Evidence that roomsharing prevents SIDS is extremely weak

Little newborn baby boy sleeping in round crib with canopy

The American Academy of Pediatrics is finally acknowledging that many principles of lactivism are contradicted by the scientific evidence. Sadly, they have replaced old unsupported recommendations with a new unsupported recommendation.

In August, the AAP finally acknowledged that The Baby Friendly Hospital Initiative, a hospital based effort to promote breastfeeding, leads to serious iatrogenic infant injuries and deaths. The relentless promotion of prolonged periods of skin to skin contact and forced rooming in (by closing well baby nurseries) has led to an epidemic of preventable infants deaths from smothering in the mother’s bed and skull fractures caused by falling out of it. Moreover, the lactivist insistence that co-sleeping improves breastfeeding rates has led to infant deaths from SIDS (Sudden Infant Death Syndrome) at home.

Sadly, the new recommendations, while an improvement, continue to promote the prejudices of lactivists that women should be as close to their babies as possible for as many hours of the day as possible in place of the actual scientific evidence. Specifically, the AAP strongly recommends roomsharing despite the fact that the scientific evidence for a protective effect is extraordinarily weak.

According to the new guidelines:

It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.

There is evidence that sleeping in the parents’ room but on a separate surface decreases the risk of SIDS by as much as 50%.

Actually, as far as I can determine, there is little evidence that sleeping in the parents’ room prevents SIDS. There are four case control studies, two from 2005 and 2004 and two from the 1990’s that show an association between infants sleeping in the parents’ room and decreased risk of SIDS. But as basic statistics teaches us, correlation is not causation.

1. The 2005 study is Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study that took place in Scotland involving 123 infants who died of SIDS between January 1, 1996 and May 31, 2000, and 263 controls.

The authors found:

Sharing a sleep surface was associated with SIDS (multivariate OR 2.89, 95% CI 1.40, 5.97). The largest risk was associated with couch sharing (OR 66.9, 95% CI 2.8, 1597). Of 46 SIDS infants who bedshared during their last sleep, 40 (87%) were found in the parents’ bed…

In other words, the association between roomsharing and prevention of SIDS was so minor that they didn’t even include it in the abstract.

What did they find when they looked at roomsharing?

Separate room not sharing was not associated with a risk of SIDS on univariate analysis (OR 1.32 95% CI 0.67, 2.60) but became a risk on multivariate analysis (OR 3.26 95% CI 1.03, 10.35)… Further stratified analysis showed that separate room was associated with a significant risk of SIDS only if a parent smoked (OR 12.2 95% CI 2.25, 66.4) and not if parents were nonsmokers (OR 1.25 95% CI 0.16, 10.06)

Roomsharing was protective ONLY when parents were smokers. That’s not evidence that roomsharing is protective against SIDS.

How about the other citations?

2. Sudden unexplained infant death in 20 regions in Europe: case control study was published in 2004.

…Highly significant risks were associated with prone sleeping (OR 13·1 [95% CI 8·51–20·2]) and with turning from the side to the prone position (45·4 [23·4–87·9])… If the mother smoked, significant risks were associated with bed-sharing, especially during the first weeks of life (at 2 weeks 27·0 [13·3–54·9]). This OR was partly attributable to mother’s consumption of alcohol. Mother’s alcohol consumption was significant only when baby bed- shared all night… About 16% of cases were attributable to bed-sharing and roughly 36% to the baby sleeping in a separate room.

Curiously the authors found that a history of roomsharing but not room sharing at the time of death was associated with relative risk of 0.48, while a history of roomsharing and roomsharing at the time of death was associated with a relative risk of 0.32. The authors acknowledge that they have no idea how roomsharing decreases the risk of SIDS death let alone how a history of previous roomsharing could decrease the risk of death. That suggests that confounding variables may lead to a spurious association.

3. Co-sleeping increases the risk of SIDS, but sleeping in the parents’ bedroom lowers it is part of a 1995 Norwegian monograph, Sudden Infant Death Syndrome: New Trends in the Nineties. I have been unable to access the monograph.

4. Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome is a 1999 British case-control study.

The findings are shown in this chart:

img_1389

The authors acknowledge problems with interpreting their data:

… Certain factors characteristic of infants found in the parental bed were systematically different from those where the infant was found in a cot: bed sharing infants were much younger, few were put down in the prone position, and few were found with their heads covered. Conversely these factors were reversed among infants who slept separately from their parents.

That’s not a definitive result.

So we have 3 studies with widely disparate findings that indicate potential association, but not causation.

The potential protective effect of roomsharing on SIDS fails to meet the majority of the Hill’s Criteria typically used to determine causation.

  •  The strength of the association is unknown.
  • The dose-response relationship is unknown.
  • The potential protective is not consistent. It varies widely among the studies and in one study applies only to parents who are smokers.
  • No one has offered a remotely plausible mechanism by which roomsharing could prevent SIDS.
  •  The possibility of a chance finding orconfounding variables has not been ruled out.
  • There are no experiments or even prospective studies that look at this issue.

In other words, the claim that roomsharing is associated with protection against SIDS is based on data that is weak and conflicting. More importantly, there is no evidence that roomsharing is the cause of any protective association.

Roomsharing is not harmful. No babies will be hurt by following the recommendation.

What’s at risk is the credibility of the AAP and other physicians. When we make recommendations based on weak data, we face the likelihood that the recommendations will be overturned by better research. That has happened repeatedly with recommendations about breastfeeding.

In 2016 we are finally acknowledging that practices beloved of lactivists — exclusive breastfeeding, co-sleeping, pacifier bans and formula restriction — have risks. Thankfully, the AAP is revising its recommendations in response. The last thing they should be doing is making new recommendations that are no better supported by scientific evidence than the old ones.

  • Lion

    I still shudder at some of the things I did sleeping with my babies. I did have them on a separate surface on a single bed next to my bed, but I believe that isn’t as safe as I thought at the time. My question with regard to room sharing though, is, even if the evidence that it is protective is weak, is it harmful? So I suppose what I’m asking is, does it really matter whether mothers room share with baby or not? Is this not something that is really just about personal preference? For me, having my child close by meant a lot less effort at night. Something friends of mine have done is put the crib against their bed with the side down so that baby is on a safe but separate surface and she still breastfeeds while she sleeps. I wish I’d done that.

    • corblimeybot

      I think Dr Amy is is just trying to point out that you aren’t a horrible parent if you don’t room-share with your baby. Some media outlets are certainly promoting these guidelines like they’re proof you’re sentencing your child to death if you don’t stay in the same room with them, and it’s not really true. But it’s not harmful to room with them, either.

      Our baby stayed in a bassinet in our room because that’s what worked for us. I did think it was a ton easier than keeping her in another room.

  • Wondering

    OT:

    They say that expressed breast milk can last for up to 6 hours at room temperature but formula only lasts for 1 hour. Is this true? This seems counterintuitive to me. Both milks have sugars that bacteria love and formula comes from milk that is ultra-pasteurized.

    • J.B.

      Grounded parents recently put up something where a scientist had plated unpasteurized and pasteurized breast milk and looked at the difference. I doubt the 6 hours is that supportable.

    • guest

      It likely has to do with the fact that one is for sale and the other isn’t. Formula manufacturers have likely determined that amount of time is roughly the amount of time they can guarantee their product, when hydrated, will definitely be consumption-safe (it’s likely shorter than the typical 4-hour time as temperature control window because they assume parents may not actually adhere to 1 hour strictly).

      Foods that are not for sale are not technically subject to food safety regulations in the US, but they may have drawn the 6 hours thing from old food safety standards. Pasteurized, cold-held milk can be held out of temperature (above 41 F) for 4 hours before it needs to be tossed instead of consumed. It used to be 6 hours for cold food if it never got above 70 F,, but that’s been largely abandoned in terms of US food safety regulations, so maybe that’s where the number came from. It obviously doesn’t apply at all, when you think about expressed breast milk standing at body temperature and cooling to room temperature, but that might be where 6 hours came from.

