USANNA Mukyaye, a first-time mom is still confused. While her mother-in-law insists she puts her baby, Zachayo, to sleep on his tummy, her doctor advises her to position the three-month-old baby on its back.
"Personally, I prefer the tummy position. I have tried both and realised that my baby sleeps longer on the tummy. But the doctor warns me that tummy sleeping is associated with Sudden Infant Death Syndrome (SIDS)," Mukyaye says.
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SIDS or cot/crib death is the sudden unexplained death of an otherwise healthy baby, normally below one year of age.
But Christina Nambalirwa, 60, a mother of eight and a grandmother of several, insists that tummy sleeping has long been practised locally and is the best position for a baby.
"This back-sleeping thing is foreign. How did we raise your fathers? Unexplained deaths of infants were a very rare phenomenon. It often happened with mothers who were heavy-sleepers and rolled over their infants because unlike today, we used to sleep with our babies," Nambalirwa says.
She says in their times, they used to co-sleep and breastfeed their babies for a minimum of two years.
"Mothers often overfed their babies, and we did not have time to burp them. Work was waiting. Tummy sleeping took care of that. You risk choking your baby on its spittle putting it to sleep on its back," she says.
Nambalirwa further explains that when a baby sleeps on its tummy, it sleeps longer as it is not disturbed by light.
She adds that tummy-sleeping strengthens the baby's chest while expanding its stomach sideways, creating more room to feed.
"Have you ever wondered why our 'rural kids' are healthier? They feed frequently. The tummy is flat but more accommodative," she says further, noting that sleeping on the back makes the back of the head and bums flat. Now imagine if it is a girl, how will you enhance her looks?"
However, Dr Kajumba Muganga a paediatrician at St. Catherine's Clinic in Kampala holds a different view and encourages side-sleeping instead.
"The biggest risk with tummy-sleeping is suffocation, especially for infants below four months. Their nostrils are tiny and any minor blockage obstructs breathing" Muganga says.
"With back-sleeping, should the baby spit, it may choke," she says.
Muganga says babies with certain health problems like pneumonia, respiratory and heart problems or breathing difficulties, should be cropped up, and this is very easy with side-sleeping.
She dismisses fears that a baby's head can be deformed if it rests on one side for long, saying nature takes care of the shape. She says a baby undergoes a continuous process of molding, right from birth.
On SIDS, she says no local research has been carried out, though the problem may be there.
"Some researchers have hypothesised that tummy-sleeping puts pressure on a child's jaw, narrowing the airway and hampering breathing.
"Another theory is that tummy sleeping can increase the risk of inhaling the exhaled air, particularly if the infant is sleeping on a soft mattress or with bedding, stuffed toys, or a pillow near the face. In that case, the soft surface could create an enclosure around the baby's mouth and trap exhaled air. As the baby breathes in exhaled air, the oxygen level in the body drops and carbon dioxide accumulates. Eventually, this lack of oxygen could contribute to SIDS," it says.
But Dr Margaret Nakaketo, a neonatalogist at Mulago Hospital argues that you cannot point at tummy-sleeping as the main cause of SIDS because when considering which babies could be most at risk, no single risk factor is likely to be sufficient to cause SIDS.
"You can put your baby to sleep on the tummy as long as the umbilical cord is healed. Just make sure that the shoulder is lifted so that the airways are clear. If you choose the back position, crop it a little - do not let it lie flat so that just in case the baby spits up, the vomit does not flow back and choke it," Nakaketo says.
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