If I may add my two cents on a related subject... When our first baby was born, I was determined to stick to the AAP's recommendations (sleep on the back in a separate bed). But our son didn't sleep particularly well, and my wife had to get up every couple of hours to feed him.
Then we started co-sleeping (awful! terrible!), and things got much better. No more waking up at night. Did the same with our second, now doing the same with our third.
Now, AAP says that co-sleeping is dangerous and awful. But, if one looks at the data, Japan has one of the highest (if not THE highest) co-sleeping rates in the world, and it also has THE lowest SIDS rate. One may wonder, how is this possible if co-sleeping is as unsafe as AAP claims?
Maybe there are other factors at play, such as smoking, alcohol, obesity, etc. Japan is very different from the US along these dimensions.
We did co-sleeping with our second and third daughters, and it worked a lot better than separate sleeping with our oldest. A little worse for me once our second was big enough to helicopter off my wife's breast while feeding at night, kicking me in the face in the process. But the babies slept better, fed when they felt like it, and no problems.
Hi Ivan--Sweden also has high rates of co-sleeping and low rates of SIDS. This is a rabbit hole that calls to me, too. (I stumble into a lot of rabbit holes.)
Any thinker from the line of Nobel laureate Eugene Fama deserves attention. This Cochrane fella seems to have not diminished the brilliance of this gift.
I think that Beth's investigations are fascinating and an example of the invaluable benefits of the Pascallian insight of expected value.
We live in a reality of risks why not make the best choices with the use of our best thinking
This article struck a chord with me. When our first kid was born we were very overwhelmed with constant bombardment about SIDS which did not make any sense. Until we found a series of research papers from New Zealand/Australia which made sense - that the common cause of SIDS was the chemical we spray on baby mattresses as fire retardant. The chemicals are on the surface of the mattress and babies need to be on their back so that they don't breathe them in. Then we could make sense of this SIDS fearmongering and did not look back. Our kids (3) slept in whatever position they drifted into sweet dreams and we were (in my opinion) able to give them above average sleeping habits.
As a regular reader of Sensible Medicine and The Grumpy Economist, AND a 1987 graduate of the University of Chicago GSB in Health Administration, I found the series very interesting and thought-provoking. She obviously spent many hours looking into the relevant research, and like so many “known” dogmas these days, it turns out that it is not as simple as it appears. And now I want to know more about her doctoral dissertation research as I have spent the last 9 months dealing with a breast cancer diagnosed on a screening mammogram. If you’re ever in Austin, Texas or northern Wisconsin, I’d love to buy you both lunch and have a great discussion.
We must have overlapped at the GSB, Ellen! Wishing you the best possible health outcome, and the support of the people you love as you continue/finish your treatment. And consider this a reciprocal invitation if you happen to come to the Bay Area.
Fascinating article. I am a 70 year old grandfather and I can still recall standing up in the front seat of car, a no-no! (Has nothing to with the article but thought I would mention how things have changed) My Mother put us on our stomach to sleep, my daughter and grandchildren on their back. Looking forward to the remaining portions of the article.
Our three children all started out in a co-sleeper next to my side of the bed (I would change the baby and get him or her to fall back to sleep after my wife breastfed the baby). Our first child/son never slept well on his back but predictably slept like a baby on his belly. My wife would understandably get upset with me for indulging him, so I started laying him on my chest face down. My thought was that i could hear him breathing but of course we both eventually fell asleep. Sometimes he would roll off in between us (probably worse than letting him sleep on his belly). But eventually he slept in his own room (at 10 months) and would never settle on his back for long. Today he’s a 26-year old engineer and the other two who were better back sleepers are also alive and grown. I’m not sure that anything we did was fully correct but I know we drove ourselves crazy listening to the experts. All new parents can do is their best for their baby and try to keep their worries from the baby because they definitely pick up on those emotions.
I gave up very early on back- sleeping for my son. He did not sleep well on his back. I don't know if there's been mention, too, of the misshapen heads of babies and having to wear a helmet to keep flat spots from happening.
Thanks for this thought, Julie. Yes, positional plagiocephaly (PP) is covered in the series, and the need sometimes to distinguish it from an unrelated, more serious condition called craniosynostosis. Another rabbit hole I could easily fall down would be to delve into the research surrounding orthosis (helmets) for PP, as it seems that they don't affect the outcome much or at all.
That's exactly how my kid slept as an infant (the picture). I never got it, looks really uncomfortable. I'd but her on her back but she'd go back to it. I just let her and it was fine. I wouldn't be surprised if SDS being higher in daycare was because parents/family check more? I wouldn't mind awkward looking sleep positions, but I would frequently do a check to make sure she was ok.