      Raw milk, regardless of how magical, can not possibly be reasonably held to any less stringent a standard than cold-held, pasteurized milk, but if it’s not for sale you can technically treat it how you want and consume it whenever, even if it isn’t safe.

      This is way more than you wanted to know, but it’s a really good summary of basic food code information (with some of the “why”, but not all of it): https://www.hartnell.edu/sites/default/files/u87/food_safety_guide.pdf

      More on the “why” of my statements above: http://www.foodsafetymagazine.com/magazine-archive1/december-2005january-2006/issues-in-time-and-temperature-abuse-of-refrigerated-foods/

      • Wondering

        Thank you. This makes a lot of sense. I think there’s also a “just in case” measure that seems to apply only to infants in terms of foods. I notice the jars of baby food and bottles of baby juice have a refrigerator hold rate for only two days when opened. Again, breast milk enthusiasts insist that breast milk is good in the fridge for up to five days. So maybe food manufactures remove a little time just because they want to be extra cautious when it comes to babies and small children. So does this mean that a bottle of formula has closer to 4 hours, or should I still throw it out after 1 hour because babies may not have as good of immune systems to fight off a bacterial infection that an adult or older child would have?

        I ask, because my formula fed baby likes to cluster feed. When I make small bottles, half the time he drains them too quickly and then fusses a whole lot while I’m making a second bottle. When he cries like that, he gulps in air which then makes it harder for him to eat and then he takes a long time to sooth. If I make bigger bottles, half the time he doesn’t finish them and then I end up putting them down the drain and that gets expensive.

        • LovleAnjel

          I used to put the half-drunk formula bottles into the fridge, you can stretch it another hour or two that way. Or, mix a larger amount (say, in a pitcher) and keep it in the fridge so you can pour out the small amounts whenever they are needed without wasting as much.

        • guest

          Throw it out after 1 hour would be my recommendation, but I am a stickler for food handling for vulnerable populations (babies, old people, immunocompromised, pregnant). I wouldn’t risk longer room temp holding, since GI illness in babies is hellish at best, and formula isn’t meant to be served cooked, so you can’t bring it to 165 F and just call that good (that temp will kill almost anything, but won’t denature spores from spore-forming bacteria, so your mileage may vary with reheating, but 165 is really reliable for most cooked foods). I could easily be wrong about their reasoning, it’s just what makes the most sense to me, having worked in food inspections.

          Are there any directions on refrigerated formula for the brand you use? That could be a stopgap, even mixing up a pitcher of a day’s supply and trying to warm quickly during cluster feeds. If your formula doesn’t allow for refrigeration, I’d just deal with the expense of the wasted partial bottle, personally, but I also don’t know diddly squat about your budget, so it really is up to you. Is it a big risk? Not really. I just wouldn’t take it since it’s one I could control (and personally afford, which is not the case for everyone and that is a very important decision making factor).

          The five days thing, if the milk is refrigerated immediately in a fridge held at 41 F or lower, could be kind of plausible. Cold holding for five days for prepared foods/open foods is pretty restaurant standard, I think depending on the temp it can go to seven, but again, this is for restaurants. Breast milk is raw milk, and it isn’t the same as prepared foods in terms of safe handling.

          I’d rather use breast milk that day (or maybe the next morning), or freeze it immediately. Pain in the ass for sure, but it’s raw milk, so careful handling is worthwhile. There are no federal raw milk handling standards (or few, for things like aged cheeses), because frankly, milk sanitization is one of the greatest public health successes the US has ever achieved.

        • Kelly

          I would put milk back in the fridge if it wasn’t going to be used within the hour. I would only let it stay in for 24 hours in the fridge and then throw it out I would not keep it out though and sometimes I just wasted the last ounce or two because I was too tired middle of the night.

        • AnnaPDE

          My kid did the same 🙂 and the super-breast-fan nurse who talked to me about formula said to toss after 30min, the regardless of whether the baby had even drunk from it, regardless of refrigeration, so that would have been pretty expensive. Then the older LCs shared whispered advice about how it used to be fine to make up a whole jug for the day… and my GP sil told me to just put a drunk-from bottle (with cap) back in the fridge for up to about half a day when she visited, and ranted a bit about how formula prep guidelines are only partially about actual safety and also about trying to scare parents and making formula less convenient.
          Anyway, I followed her advice and never had a problem.
          As for reheating, I used the microwave. As long as you actually swirl/mix the liquid afterwards and check the temp, it’s fine. All the warnings apply because of potential hot spots if you don’t. Oh and don’t forget about the cold nipple – at least my kid didn’t like it, and it can make the first drops of milk seem cooler than the rest is, so I just rinsed it under the tap to warm.

          • Lion

            I’ve also wondered how much of the discard discard discard information is not to encourage selling larger volumes of formula. It makes sense as a sales tactic. I’m not saying the safety aspect isn’t important, it is, but I wonder how much of the conservative approach to the lengths of time might come from that. I only thought of that when I read what you’d posted and I’m not a conspiracy theorist, I just imagine the marketing department trying to have any influence on the safety aspect and can’t see that happening so my theory falls apart, but I suppose it’s a possibility.

          • AnnaPDE

            Bit of a win-win situation there. Except for the parents actually buying the formula, obviously.
            ETA: I can totally see marketing latching onto the safety aspect if it sells more and makes the company look like it cares.

        • Lion

          I both breast and bottle fed my kids and they cluster fed too. I used to make up a full bottle of formula and then split it in half, and I used to put any unused from the first back into the fridge and start the next feed in the cluster with that bottle (so I didn’t pour it into the remaining half left behind). It was all used up within the two or so hours of the cluster feed each night. Strictly speaking probably not OK, but neither child got sick from this.

          • Lion

            and I still thought of this as immediately discarding – because the very few times a little amount was left, out it went.

          • guest

            Depending on how long the first feed was, this is pretty reasonable, and not a bad idea. 2 hours holding time, including a fair amount in the fridge, approaches the label standards for formula holding and is def. better than 2 hours on the counter.

        • guest

          Part of that extra caution with baby foods may actually have to do with production standards; most formula cans point out that the formula itself is not sterile, and using clean water is often heavily emphasized when mixing it up. It’s also rare to store vegetable, fruit and meat purees in the fridge for adults, so how it’s produced may impact how it’s safely stored. The juice, I have no idea. Unless it’s different from adult juice in a way that makes storage different, that’s probably an overabundance of caution and maybe a money grab.

          Around 80 million Americans are served by well water, which is tested only at the discretion of the well owner, and a lot of these wells have bacterial infestations (also worked in well inspections, the number of new wells drilled that had total coliform bacteria was ENORMOUS, and total coliform bacteria could point to feces, or just stuff that’s all over us every day and totally innocuous). Thank goodness it’s typically easy to disinfect a household well, as long as the water source itself isn’t contaminated.

          Formula companies are trying to make money, but they also are trying to do so without making anyone sick, as making babies sick is really, really, really bad press (look at huggies and the “glass” in their wipes, or the chinese formula cut with melamine). So, the 1 hour is probably a balancing act between what they can guarantee, and possibly some kind of weird milk laws on a federal level (milk handling in the US is fascinating, I’d like to write a book about it someday).

          Could easily involve a money grab too, or they could just go hand-in-hand. Companies aren’t Santa Claus, for sure.

          I hope some of these suggestions help you with cluster feeding, growth spurts are a pistol. I’m certainly taking notes for future baby feeding!

      • Lion

        Thanks, that was very interesting to read. Wish I’d read it before posting my posts above. Something popular in Africa where I live is using milk that has gone off and is lumpy – called Maas on a very dry and crumbly porridge called phutu (pronounced poo-too). it is delicious. We ate it for breakfast as children nearly every day – heaped tablespoons of sugar on it too. I can’t remember ever getting the runs from this, but that may just be because we were used to it. I don’t have enough knowledge to know. I can tell you it was delicious, but that the thought of eating it now does make me want to throw up.

