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July 19, 1995

Smoking, Tobacco Exposure Through Breast Milk, and SIDS

JAMA. 1995;274(3):214-215. doi:10.1001/jama.1995.03530030034018

To the Editor.  —I commend Dr Klonoff-Cohen and colleagues1 for careful work in determining the association between passive smoking and sudden infant death syndrome (SIDS), especially the quantitation of exposure and finding of a dose-response relationship.However, I am disturbed about the authors' treatment of another important issue: breast-feeding and SIDS. Although they did not quantitate breast-feeding either in exclusivity or in duration, they imply in the title and in the conclusion that the lack of protection from SIDS among breast-fed babies of smoking mothers was due to tobacco exposure through the breast milk.The number of smoking mothers who breast-fed in the sample was only 22, consistent with the fact that fewer smokers breast-feed2 and nicotine interferes with milk supply. The confidence intervals (CIs) were so wide (0.16 to 12.03) that conclusions based on them are probably meaningless.One could speculate that the three smoking, breast-feeding mothers

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