Our solution has been to swaddle our children as long as possible. By the time they are strong enough to break out of the swaddle, they're usually rolling over. And at that point, they're free to roll onto their tummies if they want.
We just had our third baby and we made the mistake of asking for a pacifier at the hospital. It came with a note “pacifiers have been shown to reduce the rate of sids but also decrease the rate of successful breastfeeding.” They have turned a decision that should be inconsequential, whether to use a pacifier, into one that is life or death, and I’m sure the evidence to support this is garbage.
Nuance is very difficult at scale. This means that messages must be short and clear. It also means that evidence should be very clear before we start national campaigns. But there are lots of these pieces of knowledge. I was reminded this week about “don’t eat lunch meat while pregnant.” Why? Because of potential listeria contamination and pregnant women are more vulnerable. How big of a concern is this? Well, the latest horrible outbreak is 56 cases with 12 deaths (I haven’t seen what portion of those were pregnant women). This is the largest outbreak since 2011. In summary: pregnant women are told to not eat a convenient pre-cooked protein source because of an infinitesimally but statistically significant chance of death should a specific bacterial contamination occur. We would save more lives if we focused on whatever the top three killers of pregnant women are (I’m going to guess auto accidents, partner violence, and something else).
But it won’t end because neurotic parents eat it up. The latest one I heard of is “don’t let your baby sleep in their car seat.”
Thanks, S. Now you have me wondering (genuinely) whether your first two statements have been scientifically tested. Thinking outside of the box: if we had better data and better studies, we could develop a SIDS app where parents input their own personal factors (incidentally educating them as they go) and receive a risk score.
I assume you mean my comments about communication? I expect there is a lot of data from PR and advertising because there can be a lot of money in good messaging.
I like the idea about an app of some sort. But part of the problem of approaching this with actual curiosity is the huge racial differences. There are a lot of recommendations for pregnant women and parents of newborns that would be helpful, but it’s based on genetic factors correlated with race.
If I may add my two cents on a related subject... When our first baby was born, I was determined to stick to the AAP's recommendations (sleep on the back in a separate bed). But our son didn't sleep particularly well, and my wife had to get up every couple of hours to feed him.
Then we started co-sleeping (awful! terrible!), and things got much better. No more waking up at night. Did the same with our second, now doing the same with our third.
Now, AAP says that co-sleeping is dangerous and awful. But, if one looks at the data, Japan has one of the highest (if not THE highest) co-sleeping rates in the world, and it also has THE lowest SIDS rate. One may wonder, how is this possible if co-sleeping is as unsafe as AAP claims?
Maybe there are other factors at play, such as smoking, alcohol, obesity, etc. Japan is very different from the US along these dimensions.
We did co-sleeping with our second and third daughters, and it worked a lot better than separate sleeping with our oldest. A little worse for me once our second was big enough to helicopter off my wife's breast while feeding at night, kicking me in the face in the process. But the babies slept better, fed when they felt like it, and no problems.
I enjoyed the image of the helicopter, Doc! :)
Hi Ivan--Sweden also has high rates of co-sleeping and low rates of SIDS. This is a rabbit hole that calls to me, too. (I stumble into a lot of rabbit holes.)
Any thinker from the line of Nobel laureate Eugene Fama deserves attention. This Cochrane fella seems to have not diminished the brilliance of this gift.
I think that Beth's investigations are fascinating and an example of the invaluable benefits of the Pascallian insight of expected value.
We live in a reality of risks why not make the best choices with the use of our best thinking
This article struck a chord with me. When our first kid was born we were very overwhelmed with constant bombardment about SIDS which did not make any sense. Until we found a series of research papers from New Zealand/Australia which made sense - that the common cause of SIDS was the chemical we spray on baby mattresses as fire retardant. The chemicals are on the surface of the mattress and babies need to be on their back so that they don't breathe them in. Then we could make sense of this SIDS fearmongering and did not look back. Our kids (3) slept in whatever position they drifted into sweet dreams and we were (in my opinion) able to give them above average sleeping habits.
I've been struck by how many people have admitted that the Back to Sleep campaign made them feel guilty, fearful, or panicked.