        • guest

          It’s called clabber in (parts of) America, and was very popular in the southeastern US prior to widespread refrigeration (also because of a huge influx of Africans due to slavery). Probably still is for some people. You could equate it to cottage cheese to get Americans to understand what you’re talking about, even though it’s somewhat different.

          Your “we were used to it” has a LOT to do with why it didn’t bother you. Gut flora are very, very, very regional, and foods commonly served in the US could easily nauseate people who are from other areas, and vice-versa, just because the bugs in one’s gut are used to and able to digest what we eat on a regular basis.

          There’s also the fact that in Africa, depending on where you are, you’re often exposed to way more GI illness sources from day 1 of your life than you would be in a lot of America, so you could easily be more immunologically fortified against mild or moderate GI infestations.

          Also also, depending on how the milk was stored, prepared to make the Maas, and served (timing, temperatures, locations), it could’ve easily been lacto-fermented. Lacto-fermented foods are some of the safest fermented foods, they’re one of the least likely to get infected and are great for you to eat (god I love kimchi). You could’ve easily been eating a pretty safe dish, for several reasons.

          Human breastmilk, stored however, wherever, in whatever, and then served whenever, would be problematic. There are a long list of reasons milk is treated the way it is in the US vs. other places, and why raw milk is treated like basically filth (not by individuals, but systemically). It’s because SO MANY people got sick from raw milk in the US because it was handled in so many different, inappropriate ways. It’s still handled in many different, inappropriate ways, but pasteurization and dairy farm inspection control for those hazards before the milk gets to the consumer.

          Also, while the sniff test is okay for stuff that sits in the fridge (I do it myself, for sure), but for stuff that sits out of temperature, it’s not a question of spoilage in terms of what’s “safe”. It’s a question of bacterial proliferation; 4 hours is a pretty consistent barrier between “some bacteria” and “an awful lot more bacteria” in terms of how long it takes bacteria to proliferate. This is something that is typically only pointed out to people who work in restaurants or health inspections, very, very few people know this (I didn’t until I got my last job with health inspecting, I had no earthly idea).

          I’d also suggest you change out your office’s dairy every 4 hours unless it’s stored in vacuum sealed containers that keep it below 41F (5C), but I know stuff like that is beyond an uphill battle. You are also, presumably, only serving this to adults, who are more likely to be able to handle any GI illness than an infant.

          In short, my caution is very American, and would be moderated for adults vs. an infant.

          • Lion

            Thanks for taking the time to respond with such detail. Makes a lot of sense. Nope, our milk sits in jugs out in the open. Surprisingly, none of us are getting sick from this. Been this way for about 20 years. Though I’m now feeling rather wary about drinking tea in the late afternoon.

          • guest

            Well, if your work day is 8-ish hours, and the milk is pasteurized, you’re probably just slowly making an unappealing cheese. Also, I’m guessing you’re not in the US? Which means your milk may be from a more local source than it might be in the US, meaning it took less time to go from the pasteurizer to your pitcher; US milk laws are so strict because our milk is rarely from anywhere near us, so handling methods can lead to a lot of pathways for contamination.

            We do also operate on a lot of assumptions day-to-day in terms of how other people handle our food. Did the restaurant handle that sour cream properly? Did the grocery store make sure their refrigerators were actually the right temperature? Did Ted from Accounting wash his hands today? Maybe? But your office still ticks along just fine, with a few stomach bugs that are unrelated to coffee station milk most likely.

            The goal of food safety regulation is to get the food to you as safely as possible, and to make sure the food, even if not handled ideally, is likely to be safe. Food producers and preparers that work in bulk batches are the real hazard, especially if they’re sick or their equipment is contaminated, much more than Ted and his suspicious hands.

            Enjoy your tea, unless the milk smells off it’s probably fine (plus I’ve never been served tea in the UK or Ireland that wasn’t INFERNALLY hot, so if the water’s above 74C, you’re probably okay too). If it were raw milk, I’d have much more reservation.

            I love this stuff, so I could go on and on, thanks for reading my screeds!

    • Lion

      with breastmilk, it depends on the heat of the day. On a really hot day, it isn’t going to last very long, but on a cool day it may last a good few hours. I wanted to test the times out for myself, so I left a container of milk on a window sill and smelled it every hour or so (not exactly brilliant I know), but when it did go off, I could distinctly smell it. I can’t imagine that formula, cows milk or goats milk would be much different – I tend to use the smell test on my cows milk in the fridge, mushrooms and most of my food rather than sticking to best before date. Our tea and coffee station at work doesn’t have a fridge, the milk (cows milk) is left in jugs (full cream, low fat and skim milk) for the whole day. The offices are air conditioned. It still smells fine at the end of the day, even in summer. Not sure I’d have left my expressed milk out like that all day and fed it to baby even if it still smelled ok, but I’d imagine it would last similarly, less the effect that the pasteurisation has on longevity.

      • Lion

        oh, the smell of my off milk was like rotten eggs, not the same as that over sweet smell the cows milk gives off when it has turned. I always discarded my formula immediately, so I actually haven’t smelled off formula. I might buy a tin now specially to smell it though as I’m curious.

        • AnnaPDE

          It is one of the most revolting smells ever, at least after a few days, and sticks to the damn bottles. (Guess how I know…) Do it with a container that you’re happy to throw away.

          • Lion

            ha ha, I think you’ve convinced me to take your word for it 🙂

  • HarryPsalms

    THANK YOU!!!
    I keep trying to tell people, regardless of the subject, that a “study” on it’s own is almost worthless; one needs to dig and truly understand the nature of the study, how it was performed, what the actual conclusions were, and then compare all that to the other data which has been gathered from other studies….and even then, unless you are trained in the field, you probably still have no idea wtf is going on. Scientific consensus is a long road and requires patience. Reacting to every study along that road as if it contains conclusive evidence is a sure way to zig-zag down that road and take 10x as long to get there.

  • Sue

    The suggestion that room-sharing might reduce SIDS/SUDI rates would only be plausible if most SIDS deaths occurred overnight (ie while the parents were in the same room). Otherwise, “same room” is meaningless if the parents aren’t in that room while the baby sleeps.

    Is there any data on this?

    • CSN0116

      Good point. Not all SIDS occurs at night. Aren’t their higher incidences at daycares as well, even when they follow all the guidelines?

      • fiftyfifty1

        It turns out that when they investigate, they are not following the guidelines. Baby will typically be prone. I don’t know about other states, but in my state the increase in daycare SIDS rate is found only in in-home day cares. Daycare centers actually have a lower rate. Centers are more highly regulated and because there is always more than one worker keeping tabs are much less likely to cheat the Back to Sleep guidelines.

        • Daleth

          There’s a daycare near my work that advertises that they check on sleeping infants every FIVE MINUTES to make sure (I’m paraphrasing obv) that they’re still alive. And they go by the cribs with a clipboard to note, every five minutes, that each kid is ok. You’re not going to get that at home, much less at an in-home daycare with a bunch of kids.

          • FEDUP MD

            My daycare center checked every 15 minutes. There was documentation. I sure wasn’t checking them every 15 minutes at home…… They were extremely strict about AAP guidelines too.

          • fiftyfifty1

            “They were extremely strict about AAP guidelines too”

            The centers in my state are extremely strict about the AAP safe sleep guidelines as well. In-home daycares are much less regulated. We have not had a daycare center SIDS/SUDI death in years, while the in-home (licensed) rate is high (god only knows what the unlicensed in-home rate is). The paper did an award-winning series on it. Turns out that the back-to-sleep guidelines really do make a difference.

  • Dr Kitty

    One of the most protective factors for SIDS is a maternal college education.

    But that isn’t nearly as easy to arrange as a cot in the corner of your bedroom.

    Sort out health and social inequalities and you’ll reduce not only SIDS but most health problems. But that isn’t cheap, easy, sexy or vote winning, so….

