Just had an email from Prof Haycock with answers to some of your advance questions.
He says that if he hasn't managed to answer your question, he will try to get to it during the chat.
(He may not have seen any subsequent comments you've made this morning, yet, BTW.)
Tambajam:
The fact that some mothers feel it is safer to bed share in the early days unfortunately doesn?t make it so. In fact, if you look at the papers I have highlighted in the summary document that I passed on to Geraldine yesterday, it is precisely in the first few weeks that the risk of bed sharing appears to be the greatest, with odds ratios ranging from about 5 to about 19 in different studies (that is the risk compared with non-bed sharing infants). I prefer to avoid the term co-sleeeping since it means different things to different people: some mean bed sharing, some mean room sharing and some mean any sleeping arrangement whereby a sleep surface is shared by a baby and another person. So, except where a specific question refers to another form of co-sleeping, I will confine my comments to bed sharing.
I know Helen Ball well (and, as it happens, am a member of the steering committee of her latest research project. Unfortunately, because the study is not completed or published I am unable to comment in any way on the progress of that). She and others, such as Jim McKenna of South Bend, Indiana, have shown an association between bed sharing and breast feeding, but not causation. It may well be that the cause of the association is that when mothers stop breast feeding they tend to stop bed sharing, rather than the other way around. Unfortunately, it is a fact of epidemiological research that what are called observational studies, which include case-control studies, can only demonstrate association, not causation in either direction.
FSID does give advice on how to make bed sharing as safe as possible and has being doing this for a number of years. On the other hand, we would hardly be doing the public a service by failing to draw attention to research that is already in the public domain.
gardeningmum05:
I am very sorry to hear of your experience. It is important to recognise that risk factors are not causes in a simple sense. Whatever the epidemiological evidence may show about population risks, it is never possible to identify a definite cause for an individual case of SIDS (if a cause were identified, it would not be classified as SIDS).
flamingobingo:
As I have commented before, it is not proven that planned co-sleeping increases breastfeeding duration. Furthermore, there are no statistics that I know that differentiate between planned bed sharing (I avoid the term co-sleeping as I have already commented) and unplanned bed sharing. Some of the studies have looked at both ?usual? bed sharing and bed sharing during the last sleep. Both appear to confer risk. In the recently published (April 2009) study by the German SIDS Study (Vennemann M M et al. Pediatrics (2009) 123:1162-1170), it was specifically those infants who were accustomed to bed sharing and who shared during the last night that were at increased risk on multivariate (adjucted) analysis: those who slept in the parental bed on the last night but were not accustomed to doing so were not at increased risk in the multivariate analysis.
Yes, babies die in cots too, but in the studies conducted and published by the FSID research group in Bristol, the incidence of infants dying in cots has fallen six fold since the back to sleep campaign was introduced but has only fallen by half in those bed sharing.
GH:
The papers I have referred to (references available on the website I hope) include many cases of babies who have died during regular sleeping in their parents? bed. All the studies that have differentiated bed sharing from sofa or settee sharing have shown that the risk is far higher in the sofa situation than in an adult bed. It is not possible to give overall figures for the three categories because (a) they differ somewhat between the various studies, and (b) the risk varies substantially with the age of the infant.
AnarchyAunt:
The German study just referred to conveys the opposite message, as far as bed sharing is concerned. Occasional or accidental co-sleeping on, for example, as sofa is very much more dangerous and I think everybody is agreed on that.
gingerninja:
Death in a parental bed (or anywhere else) due to suffocation or overlying is not classified as SIDS. Figures for lone sleeping are extensively covered in the papers I have cited before, and indeed in many others.
VeniVidiVickiQV:
(I like the classical allusion!) The epidemiological data on SIDS are indeed gathered retrospectively, since one cannot in general prospectively randomise families to different infant care practices, especially if there is good reason already to believe that one or more of the options confers added risk. There are one or two exceptions. For example, there are four prospective, randomised studies of dummy use and its relation to breast feeding exclusivity and duration (reviewed in O?Connor NR et al. Archives of Pediatrics and Adolescent Medicine (2009) 163: 378-382), which found no evidence of an adverse effect of dummy use on either index of breast feeding success.
