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.

www.thelancet.com/journal/vol363/iss9404/full/llan.363.9404.original_research.28360.1

"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"

The last sentance is very intersting, I thought.

The gut I heared on the TV was very clear that the results indicated that the safest place for a baby to sleep was in a cot, in the parents room.

This is a look at the influence of formula
A little ot but I thought that instead of panicking co-sleepers every possible contributing factor should be looked at.
But in my personal opinion, smoking is the main cause.
I can say this out of experience as I smoked through ds1's pregnancy and he often forgot to breathe, it was awful.

Thanks for those links Bekki

Nobody would disagree that smoking is a key risk factor, along with babies sleeping on their fronts. But the higher incidence of babies co-sleeping under 8weeks IS new - nobody had suggested this before. And this is the largest study. Yes, FSID has got funding from C&W, amoung others, but this was a study in 20 countries and was only part funded by FSID, which in turn is only part funded by C&W, and as Droile says, the researchers would have had no contact with C&W at all - the Professor and the institute are well respected independent authorities. The links between cot death and formula are by no means conclusive, although I tend to think there is some association. This reasearch wouldn't stop me co-sleeping - though it might make me even more careful about positioning and keeping him out of the duvet.

I co-slept with my two when they were very small. It was the only way that they would sleep. I was worried about the risk of cot death, and knew that there was a relationship between over heating and SIDS. I was also worried about the abe falling out of bed or getting squashed between dh and me.

So I slept with the babies on a futon on the floor, using the amount of sheets and blankets advised for the temp of the room. I used a pillow but the baby didn't.

To my mind that was a sensible compromise and I reduced the added risk to the absolute minimum. I don't smoke and wouldn't have done this if I'd drunk alcohol.

Looking back it was lovely to be snuggled up with the babes, but I was glad when they were happy to go into the cot and the futon played hell with my back! And I'd had a section so that made getting up and down a bit of a problem!

What I don't understand re SIDS is the WHY?
WHY is the risk reduced when they sleep on their back? WHY is it lower if they are in their parents room but higher if they cosleep? WHY is exposure to cigarette smoke a risk factor? (And does this follow for every smoke contaminant, eg if I burn the toast?!) There must be a physiological reason for it

Ooh, ooh, ooh!! Here's my theory -- why do we breathe at all? How come babies don't breathe in the womb? How come people can drown without any water in their lungs? BECAUSE... some mechanism in the brain, perhaps whatever keeps babies from breathing in the womb, can be triggered to stop breathing again in certain circumstances. So sometimes the brain panics as soon as water hits the larynx (in the throat), shuts down, and a person can thus drown without any water in the lungs (like 2% of drowning victims). maybe this same mechanism in the brain is relatively easy triggered, esp. among babies.

And what would trigger the brain to think the body should stop breathing? Maybe any impediment to breathing or bad air quality -- too stuffy under the duvet, too smelly sleeping with a smoker, nose is smooshed a bit when sleeping on tummy....

I may be talking rubbish, though.

Okay - but the heat factor?

No-one understands the why. That is why there are so many pieces of advice - risk factors that have been noted when cot deaths are investigated. No one has the definative answer.

It's not rubbish zebra, there are some papers somewhere on sleep centres in the brain malfunctioning, especially in boys. I've got them upstairs in a mountain somewhere, but because it's not what I'm working on at the moment, it might as well be on the moon.

I understand we don't know what causes it per se, I would just like to understand the mechanisms of the risk factors IYSWIM. Like smoking doesn't cause a heart attack, but it does clog the arteries which causes the heart attack. So what is the same for the risk factors for cot death? Or don't we know that much either?

I think it is the chemicals in smoking that interferes with respiratory function. The levels of oxygen and carbon dioxide are interefered with. Again no-one knows how exactly it affects babies.

Here is an article that has been posted on another list.

16 January 2004

UNICEF response to Lancet publication on Sudden Infant Death among
bed sharing babies

Today's Lancet includes a study (1) into Sudden Infant Deaths across
Europe. Among the findings is a very small risk of SIDS among babies
bed-sharing with non-smoking parents. The risk is 2-fold for babies
under 1 month of age and becomes non-significant at 7 weeks
(compared with an 11-fold risk for babies sleeping with parents who
smoke).

