Many studies have demonstrated a variety of benefits from breastfeeding, including lowering the risk of sudden infant death syndrome (SIDS). The first study linking breastfeeding with overall lower infant mortality was presented at the Pediatric Academic Society meeting in San Francisco on May 2, 2004 (Dr. Benjamin’s Spock’s birthday). Most babies do well however they are fed.

But, an analysis of 8944 U.S. babies demonstrated that those who were breastfed had a 21 percent lower chance of dying for any reason during the first year. Detailed results of the study appear online in the May, 2004 Pediatrics.

The longer children were breastfed, the greater the effect.

In the study, the risk of death from SIDS was reduced by 16 percent in breastfed babies; the risk of death from injury by 31 percent. The good news is that among non-breastfed babies in the U.S., age one month to one year, about 997.3 out of 1000 will survive. Among those who are breastfed, about 997.9 will survive.

The 0.6 per 1000 difference seems small, but with about 4 million babies born each year, this difference would be about 2,400 babies lives in the U.S. alone. Around the world, 132 to 135 million babies are born each year . 97 out of 100 babies are not born in the U.S.

On May 3, 2004 the estimated U.S. population is over 293 million. But the world population is 6.4 billion. More than 19 out of twenty people in the world do not live in the U.S.

Encouraging breastfeeding is an important part of improving children’s health around the world.

A SIDS Silver Lining

Breastfed babies have longer sleep cycles than formula-fed babies, according to a study in the January 2004 Archives of Diseases in Childhood, but the breastfed babies are also more easily awaken. This might help to prevent SIDS. In the study, researchers used nasal air jets of varying force in an attempt to awaken the sleeping babies (something exhausted parents might shudder even to consider!). Formula-fed babies are tougher to wake up mid sleep cycle – much like babies who sleep on their tummies or who are exposed to second-hand smoke.

The authors recommend breastfeeding babies at least through the peak time of SIDS, between 2 and 4 months of age, so that babies won’t sleep as soundly. To me, this also suggests a word of encouragement to parents whose babies wake up so easily at night. Perhaps the very trait that is exasperating you now, is also thanklessly protecting the baby you love, so that you will be able to enjoy that precious little treasure when you’ve caught up on your sleep!

The U.S. Consumer Products Safety Commission and the JPMA have launched a new national safety campaign urging parents not to ever bring babies to sleep with them, but to always put them to sleep in cribs that meet current safety standards. (Note: the JPMA is the Juvenile Products Manufacturer Association – the association for crib manufacturers). This warning was issued because a total of 180 children (out of more than 12 million in the age range) died in an adult bed during the three years studied. This is certainly tragic. BUT, during the same period, many thousands died in cribs! I can see no justification for warning parents never to sleep with their kids!

Which is really safer? The only way to know is to learn how many kids sleep where, and for how long — statistics we just don’t have yet. But we do know a lot about the kids who die.

A recent review of all the SIDS cases in Alaska over a period of six years was published in the October 2001 issue of Pediatrics. It was consistent with previous studies. Far more important than where a child slept was the sleeping position and the parents use of tobacco, alcohol, antihistamines, or other drugs. During 6 years, 130 children died of SIDS. Only 2 children died face up in a crib; only one died face up in bed with a non-drug-using parent on a non-water mattress. Fully 98 percent of cases were associated with other risk factors.

In May 2002 the U.S. Consumer Product Safety Commission announced their major campaign to reach new and expectant parents, day care centers, hospitals, medical facilities, and retail outlets with their message to use cribs, and never to sleep with a baby. The announcement was made at a press conference at the annual International Juvenile Products Show in Dallas, Texas. I called the CPSC to see if there was any science or reason for their promotion. They offered none. What a disservice to parents — especially in light of what the CPSC calls their “significantly limited monetary and staff resources”. Instead of spending so much on a recommendation without a shred of proof, I wish their efforts had targeted the other 98 percent of SIDS cases.

Parents who choose to sleep with their babies (a wonderful choice for many families) should be taught how to do it safely. Anything that makes parents more difficult to wake up or anything that hinders babies’ ability to breathe should be avoided.

Babies are safer sleeping next to someone who is aware of their presence and easily awoken. Usually, this is the mother. Fathers, siblings, and babysitters do not tend to wake up as easily when needed, though there are exceptions.

Whoever you are, don’t sleep with a baby if you are taking something (alcohol, antihistamines, or other drugs) that makes you less aware of the baby when you sleep. The same holds true if you are so sleep-deprived that you would have difficulty waking up if the baby were in need.

Tobacco smoke, adult obesity, over-bundling, excess bedding, waterbeds, couches, and chemical irritants (fragrances that might irritate a baby’s nose and clog the air passages) could all make breathing dangerously difficult for babies.

