There have been a number of posts recently questioning the appropriateness
of the back-to-sleep recommendation to reduce SIDS risk, and wondering about
the relationship of breastfeeding or artificial feeding to the sleep
position.

I've posted on this before, but will repeat it.  We used to insist that all
babies be placed in the prone position for sleep (ostensibly to avoid death
by aspiration of vomit), for years.  Breastfeeding initiation rates of near
100 per cent have remained constant here since at least 1860, and
continuation rates at the time the prone sleeping recommendation came about,
were fairly respectable too.  In the early 1990's, about 2 years AFTER the
UK initiated its back-to-sleep campaign, Norway followed suit.  Our 'high'
(I don't have the numbers, sorry) SIDS rate had received much publicity and
a not insignificant amount of research funding.  Within a year of changing
sleep position the rate was cut in half and has remained at the new level to
this day.  It is now felt that reducing infant exposure to tobacco smoke,
esp. through maternal smoking, is the easiest way to reduce the rates
further.  I don't think anyone has looked at the data to check for a
possible effect of increased average duration of breastfeeding, though that
certainly has occurred in this period.
We do see a higher risk of SIDS in artificially fed babies than in breastfed
ones, but the effect of sleep position appears to be independent, and
strong.  I would be very, very reluctant to advocate any other position for
sleep at this point, and indeed there is a circular from our highest health
authorities directing all health care personnel to instruct parents thusly,
and to place term newborns in the supine position when in bed alone, from
the very start.
We do emphasize the need for different positions while awake, for
neuromuscular development.
Rachel Myr
Kristiansand, Norway

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