Further to my post a couple of days ago on the link between SIDS and
caffeine consumption, I have now read another newspaper report in The
Australian which mentions Dr Rodney Ford as the leading author, and
Archives of Disease in Childhood as the journal where it is published.

The study apparently found that SIDS was twice as likely if the mother
drank more than 400mg of coffee during pregnancy, "the equivalent of four
cups of coffee or eight cups of tea". Dr Ford also said that "heavy
caffeine consumption during pregnancy can affect a baby's birth weight,
cause it to have withdrawal symptoms and increase the rate of spontaneous
abortion." The study did not conclusively prove why caffeine increased the
SIDS incidence, but Dr Ford is quoted as saying "We're suggesting that
maybe these children, who were stimulated a lot during pregnancy with
caffeine, when they are born and left to their own devices . . . could be
in situations where they are stressed with their breathing. They just don't
have the get-up-and-go to keep breathing because they're used to being
flogged along be caffeine." (No mention was made of whether breastfeeding
might be of benefit to prevent withdrawal, although they did refer to
bottle feeding as a risk factor they controlled for.)

Also heard an interview on the radio yesterday with our local SIDS
researcher, the one who helped get breastfeeding off the list of
Australian recommendations to reduce the risk of SIDS.  He was knocking the
study (typical - because he didn't find it first).  He mentioned that
caffeine is sometimes given to babies to stimulate breathing, but said it
is controversial because it can increase reflux (interesting!) and hence
the possibility of choking. He listed all the problems caffeine consumption
during pregnancy can cause but then said they would not be including it in
the Australian SIDS message because it was not a strong enough link at this
stage and you shouldn't ask mothers to do too much!!!!

This gets me to my long-standing grievance. The problem with
promoting one health message in isolation (eg SIDS risk factors) is
that it can overwhelm the bigger picture of overall health messages.
Thousands of dollars are spent telling mothers how important it is to
position their babies for sleep. Breastfeeding is left out of this campaign
(in Australia) because its benefits re SIDS are supposedly not
statistically significant enough.  The fact that breastfeeding might do
more for the health of a greater number of children is not relevant to a
single-focus campaign like this.  Similarly, if the link between SIDS and
caffeine is not "strong enough" then we shouldn't overwhelm mothers-to-be
with too many things to do or not do. Is it better to let them miscarry,
have smaller babies, etc than to tell them the risk and let them make up
their own minds?  Familiar?

While SIDS is tragic, it seems to have taken over the health message
arena in a disproportionate way. I worry that other important health
messages get overwhelmed.

Ros Escott BAppSc IBCLC
Tasmania, Australia
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