I’m excited about this series. I’ve long been skeptical of the benefits of back sleeping, but recently this issue has cropped back up for me. I have a baby who has been in the nicu for 6 weeks now. They rotate her regularly to avoid head misshaping, but she spends the least amount of time on her back because she breathes poorly and can’t rest well in that position. As soon as they turn her onto her belly her breathing immediately improves, often drastically. She’s on a pulse ox so this is clearly observable. Amazing when public health advice can suddenly disappear completely in a medical setting.
Thank you for this anecdotal corroboration of the research, Dana. What courage it takes to be a mom; I hope your baby grows strong quickly, and that this difficult time becomes a distant memory. Wishing your daughter a long and happy life!
By the way, are we saying the optimum is to involve a mixture? I mean babies sleep for like 16 hours per day. Is this an area where we think the optimum might actually be moderation? I mean who's to say the best bet isn't to try 'rotate' throughout the day in different positions? Maybe ~ 5/5/5 side, front, back?
My fellow professionals in the developmental realm appreciate having some actual science behind the ‘back to sleep’ disaster we observe. The lack of tummy time has messed with an entire generation’s motor development. Thank you!
My wise mother told me to do what I needed to do to allow my kids to sleep- she wisely said that not sleeping was a risk of its own in a fast growing brain and body. I checked up on them frequently… they both slept so much better.
New borns are not usually capable of rolling over at birth but the staff was surprised to see my second son do just that in the delivery room. After that if I put him down on his back he would not stay there and would insist on rolling over to a prone position.
The Back to Sleep Campaign was initiated in 1994 to implement the American Academyof Pediatrics’ (AAP) recommendation that infants be placed in the nonprone sleepingposition to reduce the risk of the Sudden Infant Death Syndrome (SIDS). This paper offersa challenge to the Back to Sleep Campaign (BTSC) from two perspectives: (1) thequestionable validity of SIDS mortality and risk statistics, and (2) the BTSC as humanexperimentation rather than as confirmed preventive therapy.The principal argument that initiated the BTSC and that continues to justify itsexistence is the observed parallel declines in the number of infants placed in the pronesleeping position and the number of reported SIDS deaths. We are compelled tochallenge both the implied causal relationship between these observations and the SIDSmortality statistics themselves.
Thank you, David. I do reference Pelligra et al (2005) in the last segment of this Back-to-Sleep series. (This is the only problem with breaking my very long article into parts: brilliant Sensible Medicine readers have questions that are addressed in subsequent posts!)
I stand corrected on the plagiocephaly issue. It has clearly increased, but may also have other contributing causes. I am curious as to its long term clinical significance, management, and outcome as parents are advised to include a variety of other mitigating techniques. Looking forward to the future episodes.
Pediatrician here, see plagiocephaly routinely now. No complications unless severe (mainly this is in very premature babies), resolves almost always by age 2 years, so very slow but gets better. The only worry is some people (and sadly doctors) push expensive helmets and therapy, which makes no difference by age 2 years.
I assume by mitigating techniques you mean "tummy time," Denis. A future segment of the series talks about tummy-time recommendations and the difficulty of compliance. (Sensible Medicine readers are great at anticipating the issues that will be discussed!)
I also found the following study finding a brain abnormality correlated with SIDS interesting, I follow it up with other research showing that this could be related to mercury exposure:
"The abnormality affects the hippocampus, a brain area that influences such functions as breathing, heart rate, and body temperature."
"In the SIDS cases, the researchers found that the dentate gyrus, at certain intervals along its length, contained a double layer of nerve cells instead of the usual single layer. This abnormality is called FOCAL GRANULE CELL BILAMINATION."
"The hippocampal abnormality they found in the SIDS cases is similar to a hippocampal abnormality found at autopsy in some cases of temporal lobe epilepsy."
"In earlier work, Dr. Kinney and her colleagues found that many infants who died of SIDS had abnormalities in serotonin metabolism."
