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Webchat with Professor George Haycock, FSID scientific adviser, Tues 30 June, 1-2pm

(293 Posts)
GeraldineMumsnet (MNHQ) Thu 25-Jun-09 10:40:11

A little while ago, following new expert advice about co-sleeping and cot death, some of you asked if we could get someone on from the Foundation for the Study of Infant Deaths (FSID).

FSID scientific adviser Professor George Haycock has kindly agreed to come on to discuss the advice, so he'll be in Mumsnet Towers next Tuesday lunchtime at 1pm <hastily double checks date after recent calendar howlers>.

Please post your advance questions here. Obviously he may not be able to answer all of them, but we'll make sure he sees them.

Thanks
MNHQ

Grendle Mon 24-Aug-09 23:34:12

Sadly, it seems to have just moved, although my computer won't download the pdf.

It is also misleading to say having these 5 products will 'keep a baby safe'. Firstly, that depends on how said products are used (e.g. room thermometer could be used to maintain room temp at 25C, cot & mattress could be used with duvet & pillow etc), and secondly all following advice based on research can do is reduce or minimise the risk, it will not eliminate it totally, so therefore 'safe' remains misleading.

hunkermunker Fri 14-Aug-09 10:47:50

That link's broken now, Tiktok - wonder if they've reevaluated their "essential" products?

Upwind Tue 07-Jul-09 22:43:23

I guess it is the same with any novel research - it attracts more than its fair share of publicity. Dummies and co-sleeping have been in the news and probably discussed by healthcare professionals. If you have not thought it through, or have a poor grasp of relative risk, heavy emphasis e.g. of the dangers of co-sleeping might seem like the right thing to do. I wonder why the NHS or indeed FSID don't compile a table of the relative importance of the various risk factors that have been estimated for SIDS? That would really help inform both parents and health care workers.

tiktok Tue 07-Jul-09 19:05:12

Very interesting post, Upwind, about the pressures exerted by the pressure group.

Why not, as you say, emphasise smoking as a factor? In fact they do, and there are some quite honest web pages about the increased risk. They do say more about smoking than they do about bed sharing, which is how it should be.

However, I think part of the thinking is marketing - they have to be seen to be making news, pushing ahead, breaking through,saying something different, or if not different, the same stuff in a new way.

One of these new things is 'five essential products' - yes, essential - to reduce the risk of cot death www.sids.org.uk/sleep-simple.html which includes a dummy. It is stretching the research beyond limits to say a dummy is 'essential'.

The message about smoking is old hat. But dummies and co-sleeping are new - why the co-sleeping thing has become a stick to beat mothers with is another issue. Would a health visitor or midwife say to a smoking mother 'do you know this is very dangerous and your baby might die?' No - because they would be more sensitive, probably.

Grendle Tue 07-Jul-09 15:42:15

Ah, but upwind, in many areas if you go past 40 weeks 10 days pregnant (or some other arbitrary figure) then despite a controversial evidence base, people start telling you that if you're not induced your baby will die. It's exactly the same kind of scaremongering. Indeed, at my 20 week scan, the sonographer was so perturbed that I hadn't had a 12 week scan and that my dates were based on an ovulation not an LMP date that she made a point of saying "It's crucial to know the accurate dates so that we can get the baby out if you go overdue, otherwise it might be comprimised". No hint in what she said that I might have a choice as to whether to accept their recommendation or that there are pros and cons to be balanced. Sadly, sometimes individual staff in the NHS are really good at scaremongering, and really poor at both understanding the evidence for certain outcomes, as well as accurately interpreting or explaining the risks involved. The 'postdates' example is quite a good analogy, as in my experience any risks of induction (which are known and real) are generally glossed over, in the same way as downsides to using dummies etc are glossed over by FSID. Even if they don't think the evidence of effects on breastfeeding by using dummies is particularly strong, what about permanent alterations to platte shape, potential links to sleep apnoea, dental occlusion and other problems later in life (e.g. snoring)? Many parents might consider these important considerations to know about when making their decision, but FSID seem to choose only to present the perceived positive benefit, rather than giving parents information with which to make an informed decision. Perhaps not surprising, given that they are taking money from a dummy manufacturer sad. That really undermines their credibility on the issue.

Increased risk never equals will happen. The relative increased risk can be big (e.g. doubled), but the absolute risk still very small, if the original risk was v low. Additionally different individuals will find different levels of risk acceptable. I do wish people would treat parents and parents-to-be like adults and provide them with as far as possible accurate information about which they can make up their own minds.

