MANAGING CHILDREN WITH CEREBRAL PALSY

Master O.K is an 11 months old infant who was brought to the clinic because the mother noticed the child cannot crawl or made attempt to stand. 

The infant’s history was taken, the examination was done and the infant’s condition was said to be fair.

She was asked to bring the husband the following day for full explanation of the child’s condition.

The following day i explained to the parents that the child was likely to have suffered some brain damage during child birth, a condition called Birth Asphyxia. 

The Infant now has Cerebral Palsy (CP). This means this child developmental milestones will be delayed that is, she will not be able to walk, talk, stand and probably hear on time.

Cerebral palsy (CP) is not a disease; it is not hereditary or contagious, it is a disability.
The disorder can be managed with proper therapies and medication, with the use of assistive technology that can maximise independence, reduce barriers and enhance quality life.

Parents of children with this special condition need adequate orientation and education so that they would know the health status of their children.

The first thing a family whose child was diagnosed with CP needs is counselling, information and education; without this, the family will be left groping in the dark.
Management of CP is not only intensive, it is expensive. CP is said to be one of  the most expensive congenital disorder to manage. It is difficult for a family to keep up.

I have approached Dr Gbemisola Boyede a Consultant Neurodevelopmental Paediatrician at the department of Paediatrics, Lagos University Teaching Hospital (LUTH) to give us a specialist overview to the subject.

Here is Dr Gbemisola,s overview: Cerebral palsy often abbreviated as CP is a group of disorders that affect a person’s ability to move and maintain balance and posture.

“Cerebral” means having to do with the brain. “Palsy” means weakness or problems with using the muscles.

The problem in CP is actually caused by abnormal brain development or damage to the developing brain (early childhood) that affects a person’s ability to control his or her muscles. The 7th October is World Cerebral Palsy Day. This is a day set aside to create awareness and support for the 17million people worldwide who live with cerebral palsy.

CP is the most common motor disability in childhood. The prevalence of CP is 2–3 per 1000 live births. It is especially much more common (100 per 1000 live births) in children who were born extremely premature.

CLINICAL FEATURES

Although the abnormality in the brain remains unchanged (non-progressive), the clinical picture of CP may change or be modified with age.

All people with CP have problems with movement and posture.  However, these are not the only problems with CP.

Many also have other conditions such as intellectual disability; seizures; problems with vision, hearing, or speech; changes in the spine (such as scoliosis); or joint problems (such as contractures).

The associated problems may even be more limiting to lifestyles than the posture or movement problems which primarily defined CP. 

The symptoms of CP vary from person to person. A person with severe CP might need to use special equipment to be able to walk, or might not be able to walk at all and might need lifelong care.

A person with mild CP, on the other hand, might walk a little awkwardly, but might not need any special help. CP does not get worse over time, though the exact symptoms can change over a person's lifetime.

CAUSES

Most of the time the cause of a child’s CP is not known, because it is difficult to tell exactly when the damage to the brain happened.

However common causes of CP in our own environment are delayed cry at birth (perinatal asphyxia) due to anything going wrong before and during delivery, prematurity (especially below 32 weeks and weight less than 1.5kg)

Other causes are severe neonatal jaundice (often requiring exchanged blood transfusions), infections in the brain (meningitis), bleeding in the brain, severe convulsions after birth and head injuries in very young children. 

Last week, a concise and brief explanation on cerebral palsy was made by a female colleague, Dr. Gbemisola Boyede.

She described cerebral palsy, often abbreviated as CP, as a group of disorders that affect a person’s ability to move and maintain balance and posture.
Boyede also said that the common causes of CP in our own environment are delayed cry at birth (asphyxia) due to anything going wrong before and during delivery, prematurity and jaundice in the new born.

SIGNS
The signs of CP vary greatly because there are many different types and levels of disability. The main sign that a child might have CP is a delay reaching motor or movement milestones (such as rolling over, sitting, standing, or walking).

