One of my graduate students, Anna Cronin-de-Chavez, is studying infant 
thermoregulation and cross-cultural infant wrapping practices for her PhD. She 
has put together the following thoughts and refs in response to the 'caps for 
newborns in Malawi' query:

Do neonates in Malawi need hats?
A newborn, because of its size, immature thermoregulation, thinner skin etc is 
at much more risk to hypothermia than hyperthermia. The range of a 
thermoneutral environment for a neonate is 32˚-34˚C, which is much higher 
than that of an adult (25˚-30˚C). Their head is one fifth of the total surface 
area and responsible for 55% of heat loss (Hawdon:2006). The temperature 
range in Malawi appears to be between 20˚– 30˚C, which according to W.H.O. 
would put infants in Malawi at risk to hypothermia in the first few days after 
birth especially: “A high incidence of hypothermia has been reported in places 
with ambient temperatures of 26-30°C (78.8-86°F)” (WHO 1997). If the infant 
has other complications such as prematurity, low birth weight, hypoglycaemia, 
etc. the infant will be at much higher risk of hypothermia in the neonatal 
period. Malaria is a risk factor for LBW and so I expect LBW would be a problem 
in Malawi. The fear of infants overheating, especially in a sub-tropical climate 
such as Malawi may come from societies where infant mortality is so low that 
SIDS is a more significant problem, and the debate about whether overheating 
is implicated in SIDS. In Malawi the infant mortality context is different, and so 
woolly hats are most likely to be a life saving intervention where newborns are 
extra vulnerable.  Perhaps the hats may pose a risk to overheating if the 
infants were in direct sunlight for too long or if they were under a radiant 
heater which made the infant too hot. Below are some references about head 
covering.

Lang N, Bromiker R, et al. (2004). "The effect of wool vrs cotton head covering 
and length of stay with the mother following delivery on infant temperature." 
International Journal of Nursing Studies 41: 843-846.
	
Elabassi E, Chardon K, et al. (2002). "Head insulation and heat loss in naked 
and clothed newborns using a thermal Mannequin." Medical Physics 29: 1090-
1096.
	
Greer P (1988). "Head covering for newborns under radiant warmers." JOGNN 
17: 265-271.

Hawdon Jane (2006). Thermal regulation and effects on nutrient substrate 
metabolism. Neonatal Nutrition and Metabolism. Thureen P and Hay W, 
Cambridge University Press: 58-66.
	
Kumar R and Aggarwal AK (1998). "Body temperatures of home delivered 
newborns in north India." Trop Doct. 28(3): 134-6.

Fleming PJ, Azaz Y, et al. (1992). "Development of thermoregulation in infancy: 
possible implications for SIDS." J Clin Pathol. 45(11 Suppl): 17-9.

World Health Organisation (1997). Thermal Protection of the Newborn: a 
practical guide. http://www.who.int/reproductive-health/publications/ 
MSM_97_2_Thermal_protection_of_the_newborn/MSM_97_2_table_of_contents
_en.html

Anna Cronin-de-Chavez, Anthropology, Durham University
Helen Ball, Anthropology, Durham University
www.dur.ac.uk/sleep.lab

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