Cot death and bedsharing.

[pie]

Hmm...well it seems I can't do anything right. Will this report make a difference to you when you baby is less then 8 weeks old? And can anyone tell me, is it supposed to increase the risk overall, or for the duration of the bedsharing under 8 weeks? I can't tell from the article. Cot death is my worst fear, and I mean I'm terrified, I feel sick right now.

VERY interesting point oaky

The very small extra risk is thought to be from smothering (blankets/duvet over baby's head) or from overheating. So, Pie, it doesn't persist. And as long as you take reasonable precautions then even that very small extra risk doesn't exist.

Interesting point Oakmaiden!

Zebra, I did my dissertation at uni on cot death epidemiology. It's ages ago, so I can't give you chapter and verse, but I do clearly remember reading several studies, even all those years ago on room temperature. There were certainly lots of case studies of cot death where parents left the central heating on all night and the baby was very well wrapped up. It always made me cry buckets, as the parents were always clearly trying to protect the baby.

pie, I wouldn't give it another thought, honestly. I would worry about duvets, but I wouldn't worry about co-sleeping at all, for what it's worth.

I have access to the whole text, but I'll paste the most important bit here, I'll put *s around the bit we're all discussing:

Findings: Principal risk factors were largely independent. Multivariately significant ORs showed little evidence of intercentre heterogeneity apart from four outliers, which were eliminated. Highly significant risks were associated with prone sleeping (OR 13·1 [95% CI 8·51?20·2]) and with turning from the side to the prone position (45·4 [23·4?87·9]). About 48% of cases were attributable to sleeping in the side or prone position. If the mother smoked, significant risks were associated with bed-sharing, especially during the first weeks of life (at 2 weeks 27·0 [13·3?54·9]). This OR was partly attributable to mother's consumption of alcohol. Mother's alcohol consumption was significant only when baby bed-shared all night (OR increased by 1·66 [1·16?2·38] per drink). For mothers who did not smoke during pregnancy, OR for bed-sharing was very small (at 2 weeks 2·4 [1·2?4·6]) and only significant during the first 8 weeks of life. About 16% of cases were attributable to bed-sharing and roughly 36% to the baby sleeping in a separate room.

i.e. it's a tiny risk (if you can call it that at all), the media have blown this out of all proportion, and I would say that FSID do have to take some responsibility for that. Is that really true about C+G, oakmaiden? They're a proper charity who do a lot of fund-raising, but maybe they get substantial donations. Anyway, I would sleep easily in your shared bed tinight, honestly

shocked that C&G fund that research... isnt i huge conflict of interest??? i co-sleep with my 12 week old... happily so... she has her own covers and i got used to sleeping with my top half uncovered to ensure she is okay... she wouldnt sleep any other way until she was 8 weeks.... from then she starts the night in her cot and come in with me when she wants her feed and stays there till morning. I'm gonna continue to do this as there are no other risk fators in my case. and it definately helps bonding and bf... and i believe it is important to have such contact and comfort in the early months... sure i've read that it helps emotional development

Tamum, that's so interesting. Would you say that most parents who lost their child to cot death were not aware of the risks? Sorry, I know this is a very sensitive thing to discuss as obviously noone is to blame in this).

Well, the research wasn't funded by C&W. The research, which was conducted in 20 different countries, was headed up by a Professor from tehe London School of Hygiene and Tropical Medicine (ie very well respected and authoritative). The study was party - and only partly - funded by the Foundation for The Study of Infant Deaths, a well-respected charity which has long campaigned on cot death issues. FSID has to fund all its own research which is I think really important research. It has some corporate 'sponsors' who donate money to the charity and one of those is C&W. I doubt very, very much whether C&W had any say or influence whatsoever on what was the largest ever study into the risk factors for SIDS.

Call it neurotic pregnant woman syndrome but this has got me really worried now

Radio is billing it as safest place is separate cot in parents room. I don't think I could cosleep anyway (I'm very jealous of my sleep and I never managed to with ds... none of us got any sleep!) but in this house there's no room for a cot in our room as well as our bed!

I'm also a bit confused. With ds (only 2.5 years ago, for goodness sake!) the advice was not to use a grobag or similar until 6 months or so. Am I right in thinking that now they're saying this is better from birth than blankets?

Confused and fed up with constant conflicting advice Don't want to put my baby at risk (obviously) but am also fed up with the constant guilt trips for things you don't have much control over.

Oh - I didn't mean that C+G directly funded the research - but that FSID are the important proponents in infant sleeping policy, and have selected to advise AGAINST cosleeping whilst ignoring the evidence which suggests sleeping in a seperate room is even riskier and making no recomendations there. If they hadn't taken the stance they do, then I doubt the papers would be so interested (certainly the article I read leaned heavily on their acceptance of the research and the subsequent change in their recommendations). And I can't help thinking that their choice in changing it is affected heavily by their sponsers - C+G. Especialy when you consider the New Zealand research which links breastfeeding with lower rates of sids.

Did anyone see the prog about the mum who had been sent to prison for "murdering" her 3 babies. (She was recently cleared and released.) The prog had looked into her family history and found that several relatives had babies who had died. They suggested that cot death might have a genetic cause. Just wondered what everyone else thinks of this.

