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

Dear Greenmonkies,

Several questions here. First, many more babies sleep in cots than in their parents' beds, so not surprisingly there will be more deaths in that setting. However, the proportion of bed sharing babies that die is significantly greater than the proportion of non bed sharing babies that die.

It is true that in many parts of the world infants do sleep with their mothers (interestingly, in some of these populations the father is excluded from the maternal bed as long as this is continuing). It is also true that most of those places have infant mortality figures that would be considered horrendous by European standards, so the safety is a matter of speculation, Also, in many of these populations the baby sleeps with the mother on a firm, hard mattress on the floor, not on a modern soft mattress with many coverings, so the findings are not necessarily capable of extrapolation to UK circumstances.

It is four studies, not one, that found no evidence of any adverse effect of dummy use on breast feeding. They are reviewed in a single study (O'Connor et al 2009), which is unique among all the published studies on this subject in that it included only those research papers that used the best methodology (prospective, randomised controlled studies) and are therefore free of bias, whether conscious or unconscious.

Again, the evidence for a protective effect of dummy use againt SIDS is based on at least 8 or 9 good quality studies and appears to apply to both breast and bottle fed babies.

Perhaps I could add that my generation (babies born during the second world war) probably had the lowest incidence of breast feeding of any generation of modern times, but we have so far had the greatest life expectancy of any generation in history. This is not an argument against breast feeding but perhaps a caution not to overstate its benefits on survival.

I'm sorry to persist but I can't find an answer to what I really want to know.

Are there figures available that show the proportion of all bedsharing babies that die of SIDS and the proportion of all lone sleeping babies that die of SIDS?

I know you have said that the risk is higher for bedsharing babies but how much higher? What exactly are the figures and how was the research carried out?

Hi Prof Haycock.

At what age does the risk of SIDS peak and when does it fall?
Also what are your views on the use of monitors that set an alarm off after no movement for 15 seconds, do you think they may be helpfull in parents being able to wake a baby from the deep sleep in which they appear to stop breathing in?

Thanks

Dear Greenmonkies (again),

As I have written somewhere else in this exercise, I know Helen Ball well. As it happens, I am a member of the steering committee of her latest piece or research. I am unfortunately bound by contract not to discuss that project until it is finished and published. For what it is worth, I last met her at a meeting convened by the University of Leicester on June 18 and 19 2009.

Perhaps I could add that my generation (babies born during the second world war) probably had the lowest incidence of breast feeding of any generation of modern times, but we have so far had the greatest life expectancy of any generation in history. This is not an argument against breast feeding but perhaps a caution not to overstate its benefits on survival

Not wanting to argue with a professor here but you know that isnt causal - who is not to say you would not have had even better health if breastfeeding was more widespread?

Surely by the same logic you could therefore argue that being born during the war increases life expectancy?

Thank you very much for such detailed info.

I think it would be very useful to quantify the risks - if that is possible. Then parents can make more informed decisions. Eg out of 100 000 or million babies how many would be expected to suffers SIDS and what the risk is in different subpopulations (eg breast feeding vs formula, bed sharing vs not etc).

It can be incredibly anxiety inducing to think that something could. for example, double the risk of SIDs but if the background risk is very low then that influences things. A bit like the 1990s pill scare and the DVT risk, it was reported in a way that made it look a lot more scary than it was!

I orginally asked "If we do not have accurate national figures on how all our babies sleep...how can we say cot sleeping versus bed sharing is safer ?"

I would like to change that to what are the national figures on how all our babies sleep ? As your last answer implies that we know these stats.

Actually, maybe I do have a question!

When I had my daughter it was by emergency caesarean late at night. I was moved from recovery to the ward and dd was put in bed with me, with the support of pillows and we were left that way for the night. Staff asserted that it was best for establishing bfing and bonding. I absolutely will not cast aspersions here on whether it was also in part due to understaffed wards and inability to be moving babies from cot to breast several times a night because of residual spinal anaesthetic. Anyway...

