In an article by Ford RPK et al, "Breastfeeding and the risk of sudden infant death syndrome," International Journal of Epidemiology 1993;22(5):885-890, statements are made that strongly support the role of breastfeeding as protective against SIDS. This study evaluated the data from the New Zealand cot death study. There were 485 cases of SIDS in the 3 years of the study (Nov. 1987 - Oct. 1990), and 1800 controls. Full analysis was done for 356 cases and 1529 controls. They evaluated the feeding method at hospital discharge, the first 4 weeks of life, and during the last 2 days of life of the SIDS babies, as well as categorizing breastfeeding as exclusive, partial, any (a combination of exclusive and partial groups) or none. There were marked differences between the cases and the control group. For SIDS cases, 86% were breastfed during the first week, 63% at 6 weeks, 50% at 13 weeks, and 36% at 6 months. For the controls, it was 92% in the first week, 77% at 6 weeks, 69% at 13 weeks, and 58% at 6 months. For SIDS cases, 48% were exclusively breastfed at the end of 4 weeks, but 65% of controls were. 25% of cases were exclusively breastfed at 16 weeks, and 60% of controls. The divergence between cases and controls persisted when confounding variables were taken into account. The authors conclude that "Infants not breastfed were nearly twice as likely to die of SIDS...We conclude that breastfeeding does have a significant association for a lowered risk for SIDS and that this effect seems to persist for several months. We found that cases compared to the control group failed to establish breastfeeding as well, that breastfeeding was stopped earlier and that exclusive breastfeeding was poorly maintained. Finally, being 'exclusively breastfed' at any of the observed time intervals differentiated between the SIDS victims and the control infants, giving them about a 50% reduction in the chance of SIDS....Added to a smoke-free pregnancy, and avoidance of the prone sleep position, mothers can now be given very positive advice on how to significantly reduce the risk of their baby succumbing to cot death." My question is, why does breastfeeding continue to be left off so many of the lists of actions to be taken to protect babies against SIDS? The authors cite an earlier U.S. study that looked at 757 SIDS cases and found an identical protective effect of breastfeeding. So why is there a "back to sleep" campaign that downplays the role of breastfeeding? Anne Altshuler, RN, MS, IBCLC and LLL leader in madison, WI e-mail address: [log in to unmask]