When my DS started rolling onto his front to sleep at 6 months, it really freaked me out, but there was nothing I could do to stop it, short of sitting next to his cot all night.

tamum and others - thanks for posting such reassuring further information. I too was feeling somewhat panicky about whether co-sleeping at 8 weeks led to the risk of SIDS continuing throughout babyhood. We use a sleeping bag for dd and she currently goes nowhere near the duvet.
Oakmaiden, that is interesting about FSID's funding, I had no idea. But from what I remember of the health lobbying/pressure group world, an awful lot of charities are part-funded by commercial organisations with an obvious interest in their work. I don't recall any overt pressure to endorse products or influence policy. But the link between C & G and the FSID is a little worrying.

Fairymum, I think when I was doing that study it was way before there was much publicity about over-heating (we're talking early eighties here, I'm sorry to say), so I don't think the parents would have been in a position to have known as much as we do now. Most of the epidemiology at the time highlighted factors like poverty and overcrowding, which clearly people couldn't do much about.

GeorginaA, I would ignore the radio. Look at the stuff I pasted- the authors themselves are calling it a very small risk. You don't usually use words like tiny in scientific papers, but that's what it is.

Sorry, tamum... reread it now complete with the stuff in brackets... I skim read to start with and saw the "36% to the baby sleeping in a separate room." and panicked

Breathing normally now

Tamum: did the studies you recall look at two cohorts, with otherwise very similar risk factors, and compare the cot death rates in the cohort where the central heating was left on all night, and in the cohort where central heating wasn't left on all night? I was just expressing doubt about whether that type of study had ever been done. I can believe the anecdotal evidence that cot death babies have often been found in very warm rooms, but how many babies were sleeping in very very warm rooms at the time, anyway, because everybody probably thought it was the right thing to be doing....? I know that cot-death rates have declined since the back-to-sleep campaigns started, but some people are suggesting that the changes in other confounding risk behaviours (like smoking) make it hard to figure out what the most important change has been.

And I wonder about back/tummy sleeping for the same reason; put them down on their tummies used to be the standard advice. Did someone go around looking at all babies, what position they slept in, and then notice that the tummy-sleepers had a higher cot-death risk, or wasn't it more the case that a high % of cot-death babies were found on their tummies, and this ergo became a perceived risk factor?

Not saying that people shouldn't try to follow the current official advice, just pointing out that it seems to be a groping-in-the-dark-for-answers situation, which means that we probably shouldn't get too het up if we find it very difficult to follow the advice perfectly.

Sorry Georgina! If only we could do bold and italics on here, it woud be so much easier to write clearly! I thought of using emoticons instead of ** but it didn't seem appropriate, really.

Not your fault, tamum! Honestly, you'd have thought at the age of 29 I'd have learnt to read properly by now, wouldn't you?

Zebra, I honestly can't remember the details of cohort studies. It wasn't the nrom as far as I recall to keep babies in centrally heated rooms at the time, it was very unusual, which was why the anecdotal evidence looked fairly strong.

I am certain, though, that the sleeping on backs was not based on the position the babies were found in, it was based on interviewing parents about the position the babies usually slept in.

May I ask another really stupid question?

If overheating is a really big issue - wtf are maternity wards so damn hot?!

That's not stupid at all, I don't think, I've always wondered that!

I asked my midwife about that and she said that they're so hot because babies need to adjust their temperature first when they are just born, and that takes them a day or two. I think that was the explanation anyway - Mears?

It seems the reason the increased risk (doubled risk but double a very small number iyswim) while cosleeping under 8weeks has made the news is because it is the only totally NEW finding in the research. I suppose that is what 'news' is! The research confirms that sleeping on back, in parents' room, not overheating etc are all important, but up until now it was thought that co sleeping if parents were drunk, smokers or drugged etc did not increase risk at all. I co-slept with ds when he was tiny otherwise he did not sleep AT ALL. And it was bloody difficult in a hospital single bed, I can tell you. The risk is very small but I do think it is worth being informed of all the risks - it seems to work, cot deaths have fallen by 70% since 1991, which isn't very long at all.

I didn't know that link Oakmaiden. Very interesting. I really do not think there is an answer to the co-sleeping. Over the years I have read various articles about how the cot death reate was less in cultures where co-sleeping was the norm. All I know is that a baby that is unsettled is much happier close to mum, especially if breast feeding. Remember the video of parents sleeping with a baby and how they moved around in their sleep to give the baby space? I think as long as your senses have not been interefered with by the use of drugs and alcohol, then babies will be safe. Do other mammals put their offspring in cots?

As to the heating of maternity units, I think work needs to be done there. Yes the delkivery room needs to be hot because the poor baby comes out wet and can easily get chilled. The wards are overheated IMO. I think half the problem is outdated heating systems that cannot regulate themselves.

Obviously I mean 'if they were NOT drunk...etc"

A lot of my friends with winter babies say this and I feel the same, too, that we didn't wrap our poor babies up warm enough for the first few months, we were so afraid of cot death. We didn't have central heating in our house at all for 6 weeks after DS was born, but when I look back I'm sure I didn't use my common sense to keep him warm enough.

Mears, in Babywatching Desmond Morris points out that in other cultures co-sleeping occurs slightly differently - ie they don't have soft saggy mattresses, duvets and central heating! Also most sleep close to the floor so the baby can be further away from the mother and still 'co-sleep' - they aren't necessarily in the same bed. Having said that, if I had ds again, I wouldn't do it any differently.