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Coming of Age in America (Much too Soon) Diet and Parenting Affect Early Puberty

The Dangers of Cow's Milk Overview of chapter from Baby Matters

Iron Supplements for Breastfed Baby? Iron Supplements in the Absence of Anemia May Be Harmful

"Milking Your Bones"
Calcium & Osteoporosis: Milk does not make strong bones.

Vitamin K at Birth: To Inject or Not

Cosleeping & SIDS

Review of the Latest and Most-Authoritative Studies...

Because the AAP, baby product industry, and media want you to hear only the sensationalized incomplete findings.

by Linda Folden Palmer, DC
Author Baby Matters

OCTOBER 2005

Reviewing study after study, the message is clear: The relative risk of death for infants sleeping in a safe adult bed with a safe parent is not greater than those found sleeping next to the parental bed, and their death risk is far smaller than those sleeping in a crib in another room. And, for infants over 2 or 3 months of age, the studies show a protective effect of co-sleeping over sleeping next to the parental bed.

Just as they once were in cribs, suffocation risks are apparent on adult surfaces. The clear message should be that the adult bed needs to be made safe without overly fluffy or heavy bedding, wedging dangers, overheating, siblings (with a very young infant), or drugged or drunk parents or parents who smoke. Sofa sleeping is not safe with babies. The message we get from the AAP?? Cosleeping is unsafe. Period. While breastfeeding is shown to reduce SIDS, breastfeeding is not mentioned, and interventions that can impede breastfeeding are promoted without appropriate substantiation.

Unfortunately, no studies bother to derive from their statistics a risk ratio for deaths of babies co-sleeping in a family bed with safe, non-smoking, sober parents and with reasonable efforts to reduce wedging and other suffocation dangers. From the available statistics, the full number can only be guessed at, but is clearly as safe or safer than the child sleeping in a crib in the same room as parents and, of course, far safer than sleeping in a crib in another room. Contradictory to the supposed goals of the AAP, it is clear that limiting safe cosleeping will not reduce SIDS.

Important to understanding of quoted stats in the news...
When you hear these terms in the news:

The term "adult bed" usually includes dangerous sofas, sofa chairs, make-shift beds, and waterbeds, which account for a large portion of the adult-surface deaths. Also, it doesn't necessarily mean there is cosleeping. An infant sleeping alone on an adult bed is at greater risk than when with a protective parent. The use of such terms wrongly makes appropriate adult bed sharing sound dangerous.

"Bedsharing/cosleeping" statistics and comments usually include sleeping with any adult in any state (including over-exhausted, drunk, or drugged), with a smoking adult, or with another child, or multiples of these; and includes dangerous sofa sharing etc. ALSO, usually statistics are for having co-slept at any time during the night of death — not necessarily cosleeping at the time of death. Conscientious parents are scared away from safe cosleeping by such slanted reporting.

Notice that most studies lump all unexpected infant deaths as SIDS and some pose suspected suffocations as distinct from SIDS. The resultant stats will be quite different. While co-sleeping may reduce actual SIDS, the suffocation risks alone are greater for bed-sharing, (as great as they used to be in cribs before safety standards were taught), when appropriate precautions are not taken.

Additionally, a new risk-association with infant death in bedsharing is pointed out in a few studies that looked for it: the finding that possibly half of those dying while bedsharing were not accustomed to bedsharing, meaning, among other possibilities, that the parents or whomever were not experienced in protecting the baby from hazards, that the bedsharing was impromptu due to overtired or intoxicated parents, or that the baby may have had extra fussiness for some health reason and was brought to the parental bed for that reason. Why do no studies fully compare safe, conscientious cosleeping with other sleep situations? The results would reveal the safety and benefits of the family bed.

The numbers in the largest study on cosleeping around the world suggest that safe cosleeping reduces SIDS greatly!   Most nations with SIDS rates much lower than the United States regularly practice cosleeping, on firm surfaces, with low rates of smoking.  See graph at bottom.

