PITTSBURGH -- America grossly undercounts the number of babies who suffocate in avoidable sleeping accidents, top medical authorities and child safety advocates agreed in a first-of-its-kind gathering to combat sudden infant death.But they sharply, sometimes emotionally, differed this weekend over whether they have enough proof to urge parents to stop sleeping with their infants, a sensitive issue that stirred political controversy in recent years."We know that 80 percent of sudden infant deaths are related to their sleep environment. We need to focus on the preventability of these deaths, no matter what they're called in the statistics,'' said Dr. James Kemp, a researcher on infant sleep safety at Washington University School of Medicine in St. Louis.Only one-seventh of the nearly 5,000 infants who die without obvious cause each year are attributed to accidental asphyxiation. Most are blamed on Sudden Infant Death Syndrome.John Kattwinkel, chairman of the American Academy of Pediatrics' Sudden Infant Death Task Force, cautioned that more statistical evidence is needed before a national campaign against adult bed-sharing with infants should be mounted."When we have the data, then we will do that," Kattwinkel said.The academy's latest guidelines, published in 2005, said bed sharing is not recommended and "may" be dangerous, but avoided stronger language in deference to breastfeeding advocates.It was a different story for many of the 200 infant death investigators and advocates attending the conference entitled "Breaking the Cycle: A Safe Sleep Summit." The conference was convened in reaction to a series of stories last year by Scripps Howard News Service detailing wildly erratic diagnoses of infant death."How many more babies are going to have to die while we wait," said Deborah Robinson, an infant death investigator from Seattle. "They will err on the side of the data. The problem is, the data are no good."Others believe its time to come to a new consensus about infant death."I have a hard time using the word 'SIDS' any longer," said Major Connie Shingledecker, a chief child death investigator for the Manatee County, Fla., Sheriff's Department. "How can I use that word and talk about suffocation. Suffocation is preventable, but true SIDS is not."In 1992, about 80 percent of 4,895 unexpected infant deaths reported to the federal Centers for Disease Control and Prevention each year were considered SIDS deaths -- a determination that's supposed to be reached only after a thorough death scene investigation, autopsy and medical history review of the baby rule out any other possible cause.By 2005, of 4,857 deaths reported, just under 48 percent were considered SIDS deaths, but almost 30 percent were attributed to "unknown causes" and the rest to accidental suffocation or homicide.Much of the recent decline in reported SIDS cases stems from a growing reluctance by local health and law enforcement authorities to use the diagnoses in cases that, they believe, actually resulted from avoidable accidents."We've shifted from SIDS to positional asphyxia for many of these cases. That's not what people want to hear, but it's our job to report it," said Peggy Regensburg, a public health program manager from New York City.The state of New York has reduced the number of reported SIDS cases by 90 percent in recent years, opting instead for the more vague diagnosis of death by "undetermined" causes.Regensburg and many others at the conference sponsored by the Cribs For Kids, a non-profit group based in Pittsburgh, argue that unsafe sleep practices are being found in so many instances that it's irresponsible not to take a stronger stand against bed sharing and other practices."First, we need to improve how these deaths are recorded," Kattwinkel said.His colleague, University of Virginia medical researcher Fern Hauck, echoed a message that wasn't always well received by many others in the gathering. "We are at a crossroads right now," Hauck said. "But we need more precise data that would require more time and money."Kattwinkel pointed to political pressure mounted against the Consumer Product Safety Commission following its 1999 announcement that adult bed sharing with infants is a significant threat and its 2002 campaign warning of the dangers of the adult bed for infants."There was considerable push-back against that," Kattwinkel said. "That's why we need to do all of the necessary epidemiology first."Also attending the meeting was product safety researcher Saud Wanna-Nakamura, who became a target after she convinced the federal commission to warn adults to stop taking their babies to bed."I didn't then know how afraid I should have been when releasing the bed data, but I was beaten up for it," Wanna-Nakamura said. "It was vicious sometimes."But that didn't stop the researcher from presenting new data at the conference, a study of 484 infant smothering deaths that resulted from pillows and cushions. Of these, 213 infants died from suffocation because of adult pillows and 128 perished while sleeping on sofa cushions."So far, we haven't been beaten up over these pillow data," she said. "We're still working to protect the American people."(Distributed by Scripps Howard News Service, http://www.scrippsnews.com)
No consensus on safety of babies sleeping by parents
Submitted by SHNS on Mon, 04/14/2008 - 18:06
Bed Sharing is OK and the Back to Sleep Campaign is not
Kattwinkel, Hargrove, Bowman, Hauck, the President, the Pope, etc. are all mammals. Yep. Baby mammals require lots of social interaction. Because science cannot find a way to test or measure how much is adequate we should leave the decision of bed-sleeping up to parents. The Back to Sleep Campaign has already done enough damage and caused enough developmental delays and deformities.
I'm always surprised when I read about SIDS though the things that I think are sort of important but never reported. For instance is it possible Dr. Kattwinkel is biased because his own daughter died at 3 days of age?
"Why should she be a beautiful, healthy-looking girl and be dead two days later?"