Other early signs of possible CP in children younger than six months include head lag, stiffness of the body (sometimes the baby feels floppy) and overextension of the back and neck. Also, at times, the child’s legs get stiff and they cross or form a scissor.

In children older than six months, features suggestive of CP include: the child doesn’t roll over in either direction, he/she cannot bring her hands together.
He/she has difficulty bringing her hands to her mouth and he/she reaches out with only one hand while keeping the other fisted.

In infants older than 10 months, the child may crawl in a lopsided manner, pushing off with one hand and leg while dragging the opposite hand and leg. At times, most children with CP are not diagnosed until they are two years old when parents seek help because they are not walking.

Treatment
There is no cure for CP, but treatment can improve the lives of those who have the condition. It is important to begin a treatment programme as early as possible.
After a CP diagnosis is made, a team of health professionals works with the child and family to develop a plan to help the child reach his or her full potential.
Common treatments include medicines, surgery, braces, and physical, occupational, and speech therapies.
No single treatment is the best one for all children with CP. Most children get a combination of therapies.

Prevention
Prevention of CP is a major challenge because we do not always know why a child has it. Some strategies that can prevent some causes of CP include good and prompt antenatal care. This may help to reduce chances of preterm delivery by recognition and proper management of high risk pregnancies.
Supervised delivery by skilled healthcare workers and prompt management of complicated deliveries is another useful strategy.

Childhood Immunisation may prevent meningitis and CP due to brain infections.
Early detection and treatment of neonatal jaundice will also prevent CP due to brain damage from severe jaundice.
It is also important to avoid head injury in children by using car seats.
Where primary prevention is impossible early diagnosis and treatment will help to prevent more complications and allow the children to maximise their potential and live a good quality life.

Conclusion

In conclusion, CP is life-long. A child will always have CP and it will not go away. The earlier the diagnosis is made and therapies commenced, the better the outcome for the child.
If you observe any of the early signs mentioned in your child, please go to the hospital and see a paediatrician who is trained in managing children with developmental problems or a paediatric neurologist.
Although we cannot cure CP, all children have the potential to change
.
Dr Gbemisola Boyede is a consultant neurodevelopmental paediatrician at the Lagos University Teaching Hospital (LUTH). She can be reached via gbemmydevpaed@yahoo.com.

Proper management can help children to outgrow asthma

Asthma occurs when there is an obstruction of the airways that carry air to and from the lungs, or when there is a swelling or an inflammation of the airways and hyper-responsiveness.

Most of the time, it is noticed in very early childhood. Asthma is not just one particular disease condition; it is a range of conditions. Cases of asthma in children between ages two and six is commonest, while the least percentage one finds is between 12 and 16 years, when the majority of them would have outgrown it.

Those who still have asthma at that teenage age are likely to have it into adulthood. About 60 per cent of children with asthma are less than six years; the remaining 40 per cent will be in children between seven years and 16 years of age.

The child should be taken to the hospital for regular check up every three to six months. That would help to ensure that the child does not suffer many of the problems resulting from the disease.

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Asthma could affect the psychology and even growth of the child if not properly managed. But if managed and treated properly, the child could outgrow it. Again, the parents should comply with the prescription that accompanies drugs given by the doctor.

They should not wait until the child has the symptoms before they give the medications.

Causes

Hereditary factor is also important to know if a child is susceptible to asthma. For example, if there is a family history of it, that is, if someone in that family is asthmatic or has reactive conditions, such as particular allergies, it could lead to asthma or what is also called hyper-reactive airway disease.

The majority of children outgrow asthma later in their teenage years.

Industrial/air pollution triggers asthma. Also, the more developed a place is, the more likely they would have a higher rate of asthma cases. Cities like Lagos would be expected to have a high rate of asthma cases.

Effluents from cars and industries have also been associated with asthma. It also depends on other factors, including hereditary and the person’s predisposition to allergies and certain conditions.

Fumes from generators used in residential areas, or smoke from firewood have all been implicated as trigger factors.

