How much wrapping do babies need at night?

Wigfield, R; Fleming, Peter; Azaz, Y; Howell, Tia; Jacobs, D. Ε.; Nadin, Pam; McCabe, Rosie; Stewart, Audrey

doi:10.1136/adc.69.2.181

Cited by 41 publications

(39 citation statements)

References 15 publications

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“…It has been assumed that the position at 4 weeks will be similar to that for the first 6 months of the child's life. The validity of this was shown in a separate study of 152 randomly selected children in Avon 8,13 which showed a slight decrease in prevalence of side sleeping between 1 and 3 months of age, with a corresponding rise in both supine and prone sleeping, but little change between 3 and 5 months of age.…”

Section: Methodsmentioning

confidence: 99%

“…As noted above, in a separate study of child care practices in a group of 152 Avon families randomly selected from the birth register in 1990 to 1991, no significant changes in routine sleeping position for infants were identified between 1 and 5 months of age, suggesting that the sleeping position at 4 weeks was a good proxy for usual practice throughout the first 6 months. 8,13 There are also the questions that must always arise in any study concerning the representative nature of the sample under scrutiny. The ALSPAC study achieved a high response rate, and covered over 85% of the eligible population.…”

Section: Discussionmentioning

confidence: 99%

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Does the Supine Sleeping Position Have Any Adverse Effects on the Child?: I. Health in the First Six Months

1997

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ABSTRACT. Objective. To assess whether the recommendations that infants sleep supine could have adverse health consequences.Design. A prospective study of infants, delivered before, during, and after the Back to Sleep Campaign in the United Kingdom (UK), followed to 6 months of age. The children were part of the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC).Subjects. Singletons born to mothers resident in the three former Bristol-based health districts of Avon in the period June 1991 to December 1992, and for whom questionnaires were completed on sleeping position at 4 to 6 weeks of age (n ‫؍‬ 9777); for these infants 8524 questionnaires were also completed at 6 to 8 months of age.Main Outcome Measures. Subjective measures of health, the presence of specific signs and symptoms, duration of sleep at night, and calling the family doctor to the home.Results. Of 43 outcomes considered, after adjustment for 12 factors using logistic regression only 2 were associated with raised risk among infants put to sleep on their back (diaper rash and cradle cap). Infants put to sleep prone had increased risk of a number of health outcomes, including cough and possibly pyrexia.Conclusions. There is no evidence that putting infants to sleep in the supine position results in increased morbidity, although changes in prevalence of rare disorders would not have been identified. Pediatrics 1997; 100(1). URL: http://www.pediatrics.org/cgi/content/full/ 100/1/e11; sleeping position, infant morbidity, health.

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Section: Methodsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does the Supine Sleeping Position Have Any Adverse Effects on the Child?: I. Health in the First Six Months

1997

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“…Figure 1 shows the relation between the effective environmental temperature and the total thermal resistance of the bedding and clothing chosen by the parents (corrected for the proportion of surface area covered, as described previously) for the daytime sleep recordings.' 11 4 In the infants aged less than 3 months this decrease was less consistent and rarely more than 0 4°C, whereas for older infants the decrease was consistent and usually greater than 0 6°C. Figure 3 shows these changes with age for typical infants aged 30 and 184 days.…”

mentioning

confidence: 93%

Thermal balance and metabolic rate during upper respiratory tract infection in infants.

Fleming

Howell

Clements

et al. 1994

Archives of Disease in Childhood

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Sequential recordings were made in the first five months after birth of metabolic rate, environmental temperature, and body temperature during sleep at home in 17 infants, each with an older sibling. Further recordings were made whenever an older sibling developed an upper respiratory tract infection (URTI), again four to six days later, and again two weeks later, aiming to achieve recordings before, during, and after an URTI in the infant. The temperature of the room and wrapping of the infant were determined according to their usual practice by the parents.Parents added appropriate wrapping to achieve thermal neutrality based on our calculated values and the measured oxygen consumption.In five of the six infants who developed an URTI in the first three months after birth there was no change or a decrease in metabolic rate at the time of the infection; for infants older than 3 months the metabolic rate increased in three of the five episodes recorded. Peripheral skin temperature decreased at the time of URTI at all ages, though in the older infants it usually increased in parallel with rectal temperature during the latter part of the night, when pyrexia was most common.Infants thus respond to URTI by heat conservation. In the younger infants the lower metabolic rate and the further decrease in this rate with URTI means that fever is rare, and their temperature may decrease on infection. In the older infants the increase in metabolic rate (from an already higher baseline) may result in fever. These differences may contribute to the increased vulnerability of the older infants to heat stress, particularly at the time of acute viral infections. (Arch Dis Child 1994; 70: 187-191) Thermal stress has been shown to be associated with an increased risk of sudden infant death syndrome (SIDS) in a number of anecdotal reports and in two case-control studies.' 2 Although the mechanism of such an association remains unclear, the reported effects of the thermal environment on respiratory pattern suggest that, at least in some subjects, the mechanism may involve an interaction between thermoregulation and respiratory control.3 In this context the head, as the site of about 40% of heat production and up to 85% of heat loss for the infant in bed, may be particularly vulnerable to the effects of thermal stress.4 In two studies an excess incidence of head covering was found in infants who died from SIDS compared with matched controls,5 6 and in animal studies relatively small changes in brain temperature have been shown to have potentially major effects on the control of respiration.7 Thus factors which increase the resting metabolic rate might have a significant influence on respiratory control both by a 'feed forward' effect of increased carbon dioxide production (which may directly affect respiratory drive) and by an effect on cerebral temperature, particularly under conditions (for example a prone sleeping position, head covering) in which the ability to lose heat from the head might be compromised.3 6 7The change...