Dr. John Kattwinkel on the death of his 3 day old baby daughter in 1966 - Dartmouth Alumni Magazine
"The Academy was looking for someone who didn't have an agenda. So they chose me."
Dr. John Kattwinkel on being chosen to head the 1992 American Academy on Pediatrics Task Force on SIDS Prevention
Can we really believe he doesn't have an agenda?
Also, infants who sleep supine compared to infants who sleep in the prone position have higher risks of the following developmental delays and deformities:
- Social skills delays at 6 months (Dewey, Fleming, et al, 1998)
- Motor skills delays at 6 months (Dewey, Fleming, et al, 1998)
- Supine Sleep causes increased rates of gastroesophageal reflux (GER) (Corvaglia, 2007)
- Milestone delays (Davis, Moon, et al., 1998)
- Increased duration of sleep apnea episodes during REM sleep at both 2.5 months and 5 months (Skadberg, Markestad, 1997)
- 6% decrease in sleep duration (Kahn, Grosswasser, et al.,1993)
- 1 in 300 infants had plagiocephaly in 1974 (Graham, Gomez, et al., 2005)
- 1 in 60 infants had plagiocephaly in 1996 (Graham, Gomez, et al., 2005)
Here are some additional quotes that show other people are also concerned about the negative effects of the Back to Sleep campaign:
“Since the implementation of the ‘Back to Sleep’ campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.”
Susan Syron, Pediatric Physical Therapist
“There are indications of a rapidly growing population of infants who show developmental abnormalities as a result of prolonged exposure to the supine position.”
Dr. Ralph Pelligra regarding the impact of the Back to Sleep Campaign
“The increasing incidence of deformational plagiocephaly is likely related to the recommendation of the American Academy of Pediatrics (AAP) and others that infants be placed to sleep on their backs.”
Persing J, James H, Swanson J, Kattwinkel J, Committee on Practice and Ambulatory Medicine, Section on Plastic Surgery, Section on Neurological Surgery. Prevention and Management of Positional Skull Deformities in Infants
“With regards to the mental developmental index scores, none of the infants with deformational plagiocephaly were accelerated, 90 percent were normal, 7 percent were mildly delayed, and 3 percent were severely delayed. With regards to the psychomotor development index scores, none of infants were accelerated, 74 percent were normal, 19 percent were mildly delayed, and 7 percent were severely delayed.”
Kordestani R, Patel S, Bard D, Gurwitch R, Panchal J. Neurodevelopmental delays in children with deformational plagiocephaly. Plast Reconstr Surg. 2006 Jan;117(1):207-218; Note: Plagiocephaly is also referred to as “flat head syndrome”
“The potential implications of a SIDS risk-reduction strategy that is based on a combination of maintaining a low arousal threshold and reducing quiet (equivalent to slow-wave sleep) in infants must be considered. Because slow-wave sleep is considered the most restorative form of sleep and is believed to have a significant role in neurocognitive processes and learning, as well as in growth, what might be the neurodevelopmental consequences of chronically reducing deep sleep in the first critical 12 months of life”?
Pelayo, et al. letter to the editor of the Journal of Pediatrics regarding the 2006 SIDS Task Force Recommendations
Please Beware
Tom- You seem to be advocating prone sleep and bed sharing. The evidence AGAINST these practices done independently is very compelling, but performing them in combination would be especially lethal.
Developmental delays and positional plagiocephaly are more likely due to the increased car seat and swing time today's children endure.
-Sleep Supine, Play Prone (Supervised!)
-Share the room, not the bed.
-Don't leave your baby for hours on end in a car seat or swing. Try carrying them in your arms (like a mammal).
Please Show Me the Evidence you refer to and not press releases
For sleep position I am advocating the prone position. If you're suggesting that the back sleep position is safe then please cite me the evidence. Not quotes by Dr. Kattwinkel. Not quotes from SIDS websites. Not quotes from the CDC website. Peer-reviewed evidence. This is science after all.
I question the "Back to Sleep" Campaign on two fundamental issues:
(1) The actual effectiveness of the supine sleep position in preventing SIDS.
(2) The long-term safety of the supine position. At the bottom I cite other articles you may want to read.
(1) IS IT REALLY EFFECTIVE?
Based upon the historical record the following study was the one that convinced Dr. Kattwinkel and the AAP to begin recommending the supine sleep position in 1992:
"Interaction between bedding and sleeping position in the sudden infant death syndrome: a population based case-control study" - Peter J Fleming, Ruth Gilbert, Yehu Azaz, P Jeremy Berry, Peter T Rudd, Alison Stewart, Elizabeth Hall; BMJ, Volume 301, 14 July 1990.
