Hacker News Reader

Comment by 317070 | Hacker News Reader

There are so many more of these. A common one is everything to do with babies.

* In the UK you should not start solids before 6 months, in France you can start at 3, and should at 4.

* Baby bed room temperature: in the UK 16 degrees Celsius, France 19 degrees, in the nordics you should have them sleep outside while I've been told that in Hungary 25 degrees is considered optimal.

Don't underestimate how much of health science is embedded folklore knowledge by people who thought they managed to extract signal from noise with a lot of confounders, especially if the patient is not sick or cannot express their subjective experience.

View on HN

Also, in the US people have a deathly fear of bedsharing with the baby due to concerns about sudden infant death syndrome (SIDS) and yet bedsharing is common in places like Japan while they also have a much lower infant mortality rate. Apparently, newborns just sleep very poorly lying on their backs alone in cold, hard cribs rather than nuzzling against their moms' breasts. As a result, the common advice in the US has not only led to skyrocketing cases of postpartum depression, but also delayed milestones such as head lifting, plus more cases of plagiocephaly and torticollis.

(that said, as a new dad, I'm also deathly afraid of SIDS so I still stuck by the American recommendations, sleep be darned)

Some of that fear isn’t necessarily unfounded. In America the people are larger and the beds are softer. This creates a larger, deeper divot around the adult for the baby to roll in to and suffocate.

I've come to think the American norm is something of a self-fulfilling prophecy. Bedsharing becomes dangerous mostly when the parents fall asleep intoxicated. You might have noticed that you're much more likely to wake up with your arm partially numb if you pass out drunk than if you go to sleep sober. But because bed sharing is discouraged, it's mostly less responsible parents who do it, which creates a stronger apparent correlation with infant suffocation.

And not just alcohol. America is highly medicated. Someone who takes sleeping pills for example is unlikely to be subconsciously aware of their surroundings.

I think this might have been the case early on. Now it seems the reality is more nuanced.

Now the default discourages bedsharing, but we know and can witness personally the many positive effects. The warning causes us to be more conscientious about doing it if we choose to, and for those who default to obeisance they are in their minds making the responsible choice.

Because of the social stigma, those who do bedsharing responsibly are not being accurately reflected in the data, causing only those careless enough to admit it to be captured.

Pretty sure Americans drink less than most Europeans.

If I recall correctly, there was some recent research connecting the cholinergic system to SIDS, pointing at possible changes in practices to reduce the risk.

If you ask around among other parents you’re going to find that bed sharing is a lot more common than the medical community wants it to be. We had a lot of reasons for doing it and so did many of our friends.

Most of the American parents I know practiced bed-sharing including myself. But we would also answer "no" when asked about at the doctor's office because that's the "right" answer. So... I am skeptical about any negative statistics on bedsharing. We're not obese and don't drink or do drugs. That probably mitigates a huge amount of associated risk.

Bed sharing isn’t just about SIDS, it’s about litterally just rolling over and smothering your child (sometimes those do get lumped in together, but increasingly they are separated if they can be).

If you are overweight, sleep on a standard western style mattress, have any sleep disorders, smoke, drink, use illegal drugs, or even some prescription medications, you are much more likely to smother your infant.

The risk of all sleep related causes of death is around 1/1000 in the US, but you can reduce that risk 100x if you follow all of the safe sleeping recommendations.

1/1000 is pretty low but it’s higher than the chance of your infant dying in a car accident, disease, or any other cause of death for full term healthy babies.

My wife (pediatric ER doctor) has had to declare numerous babies dead from a parent rolling over and suffocating their infant and usually the parents weren’t intoxicated at the time.

I have 2 kids (and a 3rd on the way). I know how hard it is to follow all the safe sleeping recommendations, but the risk is real and the cost is so high.

My favourites are

- How much alcohol can a pregnant person drink? (Not too much, obviously, but is a glass of wine a couple of different days in the third trimester okay? Probably, but it varies a lot deoending on which country you're in.)

- When can children start eating green leaves? (I don't know, but even different counties in Sweden have different guidelines on that one.)

- Should infants sleep on their tummy or back? (Definitely on their back. There is no argument there. But when I was an infant -- which is not that long ago, parents were advised otherwise.)

> But when I was an infant -- which is not that long ago, parents were advised otherwise

Medicine is wild. Lots of things that were taken as gospel even 15 years ago have been completely flipped on their head. The NHS massively changed their advice last year on asthma treatment and it’s basically the opposite of what they said before. We’ve seen the same with musculoskeletal injuries, nerve injuries and just general recovery.

Sorry, but what was the change? Adding corticoid inhalers when treating an asthma episode? Curious since I have asthma and didn’t hear about this change yet.

The short of it was that they decided salbutamol was overprescribed and shouldn’t be given to anyone who isn’t taking a corticosteroid inhaler at the same time. The advice has changed from “if you feel like you need your blue inhaler take it” to “your asthma should be managed by your corticosteroid dose, and if it’s not you should adjust”. Obviously not suitable for everyone but for people like my dad it got him from using his reliever once a week to not having an active prescription for it anymore.