Because the AAP, baby product industry, and media want you to hear only the sensationalized incomplete findings, I demonstrate what the studies truly found.

M. Lahr et al., "Bedsharing and Maternal Smoking in a Population-Based Survey of New Mothers" Pediatrics (U.S.) 116, no. 4 (Oct 2005): e530-42.

At the face, this is a study of smoking and cosleeping using 1867 women in Oregon, yet in this October 2005 study — in the issue just before that containing the big AAP announcement warning against all cosleeping — and published in the journal of the AAP the MD and PhD authors extensively analyze 9 large case-control studies of bedsharing and SIDS and additionally review several other studies as well.

These authors state that "Recommendations must be based on solid scientific evidence, which, to date, does not support the rejection of all bedsharing between nonsmoking mothers and their infants."

L. Knight et al., "Cosleeping and Sudden Unexpected Infant Deaths in Kentucky" The American Journal of Forensic Medicine and Pathology (U.S.) 26, no. 1 (Mar 2005): 28-32.

Knight and co-authors examine 697 sudden unexpected infant deaths in Kentucky from 1991 to 2000.

43% of co-sleeping deaths occurred on sofas (36%) or waterbeds (7%). A large portion of dying co-sleepers were sleeping with siblings, "disinterested caregivers," and other inappropriate partners, or in over-crowded beds.

The authors opine upon their analysis that cosleeping itself is perhaps not dangerous but death risks are related to unsafe cosleeping environments, including unsafe sleep partners and partners who smoke, and unsafe surfaces and bedding.

E. Mitchell et al., "Risk Factors for Sudden Infant Death Syndrome Following the Prevention Campaign in New Zealand: A Prospective Study" Pediatrics (New Zealand) 100, no. 5 (Nov 1997): 835-40.

232 New Zealand SIDS cases between 1991 and 1993 and 1200 control cases are examined for risk factors.

No increased risk of SIDS was found when bedsharing with a non-smoking mother.

There was a 31% increased risk of SIDS for NOT breastfeeding (after considering modifiable risk factors. Raw figure was 67% increased risk.)

Baby Matters
Dr. Linda Palmer: What Your Doctor May Not Tell You About Caring for Your Baby

Cosleeping & SIDS Fact Sheet The Facts Against CPSC & JPMA Announcements

Cosleeping It's Natural and Safe

Cosleeping in the Media: Media Perpetuating Dis-information

  Infant Sleep and Industry Dollars
A Letter to Doctors

Letter on Bed Deaths
Safety in Parental Beds

Crying and Caring

The Deadly Influence of Formula Survival Comparisons with Breastmilk

Attachment Parenting What is It?

Bonding Matters... The Chemistry of Attachment How parenting behaviors affect hormonal bonding.

Breastfeeding Crime Two children are torn from a family.

Colic Understanding and Eliminating Colic

Also read Dr. Linda Palmer's letters at: "Ask the Experts" on Mothering Magazine's Mothering.com

 

 

H. Klonoff-Cohen and S. Edelstein, "Bed Sharing and the Sudden Infant Death Syndrome" British Medical Journal (England) 311, no. 7015 (Nov 11, 1995): 1269-72.

200 infants dying of SIDS in Southern California and 200 control infants were studies to measure whether infants bedsharing with their parents were more likely to die from SIDS than other infants.

45 of the 200 infants died while cosleeping: 35 sharing their parents' bed, 6 sharing a babysitter's bed, and 4 died while sleeping in their mother's arms (this was included as cosleeping). This represents 22.5% of the total SIDS deaths as occurring during cosleeping: a number similar to or likely lower than the number of infants usually cosleeping. Smoking, drug use, and medical conditions were accounted for statistically.

The authors reported that there was "no significant relation between routine bed sharing and the sudden infant death syndrome."

 

 

P. Blair et al., "Babies Sleeping with Parents: Case-Control Study of Factors Influencing the Risk of Sudden Infant Death Syndrome. CESDI SUDI Research Group" British Medical Journal (England) 319, no. 7223 (Dec 4, 1999): 1457-61.

