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 still dont understand what you mean the protective effect of breastfeeding may be underestimated

Coming late to this fascinating chat. Kudos to the Prof for getting stuck in and answering so many questions . I suspect sometimes a MN webchat is worse than a PHD viva .

I think somewhere in the thread he gives the relative risk for bedsharing safely vs sleeping on sofa -to show that the former is still an increased risk. Would it therefore be possible to work out, based on number of SIDS cases in the UK each year, how many babies' lives in the UK would be saved by no-one bedsharing (by this I mean in bed, no alcohol etc, not by eliminating unsafe sofa sharing or whatever)? I have a suspicion that the actual number would be v small, albeit devastating for each family .

[disappointed emoticon]

So from the info in this thread, I've managed to glean that about 300 babies per year in the UK out of the 700,000 that are born sadly die of SIDS. Of these deaths, it seems 117 babies die in their parents bed, but it doesn't seem possible to say under what conditions this bedsharing was occurring.

For example numbers of babies whose parents are smokers, number of babies whose mothers smoked in pregnancy, number of prem babies, number of parents who drank alcohol and bedshared on the night their baby died, number of families where one/both parent took drugs (legal or illegal) and bedshared on night baby died, number of babies whose parents who used duvets, number of babies babies who were not exclusively breastfed, number of babies who used dummies, ill babies or those with underlying medical conditions etc etc.

As an exclusively breastfeeding and 'following the guidelines to the letter' bedsharing mother, who does not use dummies, what I would want to know is:

The average SIDS rate for the UK population is 0.4 per 1000 live births, i.e. 1 in every 2500 babies born will die of SIDS . But, under the feeding/sleeping/lifestyle arrangements I choose for my baby (described above) the rate is X per 1000 live births, i.e. 1 in every Y babies born will die of SIDS.

From what the prof has said, Y will be higher for the conditions I have described, than for a family that does everything exactly the same as me except the baby is in the parents room in a safe cot/crib and consistently uses a dummy (giving say a 1 in Z risk). The latter is my understanding of FSID's recommended lowest risk conditions. However, to make an informed decision I still need to know what the 2 figures (Y and Z) are for comparison so I can assess for myself the relative risk. It would also be interesting to be able to compare each of these unknown figures with the average rate for the UK, as they may well both be rarer than 1 in 2500, given that the average risk includes front sleepers, smokers etc -factors that are known to be big risks. Only when we know the estimated figures can parents make genuinely informed choices as to what levels of risk they deem acceptable. Without these, we make our decisions solely (rather than primarily ), on what we instincitely feel or believe is best for our individual family.

Read the whole thread...
Agree with Leningrad ... also seen research that perhaps over 70% of families co-sleep at some point (in the USA...not a third world country). So co-sleeping could be safer and I do think the prof should have answered that point...
Perhaps we could have a mumsnet survey ie co-sleep, always, often, sometimes, never...just a thought...
I know from experience that you have to be really critical of any research paper - research depends on getting funding which depends on getting published and sometimes a good story that requires more research papers is a good career move (same argument is out there for global warming...) and there is a you scratch my back and I'll scratch yours attitude in peer reviewed research...and that in a competitive environment errors are not always acknowledged...

The incidence of SIDS was so high pre 1990s because the health professional advice for 30ish years was to put babies down on their fronts...

Sometimes I think you have to go by instinct - and my instinct is that it is safer to have LO next to you ..IME I was always aware they were there...probably because it meant I never got so knackered that I completely zonked out. A couple of times I did the falling alsleep feeding sitting up thing ...which surely has got to be more dangerous -never dropped mine though...So if I ever have another I will be co-sleeping...

To be devil's advocate though - 'mammalian babies are safer snuggled into the mothers' -I know that some cats quite often manage to suffocate/squash their kittens...

I've not read the whole thread.
I just wanted to say that I wholly support co-sleeping. I have always thought there must be a reason that SIDS was called "cot death" in the UK and "crib death" in the US and Canada.

I have had both my babies in Japan. Here co-sleeping is the norm because so many families live in tiny flats. Only a small percentage of the population live in a house with a big enough bedroon for a cot, and I don'T know of anyone whose children sleep alone in a separate bedroom.
Each time after giving birth to my babies we stayed 5 nights in hospital co-sleeping on a fouton. This is normal here.
I think foutons are very safe for a start because they are thinner than a mattress and don't sink in the middle. Breastfeeding untill 3 years of age is encouraged here by doctors. I think awareness of safe co-sleeping is much higher here.
I don't know of any official figures regarding SIDS but I do know that Japan has the lowest infant mortality rate in the world so if you factor in that almost everybody co-sleeps I don'T believe that co-sleeping in itself is related to SIDS.

TO co-sleepers out there. HAve you ever noticed that when you take a deep intake of breath your baby will do the same moments later? The breathing is synchronised.

Grendle, those are the sort of stats I wanted too. I posted twice asking for them but no reply.

Having ruminated on this it seems that this just to me smacks of paternalism. Similar to the blanket advice to not drink any alcohol at all in pregnancy. A touch of the "we can't trust you silly ladies to assess the evidence and make your own minds up so we're going to tell you what to do".

Also I was disappointed that the Professor was so dismissive of breastfeeding.

Interpreting risk is fraught with problems - I recently enjoyed this article on the BBC website news.bbc.co.uk/1/hi/health/8019357.stm.

It was a very interesting webchat, though and thought-provoking.