That was a worldwide change after they figured out long acting beta agonists were basically killing people because they don’t treat the underlying inflammation like inhaled corticosteroids do.

Shit I should talk to my doctor again. Although probably for exercises induced things might be a little different.

Very possibly, although I wouldn’t be surprised if the advice has changed. Asthma is an inflammation of the lungs and the learnings seem to be that any inflammation is bad, so we want to prevent inflammation rather than respond to it.

Definitely worth a conversation!

Yeah that doesn’t surprise me - I just don’t have enough knowledge of outside the UK to know if it was advised elsewhere. Anecdotally, my breathing is so much better since I’ve adjusted to the correct dose and never missing one, I’ve gone from needing a reliever with me at all times to not using it once in a year.

For sleeping on their back. Our youngest daughter would not sleep on her back. She still sleeps on her tummy with arms folded under her. The only way she sleeps otherwise is in the car seat when properly exhausted. Put her to bed and she will turn around and fall asleep. So what does medicine say then?

Sleeping on the back only matters when they are very young. It’s for when they don’t have the strength to turn themselves out of a face-down / suffocating position. That’s why you practice tummy time (neck/head lifting) with an infant. Once they are older they can sleep how they like

Depends on the kid too. All 3 of my kids could lift their head up when they were born. A couple of times I forgot all babies aren't like that and picked up a friend's baby without adequate support.

It says that there is like a 10x risk of SIDS in the first four months of life with tummy sleeping.

I don't agree with her on everything, but Emily Oster's chapter on SIDS (in the second book I think, Cribsheet) I think does a good job outlining the data on it. And my brother just had a kid who also would absolutely not sleep on his back. Once he could roll he just sleeps on his tummy (but once they can roll SIDS is not really an issue)

What I was taught is that one should not put them down on their tummy, but if they're able to flip themselves over when put on their back they're no longer so likely to die from it.

> But when I was an infant -- which is not that long ago, parents were advised otherwise.

So...research was done and people learned they were wrong?

I'm not quite following what you think the takeaway was here?

The "Back to Sleep" campaigns saw something like a 50% decrease in infant mortality within 12 months in the UK. It isn't really comparable to "fad diet of the year" medical advice.

> How much alcohol can a pregnant person drink? (Not too much, obviously, but is a glass of wine a couple of different days in the third trimester okay? Probably, but it varies a lot deoending on which country you're in.)

It's important to differentiate a low individual risk for you, vs what that means to a whole population.

You will easily find someone willing to say "oh I had two glasses of wine a week while pregnant and my kid was fine".

If everyone started drinking 2 glasses of wine a week in the third trimester, FAS rates will increase, and mean IQ score will dip. Will they dip by a lot? Probably not, but definitely not zero. So of course anyone in a position to make a society-wide recommendation, recommends "no alcohol".

Individual parents may look at data and say, that's a risk they're willing to take.

The temperature thing is one I always wonder about.

The WHO claims the ideal overnight temperature for sleeping is 18 degree (C). I lived in Vietnam for a decade and to a rough approximation 0% of the population ever experiences 18 degrees overnight for sleeping. And I imagine it's not too different in much of Thailand, Indonesia, India, etc.

I'm pretty dubious that hundreds of millions, maybe billions, are thriving in "suboptimal" overnight temperatures!

Does the African savanna regularly get down to 18c at night, such that we'd expect that to be some kind of evolutionary equilibrium that just happens to map to (northern) European and North American norms?

Well, hot places do tend to have indolent populations.

Humans can thrive in nonideal situations. I would say too ideal is unhealthy.

Plus the effect might be small or something easily adapted to.

Vaccination recommendations for COVID and flu are another one.

US: essentially everyone

Most of Europe: only recommended for age 65+ or otherwise at risk

  …in the nordics you should have them sleep outside…

Is this a joke or are the Nords breeding a race of supermen Vikings a la the Fremen?

It's true. Though it's not about leaving them outside for the night with only a dull knife with which to fight off the wolves. It's about leaving them in their prams outside for nap time. Obviously bundled up to keep warm during winter.

We're not really concerned about baby kidnappings here, so it's not uncommon to see prams with sleeping babies outside of cafes while the mom or dad is inside having some coffee.

Here in Poland my mum used to make me sleep outside (on the balcony) when it was as low as -20°C outside. (Covered in lots of layers.) It’s definitely not just Nordics.

They're fremen: https://www.bbc.com/news/magazine-21537988

Not a joke. When my daughter was younger and we were visiting the daycare (förskola) facilities around us to pick one, in one of them they didn't have a room for children to sleep indoors, they always slept outdoors (even in the winter). This daycare was very highly recommended.

Anecdotally, when my daughter was a baby and had issues falling asleep, all it took was to take her for a walk outside in negative (celsius) temperatures and it was like we gave her sleeping pills. It never failed.

I grew up in a different country, so this whole concept was alien to me and it was diametrically opposite to my instincts, but I have to say that I'm a believer now.

Reply on news.ycombinator.com