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
Monica Gately says:
So the crux of this response is that you have no formal research, it’s just all your observations/opinions…. not good enough for me
July 28th, 2011 at 8:11 am
Tizzie says:
Yes Monica, as stated on page xii of my book Save Our Sleep.
July 28th, 2011 at 8:19 am
Renee says:
Interestingly, “formal” research quite often comprises observation as a valid method of conducting qualitative research.
July 28th, 2011 at 8:44 am
Corinne says:
Formal research is validated by the peer review process:
http://www.senseaboutscience.org/pages/peer-review.html
This helpful leaflet explains how scientists present and judge research and how you can ask questions of the scientific information presented to you: http://www.senseaboutscience.org/data/files/resources/16/IDontKnowWhatToBelievereprint2008.pdf
July 28th, 2011 at 9:02 am
Monica Gately says:
Even more interestingly “formal” research is typically published in scientific journals and subject to peer review with testable hypotheses, not just one person’s anecdota.
July 28th, 2011 at 9:13 am
Shel says:
I absolutely agree that more research is needed. Has anyone contacted NICE in the UK (The National Institute for Health and Clinical Excellence) to suggest it as a topic for guidelines?
July 28th, 2011 at 9:21 am
Lauren says:
As one who uses Tizzie’s methods, I was reluctant to following her bedding advice after hearing overheating was a SIDS risk factor. My (breastfed) baby was getting plenty of milk yet waking through the night. The night waking didn’t bother me but she wasn’t overly hungry so it seemed strange that she’d have a small feed and a cuddle and happily go back to sleep. It wasn’t until I read Tizzie’s advice that babies may wake during the night because they’re cold but resettle after some time on mum’s chest because they’d warmed that I started to wonder if she might be cold. The next night I put her in a sleeping bag and added a blanket. She never woke during the night again. I did note that she still felt cool and was stirring frequently at the coolest part of the morning. I added one more layer each night until my baby was warm enough sleep comfortably (8 layers of cotton). Interestingly, she never feels overly warm when I get her out of her cot. In short, thanks for your bedding guide Tizzie. Without it, I may never have realised that my baby was cold.
July 28th, 2011 at 9:24 am
Susan says:
Thank you for a comprehensive reply Tizzie. I for one appreciate the years of work you have done and I have no doubt that baby safety is at the forefront of your recommendations. With respect to anyone that is not satisfied with this, as you said, that is fair enough. It is for each parent to look at all the research, formal or not, and make their own decisions. I think it is a testament to you that you continue to look at this and so many issues, and be prepared to adjust your advice accordingly.
Thank you for your ongoing work.
July 28th, 2011 at 9:48 am
Nat Denny says:
Thank you Tizzie for helping me ensure my both of my girls sleep in the safe back sleeping position all night long.
There are few things in relation to SIDS that are concrete or not debated by the various SIDS groups across the globe – the only major risk that all agree on is that tummy sleeping is the biggest SIDS risk of all.
We are each entitled to read the same recommendations, studies and come to different conclusions. We are also each entitled to measure the risks of bedding, tummy sleeping, bedsharing etc. and make decisions for our babies given we each know our babies best.
I find it ironic that advocates for bedsharing seem to be the noisiest about this topic yet on the topic of the dangers of bedsharing the silence is deafening.
July 28th, 2011 at 10:00 am
Mr Craig L George says:
This still clarifies very little, in my opinion. I was very much hoping for Mrs Hall to be able to provide us with some good evidence that supported her observations, and while i am appreciative she took the time to reply to some of the points made, I also feel disappointed, in a ‘Is that it?’ kind of way…
Research will always be open to interpretation, and very little can be 100% proven either way, but that is why it is called research; it is something that is ongoing, yet also falsifiable and justifiable. it is very easy to twist results, show bias’, be selective in which excerpts you take from it and in essence, you can, if you feel like it ‘make’ a study show what you want, if you are intelligent enough!