Some people can actually have it without any hereditary link, but they are in the minority.

I will use the experience of one of my patients to narrate the shortage of asthma facilities in Nigeria.

Mrs. A.Y brought her six-year-old with symptoms and signs suggestive of asthma. She had been to two other hospitals where she was told that her son had asthma.

After I took her son’s medical history, family history of asthma and the complaints (symptoms) similar to asthma, I proceeded to examine the young boy.

He was very cooperative, I ordered some blood test for infections, blood count and allergy. They all came out negative, even the chest X-ray was normal.

I explained to her that her son would have a provisional diagnosis of childhood asthma. She requested a confirmation. I explained to her that the definite diagnosis of asthma would be on the result of a lung function test from a spirometer or a simple peak flow meter.

She was not pleased as she insisted on having the lung function test done. Unfortunately, after visiting other hospitals for the spirometry, she came back telling me that she was disappointed with the health care system in the country.

According to her, none of the five specialist hospitals, two children hospitals and one public teaching hospital she visited had a functioning spirometer.

A spirometer is an apparatus for measuring the volume of air inspired and expired by the lungs. A spirometer measures ventilation, the movement of air into and out of the lungs. It is used in diagnosing different types of abnormal ventilation patterns.

The test is very simple and it involves asking the patient to take in a big breath and then blow as hard and long as he or she can into a machine with a meter that reads the lung volumes.

Lack of this equipment has compromised the definite diagnosis of asthma in the nation’s hospitals. Government must look into it.

Back to Asthma.

Signs and symptoms

The child has difficulty in breathing or shortness of breath, cough, which is worse at night. It also depends on the degree of severity of the asthma. But the first signs are breathlessness and cough, pigeon chest – the chest may look bloated like that of a pigeon because of air congestion, the child is breathing air but cannot breathe it out.

Diagnosis

Most people who are said to be asthmatic are not. A diagnosis, which includes the lung function test, as well as spirometry, where the child is asked to take in a big breath and then blow as hard and long as he or she can into a machine, is used in making definitive diagnosis. It is especially in use for young children.

There is also the peak flow metre, used to measure how well air moves out.

There is also the six-minute walk test.

• To be continued

FAMILY PLANNING: MISCONCEPTIONS

Last Saturday, September 26, 2015 was 2015 world contraception day, not much was said in all the local media.

 I was scrolling through the pages of several newspapers to read about contraceptive news even the local TV stations to my amazement did not make a single reference to contraception on that day.

When pregnancy is unintended, or when it happens too early in life, the consequences are far-reaching. It affects the woman, her family and her entire community.

Contraception allows people to decide, plan and attain their desired number of children, as well as determine the spacing of pregnancies.

The benefits of contraception are many. A woman’s ability to choose if and when to become pregnant has a direct impact on her health and wellbeing.

 By reducing the number of unwanted pregnancies, family planning and contraception can help to reduce the number of unsafe abortions – a significant cause of death amongst women.

The acceptance to family planning (contraceptive) service is generally low and unacceptable in Nigeria despite several strategies that are designed to increase the levels of acceptance among the populace. 

As a certified family planning provider, some of the barriers to the acceptance of contraceptives methods by our clients are mainly due to myths and misconceptions. 

These myths and misconceptions about contraceptives are highlighted below with the right facts/ statements to correct the wrong impressions the public have about contraception:

 Contraceptives will make one gain weight excessively.

A 2009 study in the American Journal of Obstetrics and Gynecology found that women using the injectable contraceptive shot gained an average of 11 pounds about 5kg and increased their body fat by 3.4 percent over three years, though they're not sure what caused this effect.

 Evidence based medicine does not support the fact that all contraceptives cause weight gain in women. For women who are afraid of weight gain, they are encouraged to have regular exercise, taking healthy meals, vegetables, fruits, water etc to help check the expected weight gain 

You don't need to be on birth control if you're breastfeeding.

