Remember how there is a major push back every 
year before or during World Wide Breastfeeding 
Week?  I wonder if the articles in Atlantic and 
Today's Parent magazine were "commissioned" to 
deflect the impact of any news on the SIDS issue.

I got this from another list.  I highlighted the 
section which was stated as breastfeeding's being 
the norm (Weissingerized). It was from JHL.  [The 
other highlights are mine too. One can either 
write that breastfeeding reduces the risk of SIDS 
by half or one can write that formula feeding 
doubles the risk of SIDS.] Then the information 
reverts to the benefits of breastfeeding instead 
of the risks of formula feeding. I had to delete 
some of the details of the online credits because of Lactnet's line limit.
Patricia Gima
_________________________________________________________________________________
This activity is developed and funded by Medscape.

Breast-Feeding May Reduce Risk for SIDS by Half Throughout Infancy CME/CE

To participate in this internet activity: (1) 
review the target audience, learning objectives, 
and author disclosures; (2) study the education 
content; (3) take the post-test and/or complete 
the evaluation; (4) view/print certificate View details.

Learning Objectives
Upon completion of this activity, participants will be able to:
1.       Describe the association between 
breast-feeding at age 1 month and the risk for sudden infant death syndrome.
2.       Report whether breast-feeding in the 
previous month is associated with a risk for sudden infant death syndrome.


March 10, 2009 — Breast-feeding reduces the risk 
for sudden infant death syndrome (SIDS) by 
approximately 50% at all ages throughout infancy, 
according to the results of a case-control study 
reported in the March issue of Pediatrics.
"In the last 20 years, the prevention campaigns 
to reduce the risk of sudden infant death 
syndrome were very successful," write M. M. 
Vennemann, MD, MPH, PD, from University of 
Münster in Münster, Germany, and colleagues from 
the German Study of Sudden Infant Death Study 
Group. "In some countries the advice to 
breastfeed is included in the campaigns' 
messages, but in other countries it is not."
The goal of this study was to evaluate the 
association between type of infant feeding and 
SIDS. In the German Study of Sudden Infant Death, 
333 infants who died of SIDS (cases) were matched 
by age with 998 control infants. Breast-feeding 
at age 2 weeks was reported by 49.6% of case 
infants and by 82.9% of control infants.
Exclusive breast-feeding at age 1 month was 
associated with half the risk for SIDS. Although 
partial breast-feeding at age 1 month was also 
associated with lower risk for SIDS, this risk 
was not significant after adjustment.
Reporting exclusive or partial breast-feeding in 
the last month of life before the interview was 
associated with a lower risk for SIDS. Both 
partial breast-feeding and exclusive 
breast-feeding were linked to a reduced risk for 
SIDS, based on breast-feeding survival curves.
"This study shows that breastfeeding reduced the 
risk of sudden infant death syndrome by ~50% at 
all ages throughout infancy," the study authors 
write. "We recommend including the advice to 
breastfeed through 6 months of age in sudden 
infant death syndrome risk-reduction messages."
Limitations of this study include less-than-ideal 
response rate of controls; participants, 
especially controls, more likely to be 
socioeconomically advantaged vs those who did not 
participate; possible residual confounding; and 
retrospective collection of data, creating possible recall bias.
"In our study, 73% of the infants died before 6 
months of age," the study authors conclude. "The 
implication of our findings is that breastfeeding 
should be continued until the infant is 6 months 
of age and the risk of SIDS is low. Because 
breastfeeding rates are low in the socially 
deprived sections of our population, there should 
be special programs to encourage mothers of low 
socioeconomic status to breastfeed their infants 
not only for the established benefits of 
breastfeeding for the mother and infant but also 
to reduce the risk of SIDS in their infants."
The German Federal Ministry for Science and 
Education supported this study from 1998 to 2003. 
Coauthor E. A. Mitchell, FRACP, DSc, was 
supported by the Child Health Research Foundation 
in New Zealand. The other study authors have 
disclosed no relevant financial relationships.

