Cot death - what every parent needs to know
The Richardson Report  into cot death elegantly explains all the facts of the cot death epidemic. This is something all parents with babies need to know about.
The idea is straightforward. All mattresses are impregnated with fire retardants, antimony and phosphorus, often with arsenic as a contaminant. When a baby lies on a mattress, inevitably secretions fall into the mattress through posseting, saliva, nasal secretions or vomit. This allows the growth of the fungus, scopulariopsis brevicaulis. This fungus feeds on human secretions and is normally present in all bedding materials which are rich in secretions. However, this fungus attacks fire retardants in such a way as to release poisonous gases; namely phosphine, stibine and arsine. These gases are heavier than air so they concentrate in the mattress. Babies may be much more susceptible to these poisons than adults. The early symptoms of poisoning are headache and irritability. They may cause death, possibly through respiratory depression or heart failure, because they act as cholinesterase inhibitors, in the same way as organophoshates. These are the same chemicals as those used in germ warfare and in pesticides (their effects are probably similar to nerve gases used in chemical warfare).
Cot death explained
This hypothesis explains the facts of cot death:
- Cot death is unknown in Japan where boron is used as a fire retardant. However, when the Japanese come to live in the West on our bedding materials, they experience the same incidence of cot death.
- It occurs more often during a mild illness when a baby has a temperature. An increase in a baby's body temperature from 37 degrees (normal) to 42 degrees causes a 20 fold increase in poison gas production.
- It occurs more in winter when parents overwrap their babies and turn the central heating on. Many deaths occur in the early morning when the central heating turns on automatically. Indeed, the incidence of cot deaths exactly parallels heating bills.
- It is more common in boys because their metabolic rate is 15% higher than girls so they are more likely to overheat.
- It is uncommon in first born babies on new mattresses because the fungus has not had time to establish itself in the mattress. Subsequent children are less likely to have a new mattress and second-hand mattresses will already be inoculated with the fungus. Deaths in babies under one month have always been on mattresses previously used by other children. There is a high incidence of cot death in Service families who are provided with mattresses (which will already have been infected with scopulariopsis brevicaulis) in their houses.
- Babies who lie on their tummies inhale gases directly from the mattress. Cot death is less common in babies over 5 months because by this time they are strong enough to lift their heads off the mattress or rollover and avoid inhaling the poison gases.
- Babies dying of cot death have abnormally high levels of antimony in their blood (from stibine gas).
- The high incidence of cot death in Aborigine babies is due to their use of sheepskins for babies to sleep on. There are high levels of arsenic in sheep wool (arsenic levels are high in the soil and it is excreted in the wool) - this is broken down by the fungus to produce arsine gas which kills the babies.
- Cot death is more common in low birth weight or otherwise disadvantaged babies probably because they are more susceptible to poisoning.
As a result of this report specific recommendations have been made:
- All mattresses should be covered with polythene to prevent release of poisonous gases. They should be washed regularly or replaced. (My personal advice would be to also use a folded cotton sheet which could be washed regularly to clear out secretions and get rid of the fungus. Best of all would be a Japanese futon/mattress that uses Boron as a fire retardant)."Vented mattresses" are particularly bad because they allow large accumulations of posset, vomit, nasal secretions, saliva etc. to accumulate in the mattress and encourage heavy growth of the fungus.
- Babies should not be overwrapped (I recommend in particular the head should never be covered as this is a vital cooling device.) A window should be left open in the bedroom and central heating at a minimum level.
- Babies should be laid on their backs, not on their tummies. This advice of course explains the success of the "Back to Sleep" campaign! It has been estimated that this advice alone has saved the lives of 15,000 babies between 1991 and 2014.
I now hear (to be confirmed) that phosporous, arsenic and antimony compounds are no longer used as fire retardants in mattresses. However it is likely they have been replaced by poly brominated biphenyls (PBBs). These are also toxic compounds - they may or may not contribute to cot death, but they are extermely toxic in their own right and no baby should be exposed to them. One should also be aware that sheepskins may come from sheep that have been dipped and those dipping chemicals, which may include organophosphates, may still be present in the wool.
I think the above advice for mattress for babies holds good - ie choose a natural organic material that can be regularly washed, such as organic cotton or organic wool for all the baby's bedclothes.
- Richardson, B A, "Sudden Infant Death Syndrome: a possible primary cause", Journal of the Forensic Science Society 1994;34(3):199-204
- See Paper Abstract
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