Relationship to mercury?
Ex Vivo Imaging of Postnatal Cerebellar Granule Cell Migration Using Confocal Macroscopy
"During their migration in the different cortical layers of the cerebellum, granule cells can be exposed to neuropeptide agonists or antagonists, protease inhibitors, blockers of intracellular effectors or even toxic substances such as alcohol or methylmercury to investigate their possible role in the regulation of neuronal migration."
Abnormal neuronal migration in human fetal brain due to mercury poisoning
"Neuropathologic study revealed a disturbance in the development of the brain in both cases, consisting essentially of an incomplete or abnormal migration of neurons to the cerebellar and cerebral cortices. The laminar cortical pattern was disturbed in many regions of the cerebral cortex, as shown by irregular groupings and columnar arrangements of cortical neurons. Many heterotopic neutrons, both isolated and in groups, were found in the white matter of cerebrum and cerebellum. Prominent astrocytosis was also noted in the white matter. These findings indicate a high degree of vulnerability of human fetal brain to maternal intoxication of mercury and that the effects can be selective. The nature and pattern of the lesions demonstrate that mercury caused faulty development and not destructive focal tissue damage as has been observed in mercury intoxication in adults and children."
Granular cell dispersion and bilamination: two distinct histopathological patterns in epileptic hippocampi?
"The dentate gyrus is believed to play a key role in the pathogenesis of temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS)."
"in 10% of the cases combined with a focal or extensive “bilaminar arrangement” of neurons (Thom et al. 2002). Although this particular arrangement of granular neurons has been recognized by many investigators,...".
If people were really interested in preventing SIDS they should refuse some if not many of the vaccines “required” of the CDC( the same folks still pushing lethal COVID shot with secret ingredients)….monitors of pulse/O2 and breathing of kids during this critical time of greatest vulnerability are surely about….The Peds Assoc just like the OBGYN folks pushed the COVID vac without ANY meaningful studies showing it safe and then wanted to hide such for 75 yrs!!?? My kids had WAY LESS vacs required by the CDC…there is little need for the vast ! numbers now…and they have never been double blinded studies…and the 9th Circuit in CA has said the COvID is not even a vac…the most liberal Appeals Court in the USA. Save your kids from CdC tyranny.
Looking so forward to part 2! This is a topic that keeps me kinda glad that my DNA dies with me. I know how much I love my step kids and now grandkids (I’m the only gramps two of them have!), the thought of a SIDS death petrified me for those first months. Every other aspect of life is pretty acceptable to me; this one is always tough.
A.M. Schimberg and Jim Ryser--A future segment of this series addresses the rate of SIDS, which varies according to multiple risk factors, many of which the Safe to Sleep campaign doesn't discuss. I think the subtext of both A.M.'s reply and Jim's worry is important: most families would like to know the overall prevalence of SIDS (i.e. unconditional probability) AND how their particular family characteristics--infant and maternal health, genetics, demographics, baby-care practices, etc.--affect their chance of experiencing SIDS (i.e. conditional probability).
My kids are 10, 12, and 14 now, but I remember them not sleeping well at all on their backs. I did it because if they died of SIDS I would feel it was my fault. What a relief when they could roll onto their stomachs!
I have a collection of old baby care books. Prior to Dr Spock some books did say that back sleep may be “safer” (no reason given). However, the books told the parent to do whatever way works best for the baby, so no guilt.
My oldest did get a flat spot on his head, but it fixed itself over time.
1st kid skull flattened with back sleep. I am a light sleeper so once we shifted to more co-sleeping all of us slept better, easy to breast feed and fall back to sleep.
I am very much looking forward to the rest of this series! My 6 year old is in OT to sort out his myriad retained primitive reflexes which are affecting every area of his life, including focus, concentration, and emotional regulation. As I watch the positioning of many of the exercises we’re asked to do at home each day, and how the first thing our lovely therapist tackled was sleep and sleep position, I have wondered more than once if sleeping on his back as an infant (hello, postpartum anxiety) really served him all that well.