    • swbarnes2

      On the other hand, African Americans have higher rates of SIDS, even when you look at college educated mothers. (See this in CDC WONDER database) Which makes more sense…that college educated black women are highly likely to be doing crappy sleep practices, or that there is a big genetic component, that those women can’t help?

      • CSN0116

        I’ve read work on the topic. So AA mothers experience higher infant mortality rates at every SES level, i.e. SES does not seem as protective to them. The cumulative stress load of existing in a racist society is one theory I’ve read. More specifically that this stress impacts pre pregnancy health, the developing fetus, and even gestational length. It’s a fascinating idea. I guess one would have to compare how AA women of varying SES fair in societies not as racially hostile and unequal as the US.

        • Daleth

          I always wonder, when “stress” is described as causing XYZ health effect, if we just haven’t identified the cause yet. Didn’t they used to think stress caused ulcers, until they realized it was actually H. Pylori?

          • Kerlyssa

            Stress has different meanings in different settings.

          • David Whitlock

            A final common pathway in “stress” is always “oxidative stress” and the triggering of “fight-or-flight” mechanisms.

            Many disorders are made worse by “stress”. This is because “stress” affects the pathways that are involved in generating and resolving the symptoms of whatever the “disorder” is.

        • lawyer jane

          They also suffer racial discrimination in health care regardless of SES. So even a high SES African American mother might have her health concerns (for herself or her child) blown off, or be treated less aggressively, etc. That could lead to worse outcomes.

  • Irène Delse

    So, when I read this:

    “Certain factors characteristic of infants found in the parental bed were systematically different from those where the infant was found in a cot: bed sharing infants were much younger, few were put down in the prone position, and few were found with their heads covered. Conversely these factors were reversed among infants who slept separately from their parents.”

    …I start to wonder if the researchers really were seeing SIDS where it should have been called death by suffocation. Those infants who died while bedsharing could have been suffocated. Those who were found dead while prone and/or with a cover on the head could have suffocated too. The AAP could have issued an evidence-based advice simply by reinforcing what is already recommended: “back to sleep”, no co-sleeping and no pillow or other soft object in the bed.

    • crazy grad mama

      I have always wondered to what degree SIDS deaths are conflated with suffocation, and why we don’t do a better job of separating them out. Is it not medically possible to distinguish between suffocation and “baby stops breathing for some other reason”?

      • Spamamander (nasty amphibian)

        From what I understand, in infants it is pretty close to impossible. The tiny amount of force needed to smother an infant (whether accidentally or, Dog forbid, on purpose) won’t necessarily leave any traces. Unless there is an actual illness or genetic problem it’s just “stopped breathing”>

        • crazy grad mama

          Interesting, thanks.

        • LovleAnjel

          There’s also thought that some infants may have faulty CO2-determined breathing cues, in which case having a light blanket over the face, which would not cut off air but would increase the %CO2, does not trigger increased breathing or movement the way it should. Do you count that as suffocation or SIDS?

    • guest

      The inability to tease out suffocation deaths from whatever SIDS is has led to the SUID acronym; sudden unintended infant death. It’s a much better acronym for what is essentially a grab-bag cause of death; it rules out murder, but not much else. SIDS is just more iconic and recognized right now. Kind of like the change from STD’s to STI’s; more general, but more accurately descriptive of a broad category of problems.

      • Irène Delse

        Thanks for the explanation. I guess the only way sleeping in the same room can reduce the risk in SIDS/SUID is if one or both parents happen to be awake and see the infant has just stopped breathing. Not a very common scenario, alas.

  • lawyer jane

    It just boggles the mind how they can base public health recommendations on such slim evidence. I really don’t get it. It seems like a lot of their suggestions aspirational, and based on the principle of “if we suggest something really stringent, then people will do 10% of it.” But unrealistic recommendations are likely to be ignored, and they prejudice the recommendations that actually *are* based on sound evidence, like other safe sleep guidelines.

    • fiftyfifty1

      “It seems like a lot of their suggestions [are] aspirational”

      So true. This is the case for public health recommendations in general, but especially those that involve fertile women/pregnant women/mothers of infants.

    • J.B.

      As someone without any particular knowledge of the subject, I wonder if the recommendations boil down to 1) do things that will keep baby from sleeping as deeply and 2) prevent suffocation. Yugaya always yells at me for this, but there was no way on earth I could get my high reactive babies to sleep on their own. Trying to put the first down on her own I got incredibly sleep deprived and fell asleep in very unsafe positions (oh, and while driving.) So I did bed share for naps with the younger child.

      • lawyer jane

        Yep, there are some babies & families that will not get healthy sleep using the “back to sleep” recommendations. That’s why I think that these recommendations should be truly evidence-based, and not risk-based — so you can know how to reduce the risk of bedsharing if you chose to do that. This latest AAP recommendation actualy *does* go in that direction, but unfortunately the good advice is diluted by the bad advice.

  • Kim Bryant

    This is a very informative article. Thank you for it. I have one tiny bone to pick with you – the sentence where you say no babies will be harmed by following the room-sharing recommendation. When my son shared our room (in his bassinet) no one could sleep. I woke up to every little noise, and us turning in bed seemed to wake him up. When he moved into his own room at 5 weeks, everyone started sleeping better. I think that some parents may feel forced to room share, even when it isn’t working and they aren’t sleeping. Just like forced rooming-in in the hospital, I think it could lead to accidents caused by parental exhaustion.

    • ForeverMe

      I was going to note that as well – that when room sharing, parent(s) and infant(s) both might wake more often and sleep more lightly. (At least that was my experience).

      I, though, wonder if this (lighter sleeping) is what (might be) slightly protective against SIDS when room sharing? (And I wonder- could smokers sleep even more lightly than nonsmokers due to mild stimulant effects from nicotine??)

      Personally, I would breastfeed in bed at night, then move the baby into a “co-sleeper” (essentially a playpen with a sleeping surface that was almost level with our bed, so I could safely and easily move the baby into his/ her separate bed without getting up, and even if half asleep).

      And maybe it was just my kids, but they quickly learned to “reach out” for me in their sleep- and when I wasn’t “rightthere”, they woke up immediately. They also often woke up when someone got up, or moved, or coughed, etc…..

      And I may not be up to date on this stuff, but isn’t that a theory as to why BF might also be slightly protective against SIDS? (That they wake up more often to eat and don’t sleep as long or as deep?) Or not? I’m just throwing this out there… if that is just BF woo, please correct me!

      • crazy grad mama

        I’ve long suspected that what we’re seeing in all of the statistics on SIDS is a correlation between SIDS and deep sleep. Which makes me wonder if we can go too far, because surely deep sleep is necessary for some aspects of brain development.

    • Kelly

      I agree. I will never follow this recommendation due to the fact that none of us can sleep when there is a child in the room. When I had to sleep with all three kids in a hotel room, it was akin to torture. It did not help that the baby woke up and I could not get her to sleep except through letting her cry and you can’t do that when other people are in the room.

      • BeatriceC

        I discovered Residence Inn by Marriott a few years ago. For just about $20 more per night for an average studio type hotel room in that class, you can get a two bedroom suite with a kitchen. Last year when a poorly timed heat wave forced us out of our non-air conditioned house and into a hotel (recent surgery for one of the kids and it was hot enough that his cast was literally falling off because of the amount of sweat he was producing at night), it was about $180/night for a standard studio room with two queen beds and $200/night for a two bedroom/two bathroom suite with a full kitchen and living room. I will never travel with kids and stay in a different hotel.

        • Maud Pie

          My daughter and I stayed at a Marriott Residence during the 3-week interim between moving out of the marital home and into my apartment. (This was not a domestic violence situation requiring a rapid departure. I had planned to move directly from marital home to condo, but the sale collapsed; hence the need for temporary lodging.). I got the studio. It was so nice! It really fit my optimism that getting divorced was a positive change, and it helped keep up my daughter’s morale. After living 9 years in a house full of hoarding-prone XH’s clutter, full of his escalating religiosity, grandiose ego, and messy emotions, the minimalist living was like a vacation.