I decided to spend an hour or so on Science direct, Medline and Google, doing searches on thermal insulation in infants and SIDS risk/preventions. Aside from pretty much ALL studies finding prone sleeping is a major SIDS risk, as we are all aware, I did find a few studies that seem to suggest babies who sleep in the prone position lose less heat than those who sleep supine, which could, potentially be used to back up Tizzie Hall’s claims that babies roll onto their tummies when they’re cold. What is interesting though, is that I found many (more results that I had time to read fully in fact) more studies that DO say excessive thermal insulation IS a SIDS risk factor and that babies can and do overheat quite often- most of these babies only had raised core temperature and did not die of SIDS, however it was none the less found to be a risk factor…. For me, that is enough ‘proof’ for me to warrant not using so many layers on my young child. Again, my own choice though. Based on my own searches, i would also choose not to bed-share, but i can understand why people do choose to.
I wonder why someone as influential as Tizzie Hall, with all her entrepreneurial skills has not approached one of the universities in Australia to begin looking at this as a research topic? If I was in her position, I certainly would be asking MSc and PhD students if they would be interested in undertaking some studies. Maybe this could be something she looks into in the future to make her observations more credible and trustworthy?
I am a child and language development psychologist, and personally, i wouldn’t recommend using any of Tizzie Hall’s advice. But that is just my opinion. And like she admits, she does not expect her clarifications to change anyone’s mind, and I expect she wont.
I have heard so much negativity about Tizzie Hall’s methods, opinions and observations that it is very difficult to even try to remain ‘on the fence’ and see things from both sides, and I do not agree with some of the ‘trolling’ that appears to have taken place on both of these ‘sides.’ I do however think it is important as human beings that we ask questions where questions are due and that those questions should be answered to the best of a person’s capabilities and this reply has gone somewhat into doing that, which may keep the ‘opposers’ at bay for a while.
So, i have tried very hard to find some positive things that Tizzie Hall mentions, as opposed to the questionable advice she gives out on layers, breastfeeding, premature weaning etc. So, what could I find that is positive?
She does promote the safe back sleeping position in infants and does use the ‘feet to foot of the bed’ message, which is fantastic.
She does support the use of natural, breathable materials for use as bedding and clothing to sleep in, which again, is sound advice.
I notice on her website that she does seem to endorse only what she considers to be ‘safe’ products and in some cases, does explain her reasons why she thinks certain products are safer or superior than others, which may help people make a more informed choice when buying certain products. (e.g. her ‘safe sleeping bags’ which seems to make sense to me as a father, i must admit.)
She also says to steer well clear of any plastics that may contain dangerous BPA, which again is good, and it would appear she also posts information about product recalls, regardless of whether she sells that product or not, which again, as a parent, i would appreciate, just in case.
BUT, those are the ONLY things I can sing Tizzie’s praises on I am afraid. Everything else, I am very firmly in the ‘against’ catagory, and unless science suddenly changes and proves my own thoughts and opinion wrong, I will stay there, sorry.
Craig.
July 28th, 2011 at 11:14 am
Harls says:
I just want to ask Craig if you would be in here posting in response to this blog and voicing your expert opinions if it wasnt for your wife asking you to post ???? That is all……
Tizzie – I AGAIN want to thank you for all your advice and guidance over the last 8.5years. Im proud to have 3 Tizzie babies who have slept through the night from very early on.
To me, this IS important, it helps our babies get the consolidated sleep they require for brain development. Any parent who states they dont care if their baby sleeps through is lying !! For me, i am refreshed in the morning along with my babies to play with and enjoy them to their full potential. Who wouldnt want this ??? Out of my 3 babies, the first cried alot more as i was trying to rock him to sleep for hours until i discovered Tizzie. With following her routines for my next 2 babies, i had NO crying what so ever. Im sure the AP’s out there think that all our Tizzie babies have been scarred for life……..quite the opposite in this house thats for sure !!
I use 12 SOS blanket layers on my 10month old and he still doesnt feel warm enough to me when i get him up in the mornings. I dont see how we CAN overheat our babies when we check on them before we go to bed, babies body temps decline over night not elevate so Im reassured Im not overheating my baby.
Over the last few weeks of cocooning his bedding correctly as Tizzie has advised he is sleeping SO much better, therefore he mustnt have been snug enough.
All i can say is, choose what you want to follow and keep your opinions to yourselves. Years of observing and working with children and babies is FAR more credential in my eyes and good enough for me.
