THE SUBSEQUENT CHILD
Part 3

Any and all of these symptoms are common. Don't consider them as a cause for extra alarm but as information that your doctor can use in caring for your child.

If you panic once or twice and call the doctor unnecessarily, you will not be the first parent who has done it. Remember that while you may not view the common cold as common, other people do use some judgment, and don't insist on house calls and frequent office visits just to make yourself feel better. This is one of those times when trust, and security in your ability to make decisions, is most important.

SOME FREQUENTLY ASKED QUESTIONS

Can SIDS Be Prevented?
No, not yet. But, some recent studies have begun to isolate several risk factors which, though not causes of SIDS in and of themselves, may play a role in some cases. We share the following information with you in the interest of providing parents with the latest medical evidence from research in the U.S. and other countries in the hope of giving your baby the best possible chance to thrive. (It is important that, since the causes of SIDS remain unknown, SIDS parents refrain from concluding that their child care practices may have caused their baby's death)

Place your baby on the back to sleep.
The American Academy of Pediatrics recommends that healthy, full term infants sleep on their backs or sides to reduce the risk for SIDS. This is considered to be primarily important during the first six months of age, when a baby's risk of SIDS is greatest. It does not apply to certain infants with breathing problems or infants with excessive spitting up after feeding. Parents should discuss this recommendation with their baby's doctor.

Stop smoking around the baby.
Sudden Infant Death Syndrome has long been associated with women who smoke during pregnancy. A recent study by the National Center for Health Statistics demonstrates that women who quit smoking but then resume smoking after delivery put their babies at risk for SIDS, too. Findings from the survey show that babies exposed to smoke only after birth were twice as likely to die from SIDS as those whose mothers did not smoke at all. And, constant smoke exposure both during and after pregnancy tripled a baby's risk for SIDS.

Use firm bedding materials.
In response to recent research, the U.S. Consumer Product Safety Commission has issued a series of advisories for parents on the hazards posed to infants sleeping on beanbag cushions, sheepskins, foam pads, foam sofa cushions, synthetic filled adult pillows and foam pads covered with comforters. Waterbeds should also be avoided. Parents are advised to use a firm, flat mattress in a safety approved crib for their baby's sleep.

Avoid overheating, especially when your baby is ill.
SIDS has been associated with the presence of colds and infections, although colds are not more common among babies who die of SIDS than babies in general. Now, research findings indicate that overheating - too much clothing, too heavy bedding, and too warm a room - may greatly increase the risk of SIDS for a baby with a cold or infection. Signs that your baby may be overheated include sweating, damp hair, heat rash, rapid breathing, restlessness, and sometimes fever. To help your baby regulate his or her temperature, some pediatricians recommend maintaining consistent indoor temperatures of 68 to 70 degrees Fahrenheit; and dressing your baby in as much or as little as you would wear.

If possible, breastfeed your baby.
Studies by the National Institute of Child Health and Human Development (NICHD) show that babies who died of SIDS were less likely to be breastfed. Potential advantages to breastfeeding your baby include prevention of gastrointestinal and respiratory illness, infections and certain immunologic disorders.

Other important factors.
Statistics tell us that seasonality (i.e. the cold weather months), maternal age (i.e. the younger the mother, the greater the risk), and baby's sex (i.e. boys are at higher risk than girls) are among the factors which must be considered. Baby's age is another risk factor. SIDS occurs most frequently in infants two to four months old; nearly 90% of the babies who die of SIDS are under six months of age. We also know that there is a higher incidence of SIDS for premature and low-birthweight infants, twins and triplets.

Maintaining good prenatal care and constant communication with your baby's doctor about changes in your baby's behavior and health are of the utmost importance.

What is Meant by Risk Factors?
Risk factors by themselves do not cause Sudden Infant Death Syndrome, but can have a negative effect on infant well-being. In fact, as many as two thirds of SIDS victims have no known risk factors, and, most babies with one or more of these risk factors will not become SIDS victims.

Therefore, while doctors are hopeful that following the recommendations we have described may reduce the risk of SIDS, we must understand that following the recommendations faithfully will still not prevent all SIDS deaths. Research must continue if we are to discover how and why SIDS occurs, and expand upon these and other risk factors.

What about the relationship of SIDS to where we live?
This question comes up often, although most parents are not in an economic position to think about moving. The incidence of SIDS seem to be uniform throughout the world, and moving probably will not change anything. Evidence linking SIDS to pollution and nuclear reactors has proven only that such information can make headlines in newspapers. The death rate appears to be the same as it was a hundred years ago. If you live in the heart of a large city, the incidence may be higher, but not enough to merit your moving. Babies have succumbed to SIDS on farms as well as in the city, so moving seems an unnecessary precaution to take for your next child.

What about laboratory tests for the newborn?
Very simple, there are none, or at least none that would indicate whether an infant night be a potential victim of SIDS. Subjecting a newborn to extra unnecessary tests will not prove anything. It is also expensive. Don't insist that your physician do them.

Occasionally a doctor might request additional tests for other medical reasons. However, if your doctor indicates that he only wishes to assure you that this baby will be healthy, you must decide what you want to do. It is possible to have your physician talk to any of a number of people involved in research in this area should any problem or question arise.

What about monitoring equipment?
Monitoring equipment for newborns was developed to be used in hospitals with infants who are born with specific difficulties or in the conduct of research. Such equipment should be supervised by trained technicians and medical personnel. Advertisements sometimes appear suggesting that monitoring babies will prevent SIDS. These statements are still unproved. On the advice of their physicians, some parents have utilized monitoring equipment under special circumstances. While this will not necessarily protect your child, such participation is a matter of personal choice.

Keeping the baby out of large crowds during periods of colds and viral diseases is a good idea, but is not always possible. Neither the baby nor you can be totally isolated from any of these things. Using the common sense that most parents have, seeking good prenatal care, and finding faith in yourself and your decisions represent the only helpful measures presently available.

What about thoughts of death?
It is not unusual for parents to find themselves watching their sleeping child and envisioning how they Are going to react if they should find this child dead, too. There can be a strong inclination to think about this new baby in a negative sense, as if thinking negatively will some somehow insure that the baby will live. There is no simple remedy for changing this feeling, but most parents have expressed great relief in discovering that others have had these same thoughts. When it is recognized that such thoughts are merely a mental way of working out your feelings, they tend to diminish.

SOME PRACTICAL GUIDELINES FOR PARENTS

Many parents have weathered the crises, panic, and great joy of the subsequent child's infancy. They acknowledge that it was not always easy and that they had to work at handling their emotions. The effort was rewarded by one of the most wonderful periods in their lives.

Their guidelines are simple:

For lack of a better term, you next child has been called the "subsequent child." This new child is indeed a very special one, to you and to everyone else. The birth of a baby represents hope, and a promise that all life will continue. Joy and sorrow are memories in your life that enable you to know the importance of hope.