When evidence-based medicine evaporates

Anything that takes resources away from more beneficial treatments is harmful. Any intervention is likely to be directly harmful in some way, to some extent - and this one sounds like it will generate a lot of false alarms and anxiety.

No intervention should be introduced on a wide scale until the level of harm it cause has been carefully balanced against the benefits.

I cannot help but remember the history of the word "coney"... Peter English

CONI? New? It's concerning that it's taken such a long time for Copperfield to register the existence of the long-established CONI programme. The scheme's provided support for families for over twenty years now. Currently about 300 are enrolled each year.

What's clear from the evidence:

- Increased health visitor visits to high risk babies reduces mortality.
- Poor weight gain is a feature in infants who die suddenly and unexpectedly, so regular weighing is recommended.
- A fifth of SIDS babies were unwell 24 hours before death and symptom diaries and Baby Check help parents identify significant changes in health.
- Sweating and high rectal temperatures are described in SIDS and simple room thermometers help parents to be aware of ambient temperature.
- There is indeed no evidence that apnoea monitors prevent SIDS but they remain the element of CONI most attractive to parents because they allow them to get some much-needed sleep.

CONI is offered to a small but extremely vulnerable population of babies with anxious parents. 93% of these parents found the programme helpful.

Health visitors should already be targeting high risk families. Of the additional programme costs, half the equipment used on CONI has been donated by the Foundation for the Study of Infant Deaths. Additional stationery and disposable items cost just £40 per family. We believe there is sufficient evidence to support the expense.

The Foundation for the Study of Infant Deaths The Foundation for the Study of Infant