Letter: Cot death advice

Sir: Parents should not panic following a report that sleeping babies on their backs, the recommended position to reduce the risk of cot death, may lead to "misshapen" heads in a few babies (report, 14 July).

Many babies have heads that are slightly asymmetrical or "plagiocephalic" at birth, probably as many as one in 30. If one side of the back of the head is flatter, babies will lie on it whatever you do, and the weight of the head will make the flattening more obvious. Babies later spend less time in one position, and their growth in brain size leads to a more symmetrical skull shape. It is misleading to suggest this is "harming" babies.

A tiny number of babies suffer severe malformations before birth and require neck massage and muscle stretching from birth. This is totally inappropriate for the vast majority.

British journals have already documented that the number of babies referred for medical opinion has increased, but not the incidence of babies with severe abnormalities. The rate of cot death since the introduction of the back-sleeping advice in 1991, on the other hand, has plummeted by over 60 per cent. Babies who sleep on their fronts are nine times more likely to die of cot death than those who sleep on their backs. "Flatter heads" are reversible, cot death is not.

Babies should sleep on their backs, but also play on their fronts, and sit up to watch the world.