Baby’s Milk, Breast, Formula, Cow’s or A2
Feeding your baby is one of the most important and complex things you will do. It seems like such a simple thing – babies just drink milk don’t they? But that can be where any simplicity ends! There is no one form of ‘milk’. Here is a list of the types and forms of milk that you need to be familiar with:
- Breast milk
- Formula
- Step or stage one
- Step or stage two
- Step or stage three / Toddler milk
- Cow’s milk
- Full cream
- Low/reduced/no fat
- A2 milk
Whether you breast or bottle feed your baby, there comes a time when the type and amount of milk will need to change to take account of their growing needs. This article should give you the confidence and direction to move from milk only (whether that be breast, bottle or both) to cow’s milk. It will also assist those for whom cow’s milk is not an option due to allergy or intolerance.
Breast Milk
All experts agree that breastfeeding is the best and most natural way to feed your baby. Here’s why:
- Breast milk is fresh, clean and at the perfect temperature for your baby to drink.
- Breast milk contains the complete balance of nutrients and antibodies that your baby needs to grow and develop and to protect him from illness.
- Breast milk is also known to foster optimum brain growth.
- Breast milk is easiest for your baby to digest and breastfed babies rarely get constipated.
- Babies who are fed only breast milk as their main milk drink until six months are at less risk from conditions such as asthma, eczema, allergies and food intolerance.
- Breastfed babies may also be less likely to develop coeliac disease or juvenile diabetes. There is also some current research that suggests breastfeeding may reduce the incidence of heart disease in later life.
- Best of all, this remarkable food is free!
Breast milk contains all the nutrients your baby needs for the first four months of her life. If you can, and you choose to continue breastfeeding past this first four months, it will still be the most important part of her diet throughout the first year, supplying half or more of her nutrients until her first birthday and up to one third to her second birthday. As long as your baby is getting enough nutrients from solid foods when they are introduced, there is no need to supplement with either cow’s milk or formula until you choose to finish breastfeeding.
Formula
Step/Stage ONE and TWO
A baby on formula starts off on step/stage one formula. Some of these are marketed as suitable from birth to twelve months but many others are as described as suitable from birth to six months. After this time the companies market step/stage two or a ‘follow on’ formula for babies aged six to twelve months. I have become aware of problems when babies are introduced to step two formula. I have many clients contact me when their six-and-a-half month old, previously contented baby suddenly starts night waking, early rising, catnapping and/or vomiting. After careful consideration and ruling out many things I have found the one thing that most of these babies have in common is that they have been started on step two formula. After advising parents to move back to the step one formula their babies have returned to their happy, settled and well rested selves again.
Why can there be problems with the introduction of Step/Stage Two formula? One reason is the ratio of casein and whey. The protein in milk can be broken down into curds (casein) and whey. The ratio of casein to whey can vary according to the type of baby formula:
Step/Stage One formula. These milks consist of mostly whey, with a casein:whey ratio of 40:60. This is about the same as breast milk. They are suitable for your baby from birth up to about fourteen months, and are thought to be easier to digest.
Step/Stage Two formula. These milks consist of mostly casein, with a casein:whey ratio of 80:20. They take longer to digest and as a result are often marketed as keeping babies “full” for longer. They can, however, disagree with bubs that have a casein sensitivity.
Step/Stage THREE
Step/Stage three formula or toddler milk is the formula suggested for toddlers aged twelve months and older. I also advise clients to avoid these follow-on formulas as some contain a large amount of sugar. This can have the same effect as introducing cow’s milk before fourteen months in that it can make toddlers unsettled.
As long as your toddler is eating a varied and balanced diet which provides her with all the essential vitamins and minerals, there is no need for toddler milk.
TYPES OF FORMULA
Within the three formula steps or stages, there are also three main types of formula.
- Cow’s milk-based formula
- Hydrolysed protein formula
- Soy-based formula
As I have previously discussed, your baby can most likely have cow’s milk-based formula unless there is an allergy or intolerance to cow’s milk.
Cow’s Milk-Based Formula
The majority of formulas are based on cow’s milk, which is modified to resemble breast milk as closely as possible. This is done by adjusting carbohydrate, protein and fat levels and adding vitamins and minerals of cow’s milk.
Hydrolysed Protein Formula
If your baby has an allergy to cow’s milk, it is the protein in the milk that will cause and allergic reaction. If your baby has intolerance to cow’s milk, she will have difficulty digesting the lactose (sugar) in the milk.
The hydrolysed protein formulas are based on cow’s milk. They are nutritionally the same as standard formula milk, but the protein in the milk is broken down (hydrolysed). This means your baby is less likely to react to it. Many of these milks are also lactose free, which means that babies with intolerance to cow’s milk can easily digest them.
Soy-based Formula
This formula is made from soya beans, modified with vitamins, minerals and nutrients to make it suitable for babies. It’s important to know that soy formula is not recommended if your baby has a cow’s milk allergy as babies who are allergic to cow’s milk are often allergic to soy too. Your doctor is the best person to consult if you are considering using a soy-based formula for any reason.
COW’s MILK – from fourteen-months of age
Cow’s milk has nutrients that are important for your child as she grows. Milk provides protein, calcium, magnesium and vitamins B12 and B2 (riboflavin). However, under no circumstances should you feed your baby cow’s milk until they are over fourteen-months of age.
When moving from formula or breast milk, it’s best to give your child full-fat cow’s milk. She’ll need the energy that the fat provides. Fat also carries essential vitamins A and D, so when fat is skimmed off milk, the amount of these vitamins is reduced. Your child should be given full-fat milk until she is at least two as there is no reason for babies and toddlers to be given fat reduced milk. While we adults strive to eat and drink lower-fat versions of our favorite foods, it’s important that you start your child out with whole milk, not lower-fat varieties. ?
Lots of health professional’s recommend moving a toddler to cow’s milk soon after their first birthday. I, however, do not recommend this. I have seen very similar problems when parents try to introduce their twelve-month-old baby to cow’s milk or step three formula. The problems include runny nappies, night waking, early rising and toddler waking up soon after going to bed with tummy cramps. While this problem does not affect all toddlers my advice is to keep your baby on step one formula from birth through toddlerhood until she is ready to drink cow’s milk.
Cow’s milk is not suitable as a baby’s main source of milk until she is over fourteen-months-old (see my advice for introducing cow’s milk below). Your baby needs breast milk or formula, which provides all the correct nutrition until she is eating a variety of foods. You can use small amounts of cow’s milk in cooking from around ten months, but watch out for a reaction which could include waking 40 minutes after settling for the night or night waking, early rising, catnapping or a combination of all these problems.
Many parents find when they first introduce cow’s milk in cooked food or as a feed or milk drink their baby or toddler wakes up during the night or 40 minutes after they first go to sleep. If this happens I suggest you cut out the cow’s milk from your toddler’s diet and try it again in a couple of months. Start with small amounts in food and build up the amount of cow’s milk until your toddler can tolerate it.
Adam’s Story
Adam was thirteen-months-old when his mummy Inga gave him cow’s milk for the first time. She decided to introduce it slowly and first added it to his kids Weetbix in the morning, then in his morning bottle and last of all at night time in his 6.20 pm bottle. The first night on all cow’s milk Adam woke up unsettled 40 minutes after he had gone to bed. However, Adam had had his twelve-month injections two days before so Inga attributed this unsettled waking down to the injections. It wasn’t until three weeks later when Adam was waking three times a night and starting his days at 5 am that Inga contacted me for advice.
After a brief chat with Inga about Adam’s behaviour which included night waking, early rising and fussy eating I asked if anything had changed in his diet. Inga explained she had recently introduced cow’s milk. We changed Adam back to infant formula and within 48 hours he was happy contented and sleeping again. I have since heard from Inga that Adam continued to react like this to cow’s milk until he was two-years-old.
INTRODUCING COW’S MILK
The following plan is based on a toddler who currently drinks two breastfeeds or 410 ml of formula daily:
7 am: 12-minute breastfeed or 210 ml
6.20 pm: 10-minute breastfeed or 200 ml
To wean to cow’s milk
| Feed | Day One | Day Two | Day three | Day Four |
| 7am | 30 ml cow’s milk followed by 180 ml formula in a different bottle or a breastfeed | 60 ml cow’s milk followed by 150 ml formula in a different bottle or a breastfeed | 90 ml cow’s milk followed by 120 ml formula in a different bottle or a breastfeed | 210 ml cow’s milk |
| 6.20 pm | 200 ml formula or breastfeed | 200 ml formula or breastfeed | 200 ml formula or breastfeed | 200 ml formula or breastfeed |
If you are breastfeeding and your toddler refuses the cow’s milk offered, I would not offer the breastfeed. I would only suggest offering the breastfeed after your toddler drinks the cow’s milk. If your toddler drinks the cow’s milk, they will take less and less from the breast as you offer more of the cow’s milk by following the guide above.