Teaching babies to sleep in their own cribs is a good option for some families; sleeping with their babies is a good option for others. Many babies sleep in a crib most of the night, and then join the parents after the last feeding for some snuggle and sleep time together before starting the day.

Whatever arrangement you choose, enjoy these unrepeatable months when your child is a baby, and learn what you can about what helps you and your baby to thrive.

Children exposed to the most cigarette smoke have the lowest levels of vitamin C in their blood – regardless of how much fruit and vegetables they eat or the vitamins they take – according to a study of nearly 3000 children published in the March 2001 issue of Pediatrics.

Tobacco smoke contains free radicals – a cause of both disease and aging. Here, “an apple a day” doesn’t do the trick.

Kids use up their stores of vitamin C trying to protect themselves from the smoke. But it is not enough.

Secondhand smoke is implicated in sudden infant death syndrome, asthma, heart disease, cancer, and many infections (2 million ear infections alone, each year in the US).

Most parents understand that smoke harms kids, but one-fifth of parents surveyed still allow people to smoke around their children!

Doctors first scoffed at the now-accepted idea that ulcers were often caused — not by excess acids — but by infections with the bacteria called Helicobacter pylori. Now evidence suggests that infection with this same bacteria may also be responsible for many cases of sudden infant death syndrome.

An article published in the October 2000 Archives of Disease in Childhood reported evidence of Helicobacter pylori in 88% of examined children who had died from SIDS (it’s found in about 2% of the general population).

If it turns out that this bacteria does cause SIDS, this could open the door for effective tests and treatments to prevent this devastating tragedy.

A study in the August 2000 issue of the Archives of Disease in Childhood found that parents who smoke increase the risk of meningococcal meningitis for their children by about 200% for every 20 cigarettes smoked at home on an average day (220% if the mother smokes, 170% if only the father smokes).

Meningitis can strike suddenly and without warning.

Keeping your kids in a smoke-free environment is one way you help keep them safe — from this and from other childhood problems ranging from ear infections to SIDS.

SIDS, or Sudden Infant Death Syndrome, is defined as the sudden, unexpected and unexplained death of any infant or young child.

SIDS accounts for about half of the deaths that occur between one month and one year of age.

Genetics plays a large role. SIDS is more common in boys than in girls, and it is more common in some population groups (Black, Native American, Hawaiian, Filipino, Maori).

Most of the affected infants have damaged or immature brainstems, making it difficult for them to wake up when they are in trouble. A recent series of autopsies has demonstrated visible brain abnormalities in over 70 percent of the SIDS babies examined (Pediatric Neurology, Jul 1998).

While parents often feel horribly responsible after SIDS, sometimes there is nothing they could have done to prevent it.

Almost 35,000 healthy babies in Italy had EKGs performed in the first week of life. They were then followed for a year. Most of those who ended up dying of SIDS had an abnormality on their original EKGs (a prolonged QTc interval). Those with this abnormality were more than 40 times more likely than their peers to die from SIDS (New England Journal of Medicine, Jun 11, 1998).

Anything that causes less oxygen to get to the baby in the uterus will increase his or her risk. On average, smoking during pregnancy doubles the chances, and the odds increase with each cigarette. Other drugs of abuse such as cocaine or heroine increase the risk by as many as thirty times.

The media often focus on “crack babies,” but tobacco use continues in approximately 25% of all pregnancies in the United States (J Pharmacol Exp Ther, Jun 1998). Nicotine exposure is responsible for many more SIDS deaths than any other drug of abuse, including cocaine. Stopping smoking during pregnancy is the most immediate step we can take to save infants’ lives.

Minimizing caffeine use during pregnancy is another way to protect your child. Those babies whose mothers drank 4 or more cups of coffee per day could have up to twice the risk of SIDS (Arch Dis Child, Jan 1998).

SIDS is more common in babies who sleep in warm environments, who are over-bundled, who sleep in rooms with space heaters, who are exposed to cigarette smoke, who sleep on soft surfaces, who do not use pacifiers, and those who sleep face down or in a prone position.

The rate of SIDS is higher in those babies who do not receive timely well-child care and immunizations.

Putting children to sleep on their backs lowers the risk of SIDS by about three times. Use firm bedding in a slightly cool room.

Breastfeeding may also reduce the risk of SIDS, but the studies remain inconclusive.

The SIDS rate has dropped by more than half in the last few years to 0.7 per one thousand live births in the United States. Changes in sleeping positions are being credited for the reductions (AAP News, Jan 98).

The peak period for SIDS is between two and four months old. It is very rare before one month of age, and at least 95% of all the cases have occurred before children reach six months old.