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Comment by beagle3 | Hacker News Reader

It’s most definitely the medical establishment.

There are similar issues with the “back to sleep” campaign - the risk of SIDS apparently is indeed Slightly lower for babies sleeping on their back, but it is only very slightly lower, and some babies will not sleep on their back unless they are exhausted which causes other non trivial issues. If you actually look into the “back to sleep” study data, it is much, much weaker than proponents imply it is.

And yet, every nurse in the hospital kept telling us with religious fervor to not even think of letting the baby fall asleep on their stomach. I was so impressed that I was sure the evidence was overwhelming. But after a week with a hardly sleeping newborn (relatively speaking), I decided to look into it myself. You should to, rather than trust the “experts”. (Or a random internet post like mine, for that matter)

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I went and looked at a few studies. I did not find the same weakness of evidence that you described. E.g. [1] seems decently strong, to take just one example, although I'd be happy to be shown my error. I do agree that folks should examine the research for themselves, since it's so easy to do once you get practice. I also agree that the research on screen time is extraordinarily weak, and that there isn't really a good reason it has a causal negative impact on children as yet.

[1]: https://www.nejm.org/doi/full/10.1056/NEJM199308053290601

I am away from home on phone at this second, and likely have not kept my 10 year old notes, but from memory:

Strongest predictor of SIDS was mom’s education level, followed by whether or not she was smoking; stomach/back was third. It’s the strongest one that can (easily) be changed, but something is very fishy about the data.

Proponents point out the inverse correlation between sleeping on back and SIDS, starting at the time the recommendations were made, as proof that this is a causal relationship. However, inclusion of time prior to recommendation shows that SIDS is inverse correlated to time; and sleeping on back is positively correlated with time only after recommendations were made.

Also, it’s possible data in the last 10 years paints a different picture - but at the time, the case for causal “back to sleep” was very flimsy.

Fwiw the study I linked to is case controlled. It does not rely on the population timeseries you mentioned. I don't know the downfalls of case controlled trials, but they are not the same as population timeseries data I am certain.

Can't find my old notes, but found this graph on a quick google: https://www.cdc.gov/sids/data.htm

Note the decline in SIDS rate, which starts in 1988 (see e.g. https://pediatrics.aappublications.org/content/105/3/650 ), before the recommendation (1992) and "back to sleep" campaign (1994) and though it does track the decline of belly sleeping position, I found in the past graphs of belly sleeping from before 1986 in which it was essentially uncorrelated (or even inverse correlated, if you go back enough - but I don't trust that data).

But what's more alarming, is that although there is a continuing decline in SIDS, if you look at the combined SUID (Sudden Unexpected Infant Death) rate, it is essentially flat since 1996 (following a decline from 1990 as visible in the CDC graph, and which goes much farther IIRC). As a data scientist, this hints either (a) change of classification system that was not properly noted, or (b) that there's an underlying reason which causes infant death, which may manifest in different ways depending e.g. on whether the infant sleeps on their belly or their back.

As a new parent, this was terrifying (is anything really ever safe?) but also reassuring (the expert advice might technically be true, but seems to be useless).

I've found this over and over in many other cases - e.g., statins seem to reduce the change of a heart attack, but do nothing for (or even slightly increase) all cause mortality. Also financial advisers give advice which is technically correct but often useless.

Experts rarely qualify the limits of their advice, and that goes double when it is delivered 2nd hand (by nurses or even doctors who never bothered to look at the data but just parrot the official recommendations).

> As a data scientist, this hints either (a) change of classification system that was not properly noted, or (b) that there's an underlying reason which causes infant death, which may manifest in different ways depending e.g. on whether the infant sleeps on their belly or their back.

As a data scientist, you should really consider more than these two causes. For example, perhaps some other cause of infant deaths was rising during that same period. Or, perhaps there is a change in classification, AND there has been a saturation point reached in terms of how the existing public health initiatives can affect population behaviors. You really just cannot reason from coarse, population level death rates like this to a specific condition or cause.

Also: https://www.cdc.gov/sids/data.htm

The graph on that site very clearly shows that most of offsetting increase is caused by strangulation and suffocation, not an actual unexplained cause. It appears to be mostly a change in classification.

Finally, I really want to point out that we should not expect that a public information campaign would decrease SIDS rates to zero. After all, we can see in this thread that there are still plenty of parents who put their babies to sleep on their tummies. As far as most people know, the data could show that SIDS is 100% caused by prone sleeping and people would still doubt the evidence and put their child to sleep prone. SIDS rates would still not drop to zero, and that would not be evidence against the hypothetical cause.

