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From:
Rachel Myr <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 15 Oct 2005 01:11:00 +0200
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I refer again to the Norwegian report "Bedsharing, pacifiers, breastfeeding
and SIDS - is there a correlation?"

When we did our exhaustive search of the literature, we were unable to find
published studies that were able to establish causality between not
breastfeeding and higher risk of SIDS, or between breastfeeding and a
protective effect against SIDS.  

No studies have ever found more SIDS in breastfed babies than in formula fed
babies.  But that is insufficient proof of causality.  It may be the best we
can do, but it is not proof.  The problem with a lot of the research is that
the definitions of things like 'pacifier use' or 'breastfeeding' or
'co-sleeping' are very vague, and don't even get me started about the ones
that don't define SIDS clearly enough.

No studies have found LESS breastfeeding with bedsharing either, but that
still doesn't prove causality.  If you want to see an excellent example of
honest treatment of the facts while looking at them very critically, go back
and read LLLI's press release on the AAP recommendations.  Their stance is
clear and their treatment of the evidence impeccable.  Jim McKenna's article
that someone posted a link to yesterday was also excellent.  I didn't think
Dr.Sears did quite as stringent a job with his statement though.

And as far as relying on common sense goes, that is what we used when
deciding that sleeping infants should be placed so that they wouldn't
aspirate their own vomit, because we reasoned that unconscious adults
shouldn't be placed supine, so neither should babies.  Thousands of babies
have died because of this nugget of common sense.  

Based on what we know to be true about babies, sleep, and feeding, we can
reason that it would be logical if not breastfeeding 'caused' SIDS, or
ifpacifier use 'reduced' breastfeeding, and we can agitate for research to
be done according to designs that would actually shed light on these
subjects.  It's OK to admit that the evidence is full of gaps and
deficiencies - that goes for the evidence the AAP is basing their
recommendations on too, and I second Nancy Wight's comments about the
ethnocentrism of them.  It is not OK to make believe that 'our' evidence is
stronger than 'their' evidence, because, in fact, it is not.  That's the
whole problem.  Everyone is reading the same studies but we are disagreeing
about how to interpret their findings and how to apply them in practice to
benefit the most babies.  

It's past my bedtime so I'll stop now.
Rachel Myr
Kristiansand, Norway

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