Jan:  I hope this is not true, as even Peter Fleming  (whose data do not
show a significant independent protection from SIDS by bf) has written in
a chapter for a pediatric textbook that the data suggest a protective
effect "in New Zealand but not in the UK".  If even he admits that the
data are conflicting, it would be premature to drop bf from the
recommendations.  I question the motivations of those who do not want to
promote bf as protection from SIDS.

I've heard and read a few arguments: (1) If a mother believes that her bb
will not die from SIDS if she bf, and the baby *does* die despite being
bf, this will increase her despair and helplessness and increase her
anger; (2) If a mother chooses not to bf or is otherwise unable to bf,
and her abm-fed bb dies, she will feel unnecessarily guilty; (3) If we
promote bf as protective from SIDS when the data do not support it, we
will lose credibility in our overall bf promotion efforts.

Here are my personal opinions on why these arguments would not persuade
me to drop bf from the SIDS prevention campaigns.  Number (1) makes
little sense (if I had removed every possible known risk factor and my
baby had still died, I would know that my bb did not die due to anything
that I had done or not done which could possibly have changed the
outcome, and I would be relieved of guilt).  Number (2) I examine the way
I see any health promotion advice we give:  It is our responsibility as
health care providers to give people the info necessary to make their own
decisions; if they do not or cannot adhere to the advice given, and feel
guilty, that is no reason not to have given the info (otherwise, we may
as well get out of the health promotion field, because most of our
recommendations for healthy behaviors are difficult if not impossible for
a significant proportion of our patients to accomplish).  Number (3) is only
valid if the data truly do not support bf as protective; from my recent
review of all the literature, the fact that Fleming did not confirm the
association by no means negates the other data; all we know is that the
studies are inconclusive, probably largely due to inexact definitions of
the exclusivity and duration of bf and the confounding with co-sleeping
and other behaviors.  IMO, it does not detract from my credibility as a
bf promoter if I inform people that, although data are conflicting, bf
may protect against SIDS.

If we were recommending a dangerous or extremely costly practice whose
benefit was unproven, I could see the reasoning for not recommending it
unless there was clear, incontrovertible evidence that the benefits
outweigh the risks.  But (and yes I'm shouting) WE'RE RECOMMENDING
BREASTFEEDING!  My gut feeling is that those who want to quickly drop bf
from the recommendations are, at worst, validating our society's
indifference to downright hostility against bf, at best acknowledging
that a recommendation to bf in our social climate *is* a risky and costly
practice. Is this a soap box or what?? Alicia.  [log in to unmask]