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Subject:
From:
Kathy Dettwyler <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 27 Jun 1999 11:34:35 -0500
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Now for a lesson in correlation vs. direct/indirect causation . . .

As the president of the James McKenna Fan Club, I have read everything he
and his colleagues have published, first at their sleep research center at
Pomona, California, and now at Notre Dame.  I encourage everyone to read the
original research.

In a nutshell -- SIDS (Sudden Infant Death Syndrome) is the diagnosis of
death when the doctors can't find any reason why the baby died.  If a baby
is known to have died because the mother rolled over onto the baby during
the night, then that is not a SIDS death, it is suffocation by overlying.

A number of different theories have been put forth to try to explain why
babies die of SIDS:

apnea -- episodes of not breathing, followed by a big gasp as the person
starts to breathe again, except sometimes they just never start up again,
thus they die

very deep sleep -- it is known that apnea that occurs during deep sleep is
more difficult to rouse from, thus babies who spend more time in deep sleep
are more at risk of apneas

laying tummy down -- there has been a dramatic decrease in SIDS deaths (50%)
since the AAPs "Back to Sleep" campaign was started, encouraging moms to put
babies to sleep on their backs; again, there are several theories as to why
this matters; some people think that babies' faces get caught in pockets of
carbon dioxide, and they don't get enough oxygen; some people also think it
is a physical difficulty in the throat, such that the airway is more likely
to be blocked in the tummy down position; some people think that babies are
more likely to get into deep sleep modes when sleeping face down

irregular heartbeat/respiration -- there have been some studies showing
irregular heartbeats, and irregular respiration in babies who end up dying
of SIDS

sicknesses -- a lot of babies who end up dying of SIDS have had a cold or
fever in the prior week

botulism -- some babies are suspected of having actually died of botulism
toxin poisoning; if it could be proved, it would not be classified as SIDS,
though


McKenna and colleagues' work has not PROVEN that co-sleeping reduces the
risk of SIDS (as Dr. Sear's book on preventing SIDS claims) and this is
primarily what the AAP statement is all about.  The AAP is saying "You
pediatricians shouldn't be going around telling parents that co-sleeping has
been proven to reduce the risk of SIDS."

What McKenna and colleagues' work HAS PROVEN is that co-sleeping reduces the
risk of ALL of the aforementioned risk factors for SIDS:

apnea -- Co-sleeping mother/baby pairs have less apnea, and when the baby
does experience an apneaic episode, the mother rouses and rouses the baby by
touching it, moving around, talking to it, etc. and the baby starts to
breathe again immediately

very deep sleep -- Co-sleeping mother/baby pairs experience much less deep
sleep, and more transitions between different levels of sleep, than solitary
sleeping pairs; thus babies who co-sleep spend less time in very deep sleep,
from which it might be difficult to rouse from an apneaic episode

laying tummy down -- babies who are co-sleeping are more likely to be
breastfeeding (since the two parental behaviors often go together, since it
is much easier for mom, and because of fundamental beliefs about attachment
parenting), and therefore more likely to fall asleep on their side or back

irregular heartbeat/respiration -- babies who are co-sleeping share
heartbeat and respiration patterns with their moms -- they "entrain" on her
heartbeat and breathing, thus helping them stabilize their own patterns

sicknesses -- babies who are co-sleeping are more likely to be
breastfeeding, and therefore less likely to have any illnesses that might
contribute to SIDS

botulism -- babies who are co-sleeping are more likely to be breastfeeding,
and therefore less at risk of botulism toxin poisoning

It is a logical conclusion to arrive at that since co-sleeping reduces the
main risk factors thought to be responsible for SIDS, then co-sleeping
therefore reduces the risk of SIDS itself, but this has not been PROVEN.
You would need to have a carefully controlled study involving hundreds of
thousands of children (since SIDS deaths occur only 1/1,000 births), with
half the babies always sleeping by themselves and half the babies always
sleeping full-time with their mother.  Then you could look at comparative
rates of SIDS deaths.

Kathy Dettwyler

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