Day four onwards
After four days you can swap any other drinks to cow’s milk – such as the morning or afternoon tea you might give in a cup, or the formula you add to meals, excluding the last milk feed of the day. The last feed of the day should remain a breastfeed or formula-feed for now. If your toddler remains settled and is sleeping well after a further two weeks you can then follow the process above to wean the last milk feed to cow’s milk as well. If your toddler becomes unsettled or begins rising early, please go back to full formula or breastfeed and try the above approach again after two months.
In summary, if your toddler was previously settling and sleeping well but is starting to wake at night or rise early, please look at her diet and food intake first as the possible cause of her sleep problems.
A2 COWS MILK
A2 milk is becoming more common in our shops. Toddlers seem to transition to A2 milk more easily than regular cow’s milk. A2 refers to the type of a protein (beta-casein) found in cow’s milk. A2 is the original form of beta-casein which was produced by cows thousands of years ago. Over time a second form of beta-casein known as A1 began to appear in dairy cattle and eventually became the most the common form of beta-casein in many breeds of cows. But some dairy cows still only produce the A2 type of beta-casein and their milk is used to produce A2 milk, which seems to be kinder on little ones tummies.
Water and fluid intake
If children under six years are offered a cup of milk or water at the start of their meal they have a habit of drinking it all and, because their body does not know the difference between water and solid food, they fill up on liquid and have no room left for their meal. As adults we sip drinks while we eat our food. This is a learned skill. To teach your toddler these skills only offer her a drink after she has eaten three-quarters of her meal and then only a sip of milk or water. I recommend the Amadeus 360° cup and the Anyway up cup because children can only take small sips from them. Explain to your child why it is necessary that she only take small sips. When she has finished her main meal and a second course you can offer her a cup of milk or water and allow her to have a big drink.
PROBLEM SOLVING
Milkaholics
When toddlers are over thirteen months and their diet is mainly milk-based, they are known as ‘milkoholics’. This can often happen if a baby has been introduced to solids late. If a baby has had only milk until the age of six months or later, parents often find it hard to introduce solids into their child’s diet. This can result in a toddler who still has one to six night feeds every night and four or five milk feeds during the day.
Over time I have found it easier to abruptly change a milkaholic’s diet than to slowly wean them off these extra milk feeds. If your child is over fourteen months I advise you to move her to two feeds, one in the early morning and the other in the evening as part of her bedtime ritual. For the first few days your toddler will be very tired, grumpy and hungry but after this time she will start to devour her meals. If your child is under fourteen months, slowly decrease her milk feeds over a couple of weeks. Reduce the amount of the middle of the day feed by 40 ml a day.
Milk allergies
Cow’s milk is a common cause of food allergy in infants. InAustraliaandNew Zealandaround 2 per cent (1 in 50) babies are allergic to cow’s milk and dairy products. Although most children out grow cow’s milk allergy by the age of 4 years, persistent cow’s milk allergy may sometimes occur. However, ongoing symptoms in adults are very rare.
If your child drank cow’s-milk-based formula as a baby without any problems, you can rest easy that she’ll have no problems tolerating regular cow’s milk. Even babies who were breastfed for the first year can usually handle regular cow’s milk because they’ve been exposed to cow’s milk protein in their mother’s milk (unless their mothers avoided all dairy).
The main symptoms of milk allergy are blood in the stool, diarrhoea, and vomiting. If your child also develops eczema, hives, a rash around the mouth and chin, severe nasal stuffiness, a runny nose, cough, wheezing, or breathing difficulties, it could be a sign that the respiratory system is being affected by a milk allergy. If your toddler develops any of these symptoms, talk with her doctor.
Although rare, some children have an immediate, life threatening allergic reaction called anaphylaxis after ingesting milk protein. If your child appears to have sudden and severe problems with breathing or swallowing, urgent medical attention is required.
If it turns out that your toddler is allergic to cow’s milk, you will want to be careful to avoid foods such as cottage cheese, condensed and evaporated milks, ice cream, yogurt, margarine that contains milk, butter, milk chocolate, and powdered milk. Always read labels for sources of cow’s milk protein, like casein and whey.
Lactose Intolerance
Lactose intolerance is different to an allergy to milk. It is caused by the lack of the enzyme lactase, which helps to digest the milk sugar lactose. The symptoms are diarrhoea, vomiting, stomach pain and gas, which are similar to some of the symptoms of milk allergy. This condition is uncomfortable but not dangerous, and does not cause rashes or anaphylaxis. Small amounts of cow’s milk are usually tolerated, and yogurts and hard cheeses are usually tolerated better than milk, as they contain less or easier to digest lactose than cow’s milk. You may need to reduce or avoid giving your little one dairy products containing lactose. You can substitute lactose free formula or milk.
Babies can often develop a temporary lactose intolerance after suffering a bout of gastroenteritis. If you baby becomes unsettled after milk feeds after having gastroenteritis you may need to swap to a lactose free formula or if breastfeeding remove dairy from your diet for 4 weeks to allow your baby’s intestines to recover. You should have no problems after this recovery time going back to normal formula and re introducing dairy back into your diet if breastfeeding. I would recommend you consult with your doctor if you suspect this.
COMMON QUESTIONS
How much milk should my baby drink? A newborn baby drinks approximately 600 ml of milk daily; a four to six month old approximately 1000 ml daily; a six to twelve month old approximately 600 to 700 ml daily; and a child of one to three years should still drink about 600 ml of milk a day.
How will I know my baby is still getting enough milk when I introduce solids? Up until six months, milk is the most important food for your baby. Your baby will still be getting enough if you are following my routines as the milk feeds are given first. This means your baby will fill his tummy with milk before food.
My maternal health nurse has advised me to move my baby’s milk and solid feeds around so I am giving solids first. What do you think? I come across this time and time again and am still not sure why some advisers recommend this change. With my routines, the solids are already at proper meal times so if they were swapped with milk feeds, you would be giving lunch at 11 am and dinner at 4 pm. Some of my clients have made this change only to find their babies start to wake again in the night. By giving the milk an hour beforehand, the milk is nearly digested by mealtimes. This leaves baby’s tummy with more room for solids! But when you turn it around and give the milk second, the solids are not yet digested so the baby does not take as much milk.
My toddler doesn’t seem to want cow’s milk. What is the best way to introduce it? Cows milk has a different texture, taste, and even temperature than breast milk, which can make it a difficult transition for some children. One trick is to mix a little whole milk with some breast milk or formula at first. Slowly increase the amount of whole milk until he is drinking 100% whole milk.
Soy or milk-based formula: Which is better for my baby? Soy formula has no nutritional advantage over milk-based formula and vice versa. Both are fortified with the same vitamins and minerals. ??Usually parents choose soy formula when their baby is sensitive or allergic (or potentially so) to cows’ milk protein, or when a baby is having trouble digesting lactose or milk sugar. However there is little evidence that this is successful. In fact, most babies who are allergic to cows’ milk protein are also allergic to soy protein. If this happens, your child’s doctor may ask you to try other brands of formula that don’t contain cows’ milk protein. Sometimes, you might need to change brands a few times to find what’s best for your baby.
Are all formulas the same? Most formulas are basically the same. When it comes to the most important nutrients, all formulas are created equal. The price of infant formula is not necessarily a guide its quality as all infant formulas sold are required by law to conform to quality control standards (inAustralia andNew Zealand they are regulated by the Australia New Zealand Food Standards Code; inIreland by the Food Safety Authority of Ireland). Prices can vary from shop to shop, and between brands, so it is a good idea to shop around.
There are, however, many specialised formulas for specific situations. Formulas designed for premature and low-birth-weight babies, for example, contain more calories than other types. Formulas for babies with reflux have rice or other thickeners added to it. Soy or hydrolysed formulas are used for infants with possible allergies or an intolerance to milk protein.
To read more information of my advice regarding food and feeding please see my new book – PRE – ORDER Tizzie Hall – Save Our Sleep ® – Feeding
La gach dea-ghui, Tizzie
Thank you Prof Haycock
I would like to thank Prof Haycock for taking the time to respond to the questions posed by Analytical Armadillo in concerns to my bedding advice. My official response is below.
FSID believes that it is vital that all parents are offered safe sleep advice which is supported by independent, peer-reviewed scientific research. Babies are all very different so it is important for parents to be aware of their baby’s temperature by feeling their tummy or the back of their neck – not their hands or feet – and if they do feel hot they should remove a layer.
Here is our advice:
1. Babies do not need hot rooms and all night heating is rarely necessary. Keep the room at a temperature between 16-20ºC. 18ºC (65ºF) is just right. 20 degrees is what I recommend in Australia and other areas on this side of the world and after a recent trip to the UK and Ireland I will now be recommending 18 degrees for that side of the world. My advice is consistent with FSID guidelines.
2. Adults find it difficult to judge the temperature in the room, so use a room thermometer in the rooms where your baby sleeps I always recommend my parents measure the room temperature with a room thermometer to establish the ambient temperature of the room. I recommend a room thermometer in my online store.
Taken from my bedding guide –
“ I suggest having a baby’s room cooled to 22 degrees centigrade in summer (if you are using air conditioning), or warmed to 20 degrees centigrade in winter. If you do not have hydronic heating, I suggest you use an oil-filled column heater. I do not advise using ducted heating in a baby’s room due to the dust it blows around. A good way of keeping an eye on the temperature is to use a room thermometer.” Please note: to clarify one point above, I have found that if you set your air-conditioning to 22 degrees when trying to cool a room it gives a actual room temperature of 20 degrees.
