I have just read one of the saddest things I have ever read on the internet. Along with sad disappointment, it reminded me of the saying "The only thing more dangerous than some who knows nothing is someone who thinks they know something." This phrase is made even more applicable and more disconcerting when a professional deviates from evidence based information and gives advice to the public outside of his professional expertise. Such is the case with the celebrity pediatrician, Dr. William Sears. It bothers me because professionals are and should be held to a higher standard - and this is even more true for one with the notoriety of Dr. Sears.
Dr. Sears, God bless him, has given excellent advice on a wide variety of topics to thousands of American parents. However, he is not, nor has he ever been, a SIDS or infant death expert. To my knowledge, he has never published or participated in any research on sleep related infant death; he has never served on a child fatality review committee or task force nor has he acted in any public health capacity that would place him in a position of authority regarding the sleep related infant death research. But even more troublesome is the fact that an inexperienced lay person need only to read the latest peer review publications or do on online search at PubMed, to know that Sears' latest comments are completely out of touch with the current body of knowledge.
Take a look at his sad commentary here .
While he may have felt compelled to add his two cents to the latest controversy hitting the news, the irony is almost too much to bear when he claims to be a "show me the science" doctor, for his piece on his website involves much more wishful thinking and pixie dust than fact.
While he may have felt compelled to add his two cents to the latest controversy hitting the news, the irony is almost too much to bear when he claims to be a "show me the science" doctor, for his piece on his website involves much more wishful thinking and pixie dust than fact. Consider just a few of his claims -
"Cultures who traditionally practice safe co-sleeping, such as Asians, enjoy the lowest incidence of Sudden Infant Death Syndrome (SIDS)."
This statement is often thrown out by those who lack an understanding regarding world-wide epidemiological research. The way infant deaths are investigated, diagnosed and reported often vary widely from country to country often making it impossible to draw comparisons. For example Japan only has a medical examiner system in a just few areas with autopsies and death scene investigations not mandatory. "Taiwan and Japan both record suffocation rates that are higher than SIDS rates, and together these two causes of death sum up to values similar to those for SIDS in western countries. We include accidental suffocation diagnoses in SIDS, taking the view that from a western perspective both terms would be `synonymous.'(1) Hiroshi Nishida, chairman of the maternal and perinatal center at Tokyo Women's Medical University reported that Japanese researchers "feel ashamed every time we go abroad to make presentations of our research, because no one trusts our data."(2) Although it has risen in recent years, some studies have shown Thailand's under-reporting of infant death to be at 45%.(3) Hauck and Tanaube found "Even with similar definitions and protocols, there can be large differences in assignment of cause of death, with some pathologists underdiagnosing SIDS and others applying the diagnosis too liberally."(3) It's clear that no one even slightly knowledgeable of international research on sleep related infant death would attempt to make such comparisons.
Trusted research by Dr. James McKenna, Director of the Mother-Baby Sleep Laboratory of the University of Notre Dame, showed that mothers and babies who sleep close to each other enjoy similar protective sleep patterns. Mothers enjoy a heightened awareness of their baby’s presence, what I call a “nighttime sleep harmony,” that protects baby. The co-sleeping mother is more aware if her baby’s well-being is in danger.
McKenna's research never found any of the mother/infant sleep patterns nor the central apnea experienced by bedsharing babies to be harmful or protective. Ever. To state such is to misrepresent McKenna's research. You may read his work in full here .
Babies who sleep close to their mothers enjoy “protective arousal,” a state of sleep that enables them to more easily awaken if their health is in danger, such as breathing difficulties.
There is no study in existence that has shown any arousals to be protective. None. Again, this is a complete misrepresentation of the research based in wishful thinking - not in results and not in science.
More infant deaths occur in unsafe cribs than in parents' bed.
This is alarmingly inaccurate. Over a decade of research clearly demonstrates that the vast majority of babies aren't dying in cribs. Here's just a sampling - “Bed sharing showed an increased risk of dying accidentally, when compared with infants sleeping in designated infant containers.” (5) “Several factors related to the sleep environment during last sleep were associated with higher risk of SIDS: … bed sharing overall, bed sharing with parent(s) alone, and bed sharing in other combinations.”(6) “Bed-sharing was involved in most of the unintentional suffocation deaths (90.9%) and the SIDS deaths (70.0%). All unintentional suffocation deaths (100%) and the majority of SIDS deaths (77.5%) took place in a non-crib sleeping environment….The study demonstrates how CDR provides enhanced documentation of risk factors to help steer prevention efforts regarding SUID deaths in a community and reaffirms infants in an unsafe sleep environment have an increased risk of death.” (7) "“Bed sharing was associated with 2 times greater risk of SIDS compared with not bed sharing. .. bed sharing was still associated with an increased risk of SIDS, even when the infant was not using a pillow or sleeping on a firm surface ..." (8) "“Babies were found on a sleep surface that was not designed for infants (adult bed, sofa, or chair) in more than 75% of the deaths. Bedding covered the baby’s head or face in nearly 30% of the cases. A shared sleep surface was the site of death in almost half the cases.” (9) "“Bed-sharing appears to increase the proportion of unexplained deaths, regardless of the position of the infant.” (10)
Co-sleeping tragedies that have occurred have nearly always been associated with dangerous practices, such as unsafe beds, or parents under the influence of substances that dampen their awareness of baby.
