El derecho al olvido en el RGPD y en la Ley Orgánica 3/2018

SIDS prevention advice in the UK often warns against infants wearing hats in bed (Foundation for the Study of Infant Deaths 2009b). Goldman and Kampman (2007) documented the mechanism whereby heat loss from the head differs from the rest of the body. There is a high blood flow to the scalp and brain, which is independent of thermal state. A hot head might not trigger the normal physiological responses to lower the body temperature. Heat loss from the head also varies according to the environmental temperature. Goldman and Kampman (2007) found that the heat loss from an adult head represents about 25% of total body

non-evaporative heat losses at 20˚C, 40% at 10˚C; 50% at 0˚C, and 80% at -20˚C.

Infants have proportionally larger heads than adults or an older child, which means that in a room with a temperature less than 10˚C, an infant without a hat would lose a substantial amount of heat from the head. Therefore, contrary to SIDS prevention advice, wearing a hat, especially in cold temperatures, may not as be harmful as feared. It may actually be necessary in cold conditions to prevent the infant from getting too cold. Cold is discussed in sections 3.3.13.3 and 3.4.9 as a potential risk factor for SIDS, along with risk of hypothermia, poor sleep and infections. It is paradoxical that hats are thought to endanger infants lives in the UK yet save infant lives in Malawi and Bangladesh. This discrepancy is an indication of the degree of focus on overheating as a risk factor for SIDS in the UK, which is emphasised to the exclusion of harmful effects of cold on infants.

When we apply all the above information to the thermal care of infants we can see that not only are there multiple variables affecting thermoregulation including changes in environmental conditions, differences in individual vulnerability to thermal stress, and changing responses of each individual

68 depending on factors such as activity, sleep state, and illness, but also that

consideration must be given to differences in thermal sensation and comfort. One infant with freezing cold hands may feel extreme thermal discomfort and another no discomfort at all. ‘One-size-fits-all’ for thermal care of infants is inappropriate, since individual needs and responses are more important than measuring body temperatures alone. This partly explains some of the conflicting advice given by health professionals relating to thermal care and individual practice. Infants may express thermal comfort or discomfort not only through physiological signs, such as skin temperature or colour, but also through behavioural cues. Thermal

discomfort is expressed through lack of sleep, irritability, crying, attempting to remove clothing/bedding, or objecting to clothing/bedding being added.

As Goldman and Kampman (2007) considers, infants are often observed to display positional changes in reaction to heat stress. An infant might lie flat on its back with its arms outstretched in order to lose heat, and might curl up into the foetal position to reduce its body surface area and conserve heat. As infants have such high mass to body surface area ratios, the strategy of reducing body surface area by curling up may be a very important one particularly for infants. This behaviour is inhibited for swaddled infants. It is not clear whether this is ever a consideration when attempting to prevent or treat hypothermia in newborns, despite its apparent importance. These two reflexes may be helped or hindered by parents in infants who are too young to roll over by themselves. By placing an infant in a prone position, it would presumably have difficulty putting its arms out wide, especially if sleeping on all or part of its arms. This restricted ability to change body position or alter body posture is rarely considered as one of the reasons that prone sleeping infants are more at risk of overheating. However, an infant placed in a prone or supine position who cannot roll over independently will have trouble getting into the foetal position to conserve heat, and may be at risk of getting too cold in cold environments. Some mothers insist their babies prefer the non-recommended sleep position of sleeping on the side. The ability to change body posture in order to lose or conserve heat may be one reason for this preference, especially where the infant is too cold to fall asleep.

69 Although considering ways to create appropriate thermal conditions for an infant’s microenvironment is necessary, considering the complexity of judging the thermal needs of each infant we cannot rely solely on creating a single,

standardized ‘appropriate’ thermal environment for all infants. Mothers also need to respond to the behavioural cues given by their infants in expressing thermal comfort or discomfort. Where there is a heavy reliance on official

recommendations for clothing/bedding/room temperature (Foundation for the Study of Infant Deaths 2009b), these cues may be missed or misinterpreted because there is an assumption that the one-size-fits-all approach will automatically ensure thermal comfort in all contexts and automatically will removal thermal risk.

The emphasis in the UK on overheating as a risk factor for SIDS over the past two decades may have contributed to an underappreciate of the negative effects of cold stress among mothers. Missing cues of cold stress can be detrimental to the infant in many ways, in addition to potentially increasing SIDS risk. For example, a baby that consistently refuses to settle at night may be judged to be a difficult sleeper when in fact he or she might simply be too cold to sleep and may be expressing a need for warmth. However, if there is too great a reliance on the

‘prescribed’ thermal care practices, the issue of thermal discomfort may not be recognised and other reasons for irritability may be explored instead, such as the baby being ill, hungry or just ‘fussy.’ In terms of preventing SIDS, thermal stress, from either excessive heat or cold, may increase SIDS risk among some vulnerable infants. Therefore, the ability to recognise and respond to individual cues

regarding thermal discomfort is clinically significant.

The illustration below is taken from Foundation for the Study of Infant

Deaths SIDS prevention literature designed for parents. Foundation for the Study of Infant Deaths is the leading SIDS prevention charity in the UK and is relied on by parents and health professionals to provide evidence-based advice on the

prevention of SIDS. Their literature and advice occasionally advises parents not to let infants get cold, but the overriding theme is a focus on the dangers of

overheating. The above illustration demonstrates their emphasis on the dangers excessive heat for infants

70 Figure 8 Illustration from Foundation for the Study of Infant Deaths SIDS prevention literature emphasizing the dangers of an infant getting too hot

(Foundation for the Study of Infant Deaths 2009a)

3.3.9 Our understanding of the impact of clothing and bedding on the