My advice is consistent with FSID guidelines.
3. When you check your baby, if they are sweating or their tummy feels hot to the touch, take off some of the bedding or clothing. Don’t worry if their hands or feet feel cool, this is normal. I clearly state in my bedding this exact same thing. Here is the direct quote -
Please note: Using the above guides, you will still need to watch your individual baby and adjust the bedding if your baby appears too hot or cold. Here are a couple of pointers to tell if your baby is too hot or cold.
Signs of a baby who is too hot might include:
• the baby will be waking and moaning,
• having a sweaty back
• having sweaty or wet clothes.
• Shallow, rapid breathing
Signs that your baby is too cold might include:
• Moving all around the cot
• Never laying still
• Rolling on to their tummy
• Catnapping in the day, or
• Waking from 4am (but more often 5am)
You might also need to adjust the recommended bedding depending on the humidity level where you live as well.
The sheets and blankets in your child’s cot should be made from cotton or bamboo.
Tips:
• Never tuck a sleeping bag in under the mattress because this will restrict your little one’s movement and is dangerous.
• The most important rules to remember to protect your little one from SIDS are to have a totally smoke-free pregnancy and environment for your baby, and to always place a baby in the safe sleeping position on their back to sleep
• Toddlers over 18 months appear to be better at controlling their own body temperature while they sleep so might need less bedding.
• To see how I set a cot up with bedding please visit my BLOG February 2010
My recommendations are consistent with FSID guidelines.
4. Use lightweight blankets or a baby sleeping bag. If your baby feels too warm, reduce the number of layers or use a lower tog baby sleeping bag. In warm summer weather, your baby may not need any bedclothes at all. Do not use a duvet, quilt or pillow for babies under 12 months.
I am confused by the word “or” used here; “Use lightweight blankets or a baby sleeping sack” My confusion comes because research I have read by Monique P L’Hoir states “ we hypothesized that turning prone is prostponed when a sleeping bag was used, and even more so if the baby was tucked in with a blanket as well.” This statement is in line with what my observations have shown. Although I have also seen that if more lightweight bedding is used this may delay the baby rolling to their tummy for even longer. I can’t help but wonder here if it is FSID who are suggesting a sleeping bag or bedding or if it is the sleeping bag companies suggesting this….
For the research see information heading 134s COT DEATH AND SLEEPING SACKS the very last line states “we hypothesized that turning prone is prostponed when a sleeping back was used, and even more so if the baby was tucked in with a blanket as well.” http://www.ispid.org/fileadmin/user_upload/textfiles/SIDSI2006finalabstractbook.pdf
My recommendations is to use layers of lightweight 100% cotton or bamboo blankets and watch your baby for signs of being too hot or too cold as stated above. From my bedding guide–
“So why not just add more clothing under the sleeping bag and then eliminate the need for blankets? The reason I recommend using bamboo or cotton blankets along with a safe sleeping bag, and not normally using more than two layers of clothing underneath the sleeping bag, is because I feel more than two layers under a sleeping bag causes a risk of its own. You might for example, as advised by some sleeping bag manufacturers, add extra layers under your baby’s sleeping bag. Then, when you go in to check your little one at night and discover he feels too hot, you may decide not risk lifting him to remove some clothing layers because you are scared of waking him. You and I would like to think we would put safety first, but it’s important to remember that some nights we might feel too tired to risk waking our sleeping baby. In my opinion this is a far more dangerous situation than using bamboo or cotton blankets that can be added and removed as needed. On the other hand, if you found your baby was too cold without enough layers under his sleeping bag you might just grab the nearest thing – for example a quilt or polyester blanket – and throw it over your baby. A safer approach is to have the correct safe bedding at hand and educate the people who are around your baby at sleep times about how to put your little one to bed safely. My advice is consistent with FSID recommendations.
5. Even in winter, babies who are unwell and feverish need fewer clothes and bedclothes. Currently I do not have this warning in my bedding guide but as a result of this blog I have now realised that some parents are confused how to dress their babies and what to cover them with when unwell so I will be adding a paragraph to explain that less bedding and clothing is needed when a baby is unwell. My advice will be updated to include this FSID recommendation.
6. Babies need to lose excess heat from their heads. Make sure their head cannot be covered by the bedclothes by sleeping them ‘feet to foot’ (with their feet to the foot of the cot) so they don’t wriggle down under the covers.
Taken from my safe bedding guide –
- The most important rules to remember to protect your little one from SIDS are to have a totally smoke-free pregnancy and environment for your baby, and to always place a baby in the safe sleeping position on their back to sleep
And taken from my SIDS article – http://www.saveoursleep.com.au/reading/free/sids.asp Which can be found under ‘Free Reading’ on my website –
Make sure your baby’s face and head stay uncovered while your baby is sleeping. A good way to ensure this is to put your baby’s feet at the bottom of the cot so that she can’t slip down underneath the bedclothes. Tuck in bedclothes securely so they can’t become loose. Never put quilts, doonas, duvets, pillows, lambskins or cot bumpers in a cot or under the sheet covering the mattress.
My grandmother says I should put a hat on my five-week-old baby to make him sleep better. What do you think? This is a question posed to me which is on my website and my answer to the question is below – this FAQ is also in my book.
I have heard this a few times and believe it to be a very dangerous old wives’ tale. You should most definitely not put a hat on your baby to help him sleep as this could cause your baby to overheat and will increase the risk of SIDS. If your baby is too hot and needs to cool down, he will need to be able to lose that heat through his head. You may put a hat on your baby if you are outdoors in cold weather, but take it off once inside.
My advice is consistent with FSID guidelines.
7. Babies should never sleep with a hot water bottle or electric blanket, or next to a radiator, heater or fire, or in direct sunshine. I do not recommend any of these things but do not state this in my bedding guide. My advice will be updated to include this FSID recommendation.
8. When it’s warm, you can cool the room where your baby sleeps by closing the curtains and opening the windows during the day. Offer your baby plenty to drink, and in very hot weather, sponge them down regularly with tepid water. Use a fan but do not place it directly onto your baby. I concur as stated in my bedding guide.
My advice is consistent with FSID guidelines.
9. Remove hats and extra clothing as soon as you come indoors or enter a warm bus, train or shop, even if it means waking your baby. I have shown an example above where I also recommend this. My advice is consistent with FSID guidelines.
10. A car can become very hot in the summer. Avoid direct sunlight on your baby. In winter, keep the heating low, and remove your baby’s outdoor clothing. A thermometer may be helpful. I believe we have addressed this above. I will add the point about babies getting hot in cars to my SIDS article. My advice is consistent with FSID guidelines
Research Evidence:
The most important publication implicating over-wrapping of babies as a risk factor for SIDS is the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) report 1 which had a very large dataset. Some of the data in the report had been published before. 2-4 In the chapter Thermal Environment and Arrangement of Bedding the authors state
“For both the usual sleep and last/reference sleep, the SIDS infants were wrapped significantly more warmly than the control infants. The difference in the distribution of tog values remained significant when adjusted for socio-economic status. Notably twice as many SIDS infants put down for the last/reference sleep were covered by 10 tog or more bedding, and three times as many were found this way compared to the control infants.” – I do not, for the majority, recommend covering with 10 tog or MORE of bedding. So therefore my recommendations I believe are consistent with FSID guidelines. I recommend in my guide 6 layers of 0.6 tog blankets which is 3.6 tog plus a doubled over sheet of 0.4 tog totalling 4.0 tog and a maximum of 16 layers at 0.6 tog with is 9.6 tog include the doubled over sheet at 0.4 tog which is 10 tog. I note the above statement is 10 or more so I will adjust my maximum layers for a baby over 4 months sleeping in a cot to 15 layers as 16 layers equals 10 tog. I would like to point out that if the above study was undertaken on baby’s 3 months and under, which I suspect it was then I do not recommend more than 12 layers for baby in cot and 10 layers for a baby in moses basket – total 6.4 tog and 7.6 tog respectively (including doubled over sheet calculated to .4 tog) I also strongly advise my parents to begin with my recommended bedding, not my maximum bedding and watch their baby’s for signs of being too hot or too cold and add or remove the bedding as needed. My advice is 99% consistent with that of the current research outlined here and I will adjust the maximum layers for a baby over 4 months sleeping in a cot to 15 layers of my recommended blankets.
To Note: You may argue that the ‘standard blanket layer’ is 1.5 to 2.0 tog however it is my belief that this average would have been achieved by evaluating the broad range of blankets on the market – cotton, bamboo, wool, polyester, polar fleece etc. I have not been able to find an answer to ‘what is the average tog of a cotton or bamboo blanket?’ so therefore I can only go with what the range of blankets I recommend have been tog tested too. I have made it clear in my bedding advice as taken from my bedding guide – “The sheets and blankets in your child’s cot should be made from cotton or bamboo”
CESDI indicated that worrying about overheating might actually be protective:
“Significantly more control than index mothers worried about their baby getting too hot, suggesting a protective effect…”
It was the mothers of the SIDS infants who worried most about their baby being too cold:
27.8% of the mothers of SIDS infants compared to 15.8% of controls. I would argue that parents following my routines and advice could be more aware of the dangers of both overheating and underheating than parents not following my advice because of the emphasis and importance I stress in bedding and setting up a safe sleeping environment. I would argue that you would find my parents would be monitoring their babies on a very regular basis.