Pediatrics. 2009;123:e406-e410.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
1.       Describe the association between 
breast-feeding at age 1 month and the risk for sudden infant death syndrome.
2.       Report whether breast-feeding in the 
previous month is associated with a risk for sudden infant death syndrome.
Clinical Context
SIDS is a leading cause of death in infants. In 
the February 2000 issue of the Journal of Human 
Lactation, a meta-analysis by McVea and 
colleagues noted that the SIDS risk was 2-fold 
higher in formula-fed vs breast-fed infants. The 
German Study of Sudden Infant Death, described by 
Vennemann and colleagues in the June 2005 issue 
of Acta Paediatrica, found that in a population 
where most infants do not sleep prone, SIDS cases 
were less likely vs control infants to be 
breast-fed at age 2 weeks (49.6% vs 82.9%; 
adjusted odds ratio [OR], 0.43). However, 
breast-feeding is not universally included in SIDS prevention guidelines.
This population-based, case-control study extends 
the German Study of Sudden Infant Death to assess 
whether the extent of breast-feeding at age 1 
month or in the month before SIDS is associated with the risk for SIDS.
Study Highlights
333 infants who died of SIDS between 1998 and 
2001 were matched in age to 998 control infants 
born 4 to 6 weeks after the case infants.
The response rate was greater for case families 
vs control families (82.4% vs 58.7%).
Interviews were conducted at the same age for 
case infants and control infants.
Autopsy protocol for case infants was standardized.
Most SIDS cases (59%) occurred between ages 2 and 5 months.
Interviewers administered questionnaires 
regarding exclusive breast-feeding, partial 
breast-feeding, or no breast-feeding at ages 2 
weeks, 1 month, and in the month before SIDS in 
case infants or in the last month before the interview in control infants.
Multivariate analysis controlled for maternal 
smoking in pregnancy, maternal family status, 
maternal age at delivery, socioeconomic status, 
previous live births, infant birth weight, bed 
sharing in last night, pillow in infant's bed, 
additional heating in last sleep, sleep position, and pacifier use.
At age 1 month, 39.0% of case infants vs 71.9% of 
control infants were exclusively breast-fed 
(adjusted OR, 0.48; 95% confidence interval [CI], 0.28 - 0.82).
At age 1 month, partial breast-feeding did not 
significantly reduce the risk for SIDS.
In the month before death or in the last month 
before the interview, 9.3% of case infants vs 
33.5% of control infants were exclusively 
breast-fed (adjusted OR, 0.27; 95% CI, 0.13 - 0.56).
In the month before death or interview, 12.9% of 
case infants vs 27.9% of control infants were 
partially breast-fed (adjusted OR, 0.29; 95% CI, 0.16 - 0.53).
Survival curves showed that partial 
breast-feeding and exclusive breast-feeding were 
linked with a decreased risk for SIDS at all ages.
Breast-feeding decreased the risk for SIDS by approximately 50% at all ages.
Limitations of the study included low response 
rate for control families, higher socioeconomic 
status in participants vs nonparticipants, 
possible residual confounding despite 
multivariate analysis, and possible recall bias 
because of retrospective design.
Pearls for Practice
The risk for SIDS is decreased by half in infants 
who are exclusively, but not partially, 
breast-fed vs those who are not breast-fed at age 1 month.
Exclusive breast-feeding or partial 
breast-feeding in the previous month of life or 
in the last month before the interview decreases the risk for SIDS.

A 1-month old infant is in your office for a 
well-child examination. Which of the following is 
most likely to be associated with a decreased risk for SIDS?
Exclusive breast-feeding only
Partial breast-feeding only
No breast-feeding only
Exclusive breast-feeding or partial breast-feeding
None of the above

During infancy, which of the following is most 
likely to be linked with a decreased risk for SIDS?
Exclusive breast-feeding only
Partial breast-feeding only
No breast-feeding only
Exclusive breast-feeding or partial breast-feeding
None of the above




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