The UNICEF UK Baby Friendly Initiative believes that parents should
be fully informed about the potential risks and benefits of bed-
sharing. Our information materials for parents and health
professionals were produced - in collaboration with the Foundation
for the Study of Infant Deaths - prior to the latest research and do
not at present include any amendment which may be necessary in
response to that research. Nevertheless, these materials remain
relevant in highlighting both the risks and benefits of bed-sharing.

Although the Foundation for the Study of Infant Deaths has changed
its guidance on bed sharing in response to the latest study, the
UNICEF UK Baby Friendly Initiative believes that two key concerns -
outlined below - need to be discussed in full before any revised
guidance is issued.

It is our intention to update our materials, if appropriate, in the
light of the discussions of a meeting of a Working Group of the
National Patient Safety Agency in early February, which will be
attended by UNICEF, the Royal College of Midwives, the Foundation
for the Study of Infant Deaths, the Community Practitioners and
Health Visitors Association and experienced health professionals and
researchers. This meeting aims to produce national best practice
guidance for health professionals on bed sharing.

Following correspondence with the study's authors and other experts
on the issue, two major concerns about the study's findings have
been aired:

The definition of bed sharing. The study does not differentiate
between babies who slept in bed with their parents and those who co-
slept on sofas or other inappropriate sleep surfaces. This raises
questions since sofa-sharing is known to be a very significant risk
factor for SIDS and may account for the increase risk which has been
found.

Infant feeding method at the time of death was not recorded. We do
not therefore know whether the babies who died while bed sharing
with non-smoking parents were breast- or bottle-fed. The UNICEF UK
Baby Friendly Initiative recommends that artificially-fed babies do
not bed share as there is evidence that their mothers do not adopt
the 'protective' sleeping position observed in breastfeeding mothers.

The following factors must also be borne in mind:

• There is some evidence (2,3) that attempts to discourage bed
  sharing are unlikely to be successful. Our previous position,
  endorsed by FSID, was to inform parents of the benefits and risks of
  bed sharing and to make decisions appropriate to their own
  circumstances.

• Bed sharing promotes successful breastfeeding (2,3). If bed
  sharing is discouraged for babies under 7 weeks old, this has the
  potential seriously to undermine national efforts to promote
  breastfeeding.

• There are many significant health benefits of breastfeeding to
  both mother and baby. There is some - inconclusive - evidence that
  breastfeeding may protect against SIDS. A study (4) in the current
  edition of Archives of Disease in Childhood suggests that a
  protective effect of breastfeeding may be due to breastfed infants
  being more easily aroused from active sleep when they are 2-3 months
  old - the period of peak incidence of SIDS.

• Care needs to be paid to the potential risks of advising mothers
  against bed sharing. If a mother gets out of bed at night to
  breastfeed, there is a risk that she may fall asleep with her baby
  in a chair or on a sofa, which is known to be much more dangerous.

The UNICEF UK Baby Friendly Initiative intends to ensure that its
guidance on the issue of bed sharing and breastfeeding continues to
be evidence-based and effective. If necessary, we will update our
leaflet and/or bed sharing guidance as soon as the evidence supports
a change.

1. Carpenter RG et al (2004). Sudden unexplained infant death in 20
   regions in Europe: case control study. Lancet 363: 185-91 [Full text]

2. Hooker E, Ball HL, Kelly PJ (2001). Sleeping like a baby:
   attitudes and experiences of bedsharing in northeast England. Med
   Anthropol 19: 203-222. [Abstract]

3. Ball HL (2003). Breastfeeding, bed-sharing, and infant sleep.
   Birth 30: 181-8. [Abstract]

4. Horne RSC et al (2004). Comparison of evoked arousability in
   breast and formula fed infants. Arch. Dis. Child 89: 22-25 [Abstract]

Don't you ever find it stuffy, even hard to breathe, in a very hot environment (think Sauna)?
Agree we don't really know... just piped up with my theory. Not that it helps much with prevention, anyway. But it would support the thory of genetic risk, which could help at risk families to know.

Ack - sorry about the formatting making it REALLY long....