In my year as a pediatric intern, the four cases we had of SIDS in the ED were all co-sleeping related. There’s nothing quite like the horror of mothers who realize they rolled over onto their baby. I think there’s most definitely a role for babies sleeping on their stomachs maybe at a certain age or when an adult is awake. It’s also a good idea to see if “back to sleep” was so successful maybe because of confounding advice of “don’t co-sleep, sleep on a flat surface, don’t smoke around them.” I think though that we make it clear to parents “while the evidence for back versus front may be a bit murky, it is of utmost importance to avoid sleeping with your baby lying next to you or in your arms.”
Co-sleeping is yet another rabbit hole I'm sorely tempted to fall down. It seems from the literature that particular types of co-sleeping can be done safely (Sweden is a country with low SIDS rates and high co-sleeping rates), and that there may be health benefits to the baby and the mom. Your point about couch-sleeping with baby in arms is important. Related: many SIDS deaths happen in devices where the baby can be in a "crumpled" position--car seats, bouncers, strollers--and I'm sort of alarmed by the number of parents I see who don't attend to the neck and face position of their infants in wraps and carriers.
I was an anthropology major in college before I went into medicine and was fascinated that mothers in virtually every society throughout recorded history co-slept safely with their infants. But when I became a mother in 1999, I was aware of the Safe Sleep campaign and dutifully tried to keep my daughter on her back. She was a colicky, eczematous mess and I was exhausted by our mutual lack of sleep. So....in near-desperation, I turned to co-sleeping. I made sure that I did not drink alcohol (I wasn't anyway) and slept in a cool room with only a light sheet over me, with no heavy blankets or fluffy bedding. If I'd had a bed partner I might not have co-slept, but I was single, so no worries there. The positive change in her sleep was nearly instantaneous, even with the colic. I am most excited to read the rest of your series as I anticipate my daughter having children in the near future!
Yes absolutely! There’s cool bassinets that can be secured to the adults mattress where you are physically unable to roll onto the baby, but they can smell, see and even touch your hand/arm. Options like those have merit. I completely agree with the emphasis of scrunching! Airway cutoff is a huge factor in safe sleep
As a mother, I would love to see more support for tired new moms. I think that would help alleviate the co-sleeping problems. I didn’t plan on co-sleeping, but with my first child I had postpartum anxiety (retroactively self-diagnosed) and I was terrified to go to sleep at night because then I wouldn’t be able to stop my baby from unexpectedly dying from SIDS (ironic, right?) “Some babies just randomly die in their sleep and we don’t know why!” I put her in a little metal framed bassinet in bed with me so I could watch her breathe while she slept and when she outgrew that, I relied on a website that taught 7 pillars of safe co-sleep. Worked out OK but it was rough for several months.
I look forward to this series, in the early eighties I was actively involved in the then world’s largest cluster of SIDS in Bridgewater, Tasmania. Along with one colleague, we were the PCP ‘s (GP’s) in the only practice in this physically and socially isolated public housing settlement.
Over the course of 18 months 20, (5%) of all out live births died of SIDS, we were the first responders at all of these cases, as GP’s were still on call in those days.
We were involved in extensive environmental and clinical research studies with the University of Tasmania which drew a long series of negative results, but our observations lead us to a specific possible cause which we addressed and the deaths stopped quite suddenly.
Our observations led future researchers to focus on airways obstruction, and eventually led to the back sleeping recommendations.
At that time, our possible cause seemed isolated, and the literature to then had described over thirty factors as possible causes for SIDS, we did not have enough evidence to publish another associative link, and so passed our thoughts on to an active research team on this topic.
John, if you are interested, I would be happy to tell the story once this series is finished.