No need to create nasty replies about someone you dont believe in, just go away, simple !! anyway……thankyou for saving our sleep Tizzie
oh…..and my GP AND maternal child health nurse both told me to start solids at 16-17 weeks, fully agreed with Tizzie Halls recommendations.
July 28th, 2011 at 12:41 pm
Fleur Lees says:
I actually didn’t ask my husband to post, but i am proud of him for doing so of his own volition. I was also surprised when he texted me to say he had, as he usually steers well clear of this kind of thing and leaves it ‘up to the bickering women,; as he put it.
I am the ‘Fleur’ quoted in Analytical Armadillo’s blog post, questioning the layers. Obviously i do not follow her methods and am not a fan. But i do question some (though not all) of her methods, not because I want to criticise her as a person, or as a mother, but because I am a concerned person (along with many other hundreds it would appear) who finds it worrying that people are using so many layers, which could pose a potential risk…
I am not going to tell anyone to stop believing what they want to, or stop using the methods they want to- that is up to them as parents and we all parent differently…. that is perfectly normal. It just seems very odd to me that Tizzie’s advice seems to go against what our country’s (I’m in England) guidelines seem to say.
Obviously, this is posted on Tizzie’s own page and blog, therefore the majority of responses, will of course, be pro her methods, which is only to be expected, in the same way, people’s responses on Analytical Armadillo’s blog will be mainly pro AA’s point of view.
i dont believe for one second that my husband posted to be nasty or anything like that, but purely to offer another view point forwards. I dont think he has been rude either, although I am very aware that some posts on Tizzie’s facebook page and other sites have been quite rude about her, as she states in her response.
I don’t think opinions should be kept to one’s self. i think opinions, information, observations etc should be shared among all- that is how people make fully informed decisions, but seeing varying points of views from all angles, then deciding what might work best for them in their individual circumstances and family dynamics- as parents that is all any of us can do. I see it as fans have chosen to follow Tizzie and that is fine. Opposers have chosen other methods and that is fine too.
But what was in question in this instance was purely a safety aspect. No one is knocking the parents who choose either way of raising a child, but people were questioning the possible risks of overheating, which Tizzie has tried to explain in her response and I do think the majority of people out there will appreciate.
i am very interested now in hearing what FSID has to say on the matter, even if they prove Tizzie right and say it’s 100% safe… If they do, then all this will go away and the argument will be finished once and for all. Or if it proves them unsafe, the argument will also be ended I guess… Either way, i guess the outcome will be positive, in the sense that one side or the other will be silenced.
July 28th, 2011 at 2:33 pm
Morag says:
I’m confused as to why you would even want a baby to sleep all night given that it’s normal and necessary for infants to wake frequently at night to breastfeed (for comfort and nutrition) and also to prevent SIDS. Co-sleeping regulates a baby’s temperature, heartbeat and breathing so blankets and cots are not only unnecessary they are less safe. Just my experience as a mum of six (and the opinion of world sleep expert James McKenna).
July 28th, 2011 at 2:49 pm
Sam says:
You keep referring to “your research”, but what research?! When and where was it conducted? How many subjects did you use? What were the controls and variables? What was the abstract, what was the conclusion? Has the research been peer reviewed? I was hoping that this information would be included in your response to the Armadillo. I am disappointed. Will it EVER be published? When?
For all I know, this research could be on one baby behind closed doors in your bedroom in the dead of winter when your heating broke. In which case I would not be likely to take it very seriously and would be even less inclined to follow advice from it in the summertime.
Or it could be 800 babies, carefully controlled, carried out in conjunction with a large university or sleep lab…. In which case I’d be more likely to think: OK, maybe Tizzie knows her stuff.
July 28th, 2011 at 3:17 pm
Susan says:
With respect Morag, that is a matter of opinion. If it was natural for a baby to have multiple wakings, why do so many babies sleep through the night? If they were ‘meant’ to wake up, would could not force them to stay asleep. They would wake up, simple. My baby wakes up at times but does not want to feed! She needs a burp, and then wants to go back to bed. Yes, in a cot. We don’t all choose the approach of bed sharing (which some argue is a SIDS risk – all open to interpretation you see). So we have to find the safest way to cot sleep, as you find the safest way to bed share. And I agree with Harls, that a good night and good day sleeps are essential, in my experience with my children. It is a basic human need.