Grendle wow, brilliant summary, now if we could just get the Prof to admit it.......

intresting this ,hope it helps people ,as a lot of you know my grandson died 2006,fell asleep on his dads shoulder,he never woke up again ,it was horrific ,still is ,and the guilt attached was/is horrific ,we had ten wonderful weeks with our little man,the days after with police were heartbreaking.
ten month later we had his inquest by marta cohen,she was lovely and we were told sorry no answers if he was in his crib ,he would have been classic cot death,he was a sudden infant death.
fsid/coni care have been fantastic providing help.and i hope that eventualy cot death stops, i know its rare ,we never thought we would ever be the one to lose ours and thank everyone that raises money to fsid to help find answers.
thanks for this

So sorry to hear about your grandson hazygirl

That was very interesting.
I missed the chat yesterday but have read through the threads.

I have to say the (few) studies have been well designed but the odds ratios are not nearly as huge as the public health campaigns would have us believe.

I agree that population based studies cannot be trully accurate in this culture as so many women (me included) lie to their HV about sleeping arrangements due to shame.

I would agree with the earlier post about accepting small degrees of risk. I felt that the risk to my children was greater if I was sleep deprived in terms of being safe to drive and not worsening my already present depression.

goingnowhere - I do see where you're coming from, and I sympathise. It can be a bit of a minefield trying to figure out what to do for the best sometimes. I for one would love better info on peanut allergy risks.

grendle - excellent summary. It would be so much better if risk - not just for SIDS - were presented as "x in 1000".

I was also a bit disappointed Prof Haycock didn't talk more about breastfeeding. The German study he mentioned, which is here found a difference between exclusive and partial breastfeeding, which I think is interesting given that the meta analysis that FSID cite compares "ever breastfed" with "never breastfed".

I was also disappointed that a professor of Paediatrics believed that the 'benefits of breastfeeding are exaggerated in the developed world' This seemed to skew his interpretation of the stats.

Exactly my feelings, poface. Especially when there's pretty much an epidemic of type 2 diabetes and obesity going on.

I find it interesting that there is so little mention of smoking in the reduction of SIDS rates. Haycock himself has said "?The figures show that maternal smoking is now the most important avoidable risk factor for Sudden Infant Death Syndrome (SIDS).

"If no women smoked in pregnancy, about 60 per cent of cot deaths could be avoided. This means that in the UK the number of deaths could fall from around 300 a year to 120 a year.?
www.fsid.org.uk/smoking-fleming.html

Up to the 1990s smoking, even in the presence of pregnant women or children was more socially acceptable. More parents of newborns (both mothers and fathers) smoked.

If smoking is so important, why does supine sleeping get so much more attention and credit?

Interesting. I find that absolutely bizarre tbh Upwind.

Sakura - thanks for that its an interesting point.

What an interesting and thought-provoking thread, I have just read through it all.

One thing I have always wondered: has a baby ever been identified as having died from SIDS whilst being carried in a sling? I often think that some of the proposed risk factors for bed-sharing, sofa-sharing etc are the same - the baby is snuggled up in an effectively face-down position, up close against the mother, prone to over-heating (or mine did) - but I have never heard of a baby dying in these circumstances. Could this be part of the hypotesis that the parent's breathing helps regulate the infant's?

Fabulous summaries, thanks.

Yes, the crucial data is still not available. Maybe it can't be. Maybe we need to design our own project and submit it for funding to FSID? Must be a coupla epidemiologists lurking in need of a grant or two?

Agree, upwind, on the smoking thing. This is over and over again by far the biggest risk factor. FSID sponsored research by Fleming makes this very clear see this news report

For every hour a day a baby is exposed to smoke, the risk factor increases by that proportion. So 2 hours exposure, 2 times the underlying risk...

86% of all cases of SIDS are hypothesised as linked to smoking...

Puts things relating to co-sleeping in some context.

I do think we should have our very own MN statistician though

dumb question but why not safe to have in the middle? (as long as neither partner been drinking etc obviously) - we did this but baby in one of those nany nest things as I was paranoid about us rolling over on them - never happenned though.

Isn't it possible that the number of unexplained cases left after accidents, suffocation, smoking etc ruled out have an underlying medical problem/difference? For example the Professor hinted at research that shows such babies may have different brain structures and so are more succeptible. It's tempting, I suppose, to think they would sadly be at risk wherever they slept but I suppose if they are particulary vulnerable to low O2 levels etc then I guess it makes sense to try and get all babies to sleep in cots, with adults in teh room but no duvets etc. The problem with this is it is lwoest common denominator again - the vast majority of babies would be fine bed-sharing. Do we have to scare the crap out of all parents to save the 50 odd babies a year? I suppose we would all say yes if ours was one of these babies.

Some unexpected, unexplained deaths remain that way. A mother I knew was breastfeeding her baby, looked down and the baby was not breathing - he had died at the breast There was nothing to find at post-mortem, and it went down as SIDS, but as time goes on, pathology becomes better able to find rare anomalies and infections, and maybe he had one of these.

Babies in the middle of their parents, you ask, fabhead? The vast majority of babies will be fine here, of course they will, but the research, such as it is, on what parents actually do, is that breastfeeding mothers (less likely with formula feeding mothers) form a protective nest of their body around the baby, and partners don't. Is this a 'risk'? We don't know. Does the protective nest still work with dad on the other side? We don't know.

www.nd.edu/~jmckenn1/lab/index.html is an interesting website.