There is no scientific evidence to suggest babies roll over because they are cold, indeed, the peak age of death for SIDS infants is 2-3 months, an age when most babies are unable to roll. Point accepted for the stated age range. In this age range I have found babies who may be cold in bed will wake frequently overnight for short feeds. It is my belief that of course some of these awakenings will be due to genuine hunger but some are also, in my belief because it is the baby’s only way of warming up – nice warm milk feed and cuddle with mum. I do however stand by my statement that once able to, a baby who is cold in bed will roll to their tummy, tuck their arms underneath them, stick their bottom in the air and bury their face in the mattress. It has been proven that the SIDS risk is lower once babies are of an age to be able to do this however the risk is still there so if we can help a baby to stay in the supine sleeping position by ensuring they are warm enough by covering them with the correct and safe amount of bedding would that not be optimal? I can’t provide you with actual research as to why I believe this I can only assure you that I have seen it time and time again in babies of this age. I of course have detailed case studies of the babies I have worked with but my understanding is that does not constitute a ‘study’.
Two other studies examined the relationship between wrapping and SIDS risk, one from Tasmania5 and one from New Zealand 6. Both of these found that the risk was only significant for infants slept prone, but the numbers were relatively small. TheNew Zealand study also found an interaction between over-wrapping and maternal smoking. My advice clearly states the risk of smoking during pregnancy.
There is also evidence to show that overheating interacts adversely with infectionso it would be unsafe to overwrap a baby who was unwell and there are two studies that show that SIDS may occur against a background of minor illness7-8: I was aware of this but as I have mentioned above I will be adding information to my safe bedding guide for parents when there children are unwell.
The current evidence-based advice is that over-wrapping increases the risk of SIDS especially for infants slept prone, who are unwell and for those of smoking mothers. I have also stated this previously therefore. I don’t believe my bedding advice for a healthy baby sleeping supine and in a smoke free environment in anyway contradicts current SIDS research. All parents should check that their baby is not too hot by feeling their tummy or the back of their neck. FSID encourages parents to follow the Reduce the Risk guidelines because they are supported by externally reviewed, scientific studies conducted by leading SIDS researchers.
I also encourage – as listed above, for parents to monitor their babies carefully for signs of being too hot or too cold.
1. Fleming PJ, Bacon C, Blair PS, Berry PJ, editors. Sudden unexpected deaths in infancy. The CESDI SUDI studies 1993-1996. London: The Stationery Office, 2000.
2. Fleming P, Berry J, Gilbert R, Rudd P. Bedding and sleeping position in the sudden infant death syndrome. Bmj 1990;301(6756):871-2.
3. Gilbert R, Rudd P, Berry PJ, Fleming PJ, Hall E, White DG, et al. Combined effect of infection and heavy wrapping on the risk of sudden unexpected infant death. Arch Dis Child 1992;67(2):171-7.
4. Fleming PJ, Blair PS, Bacon C, Bensley D, Smith I, Taylor E, et al. Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Bmj 1996;313(7051):191-5
5. Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Wang YG. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med 1993;329(6):377-82.
6. Williams SM, Taylor BJ, Mitchell EA. Sudden infant death syndrome: insulation from bedding and clothing and its effect modifiers. The National Cot Death Study Group. Int J Epidemiol 1996;25(2):366-75.
7. Stanton AN, Downham MA, Oakley JR, Emery JL, Knowelden J. Terminal Symptoms in children dying suddenly and unexpectedly at home. Preliminary report of the DHSS multicentre study of postneonatal mortality. Bmj. 1978 Nov 4;2(6147):1249- 51.
8. Gilbert RE, Fleming PJ, Azaz Y, Rudd PT. Signs of illness preceding sudden unexpected death in infants. Bmj. 1990 May 12;300(6734):1237-
To conclude – I continue to be satisfied that My advice and recommendations are consistent with current FSID guidelines and will make the additions to my safe bedding guide as detailed above.
Le gach dea-ghui, Tizzie
In response to ‘The Analytical Armadillo’s’ Blog.
Thank you for your blog post and questions regarding my recommended bedding and advice. Firstly, I by no means feel anything I say here is going to change anyone’s minds in regards to my advice or books. However I am more than happy to address some of the questions from your blog and hope that your blog will also be answered and addressed by SIDS researchers. I feel the easiest way was to respond to your blog is to create a new blog and copy in excerpts from The Analytical Armadillo blog and provide feedback.
As stated in The Analytical Armadillo blog I agree it is confusing that parents are given such conflicting advice from different professionals on the one topic. Often from day one the confusing advice starts new parents will often experienced while in hospital different opinions from each midwife they see on how to breastfeed. The pressure on parents intensifies, as they get ready to introduce solids to their baby. There has never been more confusion over when to introduce solids and what foods are safe for babies, toddler and pre-schoolers. There is conflicting advice from the World Health Organisation (WHO), the NHMRC (National Health and Medical Research Council), the Australasian Society of Clinical Immunology and Allergy. Parents hear they should try to ‘exclusively breastfeed’ their baby until six months. But on the other hand allergy experts recommend introducing solids between four to six months as research is increasingly suggesting this reduces the risk of food allergies. Exclusive breast-feeding for six months is a WHO recommendation, and is aimed at reducing serious illnesses, such as severe diarrhoea, in developing countries where contaminated water. In most of Australia, the UK and Ireland water is clean and so it’s safe to introduce solids at 16 weeks but unfortunately all the advice just makes new parents lives hard and confusing. Ultimately I believe as parents we need to look at the recommendations and research that is out there, consult our own chosen respected health professionals and experts and then make the final decision on what we believe to be right for ourselves and our families.
Now for the blog -
A Facebook group named “The Dangers of Baby Training” sums up the problem neatly:
As an example, in a room heated to 20* C in the winter or cooled to 22*C in the summer, Tizzie hall suggests for those of us in the UK & ireland to use a vest, a sleepsuit/babygro, a ‘double wrap’ swaddle, a cotton sheet folded into 2, and 4 layers of blankets, preferably bamboo. Our UK/Ireland SIDS & government guidelines suggest a room temp of between 18-20*C, with your child wearing a vest, sleepsuit/babygro, a light swaddle or light sleeping bag (never both, as shown in TH’s video guide on youtube), 1 cotton sheet and 1 lightweight blanket….and never advocates the use of more than 4 layers, even in the coldest of conditions. Why is there such a big difference?
I am not sure why there is such a big difference, I believe there might be a few of reasons for this, one is SIDS researchers might be giving guidelines for parents using all sorts of bedding and my guidelines are based on what I believe to be the safest and the only bedding I recommend parents use on their children which is the cotton or bamboo bedding endorsed on my websites. Their recommendation is not based on cotton or bamboo bedding only and might include bedding and fleece clothing, swaddles and blankets so they might be giving their advice based on what if the parents were using polyester clothing, swaddles and blankets. They might not have had time to do there own research and their recommendations might be based on what a sleep bag company has recommended to them. My advice is based on years of my study and observation of how babies sleep, I have not taken into account the advice of sleep bag companies because it just doesn’t add up to me as I will talk about below.
As talked about above the difference comes in tog rating of the bedding used which is usually not explained or addressed in other guidelines, and I will be updating my safe bedding guide to explain this realising that most people are considering a layer of a blanket to be 1.5-2 tog which my recommended blankets are not and I will clarify in my guide. So where SIDS researchers say 3 blankets (which might for example be 1.2 tog) and I say 6 SOS blankets (which are .6 tog) we are in fact recommending the same amount of warmth.
There are many studies which have been done and most of which I have read all have a conclusion stating – more research needs to be carried out in regards to the thermal layering and if it is a risk factor of SIDS (further information below)
Earlier this week, Tizzie’s forum was available to non subscribed members, where apart from clarifying the maximum blanket layers that should be used –
“on a newborn to 3 month old baby sleeping in a bassinet is 10 layers, a newborn to 3mth old baby sleeping in cot is 12 layers and a baby 4 months and over is 16 layers”. (no reference to room temperature was made)
Reference to room temperature is within my bedding guide which my clients are well aware of.
also stated:
“Tizzie’s safe bedding guide is written on the amount of layers NOT how many tog those layers add up to. When we talk about references to the tog of a quilt in relation to the amount of bedding needed to keep your baby sleeping warm and safely this is an example to demonstrate that babies do require bedding to sleep safely. Cotton or Bamboo cellular blankets will trap warm air in to keep your baby warm enough to sleep safely with more efficiency than a adult quilt does. We do not need to achieve the same tog rating as a 14 tog quilt but we need to achieve the same warmth which is quite different when using cotton/bamboo blankets.
