Parenting
Beware of 'bad science', by Mark Vonnegut
Our government's recent warning that it was unsafe to ever have babies or small children sleep in bed with their parents went way too far.
The controversial US Consumer Products Safety Commission report and its recommendations should be opposed not on the basis of taste-- although its use of scare tactics makes it vulnerable--or even because it goes against the intuition and practice of so many pediatricians and parents. It should be challenged because it's bad science.
Bad science sets out to make a point, looks neither to the left nor to the right but only straight ahead for evidence that supports the point it sets out to make. When it finds evidence it likes, it gathers it tenderly and subjects it to little or no testing.
And that's exactly what the commission did in this, its first attempt to quantify the number of fatalities resulting from the practice of parents "co-sleeping" with their babies and toddlers. The study, published in the October issue of the Archives of Pediatrics and Adolescent Medicine, was based on the deaths of 515 children under age 2 from 1990-1997. All 515 died in adult beds. The commission concluded that all the deaths were caused by that fact.
Such a conclusion amounts to connecting dots that shouldn't necessarily be connected. If a young child dies in bed with his or her parents, there can be many reasons. Completely normal babies can go home after a "well baby" checkup (with or without immunizations) and die of Sudden Infant Death Syndrome, or SIDS. Those babies could be in a safety-certified crib, or in an adult bed. Babies can also have overwhelming infections, strokes, or congenital heart disease--all of which may or may not be correctly diagnosed on autopsy.
The problem may not be with the children. Maybe it's safe to be in bed with a sober parent, but not a drunken one. Maybe some of the parents involved, as was the case with some of the familial SIDS research, murdered their children.
Small numbers also make for bad science. Given how many babies and toddlers there are in the United States, 515 is a very small number. And the number of those deaths due to a "co-sleeping" parent rolling over on a child, rather than the child becoming caught in bedding or rails, is even smaller: 121. The amount of reliable, testable information available in each case is virtually nonexistent. To really understand the cause of something that claims the lives of, roughly, 1 in 100,000 babies and toddlers, you need to follow at least 1 million control cases. Only then can you examine a wide array of variables.
The commission based its findings on death certificates, medical examiners' reports, and news accounts, dividing them into two categories: the 121 youngsters said to have died because a parent or caregiver rolled over on top of them, and the 394 who were strangled or suffocated in the bedding or bed railing. The study did not examine other causes.
Also unknown is the total number of young children who, either regularly or occasionally, share a bed with parents. As long as that remains unknown, there is no way to measure the relative risk of the practice--a "limitation" the commission's study notes.
What else makes for bad science? Investigators with a vested interest in their conclusion. A study that concluded there was no danger lurking in the "family bed" wouldn't have been covered by the press, wouldn't have made such a stunning video as the one that accompanied the commission's report (complete with dolls being strangled by the sheets) and wouldn't have advanced anyone's career, nor proved to Congress that the agency was worth its weight in taxes.
The truth is, almost all mammals (including humans) sleep with their babies. Indeed, most human babies in most cultures sleep with their parents, and always have. Sleeping apart from babies is a mostly British, Northern European experiment that we would do well to wait on until the data is in.
Even in the United States, most parents end up sleeping with their babies and young children at least some of the time, and previous studies-- all reported in medical journals--have found no direct risk.
Indeed, there is some evidence that the commission's own research shows little difference in where a child under age 2 sleeps. An earlier study by the commission (using different years, but the same data) showed an annual death rate of 50 for children sleeping in cribs, most of which did not meet federal standards. The "adult bed" death rate works out to be 64 per year. Although every young life has inestimable value, statistically speaking that is not a big difference.
Yet Ann Brown, chairwoman of the commission, in a statement accompanying the report gave this stern warning: "The only safe place for babies [to sleep] is in a crib that meets current safety standards and has a firm, tight-fitting mattress." No room for discussion, no allowance for variation in sleeping arrangements, no acknowledgment of what many parents have found works quite well for them.
Parents choose to sleep with their babies and toddlers for intensely practical and personal reasons: less crying and more sleep. A crying, unhappy baby can shape the behavior of his or her parents better than any shock ever shaped the behavior of a lab rat. So if snuggling in bed together is what it takes to end that crying, a shared bed is what a parent will choose.
If we are going to come down firmly against the results of that shaping, if we are going to advise parents to disregard their instincts and disregard the manifest will of babies, we should have much better science than this to go on.
Not many generations ago, the practice of breast-feeding was just about killer off by bad science that "proved" the practice was unsanitary. Now science can't say enough nice things about breast-feeding; just this week brought news that breast-fed babies are less likely to develop leukemia. Maybe in a few generations, we'll see studies that indicate that babies who sleep with their parents have fewer ear infections, do better in school, and don't engage in pseudo-science when they grow up.