Sunday, 24 October 2010

SIDS: Danger of overlay

Nancy Fowler Larson
October 19, 2010 — The value of breast-feeding should be considered before advising mothers not to share their beds with their infants, according to a British study published online October 18 and in the November issue of Pediatrics.
Nearly half of all English infants sleep in a parent's bed at times; one fifth does so regularly during their first year. The practice has been linked to sudden infant death syndrome, and many professionals and organizations, including the American Pediatric Society, advise against it.
However, bed sharing is also known to support breast-feeding.
"Both cross-sectional epidemiological and sleep laboratory studies showed close links between the frequency and duration of breastfeeding and the practice of bed sharing," write Peter Blair, PhD, Community-Based Medicine and Social Medicine, University of Bristol, United Kingdom, and colleagues.
The researchers sought to further the knowledge about bed sharing and breast-feeding through a longitudinal, population-based study using data gathered in 1991 and 1992 for the Avon Longitudinal Study of Parents and Children. To that end, they examined bed-sharing and breast-feeding habits during 5 periods (0 - 2 months, 6 - 8 months, 17 - 20 months, 30 - 33 months, and 42 - 45 months) in 7447 children.
Patterns of bed sharing were broken down into 4 unique groups: parents who never shared their beds with infants (66%), those whose babies slept with them in their beds only in infancy (13%), those who shared their bed with a child only after the first year (15%), and parents who shared their beds consistently for 4 years (6%).
Bed-Sharing Associated With Breast-Feeding
The results showed that mothers who shared a bed with their newborns were better educated and of a higher socioeconomic status, and that those whose children routinely slept in their beds during the first 15 months of life reported a significantly greater incidence of breast-feeding, among other findings:
  • all 3 categories of bed sharing had an important relationship with breast-feeding at 12 months (P < .001), whether the bed sharing occurred late (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.36 - 2.18), early (OR, 2.36; 95% CI, 1.87 - 2.97), or during the entire 4 years (OR, 5.29; 95% CI, 4.05 - 6.91);
  • 29% of the mothers who slept with their infants at 0 to 2 months (251/872 mothers) had university degrees compared with 14% of mothers (888/6464) whose babies slept separately during that period (P < .0001); and
  • the finding for education lessened for those who shared a bed with their 6- to 8-month-old-infants (17% vs 15%; P = .17) and there was a negative relationship with education for those sleeping with their 17- to 20-month-olds (11% vs 16%; P < .0001).
Because bed-sharing mothers of newborns were found to be better educated and more socioeconomically advantaged, their babies are at lower risk for sudden infant death syndrome because they will likely follow other infant safety guidelines, the researchers reasoned. Therefore, more lives could be saved if preventive messages focused on behaviors other than sharing a bed.
"Given the likely beneficial effects of bed sharing on breastfeeding rates and duration, risk reduction messages to prevent sudden infant deaths would be targeted more appropriately to unsafe infant care practices such as sleeping on sofas, bed sharing after the use of alcohol or drugs, or bed sharing by parents who smoke," the authors write.
Limitations to the study include the fact that using 5 time periods reduced the number of infants who could be studied (of the 14,062 mother–infant pairs on whom data was collected, only 53% [7447] provided information for all time points). In addition, most longitudinal studies have a larger dropout rate for socioeconomically disadvantaged participants — a situation that could skew the results toward those of higher socioeconomic status.
Regardless, the bottom line of the study results is a simple one: "Advice on whether bed sharing should be discouraged needs to take into account the important relationship with breastfeeding," the authors write.
The UK Medical Research Council, The Wellcome Trust, and the University of Bristol provided core support for the Avon Longitudinal Study of Parents and Children. The Foundation for the Study of Infant Deaths supported this specific study. The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online October 18, 2010.

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