  • CSN0116

    I am an anti-vaxxxer-level conspiracist when it comes to the AAP, Back to Sleep, and their current sleep recommendations. I wholeheartedly believe that VERY little of this matters – aside of bedsharing and the DUH risk of SUFFOCATION (which is not SIDS), there is such little evidence that this other shit does anything, at all.

    [Foil hat on.]

    It is beyond coincidental that SIDS rates plummeted in the 90’s at the same time that maternal smoking rates plummeted and the criteria to list SIDS as the cause of death on death certificates became much more stringent, thus creating the illusion that a few people found some near “cure” for SIDS, i.e. forced back sleeping. Code shifting much? Spuriousness? Uncontrolled confounding variables? Indeed. But then there wouldn’t exist the ability to just let parents friggin parent the way they see fit with a dose of common sense. Nope, the AAP has single handedly produced a generation of hysterical parents who must cater to 1,000 constantly changing “recommendations.” And funny how so many of these recommendations require dubious amounts of sacrifice on behalf of the mother, her time, her body, and her relationship with her partner.

    So how is it that a high percentage of parents admit on anonymous surveys to regularly violating sleep recommendations – bed share, use swings, rock and plays, and car seats to sleep baby, side sleep, belly sleep, put baby to sleep in a separate nursery – yet SIDS rates are staying low/continuing to drop? Could it be that very little of all this matters and that a host of other things greatly contributed to the decreased SIDS mortality?

    I do not like the AAP. I believe they possess agendas up the ass and are willing to hastily cater to special interest groups, mainly lactivists, with their “recommendations.” In addition to the bullshit addressed above, their jump to suddenly tell parents to delay the introduction of solids has very quickly led to an absurd rise in childhood allergies… and even with the most current research refuting the recommendation all I continue to read is, “breastfeed exclusively for six months.” Doing that completely misses the window for optimal introduction of foods. It’s mind boggling.

    Babies who die of SIDS, SIUD and accidental sleep deaths have a lot in common. The evidence overwhelmingly shows that young, undereducated, drug using, smoking, mothers who received late or no prenatal care, have a criminal history, cohabitate with someone with a criminal record, and live in a dirty house are far more likely to have their babies die in preventable SIUD or accidental sleep deaths… SIDS is only a small percentage of cases even amongst this seemingly disadvantaged population and it happens even less in wealthier, more advantaged populations. So, it would make the most sense to preach about fixing these social factors as collectively they seem to be most influencing infant sleep related deaths.

    What it all says to me is that parents (mothers) of low social and economic status might culturally parent differently – part of that difference includes “unsafe sleep practices” as defined by people like the AAP – but socioeconomic status and these practices are inextricably intertwined and impossible to separate. However, the rich mothers are breaking the rules too. Damn near everyone is breaking the sleep rules out of desperation! but alas their babies aren’t dying of SIDS. Therefore, to me, it says that it’s not the culturally-influenced parenting style killing kids, but all the shit that comes with be poor, marginalized, unequal, and discriminated against. Not breast milk, not room sharing, not pacifiers, not fans, not even forced back sleeping will fix all that.

    SIDS is not random. It never was. To scare the shit out of everyone as if they all face the same chance of this “grim reaper” up and killing their babies in the dark of night, and make 100+ environmental (not social) recommendations to prevent it, is so short sighted — IMO.

    • Sean Jungian

      Anecdotally speaking, my son slept in his car seat in our room for the first couple of months. It locked into his stroller so it was easy to wheel him into his own room when I needed to.

      • CSN0116

        Well way to up and break the “C” of the “ABC’s of Sleep”! 😛 😉

        • Sean Jungian

          It was that or a laundry basket 😉

    • lawyer jane

      I sometimes wonder if back-to-sleep has actually increased rates of death through strangulation and positional asphyxia as parents fall asleep on couches, put babies in unsafe contraptions, etc, because the babies sleep poorly on their backs.

      • CSN0116

        Good point. Delayed infant development, increased pt, ot and speech therapy, reflux, plagiocephally… makes one wonder

        • Marylynn

          Yes. My son had horrible reflux. By 2 weeks of age, I said screw it and he slept on his stomach from then on. It was the only way he could sleep.

        • Marylynn

          And there’s no way evolution would have designed humans to need helmets to have normally-shaped heads.

          • CSN0116

            4000 thumbs up

          • fiftyfifty1

            “And there’s no way evolution would have designed humans to need helmets to have normally-shaped heads.”

            That’s because evolution doesn’t “design” anything. Your statement is no different than any of the following:

            Evolution wouldn’t have designed a system where women need giant tongs or having their abdomens cut open to give birth.

            Evolution wouldn’t have designed a system where mothers couldn’t make enough milk and artificial milk was needed.

            Evolution wouldn’t have designed mouths to need metal gates (braces) to make the teeth close right.

          • Roadstergal

            And ‘normally-shaped head’ is itself a moving target. What’s normal will, as noted above, vary with cultures and sleep practices – and over time, with evolution (we share a lot of genetic homology with chimps, but our heads have some striking differences).

        • guest

          These are a bit of a stretch barring the plagiocephaly.

          A lot of the rest of those could more likely be explained by excessive work demands on both parents during infancy, increased survival of children who would have died without obstetric intervention, decreased institutionalization of children with issues, an increasingly service-based economy wherein people with speech and/or physical issues have bigger employment issues than they would in a less service-based economy, increased ability to access intervention services such as occupational therapy and physical therapy in a public school setting, increased interest in providing and expanding on such services, and the willingness to actually talk about things like reflux and trying to do something about it, instead of hornswoggling parents into thinking it’s “just colic, you have to deal with it and there’s nothing to be done it’s not a big deal it happens to everyone.”

          We’re also, as a society, actually reporting on and looking at these issues instead of either actively or passively ignoring them, and medical care is more available than ever, even though it has massive gaps in terms of access still.

          I just don’t buy that a baby being put on its back to sleep (and apparently not sleeping as deeply for the first several months of its life) being key to the problems you listed, barring again, plagiocephaly (which, if you vary a sleeping surface, head position, baby position on the sleeping surface, and actually hold the kid, can be prevented, but again, a lot of barriers to doing that exist for parents as well). There’s no way that all babies have slept deeply throughout all of human history for the first few months of their lives, on a surface that definitely didn’t have the ability to contribute to plagiocephaly, what with massive variety in infant sleep locations and expectations throughout cultures and times.

          Is “back-to-sleep” going to work for all babies? Of course not, that’s not how reality works. Feel free to wonder if it contributes to the perceived increase in infant and childhood issues as well, but that wonder should be explored with a grain of salt.

          • fiftyfifty1

            “There’s no way that all babies have slept deeply throughout all of human history for the first few months of their lives, on a surface that definitely didn’t have the ability to contribute to plagiocephaly, what with massive variety in infant sleep locations and expectations throughout cultures and times.”

            Indeed, dramatic changes in skull shape were actively promoted by some cultures. And apparently without adverse effects. In other cultures, a supine sleep position was/is standard. I remember learning ~30 years ago that “Asian skulls are typically flatter in the back than non-Asian skulls”. Turns out that a supine sleep position for infants remained popular in many Asian countries during the decades that tummy-sleeping for infants was being promoted in Western countries.

          • CSN0116

            I mentioned the OT/PT because since the Back to Sleep campaign developmental milestones for babies (rolling over, sitting up, crawling) have been pushed out. (So I read) missing out on all that would-be tummy time (and back sleeping often babies scream for tummy time and therefore get even less of it) delays the development of all of the muscles required to accomplish these milestones. I totally agree with you on all of the other reasons for such an increase in therapy use!

