“Sleep Environment Risks for Younger and Older Infants” (Colvin et al, Pediatrics 2014-0401) fails to add any useful information to the sudden infant death syndrome (SIDS)/infant mortality dialogue. Like many other articles on sleep-related risks, this article lacks clear, unambiguous definitions of critical variables, omits significant documented risk factors, and conflates SIDS and other unrelated forms of infant death, drawing conclusions that the data do not support.
Specifically: (1) The bed-partner could be human or animal, drunk or sober, smoker or not, adult or child, caring mother or inattentive other. An infant sleeping with an inebriated uncle is different from an infant sleeping next to his sober breastfeeding mother. (2) “Adult bed” included adult bed, waterbed, adult mattress, bunk bed, child’s bed, sofa bed, and air mattress. (We can only presume that sofas and recliners are included. They are common shared-sleep choices, especially for mothers who have been told their bed is unsafe.) An infant sleeping on a soft sofa cushion next to that inebriated uncle is different from an infant sleeping with his breastfeeding mother in a firm, uncluttered bed. The categories “adult bed” and “person” (defined as “sleeping on the chest or in the arms of another person”) were combined as 1 category, though one is inanimate and of varying safety, and the other is animate and of varying safety. (3) Infant feeding method is never mentioned, despite the fact that formula-feeding is a risk factor for SIDS and affects the mother’s behavior during bed-sharing. (4) The words “smoking” and “smoke” do not appear in the article, yet smoking during pregnancy and in an infant’s household is a significant risk for SIDS. The authors acknowledge that “because there is no comparison group, risk cannot be determined.” Without a control group, actual risk cannot be calculated. (5) SIDS and smothering are conflated. Most SIDS risks have nothing to do with sleep location, whereas smothering and suffocation are entirely location-related. The distinction is especially important when bed-sharing is discussed. SIDS is linked to physiologic problems; suffocation results from environmental problems. (6) Bed-sharing is cited as “the predominant risk factor for younger infants” without reference to other significant risk factors or data from comparison groups. (7) The study refers to “sudden infant death syndrome and other sleep-related causes of infant mortality” but focuses almost exclusively on the “other sleep-related causes.” The combining of safe and unsafe situations in single categories is distressing but not new. The studies on which this article relies (the Ohio child death review for example1) tend to do the same, a shortcoming that the authors acknowledge but accept. The conflation of SIDS and suffocation issues is also distressing but not new. The current review, like many before it, fails to provide adequate guidance to health care professionals and is potentially damaging to families making decisions without full information about their options.
- 1.↵Presentation by Tessie Pollack, Ohio Department of Health to Ohio Collaborative to Prevent Infant Mortality, March 2014. Available at: www.odh.ohio.gov/∼/media/ODH/ASSETS/Files/cfhs/Infant%20Mortality/collaborative/presentations/3-11-14/Tessie%20Safe%20Sleep%20presentation%20for%20OCPIM%203%2011%2014.ashx
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