Dorothea:  What a coincidence that you should pose the question about
SIDS on the very day that I just presented a workshop on that very issue
at our local hospital's annual SIDS symposium.  With a little help from
certain allies, I had gotten them from an abm-sponsored status 2 years
ago and no mention of bf at all to no abm sponsorship last year with
passing mention of a possible bf connection last year.
For this
symposium, the two keynote speakers were Peter Fleming (whose recent work
shows no significant independent effect of bf on SIDS) and James McKenna
(who has done such ground-breaking work on co-sleeping/bf and its
relationship to baby's and mom's sleep/wake cycles - for more details,
see Dr. Dettwyler's book, Breastfeeding: Biocultural Perspectives).  My
unenviable task was to lead a workshop on what, if any, relationship
exists between artificial feeding and increased risk of SIDS (I'm
purposely using Diane Weissinger's "watch your language" here), after
Peter Fleming essentially said there is no significant effect.  I
should point out that Dr. Fleming did find a dose-response trend, but
that it was not statistically significant when socioeconomic confounders
were adjusted for.  Current statistical analysis cannot tell us whether
this is because infant feeding choice is a marker for the socioeconomic
factors which cause or prevent SIDS, or because the socioeconomic factors
cause the infant feeding choice which in itself can cause or prevent SIDS.

To summarize, I reviewed the literature to date, and your pediatricians
are off the mark about the notion of bf protecting against SIDS is an old
one.  In fact, many of the older studies did not find a significant
difference in infant feeding for SIDS vs. controls.  I found 21 studies,
13 of which showed increased risk with abm, 8 found no effect.  None
showed increased risk of SIDS with bf. Some of the most recent and better
controlled studies were the ones that showed a significant correlation. It's
amazing that an effect
was demonstrated in as many studies as it was, since the definitions of
breastfeeding were extremely inconsistent and in most cases the "bf"
group included babies who had ever gotten even a drop of human milk.  As
Dr. Dettwyler points out, the only study which defined bf in terms of
exclusivity and duration was Doren Fredrickson's.  Dr. Fleming did look
at fully bf vs mixed breast/bottle vs. fully bottle and did find that
there was a trend towards increased SIDS moving from fully bf to fully
bottle.

I believe that some good prospective study of a high-risk population
needs to be done to really look at the relationship.  In the meantime, it
seems that even if bf only protects a little or possibly only in certain
populations, we should inform parents that despite conflicting results,
there is suggestive evidence of bf protecting against SIDS. I have a lot of
references if anyone is interested.  Sorry this was so long.  Alicia.
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