Originally published in MedPage Today
by Todd Neale, MedPage Today Staff Writer
Just over half — 54% — of sudden infant death syndrome (SIDS) cases in southwest England occurred when the baby was co-sleeping in the same bed as a parent, a case-control study showed.
That compares with 20% of infants among randomly selected families and controls deemed to be at high risk for SIDS, Peter Fleming, MBChB, PhD, of the University of Bristol in England, and colleagues reported online in BMJ.
In a multivariable analysis, sleeping on the same bed or couch as a parent was associated with a 21.77-fold (95% CI 3.79 to 125.00) increased risk of SIDS.
Much of the elevated risk appeared to be attributable to drug and alcohol use among the parents. In multivariable analyses, there were significant interactions between bed-sharing and substance use compared with both random controls (P=0.002) and high-risk controls (P=0.02).
But rather than advising against co-sleeping outright, they said “a better approach may be to warn parents of the specific circumstances that put infants at risk. Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa.”
Parents should also be advised to never co-sleep with an infant in any environment after consuming alcohol or drugs, they said.
The American Academy of Pediatrics recommends against co-sleeping. The 2005, recently affirmed policy statement advises parents to place their infants in “a separate but proximate sleeping environment” in the parents’ room.
The rate of SIDS dropped in the early 1990s after the AAP and other child health organizations began the “Back to Sleep” campaign advocating that parents put their babies on their backs.
Early recommendations also included reducing the amount of bedding and telling mothers to stop smoking during pregnancy.
More recent guidance has included recommendations against co-sleeping, placing infants on their sides to sleep, the use of duvets and pillows, and postnatal exposure to smoke.
It’s unclear, however, how well all of this advice has been heeded and whether there are new risk factors for SIDS emerging, Fleming and his colleagues said.
So they examined all unexpected deaths of infants up to 2 years old during a four-year period in six counties in southwest England.
They gathered two control groups, one comprising 82 randomly selected families and one comprising 87 families at high risk for SIDS because of young maternal age, low socioeconomic status, and current smoking.
There were 90 SIDS deaths identified during the study period, for a rate of 0.49 per 1,000 live births.
In addition to co-sleeping, there were several factors associated with an increased risk for SIDS:
* Child sleeping alone in a room: OR 21.34, 95% CI 2.99 to 152.56
* Using a pillow: OR 10.59, 95% CI 1.43 to 78.39
* Swaddling: OR 31.06, 95% CI 4.21 to 228.94
* Maternal smoking during pregnancy: OR 13.36, 95% CI 3.07 to 58.83
* Preterm birth: OR 11.52, 95% CI 1.64 to 80.82
* Parental report of child being in fair or poor health for the last sleep: OR 8.06, 95% CI 1.11 to 58.42
* Sleeping on stomach: OR 6.61, 95% CI 1.57 to 27.88
These risk factors were statistically significant regardless of the control group used as a comparison.
“This is important because it indicates that risk factors for SIDS apply to all sections of the community and are not just a consequence of social deprivation, because SIDS now occurs predominantly in disadvantaged communities,” wrote Edwin Mitchell, DSc, of the University of Auckland in New Zealand, in an accompanying editorial.
Other risk factors have become less significant over time, according to Fleming’s group.
The presence of bedding over the head or face of the baby, a side sleep position, excessive bedding and clothing, and postnatal exposure to tobacco smoke were not associated with SIDS in this study. They had been related in a previous study conducted 10 years earlier.
In his editorial, Mitchell said that very little could be gained from further epidemiological studies on the risk factors for SIDS, which are largely preventable.
The current challenge, he said, is finding out how to reduce these risk factors, although he did not propose any specific solutions.
Fleming and his colleagues acknowledged that the relatively small number of deaths from SIDS during the study may limit the interpretation and significance of some factors.
The study was also limited, they said, by the difficulty in recruiting control families and by the failure to interview control families on weekends, when drug and alcohol use might be more common.
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{ 12 comments }
The vast majority of the infant deaths in my experience as a Pediatric Emergency Medicine physician is due to either intentional abuse or un-intentional abuse (e.g. co-sleeping). As a husband and father, I observed my wife reading multiple “Mommy Magazines” which recommended and glorified co-sleeping with a “family bed.” She met with lactation consultants who scolded her for not keeping the baby with her at the bedside. All of these and other examples flew completely in the face of what I saw regularly in my Peds ED. My wife could fall asleep while breastfeeding in the middle of the night, much less when exhausted in bed after 3 hours of interrupted sleep. Although I understand and value the proximity of an infant with the mother (and father, for that matter), the risk of co-sleeping/roll over death is more concerning for me than sharing a bed with my infant child.
What C said. The “Mommy” magazines often spit in the face of conventional/accepted medical practice & advice.
I’ve worked in a number of hospitals over the years and every one of them have incorporated “back-to-sleep” principles in their standard discharge instructions for newborns. But you’d be amazed at the “push-back” you get.
