Australian Trilogy:
Fremantle:
Medical Heresy & Nobel
Tasmania
& SIDS: The wasted years!
.....“Fortunately a group from Tasmania
© 2013 Am Ang Zhang
© 2013 Am Ang Zhang
© 2013 Am Ang Zhang
1985-1992
“There are different kinds of parents. Overall it may be useful to
look at three main types: the
over-reacting, the under-reacting and the normal-reacting. It is beginning to sound quite simple once
you have been told, isn’t it? It also
makes child psychiatry interesting. When
parents come to see us, it is our job to decipher to which type they
belong. Now you think that is
straightforward enough. Let me tell you this, the same parents can be all three
types under different circumstances and in different situations.”
“I think she is definitely the
over-reacting type.”
“There are parents who are totally
obsessed with the right foods and healthiness for their babies but have no
second thought about pumping cigarette smokes around them.”
“She does not smoke.”
“In an interesting way one cannot learn
to bring up a child just by reading books.
Humans survived over 74 million years because they learn from their
parents and ancestors. Modern education has one major side effect – it takes
away some of our instinctual capabilities.
Think about it, instinct only surfaces when needed. Mothers usually have the instinct to respond
to their infants in an appropriate way. Observational studies of the animal
kingdom inform us that their parenting skills cannot have come by books.”
“But books are what mark us out from
animals.”
“I grant you that, but many
well-educated parents have so much trouble with bringing up children because
they trust books more than they trust
their own instincts. Books can be good
references for illness of all kinds, but beyond that instinct will help a
mother to decide if a piece of advice is good or not. The most tragic example of a public health
campaign that had gone wrong in modern child rearing is that concerning sudden
infant death syndrome (SIDS) or Cot Death.”
“Oh. She is worried about that too. But
I know that happens rarely amongst the Chinese.”
“There was a time when paediatricians advised
mothers to put babies to sleep on their tummies for the
reason that if a baby vomits, it is less likely to choke. This went on for
quite a while and nobody thought much about it if not for some rather bizarre
events that followed the publication of a paper by paediatricians from Hong Kong [1].”
“When was that?”
“1985 Lancet.”
“I thought it was 1992 when they
recommended sleeping babies on the back.”
“That is a long story. Apart from low infant mortality figures, Hong Kong also enjoyed a very low SIDS incident. In fact most recorded cases were expatriate
Caucasians. The 1985 paper put forward several theories including the fact that
the majority of Chinese parents in Hong Kong
ignored the advice to put babies to sleep on their tummies. My own speculative view is
that the unclean air, high background noise level and crowded living conditions
may have been contributing factors to a different arousal level so that infants
have a much lighter sleep pattern and are therefore less likely to just fade
away as in quiet country suburbs.”
“What happened in 1992?”
“Because such findings came out of the
small British colony of Hong Kong three
prominent Professors challenged the findings in a prestigious medical journal.
They even suggested that the Chinese were probably hiding and secretly disposing
of their dead babies.”
“We do get very bad press for lots of
things!”
“Fortunately a group from Tasmania
“I am surprised too. So what were the results of the research?”
“Nearly 50% fewer Cot Death in the
sleep on back group. That was 1991. The rest is history”
“I thought it was 1992.”
“That was when the view was taken up in
U.S.
“I see.”
From: The Cockroach Catcher Chapter 25 Crying and Sleep
It’s a Bird, a Reptile, a Mammal: It’s Platypus
[1]
1985 Cot Death paper from Hong Kong - Cot death is very rare in Hong Kong ; this may be an important contributory factor
to the low postneonatal mortality (3.1 per 1000). Over the 5 years 1980-84 only
15 cases of cot death were documented by forensic pathologists--an
approximate incidence of 0.036 per 1000 live births. If the incidence was
similar to that in western countries (2-3 per 1000), 800-1200 cot deaths might
have been expected over this period. It is argued that this rare occurrence is
real and not cot death masquerading as other causes of death. It is speculated
that perhaps life-style (including crowded living conditions), the practice of
placing babies supine in their cots rather than prone, and a lower frequency of
preterm birth could contribute.
Davies,D.P. Lancet. 1985 Dec 14;2(8468):1346–1349.
Cot death in Hong Kong : a rare problem?
[2]
Prospective cohort study of prone sleeping position and sudden infant
death syndrome. Dwyer. (Lancet
1991; 337: 1244-1247). Lancet. 1985 Dec 14;2(8468):1346–1349. The "Island State Tasmania had important
advantages for the two major strategies used to search for environmental and
lifestyle causes of disease — case-control and cohort studies. Terence
Dwyer, MD, FAFPHM, Director.
Summary. A population-based retrospective case-control study has been conducted in Tasmania since October 1988. Study measurements pertained to the scene of death of last sleep, as well as a verbal questionnaire on relevant exposures. From 1 October 1988 to 1 October 1991, 62 cases of sudden infant death syndrome (SIDS) occurred. Case response rate for retrospective interviews was 94% (58/62). The initial control response rate was 84% (101/121). After stratification for maternal age and birthweight, there was no increase in risk associated with the usual side position (odds ratio [OR] 1.05 [0.27, 5.02]), compared with the supine position (OR 1.00, reference). The prone position was associated with increased risk [OR 5.70 (1.67,25.58)], relative to the supine position. In the final multivariable model, predictors of SIDS in this study were usual prone position (P < 0.001), maternal smoking (P = 0.008), a family history of asthma (P = 0.045) and bedroom heating during last sleep (P = 0.039). Protective factors were maternal age over 25 years (P = 0.013) and more than one child health clinic attendance (P = 0.003). The results provide further support for current health education activities which aim to inform parents of modifiable risk factors for SIDS, including the prone sleeping position, thermal stress and infant exposure to tobacco smoke.
It’s a Bird, a Reptile, a Mammal: It’s Platypus
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