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API and Research Community Find Anti-Bedsharing Recommendations Unsupported

API and Research Community Find Anti-Bedsharing Recommendations Unsupported

API and Research Community Find
Anti-Bedsharing Recommendations Unsupported

API highlights this White Paper response to the Carpenter et al. analysis written by noted researchers in the areas of infant sleep, including researchers affiliated with API:

Other insightful responses include:

API supports infant sleep policies and guidelines that are based in research results sufficiently supported by the data. Current and historical infant sleep data are notoriously challenging to analyze, as API has repeatedly noted, because reporting and collection is inconsistent and incomplete. Use of data in this condition should lead to significant limitations on the conclusions drawn from it.

Unfortunately, the true state of knowledge and the real limitations surrounding safe infant sleep are obscured when data are removed from critical context and distorted in sensational and alarmist media campaigns. The most recent review of infant sleep by Carpenter et. al. (2013), which merges and re-examines imperfect historical research and data, is an example of such a distortion.

The emotional and physical welfare of infants is API's mission, and API celebrates the efforts and research aimed at reducing and eliminating SIDS/SUDS. The Carpenter et. al. (2013) analysis attempts an important review, but lacks sufficient data to support the very misleading headlines. Cultural sensitivity is absent from the the study and subsequent media campaigns with the possibility that the lowest-risk families may be scared into far more risky situations, possibly contributing to increases rather than decreases in SIDS. Notably, UNICEF has declined to change its position on bedsharing despite being specifically urged to do so by the study's authors.

To achieve the goal of public health, an absolute health-care recommendation must be based on data that fully supports the conclusions on which policy is based. Some of the analytical weaknesses noted by those who reviewed the Carpenter et. al. (2013) paper include questions about:

  • differentiation between planned bedsharing and unplanned/accidental bedsharing
  • sufficiency of data on the location of the sleeping infant
  • the extent of breastfeeding practiced
  • the data age
  • statistical imputations
  • study inclusion criteria
  • odds ratios

The fact is that parents bedshare, and for many reasons, whether they divulge that information or not. Breastfeeding and bedsharing are rightly and tightly linked. As we continue to promote the undisputed health-giving act of breastfeeding, how can we work together to help exhausted parents minimize overall risks and increase overwhelming benefits?

API believes that supporting parents instead of issuing mandates is key in forming healthy parenting habits. Parents are the only ones with the ultimate ability to make life-giving, healthy decisions for their families and API believes that real-life guidance makes the difference, such as proposed in this November 2012 analysis of the ethical considerations of the bedsharing debate. If we support public health, our energy is most productively spent working together to find ways to support families in their cultural context and social ecology. In working this way, the analytical arguments will dissipate as attention is focused on sensitive, yet healthy ways to help babies celebrate their birthdays.

For more than 14 years API has expressed its concerns about the direction of research related to basic infant sleep safety information and data collection, the media's response, and resulting guidelines and policy. Among API's responses are definitive resources on infant sleep safety for families who share a bed or use a crib: API's Infant Sleep Safety Position Paper, Parent Brochure download detailing important information for every parent, and related resources.

API advocates providing parents with sensitive information and support as an inexpensive, un-glamourous yet effective approach for guiding each decision parents must ultimately make for the health and wellbeing of the whole family across their lifespans.

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