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Press release: Statement on sleeping locations and sudden death in infants
from the Harborview Injury Prevention and Research Center

Abraham B. Bergman, MD,
Director of Pediatrics, Harborview Medical Center and Professor of Pediatrics, University of Washington

Richard Harruff, MD, PhD,
Medical Examiner of King County, Clinical Associate Professor of Pathology, University of Washington.

MaryAnn O'Hara, MD

Robert Wood Johnson,
Clinical Scholar, University of Washington

Our points:

While we applaud the CPSC for calling attention to environmental hazards to infants such as wedge spaces around mattresses/cushions, and the risks of strangulation from cords or widely spaced crib rails we condemn their campaign to implicate bed sharing, and use of an adult bed as a hazard for infants. The original data that form the bases for these recommendations are seriously flawed.; a classic case of "garbage in, and garbage out."

The major flaws are:

  1. Data: Though we know the number of infants said to have died in adult beds, we do not know the number of infants sleeping in adult beds who did _not_ die. In other words, before making statements of relative risk, it is necessary to know both the numerator (deaths), _and_ the denominator (infants who do not die.)
     
  2. Certification of death: The CPSC depends entirely on what someone wrote as a cause on the death certificate. Death investigation and certification practices vary widely in the United States. Those who certify deaths range from coroners with no medical training to forensic pathologists.
     
  3. Bias: In a review of CPSC data since 1995 one of us (MAO) found that the term "overlaying" was used in some geographic area, and not in others. The death of an infant with the same pathologic findings might be classified as overlaying or suffocation if the family is poor and/or minority, and SIDS or interstitial pneumonia if the family is white and/or middle class.
     
  4. Who should make pronouncements on child-care practices: It is not appropriate for a government agency with scant medical expertise to provide advice on child-care practices on the basis of one study. A prestigious organization like the American Academy of Pediatrics should first review the evidence and make appropriate recommendations.
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