It was available here – but the page has since changed to read: access denied:
With an option to login, so it appears one needs to register and pay now to obtain this post. The one and only reason this is no longer available to the public is because my forums and online advice area was assaulted by a group of women/men posting incredibly nasty, slanderous and down right abusive posts so with my clients my top priority I did not feel they needed to be subjected to that sort of behaviour or abuse in what we advertise and promise to maintain as a safe environment.
This confused one mum Fleur who posted on Facebook saying:
If you use her special bamboo blankets that she recommends, at the max 16 layers, at approx 0.6 tog each, that would put your child under a massive, surely dangerous 13.6 tog…. to put that in perspective, the average adult duvet here in the UK is 11-13 tog, which is considered ‘winter weight.’ The math here is totally incorrect. IF and I say IF a parent is using the maximum of 16 layers which when using my recommended blanket is highly unlikely the total tog rating would be 9.6 – quite a difference to 13.6!
The blog has since been added to with the below after it was pointed out that the math was incorrect with this –
EDIT – I THOUGHT THESE CALCULATIONS WERE INCORRECT AS 0.6 TOG X 16 DOES NOT ADD UP TO 13.6 TOG. I CHECKED FLEUR’S CALCULATIONS AND THE TOTAL TOG OF 16 BLANKETS BASED ON THE TOG FLEUR QUOTED OF 0.6 IS 9.6.
So I checked with Fleur:
“On my calculation of the tog rating – Tizzie’s fans have repeatedly told me that the tog rating of her bamboo blankets is 0.64 tog x 16= 10.24 tog (apparently she has had them tested.) and a cotton sheet folded in 2, at approx 0.2 tog (x2= 0.4 tog). I also included in my calculations the toggage (made up word, lol) of the ‘safe sleeping bags’ that she sells, which will be either 1 tog or 2 tog, depending which one you choose, and the tog of the ‘double wrap’ which again, equates to 4 layers in itself (2 inside wrap pieces and 2 outside fold over bits) which again, could be anywhere from 1 tog to 4 tog, depending on the material used). I didnt include the tog of a vest, a sleepsuit or a nappy. That was how i worked out the approx 13+ tog.
Vest 0.2
Babygro 1
Jumper 2
Trouser 2
Nappy (disposable) 2 (less when wet)
Sleep suit 4
Sheet 0.2
I found a link to the table above but it also included the following –
Blanket (new) 2.0
Blanket (old) 1.5
Duvet/quilt 9.0
I found this table in several places so I am assuming it is just slightly different on each site. http://www.dbh.nhs.uk/Library/Patient_Information_Leaflets/WPR24280-Redu%20Risk%20Cot%20Dea.pdf
What Fleur has stated in her clarification is fine but adults also dress themselves similarly for bed, use a sheet and many adults sleep next to another person which provides extra warmth under their 11-13 tog duvets, yet we expect our babies to sleep in much less……..
But, let’s just analyse this then. I recommend a baby wears a vest, a babygro, a 2.5 tog sleeping bag, doubled over sheet and 6 layers of blanket. (That is what I state on my bedding guide and similar to what the majority of my clients would be doing) so we will add up the togs 0.2 + 1.0 + 2.5 (for the sleeping bag)+ 0.4 = 4.1 tog of clothing including the doubled sheet.
I researched where the above table was found and it also stated, in the author’s opinion at a room temp of 20 degrees no more than 10 togs would be needed. (there was no indication as to why or how they came up with 10 tog or for what climate or humidity this was for, guess we just have to trust them….) That gives us 5.9 tog to work with in regards to blankets. Using the above table that would allow you to use 2.95 layers of new blankets or 3.93 layers of old blankets. My recommended range of blankets have been tested at 0.6 tog – that means we could place up to 9.8 layers of these recommended blankets over the baby. I am aware this is less than the 16 that I said was the maximum but in reality the majority of my clients don’t use that many layers. But I do not believe that a baby would come to any harm if the baby was 100% healthy, sleeping supine and with the head and face uncovered under 16 layers of my recommended blankets. You may choose to disagree… but can you show me research that can prove or deny this?
I’m optimistic however that Tizzie Hall will have evidence to share with us, because of the next half of her comment:
We have observed that many of you have been trying to achieve the total tog of the Save Our Sleep® recommended blankets with other brand blankets but we do not advise that you do this. This is because you need to use too many layers of other blankets to achieve the same warmth as the Save Our Sleep® blankets for your baby to sleep safely. Using anymore than the recommended amounts listed above is not safe.
This confused the founder of Dispelling Breastfeeding Myths:
“What I’d REALLY like to know is whether her products conform to BS8510 (describes tog testing for baby products, the concern here being to ensure that babies do not overheat)? Otherwise how is a parent to have any clue about the level of thermal insulation their child is going to experience when layering up her products? That’s the whole reason for the tog system in the first place… She says her blankets work in a different way – but BS 8510: 2009 ‘specifies requirements for the safety of sleep bags for the use of children with a minimum weight of 4 kg designed to provide sufficient warmth SO AS TO REMOVE THE NEED FOR ADDITIONAL BEDDING when sleeping in a cot or similar product in which a child is contained.’ The BS8510 is standard for sleeping bags not for bedding? My recommended blankets have been tog tested at 0.6tog per layer.
Tizzie doesn’t advise anyone uses blankets other than her own brand? This is incorrect, not my own brand but my recommended range which does included two of my own branded blankets, as well as other brands. Why – if a mum needs to use more than the 10-16 layers recommended to achieve the same warmth as the branded blankets – there surely must be a unique factor? Ultimately the tog rating of blankets is comparable, regardless of brand. This is untrue, if you do a search on the average tog of a blanket it is 1.5-2tog, as stated above. My recommended blankets have been tog tested to 0.6 tog. I have had other blankets tog tested and some blankets have come back with results of 0.2 tog and one blanket came back at 4.5 tog (In case anyone wonders, blankets range from £18.50 – £46.30 each depending upon which you choose. This makes the cost of 16 blankets £296-£740.80, not including spares for washing ie if they vomit to manipulate as Tizzie confirms they may, or sheets.) Again if you had read my safe bedding guide and the back of the packaging on my own branded blankets you would know that I recommend you fold a blanket in half and depending on the size of the baby in half again if possible. You can get 2 if not 4 layers per blanket. You do not need to invest in 16 blankets’ and as previously mentioned the majority of my clients are using between 4-8 layers (2-4 folded) blankets only. Analytical Armadillo are you trying to imply that the one and only reason I recommend layering blankets if for financial gain…..really? If this would be putting babies at risk would this not be professional suicide on my behalf…? What could I possibly have to gain from that? I am trying to keep this professional but implying financial gain is my main goal while risking baby safety is insulting.
Secondly In order to state using different brands or more blankets is unsafe – one must have identified and proven ie tested what is safe? The weight of the blankets I recommend are the same as a blanket I have had tested which came back at 0.2 tog. To get the same warmth you might have to use 20 blankets but the weight would be far too much to have on a baby and in my opinion would be unsafe so this is why I suggest using the blankets I have tested because you can use less blankets which in return is less weight on the baby but the same warmth. Otherwise how could you know that more or different brands would be unsafe? I have never mentioned other brands are unsafe, only that using more than the maximum recommended layers could be unsafe Plus I’m sure nobody would give parents so directly contradicting official SIDS advice without having hard evidence, because that would be madness right? I do have evidence it is just not in a formal official paper, perhaps observations is a better term. I would be more than happy to help FSID or SIDS and Kids in Australia conduct further study into the effect of thermal layering and SIDS as long as they also investigated my belief that a cold baby will roll to the prone position as soon as he/she possibly can. I have read a paper that states “ A well wrapped infant lying face down could tolerate an ambient temperature of 10 degrees Celsius less than if it were lying supine. This indicates to me that you are much warmer when tummy sleeping, therefore this may help to explain why some babies may choose to roll because they are cold Tuffnell et al calculate that heat loss in prone infants was 60% less than for non-prone sleeping infants, with the same insulation values for clothing and bedding.
Tuffnell CS, Petersen SA, Wailoo MP, Prone sleeping infants have a reduced ability to lose heat. Early Hum Dev. 1995;43:109-116
Much of the overheating warning and research that I have read has been based around prone sleeping babies and I recommend to ALWAYS sleep a baby on their back and if your baby is a tummy sleeping baby then you should not follow my bedding guide, I have also added this information to my bedding guide to clarify this.
- And it does directly contradict FSID as they state:
Babies who get too hot are at an increased risk of cot death. They can get too hot because the room is too hot or because they have too much bedding or clothing. The ideal room temperature is 16-20ºC. My recommendation of a room temp of 20 degrees falls within these parameters, and after my recent trip home to Ireland I will also be editing my recommendations for this area and saying that ideal room temperature in Ireland and the UK is 18 degrees. I fully support the statement that too much bedding, clothing or possibly (but not proven) more importantly the incorrect material of bedding and clothing can cause thermal stress. However my recommendations will NOT cause a baby to overheat. I clearly state in my bedding guide what signs a parents should look for in a hot baby and a cold baby and to adjust the layers accordingly. I have not found using only my recommended bedding ( a 100% cotton mattress protector, 100% cotton or bamboo sheets, all 100% cotton or bamboo clothing and only 100% cotton or bamboo blankets) within my guidelines to cause a baby to get too hot. Of course each baby is different which is why I have written my bedding guide and encourage parents to only try more bedding one layer at a time if their baby continues to shows signs of being cold.