This study looks at 325 babies who died of SIDS, including suffocation deaths, around England from 1993 to 1995, along with 1300 matched controls.

The highest risk of SIDS in this study, like most, was sharing sofa sleeping, at 49 times the risk (same number as Unger et al.) of sleeping alone in the parent's room.

The second highest risk for SIDS in this study was sleeping outside of the parental room, with 10.5 times the risk of sleeping in the parent's room.

37% of the control bedsharers (4 matched live controls for every SIDS infant) slept between their parents (suggesting this is the normal rate for this) while only 22% of infants dying in bed with a parent or parents were found between the parents at time of death — contradicting Unger's implied factor of added danger in having the father in bed.

Sharing the parental bed at the last sleep was found to be safer than sleeping in another room, but still nearly 10 times the risk of sleeping alone in the parental room. This is the highest reported factor among studies, however:

After the authors removed risk factors such as prone sleeping, being placed on a pillow, being found with head covered, smoking, alcohol, parental tiredness, overcrowded situations, and pacifier use, (which was considered a risk factor in this study), the risk of bedsharing at last sleep was 1.35 times (or 35% higher than) that of being next to the bed; a number which the authors referred to as statistically not significant for the strength of their figures. Still, wedging deaths from un-prepared beds, usually a considerable factor, waterbed usage, and parental drug usage, were apparently not removed from this value. These are all modifiable factors. Also not reported is how many of these were actually in the adult bed at time of death, rather just there for some time during their last night.

Drug usage and other such factors tend to represent the difference between conscious, conscientious family-sleep-sharing, and co-sleeping of convenience or by default.

Excluding infants under 14 weeks of age, the risk of sharing with parent or parents was 1.08 times that of lone sleeping in the parental bedroom, before wedging, drugs, and other factors are taken into consideration.

 

 

P. Blair et al., "Sudden Infant Death Syndrome and Sleeping Position in Pre-Term and Low Birthweight Infants: An Opportunity for Targeted Intervention" Archives of Disease in Childhood (England) epub ahead of time: 10.1136/adc.2004.070391 (May 24 2005).

This paper is a continued and extended evaluation of the CESDI SUDI study above, with 325 case infants and 1300 controls; this time looking at the aspect of infant size at birth. This study, like most, includes suffocation deaths in the term SIDS.

The calculated odds of SIDS for being small at birth (pre-term or low birth weight) and bed-sharing with a smoking parent is 37 times the risk of a full-sized term infant sleeping alone in the parental room.

For those born small, co-sleeping with a non-smoking parent posed a quadrupled risk of SIDS versus sleeping alone near the parental bed. Other risk factors are not removed from this statistic, but clearly the tiniest are vulnerable to suffocation and overheating complications when not well prevented.

Those who were not small at birth, and were cosleeping with parents who don't smoke had only 4/5ths the risk of dying of SIDS as those not-small infants sleeping next to the parental bed.

As in other studies, when measured, a protective effect of cosleeping is shown statistically beyond the first 2 or 3 months, or a certain weight, before other risk factors are even accounted for.

Full-sized infants cosleeping with a smoking parent showed nearly 8 times the risk is SIDS as sleeping alongside non-smoking parents.

 

 

L. Li et al., "Investigation of Sudden Infant Deaths in the State of Maryland (1990-2000)" Forensic Science International (U.S.) 148, no. 2-3 (Mar 10, 2005): 85-92.

While causes of deaths for 1619 Maryland infants during 1990-2000 are examined, 930 infants comprised of 802 SIDS infants plus 128 accidental infant deaths, (including suffocations), are evaluated for sleeping locations.

33% of SIDS cases were bed sharing with any kind of partner(s). (So what percentage of all infants are bed-sharing?)

An additional 1.6% of the total SIDS plus accidental death cases were diagnosed as overlain. The literature commonly recognizes a likely overdiagnosis of overlaying resulting from opinions on cosleeping. While only 1/3rd of these had physical evidence of suffocation, such evidence is commonly not found in many kinds of suspected suffocations.