Oh, and one more thing, how do you construct a double blind study that lets newborn infants die?
Thank you for your comment, Paul. I'm eager to hear your thoughts in the coming weeks. I almost wrote a side paper on the history of SIDS research (and just typing that sentence makes me want to dive in again). Your observations in Tasmania and Susan Beal's in Adelaide seem to have been the spark that lit Dr. Beal's fire for the rest of her career. As for your question, double-blind would not be possible, but one could randomize sleep position. If all the other safe-sleep recommendations were followed, I believe it would be an ethical study.
An RCT of sleep position is interesting to explore as a posibility.
Ethical? Perhaps.
Pragmatic?
I'm skeptical:
- What would the rough numbers needed to recruit in each arm to power such a trial?
- It might be a hard sell to new parents to accept joining such a trial. Not only because of the "we want to randomize your baby in 1 of 2 groups to see if it will die of SIDS or not" but also the purely organizational aspect of extra-work involved in probably their busiest time of life.
My children hated being placed in their backs. Pressure on the abdomen relieves gas. All 4 slept thru the night around 12-16 weeks. Wasn’t honest with pediatrician. Wouldn’t go back and change it if I could. Remember tummy time? This was imperative because of back to sleep.
I’m excited about this series. I’ve long been skeptical of the benefits of back sleeping, but recently this issue has cropped back up for me. I have a baby who has been in the nicu for 6 weeks now. They rotate her regularly to avoid head misshaping, but she spends the least amount of time on her back because she breathes poorly and can’t rest well in that position. As soon as they turn her onto her belly her breathing immediately improves, often drastically. She’s on a pulse ox so this is clearly observable. Amazing when public health advice can suddenly disappear completely in a medical setting.
Thank you for this anecdotal corroboration of the research, Dana. What courage it takes to be a mom; I hope your baby grows strong quickly, and that this difficult time becomes a distant memory. Wishing your daughter a long and happy life!
By the way, are we saying the optimum is to involve a mixture? I mean babies sleep for like 16 hours per day. Is this an area where we think the optimum might actually be moderation? I mean who's to say the best bet isn't to try 'rotate' throughout the day in different positions? Maybe ~ 5/5/5 side, front, back?
My fellow professionals in the developmental realm appreciate having some actual science behind the ‘back to sleep’ disaster we observe. The lack of tummy time has messed with an entire generation’s motor development. Thank you!
My wise mother told me to do what I needed to do to allow my kids to sleep- she wisely said that not sleeping was a risk of its own in a fast growing brain and body. I checked up on them frequently… they both slept so much better.
New borns are not usually capable of rolling over at birth but the staff was surprised to see my second son do just that in the delivery room. After that if I put him down on his back he would not stay there and would insist on rolling over to a prone position.
Fascinating! Did he acquire other gross motor skills sooner than average?
Mandatory reading:
A reassessment of the SIDS Back to Sleep Campaign
https://pubmed.ncbi.nlm.nih.gov/16075152/
https://onlinelibrary.wiley.com/doi/epdf/10.1100/tsw.2005.71
The Back to Sleep Campaign was initiated in 1994 to implement the American Academyof Pediatrics’ (AAP) recommendation that infants be placed in the nonprone sleepingposition to reduce the risk of the Sudden Infant Death Syndrome (SIDS). This paper offersa challenge to the Back to Sleep Campaign (BTSC) from two perspectives: (1) thequestionable validity of SIDS mortality and risk statistics, and (2) the BTSC as humanexperimentation rather than as confirmed preventive therapy.The principal argument that initiated the BTSC and that continues to justify itsexistence is the observed parallel declines in the number of infants placed in the pronesleeping position and the number of reported SIDS deaths. We are compelled tochallenge both the implied causal relationship between these observations and the SIDSmortality statistics themselves.
Thank you, David. I do reference Pelligra et al (2005) in the last segment of this Back-to-Sleep series. (This is the only problem with breaking my very long article into parts: brilliant Sensible Medicine readers have questions that are addressed in subsequent posts!)