This very common myth is totally false and probably to blame for many unplanned pregnancies. Breastfeeding exclusively (without supplementing with formula) can suppress the hormones from the pituitary gland that makes one ovulate thereby decreasing the fertility at this time.One can get pregnant if having unprotected sex. 

 Using a contraceptive for a long time will make it harder to get pregnant later.

For most contraceptives it is possible to get pregnant as soon as one stop taking/using them. This holds true for all methods of hormonal contraceptives (like the daily oral pill and implant) with the exception of the injectable contraceptive. 

For the injectable contraceptive it can take up to 6-9 months for all of the hormones in the injection to leave the body before fertility is restored. However, it's still possible to get pregnant during this time.

Once the family planning method is stopped, the fertility returns and the woman will be pregnant again.

Your body needs a break from birth control

The only reason for one to take a vacation from contraceptives is if planning to get pregnant. Other than that, you can stay on your chosen method of birth control for as long as you want.

 Birth control pills cause cancer.

There is no evidence to support the claim that hormonal contraceptives cause breast, cervical, or any other kind of cancer. In fact, studies show that women who use hormonal contraception have a lower risk of ovarian and uterine cancer.

Injectable change my mood or sex drive

Some women using the injectable report these complaints. This is not true, The great majority of injectable users do not report any such changes. Some women report that both their mood and sex drive improve because they are protected against an unwanted pregnancy.

Birth control pills cause high blood pressure

Birth control pills may increase blood pressure in some women. It's more likely to occur if the person is overweight, have had high blood pressure during pregnancy, have a family history of high blood pressure or have mild kidney disease.

The combination of birth control pills, obesity and cigarette use may be especially dangerous for women.

Make sure your doctor measures and records your blood pressure before prescribing the pill and have your blood pressure checked every month or 2 monthly.

 

Candidiasis is not the same as ‘toilet disease’

In my last piece, I talked about the feedback I received from a female reader who said she has been having whitish vaginal discharge since 2010, which she said comes and goes after undergoing different types of treatment.

She made two requests, the first being a request for a drug prescription; while the second was a request to send her a reply through the e-mail platform.

The first request was turned down because prescription by proxy is against the ethics of the medical profession.

A young lady who has similar symptoms with the scenario described above came for a consultation, with the history of whitish vaginal discharge. The following conversations took place during the consultation:

Doctor: Good day, how may I help you?

Patient: I have TD

Doctor: TD? What is TD?

Patient: TD means toilet disease.

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Doctor: What is toilet disease?

Patient: Toilet disease is infection, itching, whitish vagina discharge; these are the symptoms I am having.

Doctor: These are symptoms of candidiasis and are not likely gotten from the toilet.

Just the way this young lady thought she has toilet disease, a lot of women out there also believe that the vagina discharges they sometimes experience is associated with toilet use.

Women have a wrong notion that when they have vaginal discharge or itching, it is acquired from the toilet. This is not a true statement.

However, conditions that lead to these symptoms are, most times, not contacted by using dirty toilets but rather are either sexually transmitted or through poor hygiene or transmitted through fomites or through intimate contact with the clothing of people who have such conditions.

People, especially women, do not have to worry about contracting sexually-transmitted diseases such as herpes, gonorrhoea, syphilis and HIV through dirty toilet seats.

This is because these diseases are spread via unprotected skin-to-skin sexual contact. Most of the viruses or bacteria that cause them die very quickly outside the body; so it is very unlikely that they can be transmitted through a dirty toilet seat.

Yeast infection (candidiasis) is a common problem in women and some men. It can be seen in the vagina, vulva, mouth and on the skin, especially in moist areas. It can be present in the body for a long time without any obvious symptoms.

Yeast infection (candidiasis) can also be sexually transmitted. Men tend to be sometimes free of symptoms but should be treated, especially if the condition is recurrent.

Vaginal thrush, also known as vaginal yeast infection, is an inflammation caused by a type of yeast called Candida albicans.

Vaginal thrush is very common and about three in four women will have at least one episode of thrush at some point during their life.