            And I’d throw plagiocephally and reflux as sure(er) bets. A flat back-sleeping infant (or adult) with reflux will experience exacerbated symptoms. A change in sleep position – mainly elevation but side or belly sleeping – may not “cure” reflux, but can sometimes drastically minimize symptoms to where other interventions aren’t even necessary.

    • Emilie Bishop

      I live near Seattle. At Seattle Children’s Hospital is a researcher studying, of all things, inner-ear abnormalities in babies who die of SIDS. Apparently there is a correlation and he’s trying to determine causation. We read about him in the Seattle Times either just before or just after our son was born and donated a small amount of money to his research. It was so exciting to me and my engineer, logical-to-a-fault husband to see genuine research into the cause of this devastating disease and not just more mass hysteria that terrifies new parents. I don’t agree with everything you said, but I agree with your general point that we need more facts and less fear in this discussion.

      • CSN0116

        I have heard of this theory and I hope he makes strides! I’ve heard of brain scans and some abnormality also being correlated. It would all make some sense. Premature birth and low birth weight are both strongly correlated with SIDS risk.

        And I don’t expect you to agree with all of that incoherent rant LOL 😉

      • BeatriceC

        I have a special fondness for Seattle Children’s. When pretty much every surgeon in the country (that my insurance was willing to pay for) decided it was too complicated and too risky to attempt to fix my youngest son’s wrist, there was one woman there that decided to give it a go. It wound up not being a permanent fix, but his current surgeon has a whole lot more options now than he would have if the surgeon there hadn’t had the guts to try something novel.

    • Roadstergal

      “I do not like the AAP. I believe they possess agendas up the ass and are willing to hastily feed special interest groups”

      The fact that Bob Sears and Jay Gordon still have “FAAP” after their names doesn’t speak well about their tolerance of anti-vaxxers, either.

      • CSN0116

        Grrrr

        • Roadstergal

          I never want to forget that Jay Gordon was the pediatrician for Eliza Jane Scoville, too. If he’s not outright an AIDS denialist, he’s sure willing to be nice to them.

    • CSN0116
      • crazy grad mama

        Oh yum, celery sticks for Halloween.

        • CSN0116

          I selected carrots because I can buy the baby ones, cut and washed in a bag, for like $.99.

          • Roadstergal

            Baby carrots are so good. Even as a little girl, picky PITA eater that I was, I could eat carrots all day long.

            I had/have no food allergies, however. I’m sure being born before the BF Uber Alles time didn’t hurt.

          • StephanieJR

            I always got carrot sticks when my mum or gran were making stew. I should start that up again.

        • Dr Kitty

          I have told my daughter’s school, in no uncertain terms (you guys know me) that I heartily disagree with their healthy eating policy, that I will not teach my child that foods are “good” or “bad” and that I’ll send whatever I consider to be an appropriate and balanced lunch.

          So yeah, sometimes she’ll have 2 Oreos or 2 squares of chocolate or something else “unhealthy” as a treat.

          I’m obviously not going to break the nut free policy, but I have serious issues with the “no chocolate, no buns or cakes, no sweets, no crisps” policy.

          • fiftyfifty1

            ” I have serious issues with the “no chocolate, no buns or cakes, no sweets, no crisps” policy.”

            I do too, except here that would be a ‘no chocolate, no sweetrolls or cupcakes, no candy, no chips’ policy.

          • Dr Kitty

            Divided by a common language, alright!

          • fiftyfifty1

            Well, at least we can all agree on chocolate.

          • Mrs.Katt the Cat

            No chocolate! Sacrilege.

          • Mishimoo

            My kids school has the same policy AND it seemed like they were only dinging us for it, which was frustrating because my kids are thin and active, so getting enough calories into them without breaking the food policy was basically impossible. Thankfully, teachers of older grades don’t police the food as much.

          • Kelly

            What would they do if they were sent that?

          • Mishimoo

            Remove the offending item, not provide a replacement, and send an annoyed letter home. It was frustrating because other kids didn’t seem to have any issues taking chips, chocolate, roll-ups, LCM bars, etc to school but the fuss over my kids taking a simple un-iced cupcake “because it’s unhealthy!” was ridiculous.

          • Kelly

            That is crazy. I can’t believe that. I feel like I would send my kid a whole cake for lunch one day just to piss them off.

          • Mishimoo

            I was so tempted! Now I’m just grateful that they’re old enough that the teachers no longer do lunchbox checks. The hyperfocus on good vs. bad foods also annoyed me, because I don’t want my kids to have the same issues with food that I do.

          • indigosky

            I’m currently fighting my son’s school because they say no peanut butter. The number of kids who have any form of nut allergy at my son’s school? 0. The percentage of kids up to date on their vaccines? 35% The number of immuno-compromised kids at my son’s school? 4.

            So my meeting tomorrow will go along the lines of them having no issues letting those 4 kids possibly die of vaccine preventable diseases, so peanut butter is much safer than 65% of the children in the school.

          • FEDUP MD

            We’re looking for private schools for our son and there is one in the area which posts on its website that all children are required to be up to date with their vaccines to attend.

            God, I think it may be our first choice based on that alone. If they’re that sane about that…..

          • Steph858

            My FSM! When I first skim-read that post, I read that as “35% of kids ARE NOT up-to-date on their vaccines.” That statistic made me do a spit-take. Then I re-read it properly and realised that it actually said “35% of kids ARE up-to-date on their vaccines.” I can’t even …

      • Sean Jungian

        Blech. My kid was allowed candy at Halloween in elementary school but:

        1) NO costumes of any kind
        2) Pumpkin-carving contest could only be a pumpkin PAINTING contest, and had to feature only characters from books. *YAWN*

        • Dr Kitty

          Thankfully they can wear whatever costumes they want, with a “disco” (hour long dance party at 9:30am in the school hall) as long as you give a small donation to school funds.

          Last year, as I was on maternity leave with time on my hands, I made Zelda and Link outfits from scratch- this year vampire princess was requested by #1 and it came straight off Amazon and #2 has a store bought werewolf outfit.

          I love seeing the kids dressed up- everything from super Pinterest that clearly took hours, to shop bought, to made by the kids, to absolutely no effort taken at all- it’s always fun.

          • Sean Jungian

            I LOVE seeing the kids in their costumes! I just turn into a mushy pile of grandma-wannabeness lol. I even like the older kids and teens who try to act like they don’t really care about treats even though they TOTALLY do!

          • LeighW

            We make my daughter’s costumes every year. Gypsy, Zombie, Ghost Bride, Claudia from Interview with a Vampire…

            This year she’s Robin… https://uploads.disquscdn.com/images/017da6ea5816a0d282ebb6191431763153736707e650e82ebd90414026681b5e.jpg

          • Kelly

            That is awesome. I have both made and bought costumes and as of right now, we do family costumes. I am pretty sure that I am trying to make up for never being able to dress up or go trick or treating as a child.

          • Dr Kitty

            Fantastic!
            Such a great outfit, both in concept and execution.

        • Roadstergal

          No costumes? What madness is this?

          (I’m going to be spending an evening this week putting together my TOS “Redshirt” costume for work.)

          • BeatriceC

            The middle school where I taught allowed costumes but with an academic theme. They could choose between a literary character, a historical figure/famous scientist or mathematician, or a current political figure. It was the only way we could convince the administration to allow costumes.

          • Roadstergal

            If the intent was to get the kids to dig into leaning something new, I like the idea. If the intent was to avoid the Violent Movies These days – heh. “Can I go as Deadpool?” “No, honey.” “Can I go as Idi Amin?” “Well… yes…”

          • BeatriceC

            There was a ban on in-school activities that didn’t have an academic purpose. The first year of that ban we brainstormed and that was the only way we could keep letting the kids have a little bit of a fun outlet and keep it “academic”. The kids got really creative with their costumes. It was fun, and they all probably learned something in the process.

