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.
	
	

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(R)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html