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Cot Death - SIDS

Cot death (CD) is the more telling title than SIDS—sudden infant death syndrome—for unexplainable and unpredictable death of a child in the cot. Losing an infant during his/her sleep is one of the most devastating tragedies imaginable, particularly one’s first child or the only possible child. Even if the infant is not the only child, but one of many, the event causes devastation for every member of that family. It is not known why this occurs, but it does happen. Every year, 7000 to 8000 infants between a few days to one year old die inexplicably whilst sleep. Of these, the greatest frequency is among infants of two to six months. Diagnosis relies on exclusion of other causes and based on autopsy examination.

Vomiting the milk and choking on it is usually not the cause of death. It is not caused by infections and colds. It is not the result of a contagious disease.  If these were the case, the primary cause would become obvious. The primary cause of CD is not really known. This is the reason they have given it the label of a “syndrome.” This word is used to indicate that the condition is being looked at seriously even if nothing new has transpired and no primary reason has been isolated. It is now being proposed that gasses emitted from the mattress may be responsible for the death. However, this may not explain the pattern and the frequency of the incidents within the first six months. If the gasses emitted from the mattress were solely responsible for the deaths, one would expect the frequency to climb the longer the infant is exposed to the gasses, from the initial days and for the duration of sleeping on the “toxic gas-emitting” mattress.

I have thought much about the possible physiological events that might cause the death of an infant during sleep. From the perspective of my paradigm shift (see the science section of this website), the only plausible physiologic event that might be responsible for cot death is the constriction of bronchioles due to dehydration and “heat management” programs of the body, when the infant is possibly bundled too much and the room is warmer than should be. I would call it infantile asthma. If childhood asthma can kill a good few thousands annually, even when treatment is available, why should asthma not be considered as a primary cause of death in infants who have no means of expression when in deep sleep?

We in medicine are confused about milk. We think it is the same as water just, because it has the consistency of a fluid. There is a marked difference between human milk and cow’s milk. Cow’s milk is more concentrated, and has more fat and proteins than human milk. Human milk is 88.5% water and cows milk is 87% water. Human milk has 3.3 % fat, 6.8% lactose 0.9% casein, 0.4% other proteins and 0.2% minerals. Cow’s milk contains 3.5% fat, 4.8% lactose, 2.7% casein, 0.7% other proteins and 0.7% minerals. These differences are significant. Cow’s milk is designed for the needs of a calf that stands and begins to move and runs around in the first hour of life. The newborn child is immobile for the first several months of life. Here lies the reason there is a difference in the natural consistency and design of human milk and cow’s milk. When cow’s milk is given to infants as their only source of water, and often time parents are told not to give infants water, the metabolic system of the infant is burdened by digestion of the concentrated milk. Concentrated milk from the cow can have detrimental effects on the infants unless the formula is diluted.

I was told at a medical conference that autopsy of infants who died in car accidents showed an obvious partial blockage of the coronary arteries of those on cow’s milk, and not of those who were breast-fed. This is a significant revelation that has not been dealt with publicly and openly.  The normal practice is that the infant is given concentrated milk and bundled to sleep. While asleep, much water, in comparison to the weight of the infant, is lost from the lungs during the exhalation phase of the breathing process. This water loss from the lungs, on top of the fact that the milk contained possibly only just enough water needed for the digestion of the milk itself, leaves the body of the infant short of water and will force it into physiological events for “drought management.” This includes the secretion of increased amounts of histamine, which in infants is also a growth hormone and abundantly available.  Histamine is also a constrictor of bronchioles. At a certain level of milk intake and unfavorable environmental conditions and the inability to cool down, it is possible that this combination could tip the balance toward the constriction of the bronchioles in the infant and cause silent death in sleep.

What surprises me is how the body of an infant is so resilient and adaptive that this problem is not seen more frequently. I can only think that the digestive process in the infant is so strongly active that the metabolic process manufactures some water from the breakdown of the solids in the milk to help the process in the same cycle of milk intake.  In which case, what tips the balance against the infant is its unfavorable environmental factors of too much heat and excessive covering of the body for “cot death” to occur. 

In old cultures, infants were given water. If they cried too much, tradition was to give the child a little sugar-sweetened water, one or two spoons of water—a few cubic centimeters, or about an ounce of water—one manufacturer had produced what was called “gripe water” to prevent colic. As the child grew, they would give more water. I remember the child would sometimes be given water in a bottle after some milk. Old cultures understood the importance of water to an infant and a growing child. Not too much of it, but a balanced amount and always with or after milk. I think we should go back to the practice of introducing some water into the diet of infants in the process of growth, particularly in the second and third months of life, when the occurrence of cot death becomes frequent and reaches its height by the age of six months.  This practice might possibly also cultivate a taste for water from infancy and establish a stronger thirst sensation—and prevent over eating when one is only thirsty later in life. 

For more information on the role of histamine, see the articles on this topic in the science section,, or read my book ABC of Asthma, Allergies and Lupus.                                

F. Batmanghelidj, M.D.

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