They used the ALSPAC dataset for the above study.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1663432
When you read this study I have 3 simple questions (1) Were the controls randomized?; (2) Were the controls similar phsiologically to the infants who died of SIDS?; (3) Was the method of picking the controls biased. Read the study and the letters to the editor on pages 492 and 871 and the answers are clearly: (1) No (2) No there were significant weight differences - the controls were much heavier (3) They had the case workers pick the controls! That's not only insane but unscientific! Surprise surprise the caseworkers picked babies that were much heavier as controls than the ones that died of SIDS. I don't think it's too big of a leap to suggest these babies were from families easier to deal with especially in the middle of the night trying to find controls. I think the health workers were biased in thier picking of the controls and this fundamental error in the methodology calls into question the validity of the study the which Dr. Kattwinkel and the AAP used to change begin recommending infants sleep in the supine position.
Also:
-The SIDS reporting is inaccurate at best
-Maternal smoking has decreased dramatically since the back sleep recommendations began
-The "Back to Sleep" Campaign consists of a number of factors and not just back sleep.
-Decade over decade the U.S. has had huge decreases in infant mortality simply based upon technolgical advances.
(2) IS IT REALLY SAFE?
Read the following ALSPAC Peter Fleming 1998 study:
"Does the Supine Sleeping Position Have Any Adverse Effects on the Child? II. Development in the First 18 Months" - Claire Dewey, Peter Fleming, Jean Golding, and the ALSPAC Study Team - PEDIATRICS Vol. 101 No. 1 January 1998, p. e5
http://pediatrics.aappublications.org/cgi/content/full/101/1/e5
Then look at the results of the logistic regression model in Tables 3 and 4. It's clear the supine sleepers still have developmental delays at 18 months of age. But, based upon statistical methodologies used they are no longer statistically significant according to the Fleming, et al. methods but there are still developmental delays. Further, they are using the Denver Developmental Screening Test at 18 months but are comparing infants within the study. And again look at the methodology. But, what happens when they compare the primarily non-prone sleeping ALSPAC infants to the primarily prone sleeping DDST infants?
Read the following 2005 letter to the editor by Alan Emond of the ALSPAC team:
Letter to the Editor - 'Using parental questionnaires to identify developmental delay’ - Alan Emond, et al.
Developmental Medidcine & Child Neurology 2005, 47: 646-648
Google the following to get this article:
Using parental questionnaires to identify developmental delay
When they compare the infants used to develop the norms for the Denver Developmental Screening Test and compare them to the norms for the ALSPAC infants you see how dangerous the back sleep postion is.
The DDST norms were developed using mainly prone sleeping infants in pre-Back to Sleep Campaign Colorado. In the ALSPAC study the infants slept in a non-prone position greater than 96% of the time at 4 weeks, 6 months, and 18 months according to this study.
Here's two quotes from the Alan Emond letter:
"Using Denver norms, 68% of infants had abnormal scores at 6 months, and 57% at 18 months."
"We then recalculated 'abnormality' in terms of ALSPAC norms. The ALSPAC sample consisted of all infants who were not born preterm (at least 37 weeks gestation), and were aged 26-28 weeks, inclusive (n=850), and 77-84 weeks, inclusive (n=1044)....We calculated abnormal scores in the same way as the Denver....Using the ALSPAC rather than Denver norms, the proportion of infants with abnormal scores was considerably lower at both ages (3% and 14% respectively)..."
So what are they doing? They are basically saying what used to be an F is now a C and what used to be a C is now an A. That's dangerous.
Here's some more articles you might want to read (some agree with me and some don't (i.e. the Wilson article - but read it throughly and you might re-think your idea that plagiocphaly is caused by car seats and read the Kordestani article and you might rethink the idea that deformational plagiocephaly is harmless).
A Reassessment of the SIDS Back to Sleep Campaign - Ralph Pelligra, Glenn Doman, and Gerry Leisman - TheScientificWorldJournal - Volume 5 July 2005
http://cgi.thescientificworld.co.uk/cgi-bin/processHtml.pl?Id=2005.03.71.html&format=Dreamweaver
Supine and Prone Infant Positioning: A Winning Combination - Martha Wilson Jones, RN, BSN; J Perinat Educ. 2004 Winter; 13(1): 10–20.
doi: 10.1624/105812404X109357.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1595182
I URGE ANYONE TO LOOK AT ALL THE SIDE EFFECTS THIS ARTICLE LISTS - and she supports the Back to Sleep Campaign.
The Flip Side of 'Back to Sleep'
By Phil Stevens MEd, CPO
http://www.oandp.com/edge/issues/articles/2006-12_02.asp
The 'Epidemic' of Deformational Plagiocephaly and the American Academy of Pediatrics' Response
Wendy S. Biggs, MD
http://www.oandp.org/jpo/library/2004_04S_005.asp
Neurodevelopmental delays in children with deformational plagiocephaly.Kordestani RK, Patel S, Bard DE, Gurwitch R, Panchal J.
1: Plast Reconstr Surg. 2006 Jan;117(1):207-18; discussion 219-20.
http://www.ncbi.nlm.nih.gov/pubmed/16404269
Here are some quotes to consider:
Since the implementation of the Back to Sleep campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.
- Susan Syron, Pediatric Physical Therapist
There are indications of a rapidly growing population of infants who show developmental abnormalities as a result of prolonged exposure to the supine position.
- Dr. Ralph Pelligra regarding the impact of the Back to Sleep Campaign
Post new comment