          • guest

            I’ve been hearing about more schools that don’t celebrate Halloween because it excludes students whose families don’t celebrate. It does make me a little sad, considering how much I enjoy my school’s Halloween parade as a child, but I can’t argue with that – it sucks to be the kid who has to go sit in the cafeteria while the others are doing something fun.

          • Lion

            isn’t it the families of the kids who don’t celebrate who are excluding the kids?

        • Erin

          I think 2. Isn’t too bad. You have Dracula, Frankenstein’s Monster, the Headless Horseman and all of Goosebumps to play with plus Stephen King.

          Pennywise terrified me so much I still keep my hair away from the plug hole when I lean over the sink.

          1. is no fun though. I used to dress up as a witch and when challenged, say I always look like this. Worked great on supply teachers.

        • Azuran

          Well…….I kinda understand the teachers not wanting to watch over 20+ kids with pumpkin knives, or having to carve 20+ pumpkin themselves.
          I don’t really get the book thing though, yet, that is incredibly vague and large. Basically everything has been made in ‘book’ format.
          But the no costume is just extremely crappy and stupid

          • Sean Jungian

            They don’t do the pumpkin decorating at school, the kids do them at home (with parents) and take them in for a contest.

            They stress book characters because they don’t want any “scary” pumpkins.

            Basically our elementary school…well, don’t get me started. Our Middle and High Schools are much better.

          • Azuran

            Oh wow……..I thought they’d be making pumpkin at school as an Halloween activity. Whatever happened to being kids and having fun?

          • Sean Jungian

            Our elementary school (the only one in the county) is run like a prison, basically. They aren’t even allowed to talk at lunchtime.

            It’s difficult to get teachers here, the ones we have are near retirement and burned out. I can’t even begin to tell you the head-butting that I went through at that school. But faculty and staff believe in children being seen and not heard.

            The “No Halloween” rule was begun back in the Satanic Panic days, they say it’s to reduce distractions but they sure go all-in for Veteran’s Day.

    • Marylynn

      My theory is that if babies were meant to back sleep, they wouldn’t need to get helmets to shape their horribly smashed heads back into shape after 6 months of lying on their backs. I can’t imagine that it is good for brain development and later executive functioning to have been kept in a state of light-sleep-only for the first 150 nights of their lives.

      I feel exactly the same way you do… and when I talk to other parents, very few actually strictly followed “Back to Sleep.” And those who do have kids with flat heads…

      My son had reflux and could not sleep on his back. He screamed in pain. On his belly, he slept. My friend’s baby of the same age, also with reflux, choked on his own vomit while sleeping on his back (but… but… that doesn’t happen! It’s a myth!). They found him in his nap bed gray and unresponsive. If they hadn’t heard his initial cough/choke noise on the monitor, he would most likely have died.

      So, yeah, I’m not sold on back-to-sleep, either. I’ll sit in a room with you and build foil hats for that one.

      • Lion

        Your post has just reminded me about the recommendation for safe sleep that parents don’t use monitors and alarms. I just don’t understand that. Surely, if in the horrible instance that your child does choke on their vomit or stop breathing, then hearing it on the monitor or having an alarm go off because of non movement is a good thing. I just cannot see why that is even in there. Are they concerned that people will do the opposite of their recommendations and then rely on electronic devices? That makes no sense (and as per posts above it seems that lots of mothers ignore the practices for some of the time at least).

    • N

      Your text is interesting to read. I wondered too for a long time if it really matters how babies sleep or are fed. For example if I am so tired that I fall asleep feeding the baby on the couch, would it not be safer (perhaps not safest but safer) if I put a mattress on the floor and try to feed baby while we both lie there, so that falling asleep on my part won’t end in dropping the baby….

      I put my babies on their back to sleep, as it is recommended. But my mother was shocked about it. For them recommendations where to put babies on their belly.

      You say SIDS is not random. So it is not coincidence, that the only baby I know of that died from SIDS had very low income parents and at that time was sleeping alone in his crib in the living room, probably full of smoke, as at least one of the parents was smoking???

      So again I learn that, “do what works best for you” and remember that it is best for you and should not be pressurised on others, as their situation is different from yours is the way to go. And again fighting poverty is far better than fighting “put in what ever you want”.

      • Z

        The only baby that I know of on a personal level who died of SIDS was my husband’s sister. The parents, my in-laws, were wealthy and well educated. But the baby died alone in the hospital’s nursery back in the early 70s. It’s quite possible that the nurses smoked in the nursery in those days. The baby had an excellent APGAR score as it were. The parents to this day do not understand what happened to her. She was 3 days old.

        • MI Dawn

          I had that happen to me when I worked as a nurse in the newborn nursery. No smoking there (late 1980s). Baby was alive and crying at 5 am when a blood test was drawn, cold and dead at 5:30 when I went to give them a bottle. Baby was supposed to go home that day. Excellent health, no risk factors from parents. Life sucks sometimes and SIDS happens.

          • demodocus

            …i shouldn’t have read that…
            Fortunately, baby is on the floor beside me and I can see her twitch and breath in her sleep.

        • StephanieJR

          That’s really sad 🙁

  • Clorinda

    Every last headline I’ve seen has had some sort of absolute statement such as “Do this to avoid SIDS”. As if it was a 100% effective solution. The articles usually have the (somewhat) more accurate language of “It has been shown to reduce”. But for all those parents who lost a child to SIDS, it is a punch in the gut either way because the headline is telling them that if they’d only put the baby in with them, they wouldn’t have lost the baby OR it is telling them that their experience losing a child to SIDS while room sharing was a lie. Either way, the headlines create more guilt, anger, and grief because of their “click-bait” style writing.

    • Sean Jungian

      It was on the news this morning and they certainly made it sound like much more overwhelming evidence than is there. I was looking forward to seeing with Dr. Amy would have to say about it.

      Edited to add: this is pretty much what I expect from health news “reporting”.

  • Brooke

    Sounds like it has more data behind it than the claim pacifier use reduces the risk of SIDS as that was based on one survey/study. Honestly I expected more outrage over them saying it’s better to bedshare if the mother is breastfeeding than to feed the baby at night on a couch and risk falling asleep while doing it, but maybe that part was missed. The room sharing guidelines are not really new, this has been recommended for at least a decade.

    • Irène Delse

      “Sounds like it has more data behind it”

      Where is this data, then? Or is that another one of your overconfident assertions? (No, don’t bother to answer this last one. Try giving data for your previous dozens of claims, first.)

    • corblimeybot

      Good thing you got in your pointless sanctimonious shot at pacifiers. #thatsourbrooke

      (Don’t even start, by the way; my kid hated pacifiers so I have no personal dog in this fight.)

      • Sean Jungian

        My first thought too! “SOMEbody doesn’t like pacifiers!”

        #thatsourbrooke made me glad I hadn’t yet taken that sip of coffee 🙂

      • demodocus

        Both of mine liked them at first. Boychild just stopped caring several weeks in. Girlchild has discovered the real purpose of thumbs, lol

      • Mishimoo

        My older two hated them, my youngest loved his for a bit and then discovered that his thumb can’t escape in the middle of the night like his dummy (pacifier) could. He’s got a fairly impressive callus now, but is starting to suck his thumb less so I’m not concerned.

    • Amy Tuteur, MD

      Wrong.

    • momofone

      What if you compare the data related to pacifier use with the data related to roomsharing? Using credible sources, of course. Then you’d know for sure.

    • Sue

      So Brooke is back to throw stones
      Disagreement must be in her bones
      If there’s outrage, it’s too tough
      If not, not tough enough
      While the audience sits back and groans.

  • Roadstergal

    “The authors acknowledge that they have no idea how roomsharing decreases the risk of SIDS death let alone how a history of previous roomsharing could decrease the risk of death. ”

    Isn’t there a familial risk to SIDS? If so, then having previous babies without SIDS would be a protective factor for the current one?

