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Sat, 6 Aug 2005 21:39:19 -0700 |
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Just as with much to do with infant care there are lots of questions
without answers.
We do not know that back to sleep is best for premature infants or
infants in the first few hours post birth. It may very well be that
side lying or tummy lying is wisest for those or again maybe it is
back sleeping, I haven't seen anything which gives a good indication.
Just a lot of anecdotes and "this is the way we have always done it"
which doesn't carry much weight.
There is a little we do know:
Infants need tummy time while they are awake. Being in a sling or
held over a shoulder or cuddled by dad on his chest qualifies as tummy time.
Infants who have difficulty turning their heads from side to side
perhaps due to birth trauma or other physical restrictions are at
risk of deforming their heads and this is a risk we should let
parents know exists. It is not a function of back sleeping unless
the infant spends the majority of it's time on it's back in baby
buckets (infant car seats) or lying on hard surfaces...It is not
something likely to be seen in an infant put on it's back to sleep
but otherwise held by adults or allowed to play on its tummy. Yes
our messages need to be better explained.
Watching an infant sleep on their tummy does not reduce the risk of
SIDS. One of the characteristics of SIDS is that the infant cannot be
roused. I have worked with families where the child has died in
someone's arms and could not be revived. I have known coworkers
describe the monitors going off and immediate in-hospital care being
given without success. A friend's infant died in the two block walk
between her house and her mother's. Watching doesn't help, sadly.
Not all SIDS is preventable at the level of knowledge we currently
have, or perhaps ever will have. Just because we can't prevent them
all doesn't mean we shouldn't do our best to prevent the ones we can.
This is a breastfeeding issue because the recommendations and
interpretations of the data often put normal breastfeeding behaviours
as risk factors. We know frequent feeding is normal, we believe
breastfeeding mothers co sleeping in a safe adult bed are reducing
their infant's risk. If we allow this discussion to be led using the
norm of ABM feeding infants placed in cribs of uncertain safety in a
separate room and not a norm of exclusively breastfed infants co
sleeping in an environment that we believe to be safe then we see two
outcomes. 1. recommendations for safe infant sleep do not support
breastfeeding and 2. when an infant dies who is fully breastfed and
is co sleeping the parents will be vilified. Unfortunately both of
these outcomes are taking place routinely.
As advocates for breastfeeding it is important that we be engaged in
the discussion and monitor both the interpretation of the research
and the application of the results. I do not do research of this type
but I hope those of you who do will start asking the questions and
producing quality research using breastfeeding norms.
Dr McKenna published an article on safe infant sleep last month. I
have copies at my office but do not have the reference here. I
believe it was referred to on Lactnet in early July. I recommend
everyone locate a copy.
If we are truly working to the goal of infants being exclusively
breastfed to about 6 months and some breastfeeding to two years and
beyond then the topic of infant sleep is part of the bigger picture
that will impact our success.
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