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

[GeraldineMumsnet]

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 .

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

I work as a volunteer breastfeeding counsellor and I often find that mothers choose to co-sleep as they feel it is safer than the alternative especially in the early days. Last week at a home visit a mother was tearfully describing how she found herself in her nursing chair slumped over her baby fast asleep after a night feed and on another occasion woke to find her baby trapped against the arm of the chair. She had then familiarised herself with the UNICEF guidelines using their bed-sharing leaflet and had set up a space in her adult bed which she felt had significantly less risk. This seemed sensible to me.

As the infant feeding survey shows 61% of breastfeeding mothers co-sleep at some point and other surveys show figures even higher than this, isn't it a bit unrealistic to expect co-sleeping to end? And by making it less acceptable don't we simply drive it underground and mean mothers won't receive the important safety information they require?

We could play tit-for-tat with research (e.g. look at Prof Helen Ball's work at Durham University) but the bottom line is surely...co-sleeping IS going to happen just as it has throughout human history. So rather than try and demonize it, why don't we all get on the same page and ensure mothers are educated on how to do it as safely as possible?

i lost my daughter to sudden infant death, and she was asleep in our bed.
there were no pillows, no duvet near her, we had not been drinking, all advise and safety issues thought of, but there is not a day goes by that i dont cry with guilt that we co-slept with her that night.
i have had 2 children since she died and they have never ever slept in our bed.
trust me, is it worth the risk.no new mother should be encouraged to co-sleep

I imagine someone else will have asked this question already as it is always being discussed in breastfeeding circles so if anyone has put it more eloquently than me then please ignore this one!

We are always told that the risk of SIDS is higher when parents sleep with their babies either in bed or on a settee. I would like to see the breakdown between these two sets of figures. The ones I read about in the local paper seem to always involve a woman who has consumed a lot of alcohol falling asleep on the sofa and suffocating her baby. I have not read about a case where two parents choose to sleep with their baby (or one parent) in their bed every night (obviously breastfeeding parents as research indicates that af mothers don't have the same responses as bf mothers) and yet managed to suffocate their baby.

I don't have exact figures to hand but it was something like 40% die in cots, 60% die on settees or in the parents' bed. I would like 3 figures: the % who die in cots; the % who die on sofas or somewhere other than a cot or the parents' bed and the % who die in bed with their parents/mother.

Do these figures exist?

If not, why not? It seems a very obvious distinction to make to me.

Yes, same here - I'd like to know the risk of SIDS when intentionally co-sleeping and following guidelines for doing so (ie avoiding smoking/alcohol/pillows), as distinct from falling asleep on the sofa with the baby.

The risk factors involved are not sufficiently differentiated for a true comparison to be made IMO.

I have heard that occasional/accidental co-sleeping is more dangerous than consciously doing so every night - is this true and what is the research to back this up?

im so glad that someone is doing this talk,we lost our grandson december 2006,sudden infant death,and i still dont understand how a lovely little boy can just go to sleep and never wake up,i just wish they could stop it and no one has to ever go through this hell

Tamba has covered it very well.

I would like to know why death in a parental bed through eg suffocation is catagorised as SIDS when there clearly is an obvious cause and why figures for death through lone sleeping are also not covered. This gives a very distorted picture.

gardeningmum, my heart goes out to you I can't imagine how that would feel but you should not torture yourself, from what you've said nothing you did caused the death of your DD. I imagine those who have lost their babies through SIDS and didn't co-sleep would find something to torture themselves about. The fact is no one knows the cause of SIDS. unfortunately demonising cosleeping has made you feel responsible.

one handed typing so scuse spelling

I'm a bit greedy and have several questions!

1. How is the data, statistics and evidence gathered when researching SIDS - I'm assuming it's all done retrospectively? Are socio-economic factors included etc?

I think it would be helpful for those of us who aren't experienced at interpreting studies and research to see what you look at, how you obtain data, etc in order to help validate our own decisions.

1. What is your definition of co-sleeping exactly?

1. Are the protective effects of breastfeeding and the more common act of co-sleeping whilst breastfeeding factored into the co-sleeping advice?

