Breast-Feeding May Reduce Risk for SIDS by Half Throughout Infancy

Laurie Barclay, MD

March 10, 2009

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March 10, 2009 — Breast-feeding reduces the risk for sudden infant death syndrome (SIDS) by approximately 50% at all ages throughout infancy, according to the results of a case-control study reported in the March issue of Pediatrics.

"In the last 20 years, the prevention campaigns to reduce the risk of sudden infant death syndrome were very successful," write M. M. Vennemann, MD, MPH, PD, from University of Münster in Münster, Germany, and colleagues from the German Study of Sudden Infant Death Study Group. "In some countries the advice to breastfeed is included in the campaigns' messages, but in other countries it is not."

The goal of this study was to evaluate the association between type of infant feeding and SIDS. In the German Study of Sudden Infant Death, 333 infants who died of SIDS (cases) were matched by age with 998 control infants. Breast-feeding at age 2 weeks was reported by 49.6% of case infants and by 82.9% of control infants.

Exclusive breast-feeding at age 1 month was associated with half the risk for SIDS. Although partial breast-feeding at age 1 month was also associated with lower risk for SIDS, this risk was not significant after adjustment.

Reporting exclusive or partial breast-feeding in the last month of life before the interview was associated with a lower risk for SIDS. Both partial breast-feeding and exclusive breast-feeding were linked to a reduced risk for SIDS, based on breast-feeding survival curves.

"This study shows that breastfeeding reduced the risk of sudden infant death syndrome by ~50% at all ages throughout infancy," the study authors write. "We recommend including the advice to breastfeed through 6 months of age in sudden infant death syndrome risk-reduction messages."

Limitations of this study include less-than-ideal response rate of controls; participants, especially controls, more likely to be socioeconomically advantaged vs those who did not participate; possible residual confounding; and retrospective collection of data, creating possible recall bias.

"In our study, 73% of the infants died before 6 months of age," the study authors conclude. "The implication of our findings is that breastfeeding should be continued until the infant is 6 months of age and the risk of SIDS is low. Because breastfeeding rates are low in the socially deprived sections of our population, there should be special programs to encourage mothers of low socioeconomic status to breastfeed their infants not only for the established benefits of breastfeeding for the mother and infant but also to reduce the risk of SIDS in their infants."

The German Federal Ministry for Science and Education supported this study from 1998 to 2003. Coauthor E. A. Mitchell, FRACP, DSc, was supported by the Child Health Research Foundation in New Zealand. The other study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;123:e406-e410.