Vaginal thrush can keep coming back. Having thrush symptoms more than four times in a year is known as recurrent infection.

Causes

Vaginal thrush is caused by an increase in the amount of Candida albicans in the vagina.

There are several conditions which make vaginal thrush more likely, including a weak immune system and poor nutrition.

Hormonal changes (for example, pregnancy), oral contraceptives, medication side effects, especially antibiotics and steroids, are also causative factors.

Medical conditions such as diabetes, human immunodeficiency virus infection (HIV), immune suppression, some cancers and their treatment, wearing tight-fitting clothes, synthetic underwears, etc., are all possible reasons why people develop candidiasis.

Signs and symptoms

Some people may not have any symptoms, so they may not even realise that they have vaginal thrush. However, possible symptoms can include vaginal itch, which is often worse at night; soreness, discomfort and irritation, thick and white vaginal discharge.

They may also experience pain during sex or while passing urine, vaginal discharge, redness and/or swelling of the vagina or vulva, stinging or burning when passing urine, cracked skin, and swelling.

The symptoms can be confused with bacterial vaginosis or trichomonas infection, genital herpes or urinary tract infection.

Bacterial vaginosis causes a greyish, frothy white discharge but also causes fishy odour; while trichomonas vaginalis causes greenish frothy discharge.

All three infections cause vaginal and vulval itching and soreness and are often misdiagnosed.

Case study

Miss Yetunde is a fresh graduate who was diagnosed with candidiasis. She went for vagina swab culture in the laboratory on her own. The result came out to be heavy growth of yeast, confirming the diagnosis of candida albican.

She was placed on both pessaries and oral antifungal for the candida. Today, the story is different, as she feels very okay and well.

Diagnosis

Candidiasis is the commonest cause of vulvovaginitis and can be confirmed by microscopic examination and growth of yeast from a swab from the vagina.

The importance of having a vaginal swab taken before starting any treatment needs to be particularly emphasised to the patient because laboratory confirmation of each suspected infection is an integral part of the management.

Women should be advised to have a vaginal swab taken whenever they suspect a recurrence.

A glucose test and an HIV test should also be done in cases of recurrent yeast infections.

Treatment

Specific treatment for candidiasis involves inserting an antifungal pessary into the vagina when the patient is symptomatic.

A pessary is a small tablet that’s inserted into the vagina. Many preparations are effective in the treatment of candidiasis. A vaginal imidazole, inserted nightly for one week, is recommended as the standard treatment for candidal vulvovaginitis.

The use of an oral form of treatment, combined with vaginal pessaries and a cream for external itching, will definitely help to reduce recurrence.

Patients with recurring infections may need long-term prophylaxis with an oral antifungal drug. The diagnosis must be reviewed if patients do not respond to treatment.

Patients with frequently recurring thrush should seek medical advice to make sure they do not have a medical condition such as diabetes, HIV or immunosupression.

Some women are placed on long-term vaginal and oral antifungal treatment. This therapy may be continued for six months in the more troublesome cases.

Pregnant women who have had more than one proven infection during their pregnancy will also benefit from vaginal antifungal pessaries.

Male sexual partners of women with thrush do not require treatment, except very occasionally when a woman has recurrent infections or when the male has a rash or a sore penis.

Complications of vaginal thrush

Persistent thrush infection may be difficult to control and requires repeated treatments. Recurrent infections can cause discomfort and affect sex life. Women affected may feel down or anxious because of this.

Prevention

The following tips may help to reduce the risk of vaginal thrush:

• Wearing of cotton underwear and loose-fitting clothing.
• Avoidance of contributing factors (e.g., douching, wearing tight pants, using perfumed soap or bath cream).
• Avoid use of products that irritate the vulv area, including antiseptics or disinfectants, as these may disturb the natural protective acidity of the vagina.
• Women should always wipe from front to back after using the toilet, to avoid spreading yeast from the anus to the vagina.
• Women should practise hanging of their underwear in the sun to help in the reduction of persistent yeast infections when convenient and appropriate.

