Someone writes in about two children who have ended up brain-damaged from suffocation, one while sleeping with his parents and one while sleeping on a waterbed. This raises a number of issues, most of which have been extensively covered in the archives, as well as the medical literature, particularly James McKenna's work on co-sleeping. Co-sleeping with a child reduces many of the known risk factors for SIDS. I won't repeat McKenna's work here, but anyone who works with parents and children should be *very* familiar with his work. I do have a few comments to make. (1) SIDS means "We don't know why the baby died" (or ended up brain damaged). If a baby suffocates, then it didn't did of SIDS. If it died of ANY known cause, then it didn't die of SIDS. (2) There are safe and unsafe ways to put a baby to sleep in a crib. There are safe and unsafe ways to co-sleep with a baby in an adult bed. All health care providers should be familiar with these issues, and be able to give parents guidelines about safe sleep environments for children -- both in cribs and in adults bed with adults (and siblings, and the family pets). It is highly irresponsible just to tell parents that they "shouldn't co-sleep." This is like telling teenagers that they shouldn't have sex (without giving them information about how to protect themselves against pregnancy, sexually transmitted diseases, and emotional/physical abuse). Since many parents are going to co-sleep, and since there is a lot of research suggesting that this is good for children, we should help parents co-sleep safely, or put their babies to sleep in a crib safely. (3) No one can guarantee a parent ANYTHING about their child, including that they won't grow up to be schizophrenic, or develop leukemia, or a brain tumor, or become an alcoholic, or die in a car accident on the way to the prom. It isn't the health care professional's job to give parents guarantees. It is their job to give parents accurate and complete information about relative risks, based on scientific research. (4) It isn't the health care professional's job to care overly much about how parents feel. Since most SIDS deaths occur in cribs, how do parents feel whose babies died of SIDS? Of course they feel awful, regarding of what anyone has said or told them. We know that breastfed babies are much less likely to die of SIDS -- yet I don't see too many health care professionals worrying that their formula-feeding parents will feel bad if their baby dies of SIDS, and therefore pushing breastfeeding. On the contrary, they withhold information from the parents so that the parents won't know about the link between formula and SIDS. (5) Of course we should advocate/educate about any measures that can reduce SIDS and/or suffocation. That is why it is so critical to educate parents about safe co-sleeping environments. And breastfeeding. Perhaps dads should not co-sleep with their newborns, only mother and baby should be in the bed. I suspect that if the baby you describe had been breastfed, the mother would have been more in tune with it, more aware, more protective, and the baby could not have been "squished" between mother and father. Or perhaps their bed was too soft, or dad was too sound of a sleeper, or one or both had been drinking or using drugs (even legal ones like antihistamines can make a person sleep more soundly than normal). We don't know all the details here. Also, I would never dismiss the idea that the parents deliberately suffocated the baby. This happens much more often than most people realize or want to admit (see Pediatrics, November or December 1997). The point is, don't leap to the conclusion that this baby would have been fine if he had not been sleeping with his parents. (6) Of course we all want to prevent tragedies. Unfortunately, sometimes people get "stuck" on one issues and can't see the broader picture. For example, the folks in South Africa who want to prevent any child from dying of HIV transmitted through breast milk. To achieve this goal, they advocate that HIV+ mothers, or mothers who might be (or become) HIV+ -- which means all mothers -- bottle-feed with formula. Now, this will definitely prevent any baby from dying of HIV/AIDS that s/he acquired through breast milk. The bigger picture is that these children will die from not being breastfed, instead -- at greater rates than they would have died from HIV/AIDS if breastfed by an HIV+ positive mother. But the advocates of universal bottle-feeding don't care what happens to the babies -- whether they live or die -- as long as they don't die from HIV acquired through breastfeeding. Likewise, the evidence is clear that solitary sleeping is a risk factor for SIDS, and that co-sleeping and breastfeeding are protective. So if we insist that all babies sleep in cribs, more babies will end up dead -- but at least none of them would have died by suffocation in a water bed or between their parents! We all need to see the bigger picture. (7) Most of you know that my husband is the Director of Immunization Programs for the state of Delaware, and that immunizations can have adverse side-effects. If we don't want anyone to die or end up brain-damaged from the side-effects of immunizations, then we advocate that parents not immunize their children. Of course, if no one immunized, then you would have many-fold more children dying or ending up brain-damaged or paralyzed from the diseases that immunization prevents. Which is better? To have no children adversely affected by the immunizations, or to prevent the much greater death and permanent disability from the diseases? If you are the parent whose child is accidentally suffocated in bed while co-sleeping, of course you are devastated, and will rail against co-sleeping. If you are the parent whose child dies of an adverse reaction to an immunizations, of course you are devastated, and will rail against immunizations. None-the-less, as health care professionals we must be able to see and explain the broader picture -- that both co-sleeping and immunizations end up providing better protection for the population as a whole. Katherine A. Dettwyler, Ph.D. Associate Professor of Anthropology and Nutrition Texas A&M University _________________________________________________________________ Send and receive Hotmail on your mobile device: http://mobile.msn.com *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. 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