In 2008 researcher at the University of Calgary showed that thermal stress, can lead to an increased risk of Sudden Infant Death Syndrome (SIDS). Increased ambient temperature such as over-wrapping a baby at night time or increasing the room temperature can affect the baby’s pattern of breathing. There are also studies that state the opposite IF the baby is supine sleeping – Keep the room temperature at 18°C to 22°C and avoid over-dressing (i.e. too many layers of clothes; particularly avoid the use of a hat when indoors) when placing the baby to sleep. Overheating has been cited as a risk factor for SIDS in the past, however, it has been shown that thermal factors are less important if the infant sleeps on the back. http://www.ispid.org/prevention.html - This is also stated in the following SIDS and Kids information sheet - http://www.sidsandkids.org/wp-content/uploads/Room-Temperature.pdf -‘However, there is not evidence to show that extra thermal insulation increases the risk of SIDS in babies who sleep on the back with the head and face uncovered.
My recommendations are to always put your baby to sleep on their back in the feet to foot position, dressed and covered in only cotton or bamboo clothing and bedding and never put a hat or bonnet on a sleeping baby. I also recommend only using cots with slats on all four sides with only one end against a wall to ensure adequate airflow.
Australia’s Practical Parenting magazine published the following, and is based on baby wearing nappy/vest/babygro plus a cotton sheet:
Room temp No of blankets
12 4 layers
14 3-4 layers
16 3 layers
18 2 layers
20 1-2 layers
22 1 layer
24 Sheet only
I assume there was no supporting evidence or research as to how Australia’s practical parenting came up with these numbers of blanket layers? Also if we assume that these layers are the average tog rating of a blanket which has been quoted previously as 1.5-2 tog. Therefore, 1-2 layers at 20 degrees could be a maximum of 4.0tog. If you are using the range of blankets I recommend then you would need 6.5 layers of blanket – which is exactly what is stated in my safe bedding guide for that room temperature in certain areas of Australia! I note that the table above does not mention humidity or the range of climates that different states in Australia experience. My bedding guide has different recommendations of layers for different climatic areas.
Here is the information from Gro-bag (a company that makes baby sleeping bags)
and details of what should go with the recommended tog sleeping bag:
Thank you for posting these charts from grobag AA and maybe from this blog you will be able to get an answer that I have been trying to get from SIDS researchers for years! I would like to know in regards to the recommendations that we see from sleep bag companies, for example what you have copied in above – did FSID/SIDS and kids make these recommendations and are the sleep bag companies following their guidelines OR is FSID/SIDS and kids following the recommendations of the sleep bag companies? Either way I would like to know why humidity and climatic differences are not taken into consideration. A personal example to demonstrate why I am bringing attention to this – My 14 month old baby slept in 20 degree room in Victoria Australia in June following my bedding guide (which I have copied in below for your information) but with 12 layers of blanket (6 x 0.6 tog 95% bamboo blankets folded in half) however 3 days layer when we arrived in Dublin, Ireland my 14 month old was in an 18 degree room, following my bedding guide but with only 4 layers of blanket (2 x 0.6 tog 100% bamboo blankets folded in half). He was sleeping in the exact same portable cot in both environments. To me humidity and climatic differences are an important and possibly un-researched modifier to the recommendations on the back of sleep bags. Here is an example of a table from my bedding guide which is available as a downloadable PDF from my website and is sent complimentary with all book purchases –
The Save Our Sleep® bedding guide for a baby who is not swaddled for sleep. Tasmania, Victoria, ACT, South Australia, lower parts of WA and New Zealand South Island:
In a room of 20C° I advise a Bodysuit, a Babygro, a 2.5 TOG Safe Sleep Bag , a sheet folded in two and 5 layers of blankets in the day and a 6th at night.
Please note
Using the above guides, you will still need to watch your individual baby and adjust the bedding if your baby appears too hot or cold. Here are a couple of pointers to tell if your baby is too hot or cold.
Signs of a baby who is too hot might include:
• the baby will be waking and moaning,
• having a sweaty back
• having sweaty or wet clothes.
• Shallow, rapid breathing
However please note that I do not recommend using most mattress protectors in your baby’s cot. I have found most protectors make babies sweat and appear too hot so parents do not use enough blankets over the safe sleeping bag and their baby’s are then cold. I have only found one mattress protector that is suitable for use in your baby’s cot. It is the 100% cotton mattress protector that I recommend in my store. I have tried and tested many mattress protectors on the market and this is the only one that I have found that does not cause a baby to sweat. If your baby is sweating and you have a 100% cotton, plastic or PVC-backed mattress protector on with the exception of the one I recommend I suggest you remove it and follow the above guide which is correct for the age of your baby and climate in which you live.
Signs that your baby is too cold might include:
• Moving all around the cot
• Never laying still
• Rolling on to their tummy
• Catnapping in the day, or
• Waking from 4am (but more often 5am)
You might also need to adjust the recommended bedding depending on the humidity level where you live as well.
The sheets and blankets in your child’s cot should be made from cotton or bamboo.
Tips:
• Never tuck a sleeping bag in under the mattress because this will restrict your little one’s movement and is dangerous.
• The most important rules to remember to protect your little one from SIDS are to have a totally smoke-free pregnancy and environment for your baby, and to always place a baby in the safe sleeping position on their back to sleep
• Toddlers over 18 months appear to be better at controlling their own body temperature while they sleep so might need less bedding.
• To see how I set a cot up with bedding please visit my BLOG February 2010
So I went to visit the page I was told to and you too can read it here
“As all of you know before giving any advice I do countless hours of research so I stand by all of my advice. These ladies don’t seem to be aware of the current SIDS guidelines stating as long as your babies head and face are uncovered and you are using cotton or bamboo bedding then it is perfectly safe to layer up the amount of these blankets to keep your baby warm. My opinion and research shows this in return keeps our babies in the safe back sleeping position. Also it is now clear overheating is only cited a risk factor and not as big a factor as was first thought but we do live in a generation with parents so scared of over heating their babies they are doing the opposite and under heating them which in my opinion a greater factor because a cold baby will roll to his or her tummy and sleep face down in the mattress.
These concerned parents may not be aware of my research that shows that if a baby is cold and not warm enough in bed they will, as soon as they are able, roll to their tummy, tuck their knees and arms in under their body, stick their bottom in the air with their face pressed down in the mattress to try and warm up, which of course we know is a very dangerous sleeping position for a baby and toddler. New research shows this causes less oxygen to get to the brain and could be connected to SIDS.
Link to research http://pediatrics.aappublications.org/cgi/content/abstract/127/3/e558
Having had a personal experience of loosing a sibling to SIDS I am passionate about baby safety and ensuring everything I recommend down to the bodysuit your baby wears and the toys your baby plays with are the safest on the market.”
So of course I checked out the quoted research.
Cerebral Oxygenation Is Depressed During Sleep in Healthy Term Infants When They Sleep Prone
SUBJECTS AND METHODS: Seventeen healthy term infants (8 girls and 9 boys) were recruited as study participants. Infants were studied at ages 2 to 4 weeks, 2 to 3 months, and 5 to 6 months by use of daytime polysomnography, with additional measurements of blood pressure
RESULTS: In infants who slept in the prone position, tissue oxygenation index was lower in both quiet sleep and active sleep at age 2 to 4 weeks and in quiet sleep at age 2 to 3 months. Tissue oxygenation index was lower in active sleep compared with quiet sleep in infants aged 2 to 4 weeks (P < .05). When the infants reached 5 to 6 months of age, tissue oxygenation index was greater in active sleep, as there was a profound decrease in tissue oxygenation index during quiet sleep over this period.
All this tells us is that oxygenation index for a young infant is reduced in the prone position. Isn’t that the whole point of the “Back To Sleep” campaign? Again Tizzie stated: my research that shows that if a baby is cold and not warm enough in bed they will, as soon as they are able, roll to their tummy, tuck their knees and arms in under their body, stick their bottom in the air with their face pressed down in the mattress to try and warm up.
THIS is the research we would like to see Tizzie please? As stated previously my research is my life work – 20 years + working with and watching babies of all ages sleeping. I do not have any formal research and I state clearly it is MY RESEARCH, if a parent decides that is not good enough for them to follow then of course that is their choice. I would love to see one of the worlds SIDS organisations conduct a full research study into this but unfortunately it is not something I can physically do, I am also not a scientist so I would assume would not be able to perform such a task alone. As also previously mentioned many studies you read about thermal insulation and SIDS clearly state in their conclusions that further study needs to be undertaken on this topic. One can only assume that any recommended layering arrangements are purely educated guess work ……
http://www.sciencedirect.com/science/article/pii/S037837820500112X
Otherwise it’s just confusing for parents:
“Once a baby is strong enough to roll onto his stomach by himself, you don’t need to worry about him staying on his back all night. This is especially true if he’s been enjoying playtime on his tummy during the day, can hold his head up well, and can roll from his tummy onto his back again by himself.”
