Well, shocking and tragic as these deaths are, I wonder if they can't be
put into some perspective.  Is there anyone on Lactnet who is really good
with juggling figures and probabilities?  Here's the kind of thing I mean:
the incidence of SIDS deaths is somewhere between 1 and 2 per 1000 in the
USA.  If we can find out how many babies younger than one year of age
there are in this country, we can estimate how many babies die per year of
SIDS (clearly, a whopping big number compared to the 64 cases reported
from co-sleeping).  Once that figure has been estimated, then we need some
kind of calculation of the possible outcomes in various situations.  One
of the variables concerned is the possible decreased duration of
breastfeeding associated with fewer night feedings if the baby does not
sleep with or very close to the mother ( I am referring to McKenna's
recent article in Pediatrics showing that co-sleeping was associated with
increased breastfeeding duration).  Then we have the subsequent increased
risk of SIDS associated with the earlier weaning from the breast
resulting from lack of co-sleeping. If one used the Fredrickson figures (I
believe they are in Dr. Dettwyler's book "Breastfeeding: biocultural
perspectives" or at least the references are there) as to what percent
increased incidence of SIDS may occur with each month of not
breastfeeding, one could estimate a potential increased rate of
SIDS from fewer night feedings (not to mention all the other increased
morbidities and mortalities from mothers switching to formula when
frequent wakings to breastfeed their remote-sleeping baby convince them
that breastfeeding is just too tiring).  If someone was willing to take
this on, we may be able to demonstrate that the consequences of *not
co-sleeping* are significantly worse than with co-sleeping.  I would add
that even among formula-fed babies there may be an effect.  I seem to
remember that Dr. McKenna referred to Hong Kong as a society where there
is almost zero breastfeeding but almost universal co-sleeping, and the
SIDS rate is infinitesimally small.  Bottom line -- a crib is probably a
riskier place for a baby to sleep (does anyone know what percent of babies
who died of SIDS actually were found in their cribs?  This would again be
nice information to highlight).

Furthermore, in regards to those few cases of babies who died in the
adult bed, we don't have to accept the conclusions that are put forward
in this paper as the only way to prevent such deaths.  There are many
other steps that can be taken to make co-sleeping safer before "outlawing"
co-sleeping altogether.  We have to keep in mind that some (maybe the
majority -- I wonder if they checked) of the cases of parent rolling over
on the baby are associated with alcohol or drug intake.  So why not warn
parents not to co-sleep if they are under the influence of drugs or
alcohol?  I also seem to recall someone posting that in the majority of
those cases where babies were suffocated between parts of the bed, the
babies were *alone* and unsupervised in the adult beds.  If we could find
out how many of those cases were of this sort, we could reiterate and
apply to co-sleeping a strict warning to parents to *never* leave their
baby unattended, *wherever* the baby is.  Other recommendations?  I think
the AAP came out with some fairly good ones last year, including avoiding
soft bedding, laying baby on only a sheet, etc. We were dismayed back then
that they were singling out co-sleeping and stating that there wasn't
enough positive evidence for co-sleeping so that they would actually
recommend it.  However, at least those recommendations implied it's okay
to co-sleep as long as certain safety precautions are taken -- and isn't
that what we all want?

I would love to see the AAP respond to this CPSC statement.  The AAP,
after all, has a broader perspective and a strong pro-breastfeeding
stance, and I imagine more clout when it comes to health recommendations
for children.   Perhaps the AAP could send out a press release which
re-emphasizes their recommendations for co-sleeping and places the CPSC
recommendations in perspective.  Any AAP members of Lactnet who wish to
take this on?  Also, it may be appropriate for the Academy of
Breastfeeding Medicine to issue some kind of position statement
on this issue.  I'll certainly suggest that at the ABM meeting on Oct
27-30 in San Diego.  Sorry to ramble on.  I'd love to hear from anyone who
would like to work on this kind of project.  Regards, Alicia Dermer, MD,
IBCLC.

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