I stand corrected on the plagiocephaly issue. It has clearly increased, but may also have other contributing causes. I am curious as to its long term clinical significance, management, and outcome as parents are advised to include a variety of other mitigating techniques. Looking forward to the future episodes.
Pediatrician here, see plagiocephaly routinely now. No complications unless severe (mainly this is in very premature babies), resolves almost always by age 2 years, so very slow but gets better. The only worry is some people (and sadly doctors) push expensive helmets and therapy, which makes no difference by age 2 years.
I assume by mitigating techniques you mean "tummy time," Denis. A future segment of the series talks about tummy-time recommendations and the difficulty of compliance. (Sensible Medicine readers are great at anticipating the issues that will be discussed!)
Readers might be interested in my writeup after attending the 2002 IOM "safety review" on SIDS:
My Take on the 2002 IOM Immunization Safety Review on Sudden Infant Death Syndrome
https://dfoster.substack.com/p/my-take-on-the-2002-iom-immunization
Great Substack with many references on SIDS
https://amidwesterndoctor.substack.com/p/a-century-of-evidence-has-accumulated
I also found the following study finding a brain abnormality correlated with SIDS interesting, I follow it up with other research showing that this could be related to mercury exposure:
Brain abnormality found in group of SIDS cases
http://www.nih.gov/news-events/news-releases/brain-abnormality-found-group-sids-cases
"The abnormality affects the hippocampus, a brain area that influences such functions as breathing, heart rate, and body temperature."
"In the SIDS cases, the researchers found that the dentate gyrus, at certain intervals along its length, contained a double layer of nerve cells instead of the usual single layer. This abnormality is called FOCAL GRANULE CELL BILAMINATION."
"The hippocampal abnormality they found in the SIDS cases is similar to a hippocampal abnormality found at autopsy in some cases of temporal lobe epilepsy."
"In earlier work, Dr. Kinney and her colleagues found that many infants who died of SIDS had abnormalities in serotonin metabolism."
Relationship to mercury?
Ex Vivo Imaging of Postnatal Cerebellar Granule Cell Migration Using Confocal Macroscopy
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4542730/?tool=pmcentrez
"During their migration in the different cortical layers of the cerebellum, granule cells can be exposed to neuropeptide agonists or antagonists, protease inhibitors, blockers of intracellular effectors or even toxic substances such as alcohol or methylmercury to investigate their possible role in the regulation of neuronal migration."
Abnormal neuronal migration in human fetal brain due to mercury poisoning
https://www.etde.org/etdeweb/details.jsp?query_id=1&page=0&osti_id=7103760
"Neuropathologic study revealed a disturbance in the development of the brain in both cases, consisting essentially of an incomplete or abnormal migration of neurons to the cerebellar and cerebral cortices. The laminar cortical pattern was disturbed in many regions of the cerebral cortex, as shown by irregular groupings and columnar arrangements of cortical neurons. Many heterotopic neutrons, both isolated and in groups, were found in the white matter of cerebrum and cerebellum. Prominent astrocytosis was also noted in the white matter. These findings indicate a high degree of vulnerability of human fetal brain to maternal intoxication of mercury and that the effects can be selective. The nature and pattern of the lesions demonstrate that mercury caused faulty development and not destructive focal tissue damage as has been observed in mercury intoxication in adults and children."
Granular cell dispersion and bilamination: two distinct histopathological patterns in epileptic hippocampi?
http://www.jle.com/en/revues/epd/e-docs/granular_cell_dispersion_and_bilamination_two_distinct_histopathological_patterns_in_epileptic_hippocampi__276425/article.phtml?tab=texte
"The dentate gyrus is believed to play a key role in the pathogenesis of temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS)."