Computer Vision Syndrome.

A 19-year-old secondary school leaver who was employed as computer operator in one of the business centres in Lagos was rushed to the hospital on a particular evening.

It was a hectic day for him, as there were lots of clients who had come to do registration for examinations on computer on that day, and the young boy was looking forward to closing about 6pm.

At about 5pm, he started blinking with blurred vision and could not concentrate; he came in fatigued. The boy was assessed and examined. He was told that he had typhoid fever and was placed on treatment. After about two days, all the symptoms still persisted till about 2pm.

He came back to the same hospital where he was reviewed by a senior doctor who diagnosed him of Computer Vision Syndrome.

Is your vision blurred? Are you squinting at the computer screen? Does your head hurt? After a full day’s work, do you feel exhausted? Is it work-related stress or changes to your vision, or something else?

If these symptoms sound familiar, you could be experiencing computer vision syndrome — a common but temporary condition experienced by many people who work on computers for long period of time.

Computers, tablets, e-readers, smart phones and other electronic devices with visual displays all can cause tired eyes, digital eye strain and computer vision syndrome.

Many individuals experience eye discomfort and vision problems when viewing digital screens for extended periods. The level of discomfort appears to increase with the amount of digital screen use.

Symptoms

Symptoms of CVS include eye strain, headaches, blurred vision, dry eyes, neck and shoulder pain, and redness in the eyes, irritated eyes, double vision, dizziness/vertigo and difficulty refocusing the eyes.

Many of the visual symptoms experienced by users are only temporary and will decline after stopping computer work or use of the digital device. However, some individuals may experience continued reduced visual abilities, such as blurred distance vision, even after stopping work at a computer.

Prevention

Some important factors in preventing or reducing the symptoms of CVS have to do with the computer and how it is used. This includes lighting conditions, chair comfort, location of reference materials, position of the monitor, and the use of rest breaks.

Location of computer screen: Most people find it more comfortable to view a computer when the eyes are looking downward. Optimally, the computer screen should be 15 to 20 degrees below eye level (about four or five inches) as measured from the centre of the screen; and 20 to 28 inches from the eyes. Adjust the contrast setting on monitors and screens to the best effect.

Seating position: Chairs should be comfortably padded and conform to the body. Chair height should be adjusted so that your feet rest flat on the floor. If your chair has arms, they should be adjusted to provide arm support while you are typing. Your wrists shouldn’t rest on the keyboard when typing.

Reference materials: These materials should be located above the keyboard and below the monitor. If this is not possible, a document holder can be used beside the monitor. The goal is to position the documents so you do not need to move your head to look from the document to the screen.

Lighting: Position the computer screen to avoid glare, particularly from overhead lighting or windows. Use blinds or drapes on windows and replace the light bulbs in desk lamps with bulbs of lower wattage. Use full spectrum fluorescent bulbs.

Anti-glare screens: If there is no way to minimise the glare from light sources, consider using a screen glare filter. These filters decrease the amount of light reflected from the screen.

Frequent breaks: Taking frequent breaks while at work helps in reducing the risk of fatigue caused by computer vision syndrome. Every 20-30 minutes that one spends at the system, a 20-30 second break is all that is required.

A routinely recommended approach is to consciously blink the eyes periodically (this helps replenish the tear film) and to look out the window to a distant object or to the sky.

Comprehensive eye examination: A regular eye examination with an optometrist or ophthalmologist is a must for anyone who spends long working hours at the computer. In some cases, glasses, depending on the person’s refractive status, will be generally prescribed, especially for intermediate vision with an anti-reflective coating to minimise the glare emanating from the computer screen.

 

Sudden infant death syndrome

A patient of mine, an undergraduate, came for consultation. A pregnancy test was done and the result came out positive. I had congratulated her, but to my surprise, she was moody.

The following conversation then ensued between us:

Doctor: Congrats, you have started another journey of nine months.

Patient: Thank you.