Do you work with hospitals in advising neonatal staff on what you believe is safest. It strikes me that in these situations with an exhausted and post operative mother, decisions are being taken by hospital staff as to where the baby is placed. Since staff do routinely place babies in beds with new mothers, do you think it raises a potential issue of culpability in the event of the very worst happening? Perhaps the choice made by the hospital staff could be construed in these cases as health care professional sanctioned? Of course I don't mean that we should assign culpability, just wondered if you worked with hospitals to advise on such matters? Advice on best practice then being provided from the very beginning.

I do hope you understand what I'm waffling on about.

As for the stats, well, according to the ones we were discussing only 11% of babies who died from SIDS were sleeping on a sofa with their carer, so does this mean, as this the smallest group, that sleeping on a sofa with your baby is the safest choice????

No. Of course it isn't. It's jut statistics.

Most people lie about co-sleeping/bed-sharing, it's a western taboo, so not many people own up to it, and most people don't do it deliberately, which in it'

s self makes it less safe than it should be. If we could get past this demonising of bed-sharing and stop trying to seperate mothers and their babies then more people would choose bed-side/side-car cots and more babies would sleep safely next to their mothers and be breastfed for longer because having your baby close and easily reached means you don't suffer from sleep deprivation because you are having to sit up and lift your baby to feed them all through the night.

Another question if you have time - have there been any analyses looking at which of the risk factors are the biggest predictors of cot death?

I must say, Dh was in the spare room while I was co-sleeping. 7 months of no snoring - bliss .

Dear Sarahrhianna,

An interesting question. Traditionally (i.e. in the 1980s and 1990s) the peak age for SIDS was between two and four months. The usual modern definition of SIDS only includes deaths that take place in the first year, although some researchers do also look at deaths in the second year. However, deaths are unusual after 6 months and relatively rare after one year.

The latest studies, however, including those from the Avon group (lead researchers Peter Fleming and Peter Blair) have shown a fall in the average age so that a greater proportion of the total now occur in the first two months than previously. It is not clear why this change has occurred, although greatly increased survival rates for very premature infants (who are at much increased risk) may account for part of the change.

The question of apneoa monitors is difficult. There is actually very little evidence that they save babies lives, at least as far as SIDS deaths are concerned, and the amount of reassurance that they can provide may be an important benefit, although hard to quantify. I will admit that when I had responsibility for the care of my two small grand-daughters when they were babies, I did monitor them at night with a 'walkie-talkie', although not with an apnoea monitor as such.

Can you give more details about the the latest advice that babies should not be put down to sleep in a seperate room for daytime naps ?

Prof Haycock - I understand that this would be speculation, but do you have any personal hypotheses as to why bedsharing is a risk factor for SIDS? Especially given that presumably separate sleeping is a relatively new phenomenon for our species.

And I'd like to add my thanks for the detailed responses.

Given that the best evidence on the relationship between breastfeeding and SIDS relies on data on ever vs never breastfeeding, do you feel that the risk reduction may be underestimated?

Thank you again!

Lenin, I was surprised too. Given the choice I still would have had her in with me but this is from the pov of a mother who had read and read and read around the subject and taken the decision to cosleep.

I do wonder whether a breezy 'it's the best thing for you and for bfing' from an hcp is actually quite remarkable because as I said it's even beyond sanction, it's advice. Now, is that opinion of the individual hcp or guidelines? Do they have a responsibility to place babies in a way that's in line with FSID guidelines?

NoHotAshes - this interests me as well. Sometimes, babies are bed sharing because they are unsettled/ill/miserable, and this may reflect something 'wrong' and it's the something 'wrong' that's increased the risk of SIDS. The bed sharing is incidental. I am not sure that all studies control for this.

And as far as I can tell, there are no studies that really control for safe co-sleeping, but I might be wrong there.