I'll admit to being very confused after reading the newspapers yesterday. They seemed to talk about SIDS and suffocation as being the same thing. As I understood it, SIDS is the term used when there is no apparent reason for the death. But if a baby suffocates surely there is a reason for the death - the airways were blocked in some way. But that death then can't be put down to SIDS, can it? Is the advice not to co-sleep pre-8wks because of the danger of suffocation or because of SIDS? I'd be pleased if someone could clarify it for me.

I agree Sue, suffocation is a cause of death, it wouldn't be listed as SIDS

ugh ugh ugh, sorry, cot death just freaks me out, it did with DS1 and it does again now. I'm sure every parent of every baby is the same but all this media half-information is probably more of a hindrance than a help. Like the breast feeding thing - I HATE breastfeeding, but have continued for 10 weeks so far, convincing myself it has a protective element against SIDS and now I am doubting that! Bloody bloody scary

does anyone else compulsively check their baby is breathing? I never sleep too long, I am always jerking awake to check he's still breathing. I wish I could afford one of those monitors, but I gather they are hundreds of pounds

I think the problem is that it's impossible to prove suffocation (hence mothers of cot death babies being accused of smothering them).

Lisa - I did that with dd, but not so much with ds (the second one). My constant edginess with her was what made me start smoking again in fact. But you will learn to relax (I had to force myself to relax sometimes by having a long bath). I think breathing monitors probably make it worse too - they go off if baby moves off the pad and don't work under thick cot mattresses anyway.

Gawd, there's some rubbish out there about this issue. Confusion about suffocation vs. SIDS is one such problem. Here is the Los Angeles public health dept. saying that breastfeeding reduces the risk of SIDS because it makes "the baby feel loved and nurtured" --

I only found that because I wanted to find real risk factors for you, Lisa78. Now I dont' think I'll bother, if somewhere like the LA public health dept. is publishing such rubbish on the 'Net. All I remember off-hand was Roy Meadows' oft quoted statement that the risk of Cot Death in a non-smoking family was something like 1:7500. As far as I can understand, if the baby sleeps on its back and doesn't get overheated, the risk goes down much more, again. The evidence is mixed on whether breastfeeding reduces the risk, although my personal best guess is (the source I cited previously) that it does very slightly for non-smoking parents. Thus beyond the very basic 3 things (don't smoke, sleep on back, don't overheat), anything else you do can make only small adjustments to the total risk. Which is another way of saying, if you have already done the basic 3 things, it's not worth worrying about cot death because there's little else you can do.

Ooh the monitors -- I knew someone who had had a cot death in her family, and then a near-miss cot death with her own child, and she decided against the monitor; she knew that it would drive her crazy, rule her life. She just couldn't go down that path.

And as will as putting the babu on his/her back to sleep, make sure that their feet are at the foot of the cot, so that they can't travel down the cot under the bed clothes and get overheated. Veru easy to do, and it also reduces the risk.

God thats awful Zebra, so parents who lose a child to SIDS can infer that their baby DIDN'T feel loved and nurtured...

DS2 is in a sleeping bag - we found by chance he sleeps better in it rather than covers - but at least that eliminates the worry of them slipping down under the covers

I suppose I just want some magic wand so it doesn't happen to my son - my cousin lost a son to cot death when DS1 was born which doesn't help!

That's a pretty unhelpful article from LA, isn't it, Zebra. The bit about babies rolling over seems to contradict the advice here, that a baby that can roll isn't at any higher risk. I thought suffocation did leave tell-tale clues such as blood specks in the lungs? I wonder if 'suffocation' is used as a coverall term when they don't want to say SIDS. The article I read yesterday said that co-sleeping raised the risk by 1.6%. Compared to their figure of 18% for a smoking household, that seems a pretty small increase.

I wasn't really aware of SIDS until I had ds2, when there seemed to be a spate of them amongst people I knew. Some were so odd; one was a baby that was already in hospital; another baby died as his mum popped into her former workplace to see if they were quiet enough for her to show him off. When she went to pick him up just a couple of minutes later he'd stopped breathing. Truly awful.

Thats horrible Sue
There have even been cases of a baby stopping breathing mid feed - Sends shivers up my spine
I paid especial attention to infant resusitation when I did first aid