"in 10% of the cases combined with a focal or extensive “bilaminar arrangement” of neurons (Thom et al. 2002). Although this particular arrangement of granular neurons has been recognized by many investigators,...".
If people were really interested in preventing SIDS they should refuse some if not many of the vaccines “required” of the CDC( the same folks still pushing lethal COVID shot with secret ingredients)….monitors of pulse/O2 and breathing of kids during this critical time of greatest vulnerability are surely about….The Peds Assoc just like the OBGYN folks pushed the COVID vac without ANY meaningful studies showing it safe and then wanted to hide such for 75 yrs!!?? My kids had WAY LESS vacs required by the CDC…there is little need for the vast ! numbers now…and they have never been double blinded studies…and the 9th Circuit in CA has said the COvID is not even a vac…the most liberal Appeals Court in the USA. Save your kids from CdC tyranny.
I am a pediatric hospitalist and sometimes round in nurseries. Goodness, I really want CME this is really good material.
Looking so forward to part 2! This is a topic that keeps me kinda glad that my DNA dies with me. I know how much I love my step kids and now grandkids (I’m the only gramps two of them have!), the thought of a SIDS death petrified me for those first months. Every other aspect of life is pretty acceptable to me; this one is always tough.
It's because the advertising for this campaign was relentless and terrifying!
A.M. Schimberg and Jim Ryser--A future segment of this series addresses the rate of SIDS, which varies according to multiple risk factors, many of which the Safe to Sleep campaign doesn't discuss. I think the subtext of both A.M.'s reply and Jim's worry is important: most families would like to know the overall prevalence of SIDS (i.e. unconditional probability) AND how their particular family characteristics--infant and maternal health, genetics, demographics, baby-care practices, etc.--affect their chance of experiencing SIDS (i.e. conditional probability).
Thank you so much!
My kids are 10, 12, and 14 now, but I remember them not sleeping well at all on their backs. I did it because if they died of SIDS I would feel it was my fault. What a relief when they could roll onto their stomachs!
I have a collection of old baby care books. Prior to Dr Spock some books did say that back sleep may be “safer” (no reason given). However, the books told the parent to do whatever way works best for the baby, so no guilt.
My oldest did get a flat spot on his head, but it fixed itself over time.
1st kid skull flattened with back sleep. I am a light sleeper so once we shifted to more co-sleeping all of us slept better, easy to breast feed and fall back to sleep.
I am very much looking forward to the rest of this series! My 6 year old is in OT to sort out his myriad retained primitive reflexes which are affecting every area of his life, including focus, concentration, and emotional regulation. As I watch the positioning of many of the exercises we’re asked to do at home each day, and how the first thing our lovely therapist tackled was sleep and sleep position, I have wondered more than once if sleeping on his back as an infant (hello, postpartum anxiety) really served him all that well.
In my year as a pediatric intern, the four cases we had of SIDS in the ED were all co-sleeping related. There’s nothing quite like the horror of mothers who realize they rolled over onto their baby. I think there’s most definitely a role for babies sleeping on their stomachs maybe at a certain age or when an adult is awake. It’s also a good idea to see if “back to sleep” was so successful maybe because of confounding advice of “don’t co-sleep, sleep on a flat surface, don’t smoke around them.” I think though that we make it clear to parents “while the evidence for back versus front may be a bit murky, it is of utmost importance to avoid sleeping with your baby lying next to you or in your arms.”
Co-sleeping is yet another rabbit hole I'm sorely tempted to fall down. It seems from the literature that particular types of co-sleeping can be done safely (Sweden is a country with low SIDS rates and high co-sleeping rates), and that there may be health benefits to the baby and the mom. Your point about couch-sleeping with baby in arms is important. Related: many SIDS deaths happen in devices where the baby can be in a "crumpled" position--car seats, bouncers, strollers--and I'm sort of alarmed by the number of parents I see who don't attend to the neck and face position of their infants in wraps and carriers.