Upwind Tue 07-Jul-09 11:50:17

"'You do know, don't you, that you are putting your son at risk of cot death?'"

I have been thinking about this over the past few days, and I have realised that I have a beef with the NHS about this. FSID are acting as a pressure group. I don't see why they seem to have chosen to target co-sleeping and dummies rather than formula feeding or smoking, but that is beside the point. They have a single objective, reducing cot death. The anxiety and PND the scarmongering about SIDS induces is not on their radar.

However the NHS antenatal classes and midwives, HVs etc should be aware of how very rare SIDS actually is. Especially for parents who are non smokers and who don't indulge in binge drinking or recreational drugs. They should also understand that their repeated reminders cause nightmares for new parents and often make life very difficult for them. It also almost suggests that a SIDS tragedy is preventable - since we don't really know what causes it, that might not be the case.

By contrast, I never heard still birth mentioned at my antenatal classes. It is very much more common than SIDS and can be preventable (my baby was induced early due to risk of stillbirth).

GreenMonkies Thu 02-Jul-09 21:47:49

coveredinsnot when DD2 became properly mobile I used to roll our duvet up into a bolster to stop her rolling out of bed in her sleep before we joined us. She could still get out of bed if she wanted to, but never fell out by accident.

(I've read the carbon dioxide and synchronised breathing theory somewhere too)

coveredinsnot Thu 02-Jul-09 20:58:26

I've read most of this thread, and have been really surprised by what the doc has had to say. I did quite a bit of reading and thinking about whether to co-sleep or not, and decided I would because of the benefits to baby and mother, in terms of not getting up in the night, attachment, etc. I really thought I had made the right decision, and have been really taken aback at the strong message put across by the doc. However, due to the great questioning by mumsnetters, I think the holes in the research have been revealed, and really now I just have more questions than before, but am still going to stick with bedsharing and probably will for future babies.

At the moment we do a 'side-car' thing too, fortunately the cot we bought was the same height as our bed, so we just took one of the sides of the cot off and hey presto, loads of space! Rolled up towels fill in the gaps. However, we've also tried bedsharing just in the bed with bed guards, but that was a nightmare, and also with my dh in another room (bliss with the lack of snoring!), and also with ds in his own room for the first half of the night. Eventually we went full circle and reinstated the side-car, and it's just perfect... or was until ds learnt how to walk, stand etc, and now I worry about him falling out - so if anyone has any tips on how to solve this one and still keep the side-car I'd love to know! Otherwise we'll drop it back down into a full cot just to keep him safe for now.

I think the comment from the person who'd had their babies in Japan is fascinating and highlights so many of the issues with applying the Doc's research data to bed-sharing. There's so much more research that needs to be done.

I also have read about how the carbon dioxide that is released from the mother's outbreath triggers breathing in the baby, did someone just make this up or has anyone else heard this? And also that when mother takes a deep breath, so does baby, and I always thought this synchronised breathing was one of the things that made co-sleeping a preferable option.

Hmmm.. I'm kind of in a quandary, feeling slightly duped by pro-co-sleepers, and dissatisfied with the anti-bed-sharers... And don't have the time to wade through and analyse the original research papers!

GreenMonkies Thu 02-Jul-09 18:52:20

By PrincessToadstool on Thu 02-Jul-09 08:04:20

18 months ago when my DS was about 8 weeks old, I admitted to my HV that I'd been keeping DS in bed with me to BF at night, and my DP was on the sofa. She put on a teacher-face and spoke ve-ry slowly, and ve-ry clearly.

'You do know, don't you, that you are putting your son at risk of cot death?'


I wonder if she would have said this to you if you'd just admitted to being a smoker, putting him in a room alone for his naps or feeding him formula? All of these things increase the risk of SIDS but they are not frowned upon the way co-sleeping is. It's very frustrating! angry

LeninGrad Thu 02-Jul-09 14:53:04

Yes, I am unsure on this. I just wonder if it means the mother will turn towards the partner when they should be nested with the baby is all.

Totally didn't practise this with DS, I turned my back on DS plenty, and he was in the middle of me and DP (with duvets and pillows, well away from him, but even so), but I knew she wouldn't turn her back so I figured as long as one of us was nested that was ok. (Actually worried two of us might just be breathing carbon dioxide all over him which wouldn't be ideal...)