I did consider more, and I looked much more deeply into it, as I mentioned though that was 10 years ago. Everything about the available data was weird - e.g. Mom’s education level came up in several studies as the strongest predictor inversely correlated with SIDS (but irrelevant in others) - controlled for the usual confounders of that input (smoking, salary, marital and spousal status, mother’s age).

And I started with saying that my conclusion was that it is likely safer for babies to sleep on their back from the SIDD/SUID perspective, but the evidence didn’t seem as conclusive or overwhelming as I was led to believe.

The hospital staff made it sound like letting my baby sleep on their tummy is signing their death warrant.

Do note, also, that prevalence of back sleeping went from less than 30% to more than 80% over the period graphed. One should not expect compliance from such a campaign in general, but (as far as medical compliance goes) a very good one was achieved. New parents are perhaps the most compliant group.

I am unlikely to dig as deep into the data again, but my well supported (I believe) conclusion at the time was that, all-cause-infant-mortality-wise, the recommendation may be somewhat justified, but the strength, might and terror in which it is given is definitely not.

I would be interested in seeing a data set for the risk of SIDS from cosleeping (even on the baby's back) vs. the risk of various other problems from indescribably exhausted parents and a baby who will scream bloody murder for hours and hours and hours and hours if you try to get them to sleep alone in a crib.

Also, not to be all hippie but would we not have evolved to want to be held as infants? What species just leaves its young to sleep without physical contact?

You won’t find it, likely. Also, on the recommendation against co-sleeping, I went looking for the actual data. What I found was not SIDS related, but deaths from being squashed, and quite a few of them. I managed to find a few case studies, and they all included a parent under the influence (alcohol mostly in cars I found) and obese parents.

Regardless of how true it is, the establishment cannot make a recommendation of the “Co sleeping is ok if you don’t drink, not overweight, and a light sleeper” kind, as many of the people in those categories are in denial of being in those categories. so it will be “co sleeping is always dangerous”.

Here in Norway they make that exact recommendation.

I'm impressed. In the US, such a recommendation would be disastrous and whoever made it would be sued to oblivion ....

But then, you nords leave your babies to sleep in the snow which is perfectly healthy but would get you a visit from child protection services in the US (did not hear of such a case, but have heard of cases for letting 9-year old kids walk from school or play basketball without parental supervision)

...which inevitably leads to things like this when the two worlds come into contact: https://www.theguardian.com/us-news/2017/nov/26/anette-soren...

I'm leery of co-sleeping mostly because it seems to be highly correlated with kids who have bad sleep habits and keep waking up their parents constantly (don't worry how you'll know, they'll tell you) well into their toddler years, and beyond. And I'm pretty sure the co-sleeping is a big part of the cause (can't get used to waking up mom & dad for entertainment every time your natural sleep cycle wakes you up a smidge if they're not there to wake up and start giving you attention instantly).

But like anything else, fuck, if it's working for you and the risk is very low, do what you need to do. I avoided it because I kept seeing hellish outcomes but if that's not what's happening for you, go for it.

My wife and I coslept (and often still cosleep) with both of our children. They both sleep through the night without issue.

Our oldest goes to sleep early and will insist on going to sleep when she feels tired and will wake up with me in the morning. Our youngest fights sleep until exhaustion and prefers to sleep in (until 9-10am if allowed). They have been raised exactly the same way.

We take way too much credit for our children's sleep habits.

> can't get used to waking up mom & dad for entertainment every time your natural sleep cycle wakes you up a smidge if they're not there to wake up and start giving you attention instantly

The opposite: When my kids wake up in the middle of the night if they are alone they freak out. If there is another person there they feel comfort and go back to sleep without waking anyone else up. But YMMV.

The problem is that those indescribably exhausted parents roll on otherwise restrict the breathing of the infant.

Babies want that feeling of comfort, which is why you swaddle.

The thing with babies is that they are, from the start, individuals. Some like a lot of contact, some don’t; some are very active sleepers, some aren’t; some will do fine by themselves in a crib, some won’t. You have no choice but to figure out what works for that kid. That’s not to say there aren’t some general procedures you should follow. I think most kids do best on a regular schedule, for example. But you’ve got to take them as you find them.

You seem to have preconceptions that you defend without evidence. There's no 'medical establishment' that purposefully gives bad advice. There are pieces of advice that are later found to turn out wrong, but on average you'll be better off trusting the experts. Don't trust blindly but 'did my own reaearch' is usually codeword for 'read a few mommy blogs'.

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