I think Craig’s response was well written. We don’t agree on everything but he accepts that we have differing opinions, that is fine. To try to force your parenting approach on others is a weak argument.
I believe that Tizzie addressed the issue of blankets very well. She showed that with regard to tog, her recommendations match that of many others. Except maybe the sleep bag companies, but for me, common sense tells me that is incorrect. I don’t need a degree to wonder, how can a tiny baby possibly be warm enough under clothing and 2.5 tog bag, when I am under clothing, duvet, two extra blankets and snuggled up to my husband. We are told not to overheat, which I agree with of course, but being warm is entirely different.
Tizzie has also gone above that by looking at humidity and the type of bedding to use. Very comprehensive advice. And in my opinion, 20 years experience working in the field is just as much, if not more qualifying to be called an expert in that field. Research undertaken in natural environment, not a set up situation. It is all valuable and worthwhile.
July 28th, 2011 at 10:58 pm
Kelly says:
I use Tizzie’s methods and both my 4yr old boy and 15mth old daughter are still alive and well with there cotton blankets and clothing and heaters heating there rooms to a toastie 20deg. Both are warm and safe ‘Sleeping’ and I check on them every few hours at night and I also attend to the needs at night>
@Morag if babys dont NEED to wake for food then they should be ASLEEP during the night, they wont need to wake for ‘comfort or warmth’ if YOU as a parent appropriately keep your child warm—-Keeping them warm is just as important than feeding your child, not doing so is neglect the same as not feeding them.
I couldnt care less if Tizzie had all the qualifications in the world, if she doesnt have experience and research her experience then all would have good reason to doubt her ability but to me experience and the hours behind her experience puts her in better stead with me than someone sitting in a library and reading literature about babies/children that is dated.
I WANT someone with experience and knowledge and if I believe in Tizzie’s book and have seen the results right infront of me then this is all the ‘evidence’ I need as a parent wanting the best for my children and so does Tizzie that is why she wrote the book.
I do really think people need to read better and not judge something they have never tried and for those who have may need to go back and read the book again or more as all of in contents are common sense.
Thanks Tizzie, to me you have answered there questions.
July 29th, 2011 at 12:04 am
Alicia says:
I still don’t see what all of the fuss is about! From what I can gather the Save Our Sleep website posted the message regarding the maximum number of blankets to prevent people using thin blankets to put too much weight on their babies. Her bedding guide recommends that I would use 4 blankets in my region at 20 degrees. That would mean I would need to buy 2 blankets!
Also from what I have read in the book, she doesn’t expect babies to sleep all night before they are ready, she recommends you get them up and feed them when they need it.
With regards to overheating, it gets very hot where I live in summer and I don’t have air conditioning. Does that mean that I am overheating my baby in summer? Just some food for thought.
July 29th, 2011 at 12:27 am
Tizzie says:
Hi Craig,
Thank you very much for your articulate and balanced reply. I appreciated reading it.
Le gach dea-ghui, Tizzie
July 29th, 2011 at 12:43 am
Nat Denny says:
In the studies I’ve seen none have quantified the term “excessive thermal insulation” or the other risk factors present (prone position, head/face covered) .
From Tizzie’s discussion tab post “hello Facebook Fan Page Guest”
//http://www.sidsandkids.org/pdf/InformationStatement-RoomTemperatureSept2007.pdf
3rd page second paragraph in the conclusion box it states. “However there is no evidence to show that extra thermal insulation increases the risk of SIDS in infants who sleep on the back with the head and face uncovered.”
Again, we are each entitled to measure these risks. For me, tummy sleeping remains by far the biggest risk.
My eldest did roll onto her tummy as soon as she could (4/5m + she was unable to roll back for several weeks) and I believe she did so because she was not warm enough. She has slept on her back since 2.5 when she moved into a big bed with a big warm doona and a 2.5 sleeping bag.
My youngest is 10.5m, still swaddled, in a sleeping bag + has numerous layers of blankets and sleeps on her back all night long because she is warm enough.