Yes of course unsafe beds and drunk parents are dangerous but for a young infant, the adult bed itself is inherently unsafe and dangerous. There is no getting around that. Certainly deaths can and do occur with drunk and drugged parents, yet there are still too many deaths occurring to sober, attentive mothers. Preventing infant deaths is an across-the-board message. We don't ignore water safety around children or forgo a car seat just because we're sober or because we think we're in a superior socioeconomic group. It applies to all of us, whether we'd like to believe we are immune or not.
Research shows that co-sleeping infants cry less during the night, compared to solo sleepers who startle repeatedly throughout the night and spend 4 times the number of minutes crying. Startling and crying releases adrenaline, which can interfere with restful sleep and leads to long term sleep anxiety.
Sears claimed in the above statements that arousals are protective. Which is it? Deeper sleep or arousals? One can't have it both ways.
Infants who sleep near to parents have more stable temperatures, regular heart rhythms, and fewer long pauses in breathing compared to babies who sleep alone. This means baby sleeps physiologically safer.
McKenna's research also demonstrated some of these features with the baby sleeping safely alongside the mother, in their own safe crib. It's a win-win situation that keeps your baby away from a greater risk of death.
A recent large study concluded that bed sharing did NOT increase the risk of SIDS, unless the mom was a smoker or abused alcohol.
Again, Dr. Sears has some reading and catching up to do. The actual research reads -
“Epidemiologic evidence shows that there is little or no increased risk for SIDS among infants of nonsmoking mothers but increased risk among infants of smoking mothers and younger infants (less than 8-11 weeks of age) of nonsmoking mothers. It seems prudent to discourage bedsharing among all infants less than 3 months old. Young infants brought to bed to be breastfed should be returned to a crib when finished…Putting an infant of a nonsmoking mother to sleep in an adult bed should be delayed until 3 months of age.”(11) “Sharing a sleep surface was associated with SIDS .. The association remained if mother did not smoke or the infant was breastfed … Bedsharing is associated with an increased risk of SIDS for infants less than 11 weeks of age.”(12) “For mothers who did not smoke during pregnancy, OR for bed-sharing was very small… and only significant during the first 8 weeks of life.” (One way to phrase this in a one sentence headline is: Co-sleeping with children under 2 months old was a significant risk factor for SIDS.) (13) “Infants aged less than 12weeks born of non‐smokers are at increased risk of SIDS with bed sharing compared with infants of non‐smoking mothers not bed sharing.” (14) “Sharing a sleep surface was associated with SIDS .. The association remained if mother did not smoke or the infant was breastfed … Bedsharing is associated with an increased risk of SIDS for infants less than 11 weeks of age.” (15)
References
(1) Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at Death, Pediatrics Vol. 107 No. 3 March 1, 2001 pp. 530 -536
(2) http://www.japantimes.co.jp/text/nn20020618b3.html
(3) Int J Epidemiol. 1990 Dec;19(4):997-1000. Why are Thai official perinatal and infant mortality rates so low?
(4) International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action, Pediatrics Vol. 122 No. 3 September 1, 2008 pp. 660 -666
(5) Sudden infant death syndrome in South Australia 1968-97. Part 3: is bed sharing safe for infants? J Paediatr Child Health 2000 Dec 36:552-4
(6)Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study Pediatrics 2003; 111: 1207-1214
(7) Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting. Inj Prev. 2011 Feb;17 Suppl 1:i23-7
(8)Bed sharing among black infants and sudden infant death syndrome: interactions with other known risk factors. Acad Pediatr. 2010 Nov-Dec;10(6):376-82.
(9)Unsafe Sleep Practices and an Analysis of Bedsharing Among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths. Pediatrics Vol. 106 No. 3 September 1, 2000 pp. e41
(10) Sleep position and bed-sharing in sudden infant deaths: an examination of autopsy findings. J Pediatr. 2001 Feb;138(2):212-7
(11) Lahr MB, Rosenberg KD, Lapidus JA. Bedsharing and maternal smoking in a population-based survey of new mothers. Pediatrics. 2005 Oct; 116(4):e530-42.
(12) Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. J Pediatr. 2005 Jul;147(1):32-7
(13) Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004; 363: 185-91
(14) Recommendations for sudden infant death syndrome prevention: a discussion document. Arch Dis Child. 2007 February; 92(2): 155–159.
(15) Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Arch Dis Child. 2003 Dec;88(12):1058-64.
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