to measure room temperature. All probes were connected to a battery powered Grant Squirrel Data Logger that was set to make recordings to the nearest 0 10C at one minute intervals throughout the night from 2200 to 0700. Each probe was secured with sticking plaster to ensure good contact during body movement or bowel actions. Before use the probes and data loggers were tested for accuracy, firstly by placing them in water at known temperatures, ...
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