Many thanks

Is really a repeat of above questions - but is there a difference between regular co-sleepers and occasional ones?
My point being that if parents do not routinely co-sleep there may have been some reason they chose to do so on that particular night ie baby more unsettled then usual (which may itself be connected to some as yet unknown underlying cause)
Hope that makes sense

I have two questions:

1. Many parents only co-sleep when their child is particularly unsettled or ill - which may itself be a warning that something is wrong. How do you factor into your research that both, the co-sleeping and the sudden death, may be prompted by an underlying problem?

2. I have been told that distinguishing between SIDS and e.g. suffocation at post mortem is often subjective. Does this mean that some of the success of the "back to sleep" campaign may actually reflect changes in pathologists' practise?

Same as question below, really - of the "co-sleeping" incidents of SIDS, how many are sofa-sharing, how many are bed-sharing?

And of the bed-sharing ones, how many are following the current safest guidelines to the letter?

And how does that compare to cot-sleeping incidents of SIDS?

Thank you - and so sorry to those of you with personal experience of this particular nightmare - unbearable

I've always been confused by the advice regarding dummies and cot death. It's my understanding that giving a dummy when a baby goes to sleep reduces the risk of cot death.

My daughter would never take a dummy - was the therefore at a higher risk of cot death because of this? If so what advice does FSID have regarding encouraging babies to accept dummies?

I have two questions/points;

1. Co-sleeping; the initial research which began the theory that co-sleeping was linked to SIDS as based on a study done in New Zealand, (quoted here in Midwifery Best Practice on page 146). How does this fit with the FSIDS advice not to co-sleep??

1. The "protection" of a dummy; according to UNICEF a dummy is not that protective, in this statement "babies who used a dummy during their last sleep were less likely to die, but that routine dummy use is not protective. This may indicate that infants are at greater risk of SIDS if they routinely use a dummy but have not been given their dummy on a particular night." So, if the dummy is not in use (ie, has fallen out of the mouth) then it has no protective effect, and in fact the baby is more at risk because it has used to the dummy and then doesn't have it. In some ways, routine dummy use could be said to increase the risk of SIDS.

Also, "since we do not know the mechanism by which dummy use may protect babies, other sources of sucking comfort during the night also need to be investigated. It is possible that thumb sucking is protective, and a baby who routinely sucks his thumb is not dependent on his parents to remember to give it to him. Some studies have also suggested that breastfeeding may be protective against SIDS. While this also needs further investigation, the access a bed sharing baby has to his mother's breast during the night may offer another mechanism for protection." In this case, a co-sleeping breastfed baby is just as "protected" from SIDS as a lone sleeping baby with a dummy, if not more.

I fail to see how risking interfering with breastfeeding by introducing a dummy is a good idea, especially when you factor in the other risks associated with dummy use, including increased risk of Obstructive Sleep Apnea and ear infections.

I can see that these questions may be difficult to answer, after all, there is no sponsorship to be had from encouraging breastfeeding, or co-sleeping (unless you get a manufacturer of sidecar/bedside cots on board) and no clear, balanced, unbiased, peer reviewed data on the concept that dummies protect against SIDS, only the study by MAM.

I look forward to your reply.

I am very uncomfortable about the link up with MAM. Why did you decide to work with one particular manufacturer of dummies and how do you maintain the integrity of the FSID? what would you do if another study showed no link to dummy use and preventing sids for example?

Why do you think using a dummy helps prevent sids but breastfeeding to sleep does not? (genuine question) I don't understand why this would be the case and would like to know more about it. I'm assuming you don't think breastfeeding to sleep has the same protective qualities? is that right?

My questions relate to the recommendation that babies should sleep on their backs:

1. Can you explain what it is that is so dangerous about sleeping on their tummies?
2. Could you let us have some figures / point me to studies that focus on the dangers of not putting baby on her back?
3. I understand the SIDS risks are much less from about 6 months. Our dd2 is nearly 4 months but in terms of her weight

she is about the size of a 6 month old baby. Her neck muscles are also very strong. Does that mean we can let her sleep on her front right now?

With both our daughters we have found that they dislike sleeping on their backs (same as their Daddy actually)
and while we suffered through many bad nights with our first daughter by sticking slavishly to the SIDS advice
I am afraid to say that with number 2 we have been much more, well, reckless I suppose!
She is sleeping on her front as I type...hence my questions.

Oh and we co-sleep, too, so I second all the questions so far.

What is riskier when it comes to SIDS?

Is it not breastfeeding, or is it co-sleeping?

