Someone writes in about two children who have ended up brain-damaged from
suffocation, one while sleeping with his parents and one while sleeping on a
waterbed.

This raises a number of issues, most of which have been extensively covered
in the archives, as well as the medical literature, particularly James
McKenna's work on co-sleeping.  Co-sleeping with a child reduces many of the
known risk factors for SIDS.  I won't repeat McKenna's work here, but anyone
who works with parents and children should be *very* familiar with his work.
  I do have a few comments to make.

(1)  SIDS means "We don't know why the baby died" (or ended up brain
damaged).  If a baby suffocates, then it didn't did of SIDS.  If it died of
ANY known cause, then it didn't die of SIDS.

(2)  There are safe and unsafe ways to put a baby to sleep in a crib.  There
are safe and unsafe ways to co-sleep with a baby in an adult bed.  All
health care providers should be familiar with these issues, and be able to
give parents guidelines about safe sleep environments for children -- both
in cribs and in adults bed with adults (and siblings, and the family pets).
It is highly irresponsible just to tell parents that they "shouldn't
co-sleep."  This is like telling teenagers that they shouldn't have sex
(without giving them information about how to protect themselves against
pregnancy, sexually transmitted diseases, and emotional/physical abuse).
Since many parents are going to co-sleep, and since there is a lot of
research suggesting that this is good for children, we should help parents
co-sleep safely, or put their babies to sleep in a crib safely.

(3)  No one can guarantee a parent ANYTHING about their child, including
that they won't grow up to be schizophrenic, or develop leukemia, or a brain
tumor, or become an alcoholic, or die in a car accident on the way to the
prom.  It isn't the health care professional's job to give parents
guarantees.  It is their job to give parents accurate and complete
information about relative risks, based on scientific research.

(4)  It isn't the health care professional's job to care overly much about
how parents feel.  Since most SIDS deaths occur in cribs, how do parents
feel whose babies died of SIDS?  Of course they feel awful, regarding of
what anyone has said or told them.  We know that breastfed babies are much
less likely to die of SIDS -- yet I don't see too many health care
professionals worrying that their formula-feeding parents will feel bad if
their baby dies of SIDS, and therefore pushing breastfeeding.  On the
contrary, they withhold information from the parents so that the parents
won't know about the link between formula and SIDS.

(5)  Of course we should advocate/educate about any measures that can reduce
SIDS and/or suffocation.  That is why it is so critical to educate parents
about safe co-sleeping environments.  And breastfeeding.  Perhaps dads
should not co-sleep with their newborns, only mother and baby should be in
the bed.  I suspect that if the baby you describe had been breastfed, the
mother would have been more in tune with it, more aware, more protective,
and the baby could not have been "squished" between mother and father.  Or
perhaps their bed was too soft, or dad was too sound of a sleeper, or one or
both had been drinking or using drugs (even legal ones like antihistamines
can make a person sleep more soundly than normal).  We don't know all the
details here.  Also, I would never dismiss the idea that the parents
deliberately suffocated the baby.  This happens much more often than most
people realize or want to admit (see Pediatrics, November or December 1997).
  The point is, don't leap to the conclusion that this baby would have been
fine if he had not been sleeping with his parents.

(6)  Of course we all want to prevent tragedies.  Unfortunately, sometimes
people get "stuck" on one issues and can't see the broader picture.  For
example, the folks in South Africa who want to prevent any child from dying
of HIV transmitted through breast milk.  To achieve this goal, they advocate
that HIV+ mothers, or mothers who might be (or become) HIV+ -- which means
all mothers -- bottle-feed with formula.  Now, this will definitely prevent
any baby from dying of HIV/AIDS that s/he acquired through breast milk.  The
bigger picture is that these children will die from not being breastfed,
instead -- at greater rates than they would have died from HIV/AIDS if
breastfed by an HIV+ positive mother.  But the advocates of universal
bottle-feeding don't care what happens to the babies -- whether they live or
die -- as long as they don't die from HIV acquired through breastfeeding.
Likewise, the evidence is clear that solitary sleeping is a risk factor for
SIDS, and that co-sleeping and breastfeeding are protective.  So if we
insist that all babies sleep in cribs, more babies will end up dead -- but
at least none of them would have died by suffocation in a water bed or
between their parents!  We all need to see the bigger picture.

(7)  Most of you know that my husband is the Director of Immunization
Programs for the state of Delaware, and that immunizations can have adverse
side-effects.  If we don't want anyone to die or end up brain-damaged from
the side-effects of immunizations, then we advocate that parents not
immunize their children.  Of course, if no one immunized, then you would
have many-fold more children dying or ending up brain-damaged or paralyzed
from the diseases that immunization prevents.  Which is better?  To have no
children adversely affected by the immunizations, or to prevent the much
greater death and permanent disability from the diseases?  If you are the
parent whose child is accidentally suffocated in bed while co-sleeping, of
course you are devastated, and will rail against co-sleeping.  If you are
the parent whose child dies of an adverse reaction to an immunizations, of
course you are devastated, and will rail against immunizations.
None-the-less, as health care professionals we must be able to see and
explain the broader picture -- that both co-sleeping and immunizations end
up providing better protection for the population as a whole.


Katherine A. Dettwyler, Ph.D.
Associate Professor of Anthropology and Nutrition
Texas A&M University

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