45% of SIDS were found alone in cribs.

An additional 3% died from defective cribs. (Double the suspected overlayings).

 

 

R. Carpenter, P. Blair, P. Fleming et al., "Sudden Unexplained Infant Death in 20 Regions in Europe: Case Control Study" Lancet (England) 363, no. 9404 (Jan 17, 2004):185-91.

20 European regions were covered during the years of 1992 to 1996 totaling in 745 SIDS cases, including suffocation cases, and 2411 controls.

Bed sharing with a non-smoking mother was shown to have 1.5 times the risk as not bed sharing but in the same room, before any other risk factors were removed from the statistic, such as unsafe bedding, drugs, alcohol (which more than doubled risk), infant not accustomed to bed-sharing, etc.

Any of this small statistical risk of bed sharing, with non-smoking mothers but under any other risk factor, was only significant for infants under 8 weeks of age. As pretty much seen across the board, once suffocation risk from inappropriate practices is out of the picture, cosleeping becomes safer than not.

Bed sharing with a smoking mother was 18 times the risk.

No increase in infant deaths was found when mother had 1 to 2 alcoholic drinks, versus none, but when mother had 3 or more drinks, the risk of infant death, (alcohol risk only found when cosleeping), was 2.3 times the risk of sleeping with a non-drinking mother. Although drinking statistics were obtained, the risk for bedsharing with a non-smoking and non-drinking mother was not reported.

 

 

B. Unger, J. Kemp et al., "Racial Disparity and Modifiable Risk Factors Among Infants Dying Suddenly and Unexpectedly" Pediatrics (U.S.) 111, no. 2 (Feb 2003): 127-131.

This study looked at all deaths under age 2 years in St Louis County from 1994 through 1997, totaling 119 deaths of SIDS, accidental suffocation, or undetermined causes. The question as to why the rates of such unexplained infant deaths are several times higher in African Americans than in other Americans was addressed.

21% of African American (AA) sudden and unexpected infant deaths and 54% of non-African American deaths occurred in cribs.

23% of "bedsharing" AA deaths occurred while sharing sleep with another individual on a sofa; and 9% so in non-AA. (Sofa sleeping is always found statistically to be extremely unsafe) — Sofas are generally referred to as adult surfaces or "bed-sharing" in most other studies — misleading parents into fearing bedsharing when sofa and chair sharing are major factors. When sofa deaths include sharing with another individual in other studies, this is termed co-sleeping and is lumped in with all cosleeping deaths. Only the most current studies attempt to separate these components.

The risk of SIDS for "bedsharing" on a sofa was 49 times the risk of not-bedsharing.

33% of AA cosleeping deaths and 18% of non-AA were when sharing with siblings — another well-known risk factor for tiny infants.

The great majority, (percentage undeterminable), of deaths outside of cribs included modifiable risk factors such as inappropriate or overly soft bedding, sofa sleeping, or drunk mother or otherwise inappropriate sleeping partner(s). Smoking was not taken into account in this study.

Only 15% of all AA (67% of total were sharing X 23% of those who did share) and 3.5% of non-AA (35% of total were sharing X 10% of those who shared) unexpected infant deaths occurred on an adult bed with his or her mother alone* — and the majority of these still included other known risk factors.

41% of African American babies in St. Louis bedshare. (No non-AA rate was provided.)

*Additional number in attendance by the father is not provided in study but his presence is usually not statistically contra-indicated.

 

 

B. Gessner et al., "Association Between Sudden Infant Death Syndrome and Prone Sleep Position, Bed Sharing, and Sleeping Outside an Infant Crib in Alaska" Pediatrics (U.S.) 108, no. 4 (Oct 2001): 923-7.

Examination of all 130 SIDS in Alaska between 1992 and 1997.