Doctor: how many kids do you have and how are they doing?

Patient: I have two kids (then she started crying)

Doctor: (After giving her about five minutes to express her feelings) It is well, this must be a cry of joy!

Patient: Doctor, I lost one of my kids two months ago.

Doctor: What happened to him? How old is he?

Patient: He was 11 months old. He slept well overnight, and in the morning, I bathed him and later attempted to feed him. Then I noticed that the child was stiff and was not moving anymore.

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Doctor: Sorry about that. Didn’t you rush him to a hospital?

Patient: I did. I got to the nearby hospital within 10 minutes, and the doctor said the baby was not breathing and that I should take him to the general hospital. At the general hospital, the doctors certified him dead.

Doctor: Did they do post-mortem? If yes, what was the finding?

Patient: No. They wrote cardiovascular failure in the death certificate.

Doctor: This is called sudden infant death syndrome, something went wrong.

Sudden infant death syndrome is the sudden, unexpected and unexplained death of an apparently healthy baby. No cause for the death can be found.

Sudden infant death syndrome, SID, also known as cot death, is a diagnosis that’s made when an apparently healthy baby dies without warning, and for no clear reason.

When a baby dies suddenly, doctors and investigators try to find out why. This includes a post-mortem examination, seeing where the baby died, and a review of the baby’s medical notes.

The cause of the death may be diagnosed as suffocation, asphyxia, entrapment, infection, ingestions, metabolic diseases, cardiac arrhythmias, trauma (accidental or non-accidental). All these are termed sudden unexpected death in infancy, SUDI.

SIDS is not very common, but it is still the most common cause of death in newborns.

Causes

No one knows why some babies die this way. It may just be a combination of factors that affect a baby at a vulnerable stage in his development. Some babies may have a problem with the part of the brain that controls breathing and waking.

Such babies don’t respond if their breathing is slightly restricted, such as if there are bedclothes covering their nose or mouth.

Factors which put a baby at a higher risk of SIDS include premature birth (before 37 weeks) and low birth weight of less than 2.5kg.

Most unexpected deaths occur while the child is asleep in his cot at night. However, SIDS can also occur when a baby is asleep during the day or, occasionally, while they are awake.

At about five months or six months, babies start to roll. At this age, the risk of cot death reduces and it’s safe to let the baby find his/her own comfortable sleeping position.

How to prevent SID

By removing known risk factors and providing a safe sleeping environment, most of these deaths are preventable.

• Don’t smoke when you are pregnant or after your baby is born, and do not let anyone else smoke in the same room as your baby. Smoking during pregnancy increases baby’s risk. The airway of infants is small; so, smoking near infants increases Sudden Infant Death Syndrome. People should not smoke in the presence of infants, as it puts them at risk of SIDS.
• Place your child on his back to sleep. The safest place for babies to sleep is in a cot in a room with you for the first six months. Infants younger than one year of age should be put to sleep on their backs in order to decrease the risk of SIDS. Statistics show that placing infants on their backs when sleeping opens their small airways better and they can breathe better while sleeping. It’s not as safe for babies to sleep on their sides as on their backs. Healthy babies placed on their backs are not more likely to choke. When the baby is old enough to roll over, don’t prevent them from doing so.
• Do not share a bed with your baby, particularly if you have been drinking alcohol or taking drugs. Never sleep with your baby on a sofa or on an armchair.
• Do help them burp to digest milk/formula, so that they won’t run the risk of spitting up and inhaling formula/milk when they are sleeping.
• Do not let your baby get too hot. Feel your baby’s tummy or neck to see if he/she is getting too hot or too cold and adjust the bedding accordingly. Remove your baby’s cap and any extra layers of clothing as soon as you come indoors after being outside, even if it means waking her up.
• Seek medical advice if your baby is unwell. For the first six months, try to have your baby in the same room as you when she takes her naps.

Take your baby for regular check-ups, do exclusive breastfeeding and keep immunizations up to date. It helps.