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New knowledge, new insights, and new recommendations
  1. P Fleming1,
  2. P Blair2,
  3. J McKenna3
  1. 1Infant Health and Developmental Physiology, University of Bristol, UK
  2. 2University of Bristol, UK
  3. 3Department of Anthropology, University of Notre Dame, South Bend, Indiana, USA
  1. Correspondence to:
    Prof. P J Fleming
    Institute of Child Life and Health, University of Bristol, UBHT Education Centre, Upper Maudlin St, Bristol BS2 8AE, UK; peter.fleming{at}

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Scientific controversy and media hype in unexpected infant deaths

The fall in numbers of unexpected infant deaths that followed “Back to Sleep” intervention campaigns in many countries in the early 1990s has been one of the striking achievements of applied epidemiology in the field of child health in modern western society.1,2 The possibility that other modifiable risk factors might be amenable to similar interventions in this mysterious group of conditions has led to multiple studies of the epidemiology of the residual unexpected infant deaths. Having been central participants in the implementation of the “Back to Sleep” campaigns in many countries, the media remain acutely alert to the possibility of any new or significant developments in this field. Thus any public pronouncements by professional organisations must be made in the knowledge that they will attract intense media attention.

The recent Policy Statement by the American Academy of Pediatrics (AAP) on the changing concept of sudden infant death syndrome (SIDS) and approaches to its prevention3 aroused an unusual level of criticism and hostility both within and beyond that organisation.4–,8 Despite the careful presentation of the evidence on which their recommendations were based, and the largely uncontroversial nature of most of the recommendations, the responses—by media and professionals alike—to the report of the AAP Task Force on SIDS have concentrated on the two issues of bedsharing and pacifier (dummy) use, and largely ignored the other nine recommendations (box 1)—most of which are based on stronger and less controversial data.

Box 1:

Summary of recommendations by the American Academy of Pediatrics to reduce the risk of SIDS3

  1. Put infants on their backs to sleep

  2. Use a firm sleep surface

  3. Keep soft objects and loose bedding out of the crib

  4. Do not smoke during pregnancy and avoid …

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  • Competing interests: none declared

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