Many parents increase the amount of bedding when a baby is unwell, but this is not what your baby needs. High temperature plus infection in babies over ten weeks old greatly increases the risk of the crib death. If heat loss is prevented, the body temperature of a restless baby with an infection will rise by at least 1°C per hour. A baby loses most heat from its face, chest, and abdomen, so lying on the back allows body temperature to be better controlled.

Baby nests, sheepskins, quilts, and comforters are all heat insulators, and should not be used for young babies, because they prevent heat loss. You need not keep your baby’s room warmer than the rest of your house; just make sure your baby has enough covering (see below). If you do have a separate heater in the nursery, use a thermostatically controlled one that will switch off if the room gets too warm and switch back on again as it cools down.

The causes of crib death are unknown, and there is therefore no advice that can guarantee its prevention. Because SIDS is by definition a death whose cause is cannot be explained by a known condition, many first- time parents see it as a threat about which they can do nothing. There are, however, ways in which parents can vastly reduce the risk.

SLEEPING POSITIONS: One of the most crucial risk factors is the positions in which you put your baby down to sleep. In most countries, babies have traditionally slept on their backs. In the U.S. as well, most babies have traditionally slept on their backs until the 1960s, and the number of crib deaths was low. In 1970, however, special- care baby units started to lay preterm babies face down because it seemed this position improved breathing and reducing vomiting, and eventually the practice was extended to full- term babies.

The significance of sleeping position in relation to SIDS was looked at in 1986, but the evidence was not convincing and it was not until 1986, when SIDS rates in different communities were compared, that it became clear that SIDS was less common where babies slept on their backs.

Quite by chance, when my first son was born in 1972, I avoided this risk by laying him down on his side, thinking that if he wanted to such his thumb it would be easier for him to do so, and I kept him there with small soft pillows placed in front and behind him. Research in New Zealand since then has shown fewer crib deaths in babies placed on their sides, but without support they can roll on to their tummies. The safest position for your baby, therefore, is on his back. Some people will tell you that this position may allow inhalation of spit- up, but there is no evidence to support this.

In rare cases, a baby’s anus is sealed at birth, either because there is a thin membrane of skin over the opening or because the anal canal, which links the rectum with the anus, has not developed. The rectal pouch may be connected to the vagina, urethra, pr bladder, and surgery must be performed at once. This condition is routinely checked for at every birth, and is treated immediately if present.

In this condition, the pylorus, the passage that leads from the stomach into the small intestine, is narrow because of a thickening of the muscle. The cause is unknown, and it is more common in boys than in girls.

Symptoms usually first appear at two to four weeks, though they can appear earlier or later. The stomach contracts powerfully in an attempt to force a buildup of food through the narrow pylorus. This is impossible, however, and the contents of the stomach are vomited up so violently that they may be propelled up to 3 feet (1 meter) – projectile vomiting. The baby may also suffer constipation and dehydration. Ultrasound and a barium swallow may be used to confirm the diagnosis. A simple operation to widen the pylorus can be performed, curing the condition completely.

This is by far the most common of a range of conditions called trisomies, in which one pair of chromosomes has an extra chromosome, making three. In Down syndrome, there are three number 21 chromosomes. Affected infants characteristically have small features, a tongue that protrudes, and slanting eyes with folds of skin at their inner corners. They tend to be rather floppy infants and have short, wide hands. They may also suffer from congenital heart disease.

Down syndrome babies usually mentally handicapped, though the degree of handicap varies widely; many are near normal. They are usually affectionate and happy children. With careful attention and early education, they often do very well, and some manage to live independently as adults.

A cleft is a split or separation of parts. During the early part of pregnancy, separate areas of the baby’s face and head develop individually, than join together. When joining does not take place or is incomplete, the baby can be born with a cleft lip on one or both sides, with or without a cleft palate. Breastfeeding is sometimes possible, perhaps using a nipple shield; if not, special bottles and nipples are readily available. Some milk may return down the nose but this doesn’t matter.

A cleft lip can be surgically closed soon or some weeks after birth. The palate can be closed from about six to nine months. Further operations may be necessary for some children.

Affected children are looked after by a cleft-palate team which will monitor speech, hearing, and teeth and will intervene should this become necessary. Support for parents is available.

In a very small number of male babies – about 0.3 percent – there is an abnormality in the position of the urethral opening on the penis. In epispadias, the opening is on the upper surface of the penis, and the penis may curve upward; in hypospadies, the opening is on the underside of the glans (head), and the penis may curve downward. In rare cases, the urethral opening lies between the genitals and the anus, and the genitals may appear to be female. Surgery can be carried out in the preschool years to correct the defect, allowing normal passage of urine and, in later life, normal sexual intercourse. Neither of these conditions, even in the severe form, causes infertility.

Congenital handicaps are rare. Some are genetic, whereas others are due to the effects on the fetus of drugs, radiation, infections, or metabolic disturbances. The fetal tissues that are most actively growing at the time when the adverse factor operates are the ones most likely to be affected. An increasing number of defects can be defected before birth and successfully treated just after birth.