45% of Alaskan SIDS deaths involved some form of bedsharing, while 35% of Alaskan infants cosleep always and 75% do so sometimes or always. (K. Perham-Hester, "Co-sleeping in Alaska: Data from PRAMS. Executive Session of the Maternal-Infant Mortality Review Committee," Anchorage, AK; December 1999)

Of all the SIDS deaths in Alaska from 1992 to 1997, only ONE infant death involved an infant sleeping on a safe mattress with a non-drug-using parent (< 1% of total deaths).

 

F. Hauck et al., "Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study" Pediatrics (U.S.) 111, no. 5, part 2 (May 2003): 1207-14.

Data from 260 SIDS cases and 260 controls in Chicago, consisting of 75% black, 31% Latino, and 12% white, are analyzed.

Bed-sharing with one or both parents, in any condition, posed 1.4 times the risk of sleeping alone. This factor was stated to be statistically non-significant. There was no compensation made for those sleeping with an adult under the influence of drugs or alcohol, while other studies show these to be significant risk factors in infant bed sharing.

When other children were in the bed, the cosleeping SIDS risk was 3.6 times the risk of sleeping alone.

Breastfeeding appeared to reduce SIDS to 1/5th the risk; however after accounting for factors of mother's age, education, marital status, and prenatal care, the strength of the number became statistically insignificant. The factors that are more-typically associated with breastfeeding are the same factors that are associated with lower SIDS rates, but studies have not determined how much of this result extends from breastfeeding itself.

 

 

C. McGarvey et al., "An Eight-Year Study of Risk Factors for SIDS: Bed-Sharing vs. Non Bed-Sharing" Archives of Disease in Childhood (Ireland) epub ahead of time: doi:10.1136/adc.(Oct 2005) .074674

287 SIDS cases and 831 controls between 1994 and 2001 in Ireland are examined for factors associated with bed sharing deaths.

Bed-sharing death risks are reported to be 3 times greater for low birthweight babies. Other studies point out dangers for young, premature infants as well. These tiny and young infants are less-able to move themselves out of a low-oxygen situation and may not put up as much of a fuss to alert parents.

The bed-sharing death risk was 14 times greater for those with smoking mothers.

There was a doubled risk of death for bed-sharing with non-smokers versus lone sleeping, before any other high-risk behaviors were removed from the statistic — and a new risk factor was discovered in this study:

50% of infants dying while bed-sharing were not in their accustomed sleep arrangement — they and their parents were not accustomed to bed-sharing.

Removing this 50% of impromptu bed-sharers would leave no increased risk for customary, non-smoking bed-sharers.

Bed-sharing deaths decrease with age, and babies bed-sharing over the age of 12 months had less than half the risk of sleep-deaths than those sleeping alone.

Heavy blankets and comforters were found to be a major risk factor.

Breastfeeding bed-sharing infants had half the risk of SIDS of non breastfeeding bed-sharers.

 

 

D. Tappin et al., "Bedsharing, Roomsharing, and Sudden Infant Death Syndrome in Scotland: A Case-Control Study" Journal of Pediatrics (Scotland) 147, no. 1 (Jul 2005): 32-7.

123 SIDS and 262 control cases in Scotland between 1996 and 2000 are examined for association between bed-sharing and SIDS. Suffocation deaths are included in the term SIDS here.

Sleeping in a separate room, alone, was associated with over 3 times the risk of SIDS as in the same room with parents.

52% of SIDS infants were reported as sharing a sleep surface at some time during the night of death, but they were not necessarily sleep-sharing at time of death. Actually, only 32% were found sharing the parents' bed at time of death. Use of this statistic for having co-slept some time during the night of death is often used to make co-sleeping dangers sound higher.

The study does not give a figure, but suggests that heavy bedding, (the weight of bedding or duvet is referred to as "tog"), is a strong factor in SIDS deaths (which would be reported as suffocation deaths in some other studies). The study authors found 81% of bed-sharing deaths relating to heavy comforters/bedding in an earlier study of theirs.

Among those found dead in their parents' bed at time of death, very few of the parents reported that this was their usual place of sleep; meaning again that for most, bed-sharing was not their accustomed sleep arrangement.