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“…A light clothing (2.5 tog) 16 was chosen to ease the nursing of the infant and the supervision of the sensors, and the room temperature was kept at 23°C (Ϯ.5°C) to obtain an environmental temperature close to the corresponding thermoneutral range. 17 The duvet covered the lower part of the body (up to midthorax).…”

Section: Study Conditionsmentioning

confidence: 99%

Consequences of Getting the Head Covered During Sleep in Infancy

Skadberg

Markestad

1997

Pediatrics

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ABSTRACT. Objective. To study the consequences of getting the head covered by bedding (fiber quilt) on carbon dioxide (CO 2 ) accumulation around the face, behavior, and physiologic responses during prone and supine sleep in infants to add understanding to why victims of sudden infant death syndrome are often found under the bedding.Methodology. Of 33 healthy term, usually nonprone sleeping infants, behavior and computerized polysomnography were successfully recorded for 30 during prone and supine sleep at 2 1 ⁄2 months and for 23 prone and 25 supine at 5 months.Results. For both ages and body positions, covering the head resulted in significant CO 2 accumulation around the face, fewer apneas (3 to 10 seconds), shorter duration of apneas after sighs, higher heart and respiratory rates, and peripheral skin temperature. Differences were generally greater at 2 1 ⁄2 than at 5 months. While covered, the prone position was associated with higher CO 2 levels close to the face, slightly higher transcutaneous PCO 2 , and higher heart rates and peripheral skin temperatures than the supine position. In the supine position 23% were able to remove the cover from the head at 2 1 ⁄2 and 60% at 5 months, whereas only 1 infant of 5 months managed to remove the cover when prone.Conclusions. The observed responses are consistent with a potential for distress when the head is covered, particularly when placed prone. Probably most important with respect to sudden infant death syndrome is the infants' inability to remove the bedding from the head upon awakening from prone sleep. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/cgi/content/ full/100/2/e6; behavior, CO 2 rebreathing, hyperthermia, SIDS, sleeping position. 3 Although the concentration of carbon dioxide (CO 2 ) in the atmosphere is .03% to .04%, the exhaled air of infants contains 4% to 5% CO 2 , 4 and it has been speculated that under certain conditions, such as sleeping face down on soft bedding, extensive CO 2 accumulation around the infant's face may result in rebreathing, asphyxia, and suffocation. 3,5,6 The possibility of CO 2 rebreathing has mainly been studied in experimental in vitro and animal models, 3,5-10 whereas studies in infants are limited. 11-13We have previously shown that a significant number of SIDS victims are found with their head covered by bedding and usually in the prone position.14 The purpose of the present investigation was to study the effect of getting the head covered by bedding on CO 2 accumulation around the face, behavior, and physiologic responses in sleeping infants, and to compare outcome measures for the prone and supine sleeping positions. SUBJECTS AND METHODS SubjectsThirty-three infants (17 girls and 16 boys) were recruited for an overnight sleep study both at 2 1 ⁄2 (mean, 74 days; range, 71 to 79 days) and 5 (mean, 152 days; range, 147 to 158 days) months of age. The ages were chosen to correspond with the age of highest risk for SIDS (2 1 ⁄2 months) and a period of significantly lower risk (5 months) in Norway. 15 Only t...

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How much wrapping do babies need at night?

Cited by 41 publications

References 15 publications

Does the Supine Sleeping Position Have Any Adverse Effects on the Child?: I. Health in the First Six Months

Does the Supine Sleeping Position Have Any Adverse Effects on the Child?: I. Health in the First Six Months

Thermal balance and metabolic rate during upper respiratory tract infection in infants.

Consequences of Getting the Head Covered During Sleep in Infancy

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