As a regular reader of Sensible Medicine and The Grumpy Economist, AND a 1987 graduate of the University of Chicago GSB in Health Administration, I found the series very interesting and thought-provoking. She obviously spent many hours looking into the relevant research, and like so many “known” dogmas these days, it turns out that it is not as simple as it appears. And now I want to know more about her doctoral dissertation research as I have spent the last 9 months dealing with a breast cancer diagnosed on a screening mammogram. If you’re ever in Austin, Texas or northern Wisconsin, I’d love to buy you both lunch and have a great discussion.
We must have overlapped at the GSB, Ellen! Wishing you the best possible health outcome, and the support of the people you love as you continue/finish your treatment. And consider this a reciprocal invitation if you happen to come to the Bay Area.
Fascinating article. I am a 70 year old grandfather and I can still recall standing up in the front seat of car, a no-no! (Has nothing to with the article but thought I would mention how things have changed) My Mother put us on our stomach to sleep, my daughter and grandchildren on their back. Looking forward to the remaining portions of the article.
Our three children all started out in a co-sleeper next to my side of the bed (I would change the baby and get him or her to fall back to sleep after my wife breastfed the baby). Our first child/son never slept well on his back but predictably slept like a baby on his belly. My wife would understandably get upset with me for indulging him, so I started laying him on my chest face down. My thought was that i could hear him breathing but of course we both eventually fell asleep. Sometimes he would roll off in between us (probably worse than letting him sleep on his belly). But eventually he slept in his own room (at 10 months) and would never settle on his back for long. Today he’s a 26-year old engineer and the other two who were better back sleepers are also alive and grown. I’m not sure that anything we did was fully correct but I know we drove ourselves crazy listening to the experts. All new parents can do is their best for their baby and try to keep their worries from the baby because they definitely pick up on those emotions.
Oh i love this series on sensible med! Im a subscriber. Small world. Your wife! 🌳
I gave up very early on back- sleeping for my son. He did not sleep well on his back. I don't know if there's been mention, too, of the misshapen heads of babies and having to wear a helmet to keep flat spots from happening.
Thanks for this thought, Julie. Yes, positional plagiocephaly (PP) is covered in the series, and the need sometimes to distinguish it from an unrelated, more serious condition called craniosynostosis. Another rabbit hole I could easily fall down would be to delve into the research surrounding orthosis (helmets) for PP, as it seems that they don't affect the outcome much or at all.
That's exactly how my kid slept as an infant (the picture). I never got it, looks really uncomfortable. I'd but her on her back but she'd go back to it. I just let her and it was fine. I wouldn't be surprised if SDS being higher in daycare was because parents/family check more? I wouldn't mind awkward looking sleep positions, but I would frequently do a check to make sure she was ok.
Our solution has been to swaddle our children as long as possible. By the time they are strong enough to break out of the swaddle, they're usually rolling over. And at that point, they're free to roll onto their tummies if they want.
We just had our third baby and we made the mistake of asking for a pacifier at the hospital. It came with a note “pacifiers have been shown to reduce the rate of sids but also decrease the rate of successful breastfeeding.” They have turned a decision that should be inconsequential, whether to use a pacifier, into one that is life or death, and I’m sure the evidence to support this is garbage.
Nuance is very difficult at scale. This means that messages must be short and clear. It also means that evidence should be very clear before we start national campaigns. But there are lots of these pieces of knowledge. I was reminded this week about “don’t eat lunch meat while pregnant.” Why? Because of potential listeria contamination and pregnant women are more vulnerable. How big of a concern is this? Well, the latest horrible outbreak is 56 cases with 12 deaths (I haven’t seen what portion of those were pregnant women). This is the largest outbreak since 2011. In summary: pregnant women are told to not eat a convenient pre-cooked protein source because of an infinitesimally but statistically significant chance of death should a specific bacterial contamination occur. We would save more lives if we focused on whatever the top three killers of pregnant women are (I’m going to guess auto accidents, partner violence, and something else).
But it won’t end because neurotic parents eat it up. The latest one I heard of is “don’t let your baby sleep in their car seat.”
Thanks, S. Now you have me wondering (genuinely) whether your first two statements have been scientifically tested. Thinking outside of the box: if we had better data and better studies, we could develop a SIDS app where parents input their own personal factors (incidentally educating them as they go) and receive a risk score.
I assume you mean my comments about communication? I expect there is a lot of data from PR and advertising because there can be a lot of money in good messaging.
I like the idea about an app of some sort. But part of the problem of approaching this with actual curiosity is the huge racial differences. There are a lot of recommendations for pregnant women and parents of newborns that would be helpful, but it’s based on genetic factors correlated with race.
I recall many other recommendations by agencies, which, decades later, turned out to be wrong.
What evidence did AAP provide for this recommendation?