I was an anthropology major in college before I went into medicine and was fascinated that mothers in virtually every society throughout recorded history co-slept safely with their infants. But when I became a mother in 1999, I was aware of the Safe Sleep campaign and dutifully tried to keep my daughter on her back. She was a colicky, eczematous mess and I was exhausted by our mutual lack of sleep. So....in near-desperation, I turned to co-sleeping. I made sure that I did not drink alcohol (I wasn't anyway) and slept in a cool room with only a light sheet over me, with no heavy blankets or fluffy bedding. If I'd had a bed partner I might not have co-slept, but I was single, so no worries there. The positive change in her sleep was nearly instantaneous, even with the colic. I am most excited to read the rest of your series as I anticipate my daughter having children in the near future!
Yes absolutely! There’s cool bassinets that can be secured to the adults mattress where you are physically unable to roll onto the baby, but they can smell, see and even touch your hand/arm. Options like those have merit. I completely agree with the emphasis of scrunching! Airway cutoff is a huge factor in safe sleep
As a mother, I would love to see more support for tired new moms. I think that would help alleviate the co-sleeping problems. I didn’t plan on co-sleeping, but with my first child I had postpartum anxiety (retroactively self-diagnosed) and I was terrified to go to sleep at night because then I wouldn’t be able to stop my baby from unexpectedly dying from SIDS (ironic, right?) “Some babies just randomly die in their sleep and we don’t know why!” I put her in a little metal framed bassinet in bed with me so I could watch her breathe while she slept and when she outgrew that, I relied on a website that taught 7 pillars of safe co-sleep. Worked out OK but it was rough for several months.
I look forward to this series, in the early eighties I was actively involved in the then world’s largest cluster of SIDS in Bridgewater, Tasmania. Along with one colleague, we were the PCP ‘s (GP’s) in the only practice in this physically and socially isolated public housing settlement.
Over the course of 18 months 20, (5%) of all out live births died of SIDS, we were the first responders at all of these cases, as GP’s were still on call in those days.
We were involved in extensive environmental and clinical research studies with the University of Tasmania which drew a long series of negative results, but our observations lead us to a specific possible cause which we addressed and the deaths stopped quite suddenly.
Our observations led future researchers to focus on airways obstruction, and eventually led to the back sleeping recommendations.
At that time, our possible cause seemed isolated, and the literature to then had described over thirty factors as possible causes for SIDS, we did not have enough evidence to publish another associative link, and so passed our thoughts on to an active research team on this topic.
John, if you are interested, I would be happy to tell the story once this series is finished.
Oh, and one more thing, how do you construct a double blind study that lets newborn infants die?
Paul, perhaps by fitting the tummy sleepers (or maybe both the tummy and back sleepers) with an apnea monitor for safety? It's a thought.
Thank you for your comment, Paul. I'm eager to hear your thoughts in the coming weeks. I almost wrote a side paper on the history of SIDS research (and just typing that sentence makes me want to dive in again). Your observations in Tasmania and Susan Beal's in Adelaide seem to have been the spark that lit Dr. Beal's fire for the rest of her career. As for your question, double-blind would not be possible, but one could randomize sleep position. If all the other safe-sleep recommendations were followed, I believe it would be an ethical study.
An RCT of sleep position is interesting to explore as a posibility.
Ethical? Perhaps.
Pragmatic?
I'm skeptical:
- What would the rough numbers needed to recruit in each arm to power such a trial?
- It might be a hard sell to new parents to accept joining such a trial. Not only because of the "we want to randomize your baby in 1 of 2 groups to see if it will die of SIDS or not" but also the purely organizational aspect of extra-work involved in probably their busiest time of life.
My children hated being placed in their backs. Pressure on the abdomen relieves gas. All 4 slept thru the night around 12-16 weeks. Wasn’t honest with pediatrician. Wouldn’t go back and change it if I could. Remember tummy time? This was imperative because of back to sleep.