New SIDS Policy Sparks Baby-care Debate

Photo by Jeff Cleary Tarayn Grizzard

The opening salvos were quieter than normal—a mere handful of articles and website press releases heralded the start of the latest battle in the ongoing conflict over best practices in baby care. On Oct. 10, the American Academy of Pediatrics (AAP) issued new recommendations for the prevention of sudden infant death syndrome (SIDS). In its release, the AAP details the results of a new study about SIDS and revises its policy regarding prevention. The guidelines include the usual practices of putting babies to sleep on their back and breastfeeding, steps well known to reduce the incidence of “crib death.”

The academy also makes the new recommendations that parents use a pacifier at bedtime and naptime, based on a recent meta-analysis of SIDS studies. And it emphasizes that although mothers may breastfeed in bed, they should never share sleeping space with their infants.

Not all experts are happy with these changes.

At first blush, the recommendations seem entirely reasonable, given the potential risk of SIDS. Yet a closer examination casts doubts on their rationale, in some experts’ eyes. As advocates of breastfeeding and attachment parenting have argued in recent weeks, these recommendations might also hinder breastfeeding moms and babies. Pacifier use has a much-debated effect on breastfeeding success, but routine pacifier use is not recommended by many breastfeeding experts because it may alter an infant’s suck pattern, promoting confusion—and it may mask hunger cues.

Many breastfeeding moms in the United States choose to share sleeping space with their infants in cosleeper cribs or in a family bed, a practice common in much of the world. In fact, many pediatricians and developmental psychologists contest that cosleeping is actually the norm for mothers and babies and that the problems with cosleeping lie with the overly soft bedding, mattresses, and pillows used in modern adult beds. Some experts, most notably James McKenna, director of Notre Dame’s Mother–Baby Behavioral Sleep Laboratory, contend that cosleeping is actually safer than solo sleeping based on the decreased apnea and deep sleep observed in cosleeping mother–baby pairs.

Given the level of support for breastfeeding, it is curious that the academy would choose to emphasize aspects of its SIDS policy that potentially hinder the practice. Granted, the meta-analysis—based partially on retrospective interviews with parents of deceased infants, many of whom poorly quantified pacifier use and breastfeeding—did show a significant decrease in SIDS risk for babies who used pacifiers while sleeping. Notably, however, the academy itself recommends that parents not use a pacifier during the first month of life for breastfeeding infants, specifically to decrease the risk of breastfeeding failure.

Skepticism over the AAP’s actions is further fueled by the funding it receives from the private sector, including artificial–baby milk manufacturers. These companies are known for influencing policy in other arenas of the medical world, including hospital breastfeeding practices.

The academy’s recommendation against cosleeping is much less equivocally stated than its advocacy of pacifier use. The AAP apparently ignored Dr. McKenna, whom the group had invited to join its policy committee. For his part, Dr. McKenna publicly disagreed with the recommendations, stating that, at worst, the new policy suggests private-sector involvement and, at best, cultural hegemony. The guidelines also appear premature, he said, because they do not take into account the lack of firm data that cosleeping is risky.

If private-sector influence is encroaching into the national academic and public-policy arena, as Dr. McKenna indicates, it is a setback for researchers and mothers and babies alike.

—Tarayn Grizzard is a medical student at HMS.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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