This study reports an increased risk of SIDS for breastfeeding in bed-sharing infants, but many of those were found dead in cribs: not cosleeping at the time of death. I consider this a useless finding. Only the number found cosleeping at time of death would be truly useful. Many of those found dead in cribs may have been unaccustomed to crib sleeping, or too fussy to bed-share (for some health reason); although this is conjecture.

20% of control infants were sharing a sleep surface during a reference sleep.

22% of those found sharing at time of death were sharing a couch.

72% of those bedsharing at time of death were under 11 weeks of age.

As usual, no figure is given for the percentage of SIDS cases that represented bed sharing with a safe parent in a safe adult bed.

 

T. Person et al., "Cosleeping and Sudden Unexpected Death in Infancy" Archives of Pathology and Laboratory Medicine (U.S.) 126, no. 3 (Mar 2002): 343-5.

This smaller study looked at 56 cases of sudden unexpected infant deaths or SIDS diagnoses from the files of one author doctor in Upstate New York. I find this study valuable to mention in that the circumstances of deaths were well described and delineated and provide a good idea of what can be assumed from untold stories in larger studies.

52% of SIDS were sleeping alone:   34% of all SIDS alone in cribs, 9% of all SIDS alone in adult beds, and 5% on couches.

25% of all SIDS cases were in an adult bed with adult(s), in any condition.

7% of SIDS were cosleeping with an intoxicated adult (on bed or couch).

16% of SIDS were cosleeping on a couch.

7% of SIDS cases were cosleeping with a twin in a crib.

(There is no evidence of twin cosleeping to be of greater risk than separate sleeping. It may be safer, as certain physiological advantages have been documented, but the numbers have not been done. Twins, overall, have double the SIDS of singletons. A study of simultaneous twin SIDS deaths reported 8 out of 41 cases where the twins were cosleeping. Anecdotally, cosleeping is very high among twins.)

 

 

R. Scragg, E. Mitchell et al., "Bed Sharing, Smoking, and Alcohol in the Sudden Infant Death Syndrome. New Zealand Cot Death Study Group" British Medical Journal (New Zealand) 307, no. 6915 (Nov 20, 1993): 1312-8.

In New Zealand, for the interval between 1987 and 1990, 393 SIDS cases and 1592 controls were examined.

SIDS risk for last sleep in bed with a mother who smoked was 4.5 times the risk of having a non-smoking mother and not sleep-sharing.

For those with non-smoking mothers who were usually bed sharing in the two weeks before their death the risk of SIDS was 1.7, but for those who were bed sharing during their last sleep, there was no risk at all found. Alcohol usage did not appear to be a risk factor in this study.

Still, the actual location at time of death is not reported. While sleeping with a mother with smoke in her lungs can reasonably increase the risk of death after being removed from bed-sharing, there is no apparent reason why, in the absence of a smoking parent, usual cosleeping should increase death risk outside of the parental bed. We have seen that some studies look at whether bed-sharing SIDS cases are with infants accustomed to cosleeping or not. These report that deaths are most-common in impromptu or unaccustomed bed-sharing situations. Notice in this New Zealand study that a higher rate of SIDS is reported for regular co-sleepers, but not for those cosleeping at the night of death. It appears, as in a few other studies, that there may be a danger factor for infants to be alone in a crib when they are accustomed to the regulation of their parental bedsharers. This factor may confound many risk reports for bed-sharing deaths as it is usual to report based upon where the infant was first placed to sleep, spent most of their last night, or simply what their usual sleep arrangement was, rather than where they were actually found at time of death.

 

 

SUFFOCATION ALONE:

N. Scheers, J. Kemp et al., "Where Should Infants Sleep? A Comparison of Risk for Suffocation of Infants Sleeping in Cribs, Adult Beds, and Other Sleeping Locations" Pediatrics (U.S.) 112, no. 4 (Oct 2003): 883-9.

This study attempts to compare infant suffocation trends (suffocation diagnoses only, versus all SIDS) between the 1980's and the 1990's. While reports from McKenna and others reveal reasons why true SIDS should be lower when sharing sleep with mother, suffocation accidents in adult beds are higher, as they were in cribs before safety education about crib sleeping became widespread.

