Category Archives: SIDS

‘Sleeping with baby’ a factor in cot deaths

At first sight, you’d think this headline had been brought to you from the Dept Of The Bleedin’ Obvious:

 ‘Sleeping with baby’ a factor in cot deaths

Sudden infant death syndrome (SIDS)—once known as cot death—remains a mystery, although it’s more likely to happen when the baby is sleeping with the parents, a new analysis has discovered.

It’s the one factor that stands out in an analysis of 8,207 SIDS deaths, which involved children aged up to one year.  In 69 per cent of the deaths, the children were sleeping in the same bed as the parents.  The ratio rises to nearly 74 per cent in children aged between zero and three months.  Older infants who were sleeping near the parental bed were often found prone with blankets or stuffed toys nearby.
These tragic cases suggest that risk factors change during the first year of life, and that babies in the first three months of life are at special risk when they sleep with parents.
(Source: Pediatrics, 2014; doi: 10.1542/peds.2014-0401)

Well, yeah, except smothering isn’t usually classified as SIDS.

If you actually look up that article, which is here – Sleep Environment Risks for Younger and Older Infants (Jeffrey D. Colvin, MD, JD; Vicki Collie-Akers, PhD, MPH; Christy Schunn, MSW, and Rachel Y. Moon, MD) – you will see that there are currently two responses to it, both saying it’s a badly conducted study:

1. Study on Sleep Location Flawed, Inconclusive

This one is quite long, and begins:

The article by Colvin et al, “Sleep Environment Risks for Younger and Older Infants,” incorrectly concludes that bedsharing is the top risk factor for sleep-related deaths.

The authors fail to include any of the other major known risk factors for these deaths in their analysis besides sleep location and position. By far the other leading risk factors for SIDS are maternal smoking, infants sleeping unattended, and formula feeding. The risk of infant death from bedsharing, it is strongly potentiated by maternal prenatal and/or postnatal smoking. The use of alcohol and sedating substances by parents/caregivers poses the greatest risk of suffocation death but was not included in the study. The smoking variable was actually available in the authors’ dataset, and their failure to utilize it is inexplicable and concerning, as it would have likely significantly altered their results.

The authors also failed to distinguish adult beds from far riskier types of sleeping surfaces, although the literature clearly shows that most accidental smothering/entrapment deaths involve sofas, recliners, or chairs.

Because the authors did not use a control group, or population statistics regarding the prevalence of all factors stratified by age and smoking status at a minimum, it is impossible to draw any conclusions about the cause of sleep-related deaths from their study. Furthermore, 25% of the infants in this study actually died in cribs.

My emphasis in that last paragraph. The second response is, in its entirety:

2. Murky definitions, missing data prevent meaningful conclusions

“Sleep Environment Risks for Younger and Older Infants” (Colvin et al, Pediatrics 2014-0401) fails to add any useful information to the SIDS/infant mortality dialogue. Like many other papers on sleep-related risks, this article lacks clear, unambiguous definitions of critical variables, omits significant documented risk factors, and conflates SIDS and other unrelated forms of infant death, drawing conclusions that the data do not support. Specifically:

(1) The bed-partner could be human or animal, drunk or sober, smoker or not, adult or child, caring mother or inattentive other. A baby sleeping with an inebriated uncle is different from a baby sleeping next to his sober breastfeeding mother.

(2) “Adult bed” included adult bed, waterbed, adult mattress, bunk bed, child’s bed, sofa bed, and air mattress. (We can only presume that sofas and recliners are included. They are common shared-sleep choices, especially for mothers who have been told their bed is unsafe.) A baby sleeping on a soft sofa cushion next to that inebriated uncle is different from a baby sleeping with his breastfeeding mother in a firm, uncluttered bed. The categories “Adult bed” and “person” (defined as “sleeping on the chest or in the arms of another person”) were combined as one category, though one is inanimate and of varying safety, and the other is animate and of varying safety.

(3) Infant feeding method is never mentioned, despite the fact that formula-feeding is a risk factor for SIDS and affects the mother’s behavior during bedsharing.

(4) The words “smoking” and “smoke” do not appear in the article, yet smoking during pregnancy and in a baby’s household is a significant risk for SIDS. The authors acknowledge that “because there is no comparison group, risk cannot be determined.” Without a control group, actual risk cannot be calculated.

(5) SIDS and smothering are conflated. Most SIDS risks have nothing to do with sleep location, while smothering and suffocation are entirely location-related. The distinction is especially important when bedsharing is discussed. SIDS is linked to physiological problems; suffocation results from environmental problems.

(6) Bedsharing is cited as “the predominant risk factor for younger infants” without reference to other significant risk factors or data from comparison groups.

(7) The study refers to “sudden infant death syndrome and other sleep-related causes of infant mortality” but focuses almost exclusively on the “other sleep-related causes” The combining of safe and unsafe situations in single categories is distressing but not new. The studies on which this article relies – the Ohio child death review for example*, – tend to do the same, a shortcoming that the authors acknowledge but accept. The conflation of SIDS and suffocation issues is also distressing but not new. The current review, like many before it, fails to provide adequate guidance to health care professionals and is potentially damaging to families making decisions without full information about their options.

* Presentation by Tessie Pollack, Ohio Department of Health to Ohio Collaborative to Prevent Infant Mortality, March 2014.

Again my emphasis. In any case, it’s been known for millenia that a baby sleeping with its parents is in danger of being smothered. It even figures in the Old testament: look up 1 Kings 3:16 if you don’t believe me. It’s not SIDS; it’s accidental smothering, but then WDDTY aren’t about to let a minor detail like that interfere with a neat-sounding fake scoop.

Why don’t doctors tell you babies sharing beds is a major cause of cot death?
Because it isn’t. Cot death is caused by other things. Babies who share beds are in danger of smothering, and doctors already tell you that.