Fern R. Hauck, M.D., M.S professor of family medicine and public health sciences at the University of Virginia
Yes but it has also been stated that “Infants who usually sleep supine but who are placed prone are at a very high risk of SIDS. The first prone sleep appears to be a particularly high risk occasion. http://fsid.org.uk/document.doc?id=42 . So what I do not understand is why a parent would risk their baby sleeping prone when simply adding some safe blankets could keep your baby in the safe supine position.
“Losing sleep because your former back snoozer is now flipping onto his tummy? You probably don’t need to risk waking him by trying to roll him back. If your baby can get himself onto his tummy, he can usually get himself off it, because rolling from back to tummy is the tougher milestone (try it yourself and you’ll see what we mean).
By the time your baby has mastered rolling around, the SIDS risk has dropped dramatically” That may be true for the majority of babies but not ALL babies which is why I try to encourage parents to find the correct amount of bedding that their baby needs to be warm enough to sleep supine. If they try layering my bedding following my guidelines and the baby continues to roll to the prone position then I suggest that parents accept their baby now prefers to sleep prone and adjust bedding accordingly. As a result of this blog I have now clarified this point in my bedding guide. So again thank you Analytical Armadillo again for your blog.
Learning to Roll Over, By Anita Sethi, Ph.d
Has Tizzie measured the vital statistics of infants under 16 blankets? Unless the blankets are weightless, what is the impact of the weight of this on top of baby to their oxygen sats? No I have not measured this, again I have just worked this out from observation on the thousands of babies I have worked with during my career. I do think you would be best to actually see the blankets I recommend as they may well be nothing like what you are imagining! However in writing such a detailed blog perhaps you have already looked at this?
In conclusion, all research is open to interpretation and judgement. Just as I have read that many parents do not agree with current research that co-sleeping increases the risk of SIDS (safe or unsafe co-sleeping) research is open to ones own evaluation of it and perhaps ones parenting goals? I am not saying if I have an opinion on this or not, just using the example. Research can be disputed or agreed upon depending on the persons current view point when reading it!
As with many topics you can find research papers to back up debating sides of any said topic. Health professionals are constantly arguing with each other over guidelines – The introduction of solids is a current main topical issue. One group says 6 months while another says 4 months and both can substantiate their claims, how do we know who is correct when they can both back up their arguments……..I believe it us ultimately up the parents to look at all the research and do what they feel makes sense to them and for their children.
I do agree this topic is confusing for parents and if the only thing that may come out of this blog is an extensive study into this area then for that I would be very thankful to you Analytical Armadillo! I do not believe there has been an extensive enough study on thermal insulation and the risk of SIDS. I have read one study which looks at thermal insulation and I have taken from that study that under heating is as much as a risk as overheating, however when considering the overheating aspect none of the studies I have read, including the below have detailed exactly what bedding has been used, what exact clothing is used and whether or not there was the presence of a waterproof mattress protector which are all, what I believe, in my personally opinion to be important modifiers to the research. - http://ije.oxfordjournals.org/content/25/2/366.full.pdf You will note this study recommends a similar average tog rating to what I recommend on my safe bedding guide which the majority of my clients are following.
I have been satisfied by the studies done and through my own observations, that as long as the baby is placed in the supine sleeping position with head and face uncovered thermal insulation is not as big a risk factor. I have clearly stated in my articles, which were written after countless hours of working with babies and countless hours reading research papers what I believe to be a safe sleeping environment and what I believe to be the safest bedding to use. There is absolutely nothing for me to gain in putting babies at risk, baby safety is one of my main concerns when working with clients. I believe it is up to parents to gather information, read studies for themselves and make their own choices.
As I said at the beginning, I have no expectations that this will alter any of your opinions of me or my advice but I do hope, with respect, you can acknowledge that I did not just come up with my bedding information out of the blue or for financial gain but I spent hours researching and hours observing babies and calculated what I believe to work best while maintaining safety.
I will look forward to the response from FSID on your blog. Should you have any further questions I would be more than happy to meet with you in person the next time I am in the UK and lets just hope that maybe, just maybe this blog will help initiate a further study into thermal layering and it’s relation to SIDS. I will not be coming back in here to answer any questions so please do not ask direct questions in any responses to this blog.
Le gach dea-ghui, Tizzie
eBooks available now!
We are excited to announce that the much awaited arrival of eBooks is finally over! The Save Our Sleep fully revised edition and Save Our Sleep Toddler books are now available as eBooks and can be purchased from the Macmillan website following these 3 steps:
View the Save Our Sleep eBook products
Choose the book you wish to purchase
Follow the instructions to purchase your book through the Macmillan website
Once you have made your purchase please email a copy of receipt to customerservice@saveoursleep.com for your complimentary copy of Tizzie’s Safe Bedding Guide.
You can now have your copy of Save Our Sleep and Save Our Sleep Toddler with you wherever you go!
Le gach dea-ghui, Tizzie
New Save Our Sleep Blankets!
While the boys and I are experiencing some gorgeous summer weather here in Dublin Nathan tells me the temperature has dropped in Australia and winter is on the way! We are looking forward to him joining us in a couple of weeks to warm up! Regardless of which side of the world you are on I thought I would remind you of the wonderful blankets available from Save Our Sleep. As our range is all 100% cotton or Bamboo they keep babies and toddlers warm in winter and cool in summer. I have just released my own brand of cot blankets which has enabled me to put my bedding guide on the packaging to help keep more babies safe at night.
Products of the Month!
Cillian
Save Our Sleep Cot Blanket and Cellular Cot Blanket
I am excited that Mummy has launched her own range of blankets. Branding these blankets Save Our Sleep has allowed Mummy to put very important information about bedding and keeping baby’s safe all night onto the packaging. I LOVE these blankets as they are so soft, snugly and silky and help to keep me warm wherever I am. I am so pleased Mummy brought them away with me as they are the best blankets to sleep with! Mummy tells me she chose these blankets to brand with the Save Our Sleep brand because – Mummy values the importance of keeping all babies warm enough in bed to promote restful, safe and sound sleep. This knowledge has initiated Mummy to source the most luxurious and delicately soft natural bamboo and cotton to bring you a beautiful, safe and warm range of blankets for your precious baby.
The Bamboo Cot Blanket is made from organically grown Bamboo has a delicate hand-feel and is surprisingly heavy. Made using 100% bamboo (except the trim) it has an amazing drape that is great to use as a blanket for night time and on the go.
The Cot Cellular Blanket is 50% organic cotton and 50% organically grown bamboo. The blanket is amazingly soft and delicate that is perfect against baby’s skin. Fabulously serviceable, the beautiful silky feel continues with machine washing and drying. Cellular blankets are synonymous with airflow and being breathable. This bamboo blend makes it even more breathable and warmer or cooler when needed.
Both the Bamboo Cot Blanket and the Cot Cellular Blanket have a lovely weave that ensures little fingers cannot poke through the material and get stuck. Ask your Mummy to get you a new Save Our Sleep blanket for you to snuggle under as well.
Win a Save Our Sleep Cot Blanket!
To celebrate the release of the new Save Our Sleep branded blankets we are running a competition on my facebook fanpage where you can take and send in a picture of your baby with either the Save Our Sleep or Little Bamboo brand cellular or bamboo blanket. The picture needs to be of a quality to use on the website! To enter simply upload your photo onto the fanpage by Friday 10th June and my team and I will choose a couple of winners. The winners will receive a Save Our Sleep cot blanket as their prize! Enter the competition…
Darragh
My product of the month this month is a bit different! It is Mummy’s routines and how it allows me to have special Mummy time while Cillian is asleep. I love my one on one mummy time while Cillian has his day sleep. I have some special big boy toys that I am only allowed to get out and play with while Cillian is asleep as they are not safe for toddlers.
I love my routine that after lunch each day Mummy and I have this special time. If Cillian wasn’t following Mummy’s routines this special time might only happen some days or at different times so I wouldn’t know when to expect it. Thank you Mummy for helping me and lots of other big brothers and sisters have this special time with their Mummy’s and Daddy’s each day! Today was extra special because Cillian had his sleep in the buggy at Dublin Zoo while mummy and I watched the new baby Gorilla and his friends. The best part was when his mummy gave him a big kiss.
Darragh loved the Gorillas so much he took this fantastic photo of the Mummy and Baby Gorilla all by himself!
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Featured Supplier
Our new blankets are now in Babies & Kids 81 Gamon St, Yarraville, VIC 3013 so pop in and feel them for yourself!
Save Our sleep products are also available in some retail stores please check for your local store on our website.
