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:
- 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.)
- 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.
- 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.
- 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.