Yes, socioeconomic factors are very definitely included in all the serious studies.
I avoid the use of the term co-sleeping because it includes too many different and diverse practices. I prefer to talk about bed sharing, sofa sharing, room sharing etc., to avoid confusion (which has unfortunately affected many published studies in the field).
Yes, the protective effects of breast feeding are factored into the research into bed sharing, in some but not all studies. Where it has been looked at, the combination of breast feeding and non bed sharing is the safest practice and the combination of bed sharing and not breast feeding is the least safe.
wuglet:
This is covered by my answer to flamingobingo above. Your second point is interesting, but a study by the German SIDS Study (a different one from the one referred to above, Venneman M M et al. Archives of Disease in Childhood (2005) 90: 520-522) found that symptoms of minor illness were no longer a predictor of SIDS in a population where the great majority of infants now sleep supine. Their results were obviously obtained from the German population but the general description fits the UK population as well.
Upwind:
Your first question is covered in the immediately previous answer.
The second point is difficult. I am not sure that the word ?subjective? is really the right one, but there may be differences of opinion on the cause of death in a particular case between different pathologists and, more importantly, different coroners since it is coroners who issue the death certificate in these cases. Most pathologists that I know, who actually do post mortem examinations in SIDS cases, believe they can tell the difference.
hunkermunker:
More deaths occur in the parental bed than on sofas, but a higher proportion of sofa sharers than bed sharers die, because bed sharing is a much commoner practice that sofa sharing. In an important study from Avon (Blair P S et al. Lancet (2006) 367: 314-319) comparing the statistics from 1984 to 2003, in the most recent cohort (1999-2003) 50% of deaths occurred in infants sleeping alone in cots, 39% in the parental bed and 11% were sofa sharing. Recent studies from Germany and the Netherlands suggest that following the guidelines ?to the letter? reduces but does not abolish the risk of bed sharing, especially in the youngest infants.
LupusinaLlamasuit:
(I hope your screen name refers to the wolf and not the disease!) I have given a list of relevant references to Geraldine which I hope will answer your first point. The FSID recommendations were actually based on published papers based on 2,616 SIDS cases and 9,296 controls ? not such a small sample really. All of these were published in peer reviewed journals.
FSID funds research projects for which funding is sought by independent researchers. If you or anyone you know has a coherent proposition for research of the kind you suggest, feel free to apply for support.
hedgiemum:
I?m afraid the information given to you by your HV is not correct (see previous answers and my accompanying document with published references).
Your personal predicament is a common one. It is worth remembering that both the risk of SIDS in general, and the risk of bed sharing, applies mainly to the youngest infants, i.e. those less than 2-3 months old.
hunkermunker:
Even at its worst in this country, before the ?back to sleep? campaign in the early 1990s, the cot death rate was about 2 per 1,000 live births (about 1,300 cases a year in England and Wales) which has now fallen to about 0.4 cases per 1,000 live births (about 300 a year). So, even when front sleeping, maternal smoking pregnancy and other avoidable risk factors were either not understood or not avoided, the great majority of babies survived. As I have tried to point out elsewhere, a risk factor is not a single cause. To use an analogy, nobody seriously doubts nowadays that cigarette smoking is a major risk factor for lung cancer, but most lifelong heavy smokers (90% in fact) don?t get lung cancer. The recommendations for avoiding SIDS are not designed to save the 700,000 or so babies born every year in this country but the few hundred who are still dying of this still incompletely understood condition.
The FSID guidelines do include the recommendation to breast feed your baby. To go back to your previous point, the huge majority of formula fed babies survive (and thrive!). The best evidence, incidentally, suggests that breast feeding modestly reduces the risk of SIDS compared with bottle feeding with an odds ratio of about 0.64. This figure comes from the USA Agency Agency for Healthcare Research and Quality report no. 153, available online at www.ahrq.gov/clinic/tp/brfouttp.htm. Beware, this report is about 400 pages long: the section on breast feeding and SIDS begins on page 97.
hanaflower:
Stats covering suffocation are not included in SIDS data, by definition, but there is one fairly recent paper from the USA covering this specifically (Scheers N J et al. Pediatrics (2003) 112: 883-889).