Marsha, your list of smoking references that deal with interferring with the upper respiratory control remind me of a story that my supervising teacher (way back when I was a biology/human anatomy student teacher before kids) told his classes about smoking. He talked about how so many folks look at the lung cancer statistics and then tell about their Uncle George who smoked a carton of cigarettes every day from age 6 and lived to be 100, and then add that it won't happen to them. His response was that cancer may or may not hit every smoker, but that one thing that WILL happen to every smoker is that the smoke (nicotine? sorry, it has been more than a few years!) paralyzes the cilia (hair-like projections) that line the airways and are responsible for moving mucous up and out. This just leaves coughing as the major way to clear mucous. He talked about how many times smokers will take a cough suppressant at night to stop the coughing and how folks had "drowned" in their sleep because the cough suppressant knocked out their other defense for accumulating mucous. I don't have any references for this, and honestly don't know whether this is in the literature or not, but IF it is, perhaps this kind of mechanism is at work when the smoke hits the infant's airways as well? Perhaps the combination of mounting mucous and paralyzed cilia are enough to trigger an apnea spell in an otherwise prone baby? He also mentioned that as soon as someone quits smoking, the cilia rejuvenate, at least up to a point. His mother died of lung cancer from smoking, and the other chilling tale he used to tell was about going to see his mom in a lung cancer ward. He described the poor souls who had throat /mouth cancer and had had tracheotomies, leaving a small straw-like tube in their necks. These folks were puffing away on the cigarettes placed in the tubes--a graphic illustration of just how addictive they can be. As I recall, his students sat spell-bound through this lecture. It would be interesting to see how many of them are smokers.... Melissa Vickers, IBCLC [log in to unmask]