Travelling
As you know the boys and I are at home in Ireland so I thought it time to share with you some more of my travelling tips! I have always found that it is incredibly beneficial to bring as many familiar things from home with us to help the boys with the transition of staying in unfamiliar places. Here are some things I would NEVER leave home without when going on trips -
My boys bedding – I always make sure I bring my boys bedding including mattress protector, sheets and blankets (directly off the cot so they smell familiar). While you may think that blankets are going to be heavy and take up lots of room, I believe it is vital that your children have familiar bedding when you are asking them to settle and sleep in new places. I always carry at least two of my boys own blankets on board with me when flying that I can fold up and place over them.
Travel car seats – I always bring our travel car seats with us, the boys are used to sitting and sleeping in car seats and I find this helps them to understand that they have to stay seated on the flights. They also sleep better in them and I don’t have to disturb them each time the seatbelt sign comes on. (Which in past experience always seems to be when a baby has just fallen asleep in a bassinet!)
Babybjorn Travel Cot - Cillian has slept in this cot every night we have been in Dublin and he has slept beautifully in it! I would not travel without this cot! It is incredibly light, easy to set up and seems to be the only one on the market that babies don’t sweat in.
Sleeping Bag – of course I always bring sleeping bags from home and I always bring at least two and carry both on the plane in case the boys get sick. I find the sleeping bags invaluable as planes are notoriously cold and the sleeping bags are familiar but also keep them warm enough to be able sleep. I also always carry a spare set of clothing on board for myself as well in case the boys are sick on me! You don’t want to get vomited on and have to smell it for hours on end!
Food - Yes I actually work out how much food Cillian will need for the duration of the trip – this time 7 weeks and I carry it all in one suitcase! If you don’t feel you can do this please consider having your child’s familiar food at least on the plane as they last thing you want on the plane is a hungry baby who is refusing anything the airline is offering. If your baby does not normally eat any commercial food please start introducing it into your baby’s diet at least 6 weeks before you trip. I bring a stick blender as well to make up as much food as I can but it isn’t always possible if you are on the road so I often just make up chicken or lamb and add it to commercial food while away. The added bonus of filling a suitcase with food for the trip over is you will have an empty suitcase you fill with shopping on the trip home!! (Shh don’t tell Nathan!)
Books & Small Toys – I always bring the boys favourite books and a couple of small toys for the trip which have continued to be read and played with here in Dublin even though they have been spoilt by family with lots of new things.
Your Chance to win a BabyBjörn Travel Cot Light RRP $395.95\
We have some very exciting news! Tizzie and the Save Our Sleep team along with BabyBjörn Australia are giving you the chance to win a BabyBjörn Travel Cot Light RRP$395.95. To be in the running to win this cot you need to visit the Facebook | BabyBjörn Australia page and LIKE their page, then write on their wall: “WHAT IS YOUR BEST TIZZIE TIP?”. You have until Thursday 30th June 2011 to enter. At the close of business AEST on this day BabyBjorn Australia will add up all the entries and then draw a random number out of hat e.g. 56 and the person who put up post number 56 will win the Travel Cot! Remember you must LIKE the BabyBjorn Australia page and pop up a post with your best Tizzie Tip on their page to be eligible. The winner will be announced Friday 1st July 2011.
Winter Warmers
Apart from the new range of Save Our Sleep blankets we have lots of other blankets available at Save Our Sleep. Here are just some of the gorgeous blankets you can find in my store.
Please note: when referring to my safe bedding guide the layers of blankets recommended are the Save Our Sleep Bamboo Cot blankets. If you are using other blankets you will need to adjust the blankets according to your baby’s hot or cold signs.
Purebaby Stripe Range
FREE GIFT – With each mint and white striped blanket bought we will give you a free Green Amadeus Anwayup Beaker valued at AUD$13.95. This offer is only while stock of the blankets last.
Purebaby Cable Knit Range
Weegoamigo Range
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Ireland here I come….
It’s just over a week before I head home to promote the release of the UK/ Irish version of my toddler book.
Buy Practical Parenting and Get My Advice for Free
Thank you to Practical Parenting UK and Vermillion for including a covermount – three chapters – of my book with the magazine this month. I firmly believe the covermount is helping parents and parents-to-be in the Ireland and the UK to understand my approach and how my book and advice can help them lovingly teach their babies the very important skill of sleep. The magazine is selling fast so make sure you grab a copy now.
Book Tour
The boys and I are arriving in Ireland on the 17th of May for the release of the Irish/UK edition of my toddler book. My toddler book will now be available both in Australian English and UK English. The books are identical in advice: it’s just the terminology that is adapted for each target audience.
The Irish/UK version of my toddler book is now available in all good book stores NOW including my websites.
We’ll also be travelling to Italy to help promote the release of the Italian version of my baby book. My baby book is soon available in six different languages – Australian English, UK English, Mandarin, Estonian and Italian! And later in the year the baby book will be released in Brazil.
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Ireland AM Interviews
I will again be a guest of Ireland AM helping parents get their babies and toddlers safely and soundly sleeping through the night, every night.
To keep up-to-date with my scheduled appreances, join my facebook page. If you need advice in the meantime click on the links below to watch my 2010 series of Ireland AM interviews.
Tizzie & Breastfeeding Expert Talking About Demand Feeding
Tizzie Hall On Controlled Crying
Le gach dea-ghui, Tizzie
To keep up to date with weekly product specials, competitions and news from Save Our Sleep join Tizzie’s fan page!
Is your baby’s carseat fitted correctly?
The start or end of daylight savings is the perfect time to carry out some saftey checks which I will talk about in my tip corner. But first my boys will share their favourite products for April!
PRODUCTS OF THE MONTH
Cillian – BazzleBaby Clip
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Hi everyone,
Mummy has found a great new product that means no more tears over lost comforters or Sophie the Giraffe!
Mummy attaches the ‘BazzleBaby clip’ to my buggy and the other end to either my Sophie the Giraffe, if it is my awake time, or to the foot of my puppy comforter if it is my sleep time while we are out about. (Mummy never uses the clip in my cot as this which would not be safe). So if I drop one out of the buggy and Mummy doesn’t notice they won’t get lost!
Another great use is in the car. I often drop my comforter in the car and Mummy used to have to pull over to the side of the road so she could give it back to me. But with the BazzleBaby Clip Mummy can attach it to the carseat harness and I can reach my comforter or Sophie if I drop them.
Darragh – Big Boy Bedding
Hi everyone!
Some of you may not know that I now sleep in a big boy bed. I love sleeping in my big boy bed and snuggling under my BAMBI bedding, which keeps me nice and warm. To protect my mattress from accidents Mummy uses the BAMBI 100% cotton mattress protector, which comes in cot, single and king single bed sizes.
On my big boy bed I also have the BAMBI Cottina 100% cotton Quilt/Duvet and now that it is getting a little chilly at night I also have the BAMBI 100% cotton Cottina single bed blanket.
Have you…?
When it’s time to turn the clock forward or back for daylight savings it’s a timely reminder to perform some important saftey checks.
1. Smoke Detector Batteries
Change all batteries in your smoke detectors. Even if you have the recommended hard wired detectors remember they have a battery back up so you need to replace the battery to ensure the smoke alarm will work if the electricity is off.
2. Child Restraints
Have you checked the restraints on your child’s car seat? Children are growing all the time and it is important to check they still fit into their car seat correctly. Please see these important tips from RACV (Royal Automovile Club Victoria):
Approximately 70% of child restraints are not installed correctly. A child restraint that is not fitted properly could result in serious injury or even death in a crash. It is strongly recommended that new restraints are professionally fitted by a trained child restraint fitter, so that parents can be shown how to fit the restraint correctly.
Child car seats with side wings offer more protection in the event of a crash.
Check the seat belt (and tether strap if in Australia) are taut and firm every time the restraint is used. A good guide is to make sure you cannot pinch a fold in the chest straps. Ensure there is no slack and no twists in either the tether strap or the harness straps.
Adjust the car seat harness straps as a child grows, which includes moving the shoulder straps so they are above or level with the child’s shoulders.
If a child car seat is to be used in a position where there is an airbag, check the car owner’s manual for advice.
If in Australia do not place a child restraint in the front seat of a vehicle.
Source: RACV Road Safety and Child Restraints Website.
3. Car Seats
It is also the time to check your child’s weight and ensure your child is in the correct type of car seat for his or her weight. It is dangerous for a child to be in a car seat once they have exceeded the maximum weight or height recommendation for their particular car seat. To check your child is not too tall for your current car seat always ensure that the child’s eye level is not above the back of the child restraint or they will be at increased risk of a whiplash injury in an accident.
4. Car Seat Position
Is your child’s car seat still positioned and anchored correctly in car? If you drive a van with multiple rows of seats, including a rearward facing row, it is easy to inadvertently fit your infant seat incorrectly. The rearward facing infant seat must go on a forward facing row of seats. If you put it on a rearward seat your baby is actually going to be forward facing which is unsafe. However, an advantage to a car like this means your older children can sit on the rearward facing seats and travel rear facing for longer which some countries have as law for children less than six years old.
Correct seat position – infant capsule is rear facing on a forward facing seat row and the forward facing car seat is positioned on a rear facing seat row, the safest way for children to travel!
Some information sourced from: RACV Website and Child Restraints Website.
Le gach dea-ghui, Tizzie