Co-sleeping with pillows and a drugged mother in hospital seems to me to be poor care.

Dear peppapighastakenoverm...

There are many epidemiological studies of the relative importance of various risk factors for SIDS. One of the most important of these is actually a book, rather than a paper, called the CESDI report into SUDI studies which was published by HM Stationery Office in 2000. This is obtainable from HMSO (cost £25 when I bought mine) which is easily accessed online.

Other important publications that bear on this include studies from New Zealand, Australia, Germany, Holland, USA and Canada and the Nordic countries. What is interesting is how similar the results are from these different countries, suggesting I think that they are describing real risk factors and not just local phenomena (although all these are, of course, developed - i.e. rich - countries.

Greenmonkies - it basically means, e.g. if you take 100 children travelling in cars at any one time, and 5 of them are injured in an accident one day. 3 of the 5 children (60%) were in a car seat, and 2 of the 5 children (40%) were not.

So you could say "60% of children injured today were in their car seats whereas only 40% were not - therefore car seats are not safe and may be dangerous"

But that would not necessarily be the case, until you know the number of children in car seats from the full number. Say 10 of the original 100 children were not using a car seat. As 3 of these children were injured, that means that on this day, 30% of children not using car seats were injured while travelling in a car. There are 90 children out of the 100 using a car seat, out of these, 2 were injured. That's 2.2% of children using a car seat.

Obviously these figures are made up as an illustration but you can easily apply it to this situation. I'd like to know the stats for how many parents bedshare too, and how this data is collected.

Several questions here. First, many more babies sleep in cots than in their parents' beds, so not surprisingly there will be more deaths in that setting. However, the proportion of bed sharing babies that die is significantly greater than the proportion of non bed sharing babies that die.

According to who??? most co-sleepers either lie about it, or don't realise that falling asleep with the baby in the bed is co-sleeping

It is true that in many parts of the world infants do sleep with their mothers (interestingly, in some of these populations the father is excluded from the maternal bed as long as this is continuing)

yes, this is called safe co-sleeping, baby is not placed between mum and dad, but dad is removed from the area where baby is sleeping (like using a side-car cot).

It is also true that most of those places have infant mortality figures that would be considered horrendous by European standards,

BUT NOT FROM SIDS!!! infections etc perhaps, but not from SIDS

so the safety is a matter of speculation, Also, in many of these populations the baby sleeps with the mother on a firm, hard mattress on the floor, not on a modern soft mattress with many coverings, so the findings are not necessarily capable of extrapolation to UK circumstances.

It is four studies, not one, that found no evidence of any adverse effect of dummy use on breast feeding. They are reviewed in a single study (O'Connor et al 2009), which is unique among all the published studies on this subject in that it included only those research papers that used the best methodology (prospective, randomised controlled studies) and are therefore free of bias, whether conscious or unconscious.

I think I take the word of internationally respected breastfeeding support networks over all in this case

Again, the evidence for a protective effect of dummy use againt SIDS is based on at least 8 or 9 good quality studies and appears to apply to both breast and bottle fed babies.

Perhaps I could add that my generation (babies born during the second world war) probably had the lowest incidence of breast feeding of any generation of modern times, but we have so far had the greatest life expectancy of any generation in history. This is not an argument against breast feeding but perhaps a caution not to overstate its benefits on survival.

what???? There is no lack of surveys showing that from a high rate of breastfeeding in the industrializing world of the early 20th century, after World WarII the incidence declined to a nadir around 1960

Der Tiktok,

I have partly dealt with this in earlier postings. Recent evidence is not unanimous as to whether symptoms of minor infection (restlessness, irritability, low grade fever etc.) are risk factors for SIDS in the 'bcak to sleep' era. However, the recent German study that I have quoted already suggests that it is infants who habitually bed share who are at greatest risk, rather than those who are taken into the parents' bed only occasionally.