Babieseverywhere Thu 02-Jul-09 14:44:47

LeninGrad, I agree with everything you have put except the last point.

I can't see how a sober non smoking DH on the far side of the bed, could do any harm as long as the mother is in the middle of the bed between baby and dad.

I am surprised why quiting smoking is not pushed more as a sid prevention, if it accounts for around 60% of the existing sids cases.

LeninGrad Thu 02-Jul-09 13:37:04

Actually, I should have the courage of my convictions and go one further - no partners in the sleep area of the bfing mum and baby for at least six months.

I just know people will baulk at this and it might ruin the message but it's right to have the 'facts', as best they are known, and make your own decisions.

LeninGrad Thu 02-Jul-09 13:33:38

Very interesting sb.

Given all the info we've had on this thread, is it stretching it do you think (and I by no means want to ladle guilt on to those who have experienced this), to hypothesise that it is a combination of one or more adults in the bed or on a sofa, in a smoking household, who have consumed a significant amount of alcohol, with duvets and pillows around, that might account for the overwhelming majority of 'bed-sharing' SIDs cases? That might leave the remaining occurrences in cots mostly down to smoking households and lack of closeness to the mother.

If this is the case, it's imperative that the message is for the mother to stay close to her baby at all times, day and night, and for there to be no smoking (at all in the house or brought back on clothes), or drinking to the point of drunkenness, or duvets or pillows or soft surfaces/gaps if you bring the baby into your bed. Also, keep your baby on your side, not between you and your DP.

Of course, if the prevalence of bed-sharing is higher than is thought, and we have seen evidence that it might be, this would make it less risky than putting a baby in a cot. One could already argue then that safe co-sleeping should actually be promoted, not discouraged.

This might leave very few cases which are genuinely unexplained (and there will always be some for whom that is the case unfortunately).

If this is the case, it would make FSIDs call for no co-sleeping, even safely, as very bad advice indeed.

poface Thu 02-Jul-09 13:06:00

that's very interesting sleepingbag. My poor dh slept separately for the first 6 months of both our dc's lives.

LupusinaLlamasuit Thu 02-Jul-09 12:51:19

thaliablogs, I'm interested to know which posts on the webchat thread are an indication of people being 'difficult'? I thought this was one of the most balanced and useful webchats for a long time, and Prof Haycock seemed to answer questions openly, questioners asked them clearly...

I didn't see evidence of 'difficult behaviour'...?

sleepingbag Thu 02-Jul-09 12:43:34

Haven't read it all so don't know if anyone has mentioned the bradford cot dealth study that is going on, have copied transtipt from radio 4 case notes:-

HILTON
There are also cultural differences in the death rates. Between 2004 and 2006 in Bradford, a city with quite a high rate of sudden infant deaths, 15 babies died, none of which were Asian. Dr Eduardo Moya, a consultant paediatrician in Bradford, has now started a research project to investigate the differences in postnatal infant care, which could account for the lower rate of deaths in the Asian community.

MOYA
We did a pilot study but we found that none of the Asian families will have the baby in a separate room. So we thought well that's very interesting and must be a strong cultural thing that they want to have their babies next to them all the time as a way of checking on the baby, it's a way of waking up if they hear or notice anything unusual and therefore seems to have some kind of protective mechanism to it.

HILTON
The research project won't report its findings for another couple of years but Dr Moya suspects it will show that the lower rate of sudden infant deaths in the Asian community is due to less smoking and alcohol consumption. Also keeping the babies in the same room. And controversially bed sharing. But bed sharing by the mother and baby alone, without another adult in the bed.

MOYA
We know from some studies done by Professor Ball in Durham that there seems to be a pattern that Asian mothers, Pakistani mothers, who are breastfeeding, they will have the bed to themselves and the babies and the husband won't be allowed in that bed initially when the breastfeeding is established. So there is no other adult sharing the bed.

LeninGrad Thu 02-Jul-09 10:43:31

B&J - 70% for some amount of time at some point according to Hall and other studies.

tiktok Thu 02-Jul-09 09:44:41

Princess, I think the 'cow' bit might be a bit unwise but I think it's reasonable to write a letter and point out the effect of this remark, which on you has been profound

This is a fascinating thread.

18 months ago when my DS was about 8 weeks old, I admitted to my HV that I'd been keeping DS in bed with me to BF at night, and my DP was on the sofa. She put on a teacher-face and spoke ve-ry slowly, and ve-ry clearly.

