No-one ever died of it so far …

People who make an effort to support breastfeeding often get strange looks, are named fanatics (even with the use of words indicating involvement in militant fascism or organized crime). A frequently heard remark is: ‘’Formula isn’t that bad at all in our part of the world, no one ever died of it’’. Studies were out there that showed this statement to not be true: children have increased mortality risks when not breastfed. Life is risky, it is impossible to lower risks to zero, not even by breastfeeding vaccination, adding vitamins and have them wear helmets 24/7. But risks can be minimized. Breastfeeding is the first, most prominent, most effective way to protect an infant from birth on against several risks. Hauck et al (2011) recently did a meta-analysis. They found 288 studies from 1966-2009 and kept 24 that met their high standards of research.  These 24 studies were then analyzed by 2 independently operating research teams, and 6 more were dismissed. The remaining 18 showed a clear, dose-related correlation between a higher mortality due to SIDS and a decreasing duration and exclusivity of breastfeeding. In plain language: How shorter the breastfeeding period and how less exclusively breastfed how more chance a child has to die of SIDS. The researchers strongly advice to add breastfeeding to the lists of SIDS preventative measures.
Hauck FR, Thompson JMD, Tanabe KO, Moon RY, Vennemann MM: Breastfeeding and Reduced Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics 2011; peds.2010-3000; published ahead of print June 13, 2011, doi:10.1542/peds.2010-3000

SIDS and sleep environment

Blair in his editorial defines SIDS as an exclusion diagnosis: a child died and after studying all factors involved we cannot demonstrate an adequate cause of death. In 1969 Beckwith put down this definition and after the following 40 years of intense research there is no prospective of finding a single plausible cause for cot death. There are, though, factors that increase the SIDS risk, including, but not limited to, breastfeeding or not and sleep arrangements. In different research groups Blair et al studied the correlations between sleep arrangements and SIDS and between bed sharing and breastfeeding. Thy found that sleeping place sharing children who died of SIDS always also had other risk factors involved, like prematurity, being ill of not well, parents who smoked or were under the influence of alcohol or drugs, the use of head-covering, pillows or sofa’s. Bed sharing in the first 15 months (or longer) proved positive in better breastfeeding outcomes. Health behaviour education for parents about sleep arrangements should always take into account these positive outcomes for breastfeeding. Good information about safe bed-sharing seem to have the best potential to secure breastfeeding and prevent SIDS as much as possible.
Blair PS, Fleming PJ: Recurrence risk of sudden infant death syndrome. Arch Dis Child 2008;93:269-270
Blair PS,  Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EMA, Fleming P: Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009; 339:b3666
Blair PS, Heron J, Fleming PJ: Relationship Between Bed Sharing and Breastfeeding: Longitudinal, Population-Based Analysis. Pediatrics 2010 126: e1119-e1126

SIDS prevention

Children who are not breastfed have double the chance to die of SIDS in comparison to their breastfed counterparts, according to Vonnegut & Mitchell in a German Ministry of Education and Science and the New Zealand Child Health Research Foundation funded study. The researchers thus advise that breastfeeding gets a prominent place in anti SIDS campaigns. The Edmund et al Oxford University research team added the knowledge that it is important to start breastfeeding as soon as possible following birth, for their research showed that 16%, respectively 22% of SIDS cases could be prevented if all children would start breastfeeding within the first 24 hours, respectively the first hour of life.  Other researcher found that the use of a dummy/pacifier just before sleeping is a strong preventive measure as well. The Cochrane group review several studies on this subject and they found that for every 2733 children that are put to sleep with a pacifier one cot death would be prevented. This study however did not take breastfeeding into account. Are breast and dummy evening out each other? Do they increase each other’s merits? Do they work against each other? For me, breastfeeding still is the strongest protection. Dummies only protect against SIDS, but they do increase the risk for less breastfeeding, incorrect oral and dental development, apnea, and ear infections, while breastfeeding lowers those risks and lowers the risk of SIDS as well significantly. Read more avbut breastfeeding and other oral obkects and their effects on child health: http://www.brianpalmerdds.com/articles.htm
M.M. Vennemann, T. Bajanowski, B. Brinkmann, G. Jorch, K. Yücesan, C. Sauerland, E.A. Mitchell,  and the GeSID Study Group: Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome?
PEDIATRICS Vol. 123 No. 3 March 2009, pp. e406-e410
Hauck FR, Omojokun OO, Siadaty MS.: Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis. Pediatrics. 2005 Nov;116(5):e716-23.
Vennemann MM,  Mitchell EA: Breast-Feeding May Reduce Risk for SIDS by Half Throughout Infancy. Pediatrics. 2009;123:e406-e410
Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR: Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. PEDIATRICS Vol. 117 No. 3 March 2006, pp. e380-e386

SIDS

Human infants are not made to be alone. Their vital functions need human company to keep on track and the need for frequent feeding necessitates the constant proximity of their mothers as source of food. Yet, almost everywhere in the industrialized world parents are advise to leave their children alone to sleep. Isn’t it strange to put a child in a cot to prevent *cot*death?  Despite the sometimes aggressive information campaigns to not co-sleep parents do take their children in their beds, but not always in a safe way. If implicated safely, co-sleeping is not risk-increasing; it increases breastfeeding. Breastfeeding is a major protective factor for SIDS. As far ago as 1993 Ford et al found a significant reduction in SIDS in breastfed children, as compared to formula fed children, even after correcting for confounding factors. These results were repeated by the German GeSID Study Group (Vonnemean et al 2009). They found that children who were not breastfed had a doubled risk of dying of SIDS and they strongly recommend to prominently include breastfeeding as a preventive measure for SIDS.
McKenna JJ, McDade T: Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric respiratory reviews, 2005, 6(2):134-152
Ford RPK, Taylor BJ, Mitchell EA, Enright SA, Stewart AW, Becroft DMO, Scragg R, Hassall IB, Barry DMJ, Allen EM, Roberts AP: Breastfeeding and the Risk of Sudden Infant Death Syndrome Int. J. Epidemiol. (1993) 22(5):885-890
Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Yucesan K, Sauerland C, Mitchell EA en de GeSID Study Group: Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome? Pediatrics 2009 123: e406-e410

SIDS and sleep environment

Blair in his editorial defines SIDS as an exclusion diagnosis: a child died and after studying all factors involved we cannot demonstrate an adequate cause of death. In 1969 Beckwith put down this definition and after the following 40 years of intense research there is no prospective of finding a single plausible cause for cot death. There are, though, factors that increase the SIDS risk, including, but not limited to, breastfeeding or not and sleep arrangements. In different research groups Blair et al studied the correlations between sleep arrangements and SIDS and between bed sharing and breastfeeding. Thy found that sleeping place sharing children who died of SIDS always also had other risk factors involved, like prematurity, being ill of not well, parents who smoked or were under the influence of alcohol or drugs, the use of head-covering, pillows or sofa’s. Bed sharing in the first 15 months (or longer) proved positive in better breastfeeding outcomes. Health behaviour education for parents about sleep arrangements should always take into account these positive outcomes for breastfeeding. Good information about safe bed-sharing seem to have the best potential to secure breastfeeding and prevent SIDS as much as possible.
Blair PS, Fleming PJ: Recurrence risk of sudden infant death syndrome. Arch Dis Child 2008;93:269-270
Blair PS,  Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EMA, Fleming P: Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009; 339:b3666
Blair PS, Heron J, Fleming PJ: Relationship Between Bed Sharing and Breastfeeding: Longitudinal, Population-Based Analysis. Pediatrics 2010 126: e1119-e1126