Wednesday 26 October 2016

dead simple intervention

Between the ages of 8 and 11, we lived on a naval housing estate near Plymouth in SW England. About half the fathers were absent at sea at any one time and the mothers had to cope with everything. Like the small boy who pitched over his handlebars [me] and who was bandaged up in the nearest house rather than being sent home. Those naval wives had a lot in common and looked after, and out for, each other. But there was only so much support that they could offer to Mrs van Sommeren, who lived two doors down from us, when her toddler died in the cot. The poor woman dissolved into floods of tears every time she saw a pot of Marmite, because that was her daughter's favourite snack on toast. I still carry a tiny residue of survivor's guilt at the memory of the desperate looks she gave us when we got out of her way on the pavement.

This was all brought back to me after 50 years of forgetting when, in between chores on Sunday morning, I caught a snippet of interview with Anne Diamond and Dr Ciara Kelly on Newstalk FM. It is sufficiently important and interesting that they've made a podcast of it. It's all about SIDS, sudden infant death syndrome or cot death [same thing] and Anne Diamond has a place to stand because her boy Sebastian woke up dead 25 years ago; but she's given a platform to stand on because she's a mega-famous British TV presenter.

At least Mrs van Sommeren didn't get prosecuted for murder as happened to Sally Clark in 1999 when two children died on her in succession. She was eventually exonerated but drank herself to death in 2007 - there is only so much trouble the soul can bear. When Sebastian died in 1991, between 5 and 6 children were SIDSed every week in Britain, and about 130 a year in Ireland. Nobody knew what caused each tragedy and Sally Clark's conviction was, at least in part, a desperate attempt by everyone to make sense of an event that is impossible to reconcile with a belief in a beneficent god. See also the case of Lucia de Berk where statistics went up against emotion in a baby death case.

When children die in hospital, the parents often go to considerable trouble to find out what went wrong and they articulate this as "so that this will never happen to another family". Anne Diamond had the same kind of response to loss and was a co-founder of a campaign called Back To Sleep which advised parents to put their small children to sleep on their backs. In 1985 DP Davis, a paedeatrician in Hong Kong, noted that SIDS was vanishingly rare in his catchment area and that the Chinese custom was to sleep children supine (face up). A study in New Zealand, where both orientations were common, found that supine sleeping was highly protective.
This was quickly rolled out across the country with nightly TV public service announcements and the rate of SIDS plummeted. Too late for Sebastian, the idea was adopted and then pushed across the UK, the US, Ireland and elsewhere. And the rate of SIDS was cut by 2/3rds within 7 or 8 years [R for CDC data from the USA: yellow the base line; blue = small change on recommendation of American Association of Pediatricians; red = big change as the message of Back to Sleep resulted in adoption of the safer position (the green line creeping upwards)] But note that only 75% of parents have gotten the message.  The effect has been stronger in the UK where the rate is down from 2000 pa to 300; and in Ireland where 130 pa has fallen to just 30. We still haven't a clue about why this works but it seems a no brainer to put some money towards this, so that everyone gets the message. Dau.I was born in 1993 and Dau.II in 1995; I don't remember any public service announcements or leaflets in the doctor's surgery about this. Luckily 998/1000 children get through their first two years without dying regardless of how they are put to sleep. SIDS is very rare but it seems smart to embrace this small change in practice to avoid a really serious consequence. It is not a million miles, therefore, from embracing vaccination against HPV to avoid a similarly rare but very negative consequence.

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