It might be interesting to do a study and see how many parents who defied those instructions (i.e. sleeping with their infants, putting them on their stomachs to sleep, etc), and experienced a SIDS/unexplained death at home . . . wound up suing a physician for “malpractice”.
did any developments occur with that correlation between SIDS and that hearing test?
http://www.scienceblog.com/cms/hearing-test-may-predict-sids-13806.html
Matt, I would suggest you read the actual study and the skeptical commentaries in the following issue to better formulate your opinions of that ‘correlation.’ While provocative and potentially correct, the study demonstrated many of the problems of media (and researchers) overstating preliminary work. Briefly, it was retrospective discovery, of low number, and contained questionable statistical analysis–all major problems that preclude any real conclusions. Taken together with its obscurity in accepted SIDS theory, I would caution you against using the cited media outlet as your indicator of scientific merit in this case.
There is a safe way to co-sleep and an unsafe way to co-sleep. The argument that co-sleeping should be discouraged despite known advantages (increased nocturnal breastfeeding, avoidance of potentially damaging cry-it-out sleep “training”) because it can be performed in an unsafe manner deprives the parents of an opportunity to make an informed decision regarding their child’s well-being. You’ll notice that the article stressed that certain co-sleeping environments were very highly correlated with SIDS – mainly drugs, alcohol and sofas. In the absence of these extraneous factors, co-sleeping can be a safe alternative to traditional crib and cradle sleeping. Excuse the pun, but proclaiming all co-sleeping unsafe when we have additional identifiable and, more importantly, modifiable, risk factors to consider, is like “throwing the baby out with the bath water”. Let’s tell parents how to co-sleep safely if they prefer it instead of forcing upon them an alternative that some babies (and parents) have difficulty adjusting to. It’s no coincidence that with the “Back to Sleep” movement (and, yes, the consequent reduction in SIDS), there has been an explosion in the “Get Your Baby To Sleep” book industry.
With all due respect to the ANONYMOUS commenters, at no time do I suggest that all co-sleeping is bad. I simply state that the way most mothers perform co-sleeping does not utilize an attached or nearby crib…the concept of placing your infant next to you on a bed is not in the best interest of the child’s health (mental, physical, spiritual, or otherwise).
I wish the ANONYMOUS commenters could work in my ED last year alone. As the collator of the ED mortalities for the year, I found that, of the 22 infants pronounced dead in our 50,000 patients/yr pediatric ED, 17 were found asphyxiated in a bed with the mother while co-sleeping. Please, tell these mothers that the way that they slept with their child is safe based on historical and “Mommy magazine” experience. Please don’t state that co-sleeping is safe except for “drugs, alcohol and sofas.”
If you want to co-sleep with your infant, fine….just do it safely with a crib that attaches to your bed (an example at http://www.thekidswindow.co.uk/furniture/bedside_cot.htm) [no financial interest to disclose], or at least do it with your figurative eyes wide open.
I discovered ‘The Family Bed’ in 1977, when I was pregnant with my first baby. “Doesn’t this sound wonderful?!?” I exclaimed breathlessly to my husband. “No!” he replied with emphasis.
Four children and several years later he looked at me over the sea of little bodies in between us and said “I can’t believe I ever thought this was a choice.”
I believe that research like this is simply another strategy to intimidate parents who are listening to their instincts and keeping their babies as close as possible. The way nature intended, the way we are wired.
Our Western culture is anti-mother/baby, despite appearances otherwise. The message of discouraging marsupial parenting comes through in oblique and subtle ways, implying there is something wrong with the parent who who wants to hold that fleeting bundle close for as long as possible.
Sleeping with your baby in a crib attached to your bed is not “co-sleeping” so let’s get that straight. Second, we don’t know the circumstances surrounding the 17 of deaths you describe which is precisely my point.
I’m not really clear on this study. I thought that SIDS is by definition a death without a clear cause. Are we to believe that sleeping next to your mom causes you to spontaneously die, or are these babies whobare sleeping next to an intoxicated parent being asphyxiated?
I’m confused by the findings of this study. As a first time Mom to a 16 week old little boy, I was told by a number of midwives that sensible cosleeping did not pose any danger to the baby. Of course, sleeping after drinking, smoking or taking drugs are instances where cosleeping is not recommended, but to me that’s a no brainer.
I’m creating a safe sleeping environment for my son by eliminating all blankets, comforters and toys from his crib as well as dressing him in a merino sleepsack and putting him on his back at night.
My son is one now and I was worried about SIDS often even as he slept in an attached cot next to the bed, on his back, with no other soft things in the crib. He was swaddled for the first few months (definitely not swaddled by the time he could roll over). I think it is very stressful to have so much conflicting information out there on SIDS and to make mother’s feel like if they do some slight thing wrong they could be responsible for their infants death. I often napped with my son in our bed but never slept well because I was so worried about him. In hindsight I don’t think I needed to worry so much, I wish there was a way to put new mother’s at ease on this topic!
Sue and mynaturalbaby, I don’t think there is ever a way to put the mother of young children completely at ease. Biologically and emotionally, you are ON for as long as that child needs you. And I hate to tell you, that is pretty much the rest of your life, although it does get somewhat easier as they get older.
The way I look at it is, there are no guarantees in life. I tried to keep my children as safe I could, I listened to my instincts and made decisions that I could be comfortable with. Things have turned out fine for us. I am certain they will for you too, whatever you decide.
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