Because it is proven that planned co-sleeping increases breastfeeding duration, which protects against SIDS. But there is no research that I know of that shows that planned co-sleeping increases the SIDS risk. Therefore, wouldn't it be better to encourage safe co-sleeping than to demonise it completely?

I feel so sad that babies die in cots too, but no one ever regrets putting their baby in a cot!

My DD3 stopped breathing in the night when she was 4 months old. She would be dead now if we hadn't been co-sleeping because I knew immediately and picked her up and she took a gasp of air and was fine. I would have not been anything like as aware or quick to respond had she been in a cot.

My husband is from the Middle East and over there, the tendency is to co sleep and over wrap new babies (think fleece everything!) and yet as far as I know, the cot death rate over there is lower, even though its a lot hotter - why do you think this is?

Really excellent questions here.

I'm sure MNHQ can point you in the direction of the recent thread on MN in which your recent poster campaign was discussed. Many of us on MN are used to interpreting scientific data.

I looked at the poster and your press releases attached to it. I used my academic position to explore where the research that the poster and press releases were based upon were published. I couldn't find them published anywhere. Given that the studies mentioned were based on a very small sample of pathology reports it seemed somewhat surprising that you would base a major campaign, claiming 'expert advice based on new scientific studies'

If you do have the references, could you please post them here?

And if it is not published in peer reviewed journals, do you think it is wise to act using your considerable credibility and influence to send out a message that many parents might misinterpret?

What made many of us cross on the other thread was the rather scaremongering tone of the poster in response to what was a very inconclusive piece of small scale research. There was no relation of the data to the actual population, and no separation of the independent risk factors (crucially sleeping on a bed and sofa etc were included together). This is poor data interpretation and reportage. To base a frightening poster campaign, directly attacking safe bedsharing, I felt, was completely irresponsible.

Given that we know that public health messages DO have an impact on parental behaviour (pace the large decrease in SIDS when the back to sleep campaing was implemented), will the FSID be funding research to explore whether its own campaign may have increased infant deaths by encouraging more unsafe co-sleeping? We had messages on the days after our discussion from parents who said 'oh I fall asleep on the sofa with her because I'm scared to have her in the bed...'

Why you allowed this to be released staggers me. The ALSPAC study in Bristol will surely provide much more robust evidence.

Lupus, are you really Ben Goldachre?

No. But I'm sure he would agree that presented as it was, it was indeed Bad Science.

He's a doctor and journalist isn't he? And so he would not have allowed such shocking grammar in his posts . Of course when I used the phrase 'base your campaign...' twice with no concluding clause such as '..upon these studies', I would never get through subeditors.

I have a much simpler question;

Why don't you consult with and take advice from Helen Ball instead of MAM??

I'd also like to say that I have looked at your website and I absolutely support the aims of your charitable company. You seem to do such excellent work supporting bereaved families and campaigning to improve and fund good research into SIDS.

I would like to support you more, but the issue about that poster campaign undermining co-sleeping and possibly BF (with its proven beneficial effect on the SIDS rate I think?) without apparently good science has really put me off.

sorry guys , not a question

flamingo- "I feel so sad that babies die in cots too, but no one ever regrets putting their baby in a cot!"

My mum regrets to this day that she put my brother down and didn't have him with her. I cry every time of how I think my lovely Mum still suffers with feelings of guilt and fear (for her gc) as well as grief.

When my baby was little, I followed the advice of not co-sleeping and used to take her out of her cot, breastfeed her and then put her back in. But I got a terrible fright one night when I woke up to hear her screaming as I must have fallen asleep breastfeeding on the chair and she'd fallen off me onto the ground.

After this, I asked my health visitor how to safely co-sleep and she just kept saying it wasn't safe 'full-stop'.

My question is: Why not offer advice on how to safely co-sleep? Women are crying out for this information and will go ahead and co-sleep anyway ... so why not help them to make it safer?

My HV told me that a link between co-sleeping and SIDS wasn't proven for "exclusively breastfeeding women who apply common sense", the link only being proven for falling-asleep-with-a-baby (on sofa or bed) in general, with formula-feeding mothers lumped in with breastfeeding mothers in the research. Is this true ?

She said this in the context of encouraging me to try co-sleeping rather than give up breastfeeding at 8 weeks as I couldn't function, I was so exhausted. I ended up co-sleeping with each of my 3 children until they stopped bfing at 12-18 months, at which point they migrated back into their cots.