'You do know, don't you, that you are putting your son at risk of cot death?'

Everyone turned and looked. I was the Bad Mother in the room.

I muttered something about duvets and pillows and got the hell out of there.

Clearly I have not let this go in all that time.

I continued to co-sleep until a couple of months ago when DS would wake when I went to bed and remain unsettled, and now he is much happier in his cot in his own room. But I would not have been ready for that one minute sooner. I am angry that this woman made me SO paranoid that I used and still use an apnea monitor which I now read is useless! I can't let go of it though.

I miscarried recently and beneath my grief I admit to a tiny sense of relief that I would not be going through all that worry and paranoia again - a pretty sad way to feel about my lost pregnancy.

AIBU to go and tell HV who wouldn't even recognise me that she is a stupid cow?

BennyAndJoon Thu 02-Jul-09 07:51:59

Very good thread. Thank you MNHQ, and please pass on thanks to Prof. Heycock. It was really good to see a guest who engaged with the serious questions and didn't try to talk down at all.

And I too really want to know what proportion of the population co-sleep grin

mangopassionfruitshake Thu 02-Jul-09 05:18:58

And thanks to Rachael for this paragraph -

"FSIDS lists its completed research including an epidemiological study on the long term changes in trends in SIDS. The conclusion is that 86% of SIDS deaths occur in smoking households and that 50% of the deaths occurred in cosleeping arrangements (37% in a bed 11% on a sofa). As around 50% of the British population smoke more SIDs occur in smoking households than would purely by chance (which would be 50%) so smoking clearly is a factor that is correlated with SIDs. Cosleeping at night in bed with a baby would only be a risk factor for SIDs if much less than 37% of the population with a small baby ever coslept for all or part of the night. Hmmm."

Do we think that less than 37% of the population with a small baby ever co-sleeps? Can we find out? That doesn't seem like too hard a survey to design/ carry out, does it?

mangopassionfruitshake Thu 02-Jul-09 05:04:26

Fantastic thread; am sorry I missed the webchat part.

Re: other cultures and co-sleeping, I'm a bit disappointed that it got interpreted as developed v developing countries, where there are lots of other factors. Maybe I invited that by talking about Thailand (which isn't that undeveloped). There are plenty of non-western cultures that co-sleep and are economically developed - e.g. Japan, which I think Sakura mentioned, Korea, parts of the middle east...

I also think there's a huge difference between the detailed, more nuanced answers given here by Prof. Haycock and the advice on the FSIDS site and that infamous poster. The studies cited don't justify the tone of either of them.

tiktok Wed 01-Jul-09 23:33:08

The difficulty with the stats is that they do show more than mere correlation - no study would be published in a peer reviewed journal that reported correlation and only that. With any epidemiological, observational study (as opposed to an intervention one, where people were ordered to co-sleep or not - which is not ethical) you are going to have to control for variables, to make sure the only thing that's different among your population is the place the baby was sleeping.

Trouble is, some studies control for this, but not whether the parent was present; or whether the baby was breastfed for whatever length of time; or whether the co-sleeping was on a sofa or bed; or whether safe practices were followed. Cot death is so rare, you need sample populations of thousands of babies with whatever data is asked for at the time, and you can't go back to your sample and say, 'whoops, we forgot to ask you this important question about duvets'.

We've already seen if you take smoking (in pg and postnatally) out of the situation, you can slash cot death rates in half any way. This is, BTW, a correlation....not a direct cause and effect. But it's a correlation with a plausible explanation, so we accept it, more or less, as something parents should be advised not to do, in order to reduce the risk of SIDS.

We don't have the data (as far as I can see) to take less-than-safe co-sleeping practices out of the equation, unfortunately. There is a study waiting to be done, and until it is, no one can be clear.

alittleteapot Wed 01-Jul-09 23:12:47

Hi, I've just read a lot of this thread, but couldn't see if the Prof answered the question about safety of side car cot as opposed to in bed co-sleeping. Anyone know? Thanks

thaliablogs Wed 01-Jul-09 23:09:56

Have to say I think the prof did a fantastic job despite some really difficult behaviour by some people on the thread. He did his best to explain why he was saying what he was, and was also very clear when he didn't have the data. TBH am a little shocked at how some posters interacted when he was being completely open and patient, and had clearly put a lot of work into appearing here.

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