Although the great number of variables and complicating factors (most admitted to) prevents solid comparisons, the statistical information can provide much insight into the causes of adult-surface deaths, so I have selected this study to use. 883 cases of infant suffocation reported to the Consumer Products Safety Commission from the 90's are studied.

Their numbers support a 20 times or more risk for suffocation only deaths while sleeping in actual adult beds versus crib sleeping. This ratio is based upon an assumption that 18% of all infants are sleeping in adult beds. Yet studies suggest that the numbers of infants cosleeping are higher than this number, and adding those in adult beds without co-sleeping would make the true number even higher. Therefore, this estimate of theirs is likely high. There is also likely some portion of the deaths reported as overlying that were actually SIDS before overlying, making this study's risk figure even slightly more overestimated. There is no mention as to how many of these involved co-sleeping. It is known from other studies that suffocation deaths are greater in adult beds when no protective parent is present. While SIDS deaths should be lower when cosleeping with mother or other protective adult, suffocation accidents are known to be higher in adult beds, as they were in cribs before safety education about crib sleeping became widespread.

Great praise is made in this report as to the large reductions in crib deaths once various mandatory and voluntary safety standards were imposed and parents were educated in making cribs safer. The suggestion was never made to do the same for family beds; rather it was suggested that any attempts to make adult beds safer should be discouraged as they have "unproven efficacy."

22% of adult-surface suffocations occurred on sofas.

Over 57% of specified-cause suffocations in actual adult beds were due to wedging/entrapment; mostly with wall, headboard, or a bedrail. Bedding, plastic, and overlying are other sources of suffocation.

18% of the adult bed suffocations (remember — not of all SIDS, just among those diagnosed as suffocations) are suggested to be from overlying, although it is well understood that this is likely over-diagnosed; often being selected as the diagnosis based solely upon opinions about cosleeping. Even when an infant is found dead underneath an adult's body, there is often no means of determining whether the adult overlaid onto the infant after it died because it was no longer a warm, reactive body rather it was non-warm and non-responding; more like a pillow.

 

 

PACIFIERS:

A pacifier is, of course, an artificial replacement for the mother's nipple. Scientists have confirmed in many ways that sucking is an important part of babyhood, in terms of emotional comforting and security, neurological development, pain management, and optimal physiological status. Opportunity for natural sucking is likely one component of the reduced SIDS in breastfeeding, cosleeping infants. It has been shown in studies on preemies that providing artificial means of sucking maintains their physiology far better than having no such opportunity, although it does not provide as much benefit as actual nursing at the breast, when available. It is odd, as most pacifier studies do, to suggest an artificial replacement for something natural without even comparing the benefits of the natural version.

 

 

P. Fleming et al., "Pacifier Use and Sudden Infant Death Syndrome: Results from the CESDI/SUDI Case Control Study" Archives of Disease in Childhood (England) 81, no. 2 (Aug 1999): 112-116.

This report was performed using the statistics from the CESDI/SUDI study of 325 SIDS infants in England with 1300 matched controls.

While there was no difference between the incidence of SIDS between those who regularly used a pacifier and those who did not, there was a slight difference in the number of infants found dead with pacifiers vs. controls: 40% vs. 51%.

 

 

P. Blair, P. Fleming et al., "Sudden Infant Death Syndrome and Sleeping Position in Pre-Term and Low Birthweight Infants: An Opportunity for Targeted Intervention" Archives of Disease in Childhood (England) epub ahead of time: 10.1136/adc.2004.070391 (May 24 2005).

This report was a closer analysis of the above, using the statistics from the CESDI/SUDI study of 325 SIDS infants in England with 1300 matched controls.

This study demonstrates that when an infant was used to using a pacifier, and then not using a pacifier in their last sleep, the statistical odds of dying without a pacifier when accustomed to using one is 17.5 times the risk of not having a pacifier at all.