July 29th, 2011 at 1:02 am
Tizzie says:
Hi AA:
I think you have misinterpreted the emails we sent you last night. A member of my team sent you an email stating that I would not be responding to further blogs asking for evidence on topics that are covered in book – e.g. breastfeeding, weaning, self settling –
“We felt it important to let you know that the reason Tizzie replied to your blog was because her specific bedding advice is not included in the book but is extra information so we felt in this situation it was worthy of a reply. However, please understand that Tizzie will not answer any further formal requests via you of any other Mummy blogger in regards to information that is outlined within her book. This includes Tizzie’s breastfeeding advice, her weaning advice, her self settling advice etc.”
We explained why we responded to your original blog and have not said that we won’t respond again once the formal reply comes for FSID we were simply letting you know that we would not respond on other topics.
At the end of my blog I again wrote “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.”
Any further response I may write will come after we hear from FSID and it will be a new blog.
The one question I am really hoping FSID answer is where the guidelines on sleep bag packaging comes from and why is humidity and climatic variances not taken into consideration. These guidelines seem to be repeated in many places including SIDS researcher’s websites.
Obviously I didn’t make this clear so I apologise please could you copy and paste the above email into your Blog.
Le gach dea-ghui, Tizzie
July 29th, 2011 at 11:51 pm
Susan says:
I would just like to make a comment relating the response to this blog, that has been posted from AA. http://www.analyticalarmadillo.co.uk/2011/07/armadillo-reply-to-tizzie-halls.html
QUOTE:
Well yes, if you used 0.2 tog blankets it of course follows you would need more than if using 0.6 tog; however until now the average tog rating of a blanket has been discussed at 1.5-2 tog. I’m not sure how the fact yours weighs the same as one blanket you tested at 0.2 is really relevant, because according to an “average”, it also has to mean a significant amount on the market are a lot warmer than 0.2 tog to obtain a 1.5-2 average? Therefore it also potentially means people could use less blankets (and therefore less weight) to obtain the same warmth as with (your recommended) 0.6 tog blanket? Say this one at 3.7 tog or the ones they refer to at the bottom of the page ranging from 1.7-2.6 – then parents could just add a thinner layer or two if required?
“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” – The logic of mothers need far more of another brand is only applicable though when comparing to the specific (unidentified) blanket you tested at 0.2.
AA – The point that you are missing here, is that the statement regarding maximum layers was issued on the SOS forum (and linked to that on Facebook), to SOS MUMS, in response to conversations that SOS MUMS had been having on the forum. Therefore we, the SOS MUMS, knew what type and brand of blanket/s were being referred to. It was not a statement that was intended for the wide international general public and it was not a statement that was saying, use no more than 16 layers of any blanket. We SOS MUMS understand the context, because it was directly related to us.
I appreciate that you have every right to examine all aspects of baby safety, but with the utmost respect, it’s comes across rather like you, and those who follow you, have a personal vendetta against Tizzie, just because you do not agree with the parenting approach. The whole blanket issue is completely out of hand. As I said, it was a statement directed at SOS MUMS in response to our conversations. SOS MUMS often discuss using the .2tog blanket mentioned and as such that they often need more than the bedding guide recommends, so the statement was a direct response to that, regarding those particular blankets. We SOS MUMS of course knew that, but to people reading from outside, it has been misinterpreted. A very responsible and valuable statement from Tizzie, regarding discussions on her forum. NOT a global recommendation to people to use 16 blankets.
July 30th, 2011 at 5:47 am
Charmain Lynch says:
At the end of the day Tizzie, there are ATLEAST 5000 fans that use you methods. I for one will thank you over and over again, you, your staff and the mums that are your fans are nothing but supportive of parenting.
There is a reason i couldnt handle going to a mothers groups as some of the discussions are boarderline ridiculous (just like above). I have time to thank you as my girl is asleep but i certainly dont have the time to argue over things that at the end of day are interpretations. I would much rather spend time with my girl than be a martyr or try and disprove others choices.
there are pros and cons of everything, but its the choice of the parent. I think some of the negativity that is bought in from your disputers unfortunately are causing angst and perfectionism that isnt required. Post natal depression is prevalent enough without random people across the globe becoming keyboard heros and judging without knowing the full circumstances of the parents or of yourself.
My advice to all the parents that are over being judged, the best thing i ever did was remove myself from facebook and other sites and spent that additional time on my girl or my man. Life is certainly rosier
Again – thank you Tizzie from the bottom of my heart!
August 6th, 2011 at 5:50 am