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Cot Death: Doctors and scientists should be clear when official advice changes

They told us that a child on its back could choke on its own vomit and die - scary stuff, so we did as we were told, even though babies have slept on their backs for millennia
  • @SusanElkinJourn

So, the lives of 120 babies would be prevented each year if only heedless, careless parents listened to those decisive, knowledgeable, consistent medical experts and stopped taking their babies to bed with them? OK, so I’ve put in the angry, sarcastic adjectives, but it feels like that’s the basic thrust of this week’s news about cot death – sudden infant death syndrome or SIDS.

Very little mention has been made of just who it was who advised the parents to sleep with their babies in the first place – none other than the medical profession.

Few people are more vulnerable to expert advice than anxious new parents, especially mothers. Of course they listen to and do what  doctors, nurses, midwives, health visitors and the rest tell them is best. They are embarking on life’s most challenging task and it’s learn-on-the-job. There is no training.

In the 1970s when my children were born, cot death was terrifyingly common and no one knew what caused it. Everybody knew a family who had lost a child to SIDS and I knew three. Even as late as 1989 there were 1,545 such deaths in the UK according to Lullaby Trust statistics.

As young mothers we were firmly instructed to put our infants on their tummies to sleep. They told us that a child on its back could, if sick, choke on its own vomit and die – scary stuff so we did as we were told although, thinking about it now, babies had slept on their backs for millennia and it didn’t seem to have endangered many lives.

In fact there was, as later research showed, a strong correlation between babies sleeping face down and cot death. Both ours survived, thank goodness, but we have lots of scary (now) photographs of them doing pram press ups as they lifted their heads to peer out like tortoises.

By the 1990s parents were being strictly instructed never to put a child to sleep belly-down because it can cause cot death. When I visited a new mother in a maternity wing in 1997 I was struck by the dictatorial tone of the notices around the ward – for all the world as if putting babies on their tummies was some bit of dangerous folly dreamed up by feckless mothers. There was no acknowledgement that advice had changed dramatically in the light of new information and understanding. What an insult, especially to all those families who had suffered the almost unimaginable tragedy of a dead child.

And now the same thing has happened again.  My generation was told never to take a baby to bed in case you fell asleep and smothered him or her. Out of sheer fear I spent many hours on bitterly cold nights sitting on an upright chair in another room to breast feed to make absolutely sure I stayed awake.

Then about fifteen years ago the medical people started to advise parents that sleeping with a baby is sensible because the infant can feed easily almost at will without much disturbing the mother during the night - much like a puppy or kitten. This week’s research from the London School of Hygiene and Tropical Medicine has shown that actually 40 per cent of the UK’s 300 annual cot deaths would be prevented if babies slept in cots next to the mother’s bed.

But I don’t hear the medical professionals saying – or at least not very loudly – that this overturns what they said before. Instead they speak as if bed sharing were something dreamed up by remiss and stupid parents and that makes me very angry.

Of course medical research is ongoing and has been since before Hippocrates. Nobody knows all the answers and we never will. That’s the nature of knowledge and the acquisition of it. New discoveries inevitably affect the way we do things and medical professionals no longer use blood-letting, blistering and leeches. Lives are saved every day as a result of new understanding about the causes of avoidable death – and, thank goodness, ‘only’ 300 babies a year now die in the UK in their cots although every individual case is one too many.

But it’s hard to forgive the Nineteen Eighty-Four-style arrogance when suddenly advice changes dramatically and frightened parents are made to feel as if they are at fault because they are simply doing what they were authoritatively told the week before last – but now we’re at war with Oceania and always have been, as Orwell would have put it.

Yes, I know that the medical profession is fearful of litigation, but it would be much easier to respect the official advice of health bodies if only more were humble enough openly to acknowledge that they, like the rest of us, are fallible and only able to offer informed advice based on the latest research - which may well be different from what earlier findings  have suggested.

No one is wrong. We are all moving forward together in trying to stamp out devastating horrors such as cot death.