[Serious concerns regarding research linking cot death with child day care]

A recent case-control study suggests that the risk of sudden infant death syndrome (SIDS) is strongly increased in children attending day care. There are several methodological concerns regarding this study. Problems with the selection of both cases and controls may have inflated the observed odds ratio. A similar overestimation of risk may have occurred because of confounding factors including age and socioeconomic status. The study is restricted to the very few SIDS cases that occur during day care hours, which reduces the statistical power and increases the likelihood of chance findings. Finally, if day care is a genuine risk factor for SIDS, prevalence rates of SIDS should be expected to be lower in countries with long maternity leave periods such as in Scandinavia, but this is not the case. Whether or not day care is a risk factor for SIDS can only be evaluated by further and better designed studies. At present, there is no scientific basis to discourage day care for young children.