    I mean, if you had a history of previous room-sharing with a live baby, that means your previous baby didn’t die of SIDS. If this is your first baby and it dies of SIDS, you didn’t have a history of previous room-sharing…

    I’m tired enough to feel a bit drunk and don’t have time to read the article, don’t mind me. 😀

    • Irène Delse

      “if you had a history of previous room-sharing with a live baby, that means your previous baby didn’t die of SIDS. If this is your first baby and it dies of SIDS, you didn’t have a history of previous room-sharing…”

      This makes sense to me. Possibly a confounder.

    • Inmara

      Isn’t the “history of room-sharing” meant as in this particular baby has been room-sharing all the time vs. usually not room-sharing but was in the parent’s room when SIDS occurred?

  • Trixie

    Looking back on my own infants, they slept so much better when we moved them to their own rooms. And I was such a more functional mother. They would stir and wake up every time one of us moved, or snored, or got up to use the bathroom. I was a zombie, unsafe to drive. When we moved them to their own rooms (alone, back, crib) they slept for 5-7 hours at a time, even as very young infants. I feel like this is another recommendation that needlesly puts mothers’ mental health at risk.

  • Cartman36

    Dr. Amy, would you consider doing a similar article regarding the evidence surrounding breastfeeding and a reduction in SIDs. It is my understanding the evidence is fairly week but I would love to see you apply Hill’s criteria as you did above.

  • Madtowngirl

    I’m so happy you’ve spoken up on this. I keep seeing it come across my feed, with comments insisting “bed sharing is totes safe tho!!!!!1111” I read the updated guidelines and what stood out to me most was that they are still claiming that breastfeeding reduces SIDS rates, therefore you should breastfeed, or at least feed the child expressed milk instead of formula. Now, even if breastfeeding is associated with lower SIDS rates, how is pumped milk more effective in preventing it than formula? It doesn’t make sense, and I’ve yet to see any mechanism which could even make that plausible.

    I admit that my own confidence in the AAP has been undermined. Don’t worry, I’m still trusting our pediatrician over the Internet, but I have gotten a bit more skeptical of the AAP recommendations.

    • Heidi

      From what I’ve read, your average person who thinks breastfeeding prevents SIDS thinks it does because they think it does a whole lot to prevent illness. I mean, in reality, it does very little to protect any individual baby against colds and GI infections and does nothing for whooping cough, measles, mumps, rubella, flu, etc, but breastfeeding’s “protective” benefits have been blown up so much, people make these assumptions.

      • Amy M

        Could a factor be that babies who are breastfeeding have to work harder to eat, and might be more roused more frequently?

        • Mishimoo

          Breastfed babies also seem to be hungrier and feed more often, so I think that contributes to them being easier to wake and having more wakeful periods throughout the night. Which really isn’t great for the mum’s physical or mental health, or for the baby either.

    • demodocus

      magic boob milk sparkles

  • Irène Delse

    “Roomsharing was protective ONLY when parents were smokers”

    Nonsmokers, surely?

    • Azuran

      It actually could make sense for the risk to be lower for smokers. Many smokers don’t smoke in their bedroom, so possibly a baby sleeping in their parent’s bedroom could have a lower exposure. Maybe parents are slightly more likely to walk into their baby’s room with a cigarette in their hand then when they are in their own bedroom. Or maybe they are more likely to smoke when they get up at night to take car of the baby if they are getting out of their bedroom to take care of it.

      • Cartman36

        I’m a former smoker and the thought of smoking inside still horrifies me. I bought some baby clothes at a garage sale once and I couldn’t tell how saturated with smoke they were until I got in the car. I had to soak them in oxy clean for 8 hours to get rid of the smell.

        • MaineJen

          We used to get hand me down clothes from neighbors who both smoked like chimneys (you’d walk into their house and immediately be overwhelmed by the smell of cigarette smoke). It always took a few washings to get the smoky smell out.

          • Azuran

            We got a used plastic white Christmas tree from family members when I was a kid. The previous owners where smokers, I have no idea how long they had that tree. But if took an entire day, a full bottle of bleach and multiple soak/rinse cycles to make it white again and get rid of the smell.

          • Roadstergal

            I had a boyfriend that smoked, and he was so anal-retentive about it – he’d smoke outside only and brush his teeth after every cigarette. His house, clothes, hair – all still smelled of smoke.

          • Amazed

            When Amazing Niece was about a month old, a friend of her mom’s sent a few clothes she had left from her own kid, as well as a bunch of pastries that she had baked. They smelled of smoke so much that we couldnt eat them. After two washings, the clothes still reeked.

          • Dr Kitty

            One of my most memorable consultations was after I had been on a house call to a chain smoker over lunch. I spent about 30 minutes in the house, but never took off my coat or sat down. It was the kind of house with a brown film on the walls and ashtrays on every flat surface.

            I spent a very unproductive 10 minutes with my first patient of the afternoon, trying to persuade them to stop smoking. Their parting shot of “it’s all a bit rich, coming from YOU” clued me into the fact that I still reeked of smoke!

          • FEDUP MD

            I have patients who reek of smoke so much that I actually start having asthma symptoms in an enclosed room with them. I keep a bottle of febreze outside and spray myself and the room when they leave because it lingers.

          • corblimeybot

            My grandmother had a smoker’s house like that. I thoroughly cleaned it for her one summer, much to my regret. Brown slime on every single surface.

        • Sean Jungian

          This seems like a great time to mention that tomorrow is my 1 year Non-Smoking Anniversary!! Yay me!

          • Roadstergal

            Brava! That’s a huge deal!

          • MaineJen

            It is a huge deal. 🙂 My husband quit smoking a while ago, and finds it excruciating to be around other smokers now…he quit for the kids, because when we were expecting our first, every doctor we saw asked if there are any smokers in the house. 🙂

            Yay Sean Jungian!

          • Sean Jungian

            Thank you! I’m SO glad I quit. I do still have one or two friends who smoke, and it doesn’t bother me really. Best thing I ever did, though. I was a die-hard and I LURRRVED smoking, I never thought I’d be able to quit. It was impossible until, one day (with my HCP’s invaluable help) it just wasn’t impossible anymore.

          • Roadstergal

            That’s so awesome.

            (Have you read When You Are Engulfed in Flames?)

          • Sean Jungian

            I have not but I do love David Sedaris in general, I’ll have to check it out. He went to Japan to stop smoking?

          • Roadstergal

            Yes – the second half of the book is “The smoking section.” It’s great. The first half has some good stuff and some OK stuff, but I loved the whole second half.

            ETA – I like this interview because Jon is also an ex-smoker.

            http://www.cc.com/video-clips/cz2ape/the-daily-show-with-jon-stewart-david-sedaris

          • Irène Delse

            Congratulations!

          • ForeverMe

            Congratulations! I, too, quit smoking (years ago, now) and the first year was the hardest. It’s great it’s behind you. I bet you already feel better (I know I did).

          • Mishimoo

            Congratulations, that is awesome!!

      • swbarnes2

        Or, depending on how large the study was, maybe room sharing really is a tiny bit better than not, but only the elevated level of SIDS in the smokers allows that to be mathematically discernible.

      • David Whitlock

        Tobacco smoke is a source of carbon monoxide, and CO does act as a nitric oxide mimic. It may be that the CO from parental tobacco smoking slightly stabilizes infant breathing reflexes.

        Similarly, the role of sleeping in the same room may be due to CO2 from the parents breathing. There are 3 triggers of breathing; low O2, high CO2, and high R-SNO (the R-SNO is extremely complicated and very poorly understood, CO does not form R-SNO mimics, so ????).

        The breathing reflex integrates these 3 known signals (there may be others that remain unknown) and when one is pathologically different, the others have to get further out of range to trigger taking a breath.

        • Azuran

          But does people breathing inside a room really have an effect on the concentration of those gases? Enough to have an effect on the baby’s breathing? Then we’d see a difference by room size or ventilation system.

          If anything, all of this could also just be because room sharing babies have less deep sleep and are woken up more often by noise their parents make. And smokers are more likely to snore and cough during the night.