Bed sharing and co-sleeping increases the risk of SIDS

The evidence has become quite clear: bed sharing, or co-sleeping, increases the risk of sudden infant death syndrome (SIDS).

The latest study to reinforce the risk of bed sharing comes out of the UK (with contributions from New Zealand and Germany). Published in the British Medical Journal, Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studies, combined data from five separate case-control studies on SIDS, creating a data set of 1472 SIDS cases to compare with 4679 healthy babies—the largest data series on SIDS that has ever been collected. The authors were able to separate out the effects of bed sharing along with other SIDS risk and protective factors to determine the risks of SIDS for families who only bed-shared, versus those who combined bed sharing with breastfeeding, smoking, and alcohol use. Other factors like the baby’s age, birth weight, and sleep position were also included. Their results are statistically strong, and show large big effect sizes.

Infants who share a bed with their parents during the first 3 months of life increase their risk of SIDS by five times—even if parents don’t smoke, don’t use alcohol, and exclusively breastfeed. In other words, breastfeeding and other positive SIDS risk factors avoidance does not erase the increased risk of SIDS associated with bed sharing.

In the combined data, 22.2% of babies who died of SIDS versus 9.6% of controls shared beds with their parents. The risk was especially high when other risk factors were present: bed sharing among infants whose parents smoked led to a 65-fold increase in SIDS; if parents consumed alcohol, the risk increased 90-fold. The risk of SIDS was “inestimably large” for bed-sharing if the mother used illegal drugs. But, again, even if none of these other risks were present, there was still a very large increase in SIDS rates. Bed sharing, even among breast-fed babies with no other risk factors, increased the risk of SIDS by a 5-fold compared to babies who slept on their own surface in their parents’ room or in their own rooms.

The American Academy of Pediatrics has recommended against bed sharing since their 2011 recommendations for the safest sleep environment for babies. Their guidelines are comprehensive and well-referenced, including many specific recommendations:

  • Babies should be put down to sleep on their backs. (That doesn’t mean they must be kept on their backs. Once they can roll, let them roll. Do not use devices that force your baby to stay in one position. Baby sleep positioners kill.)
  • Infants should sleep in a crib or bassinet—on a firm flat surface that’s safety-approved for infant sleeping. Car seats and other devices that hold baby in a sitting or semi-sitting position are not for routine sleep. (Which means that Fisher-Price Rock’n- Play Sleeper is specifically contraindicated for sleeping.)
  • Room sharing without bed sharing is recommended.
  • Avoid pillows, quilts, comforters, sheepskins, and other soft surfaces under the infant or in their sleep environment.
  • Avoiding smoking, alcohol, and illicit drug use during and after pregnancy.
  • Breastfeed
  • Consider offering a pacifier at sleep times.
  • Avoid overheating.
  • Immunize infants according to the established recommendations of the AAP and CDC (that is, don’t use one of the made-up schedules that have no scientific backing.)

Bed sharing is a choice that many families make. Some parents enjoy the closeness of baby, and feel more secure; some nursing moms feel that it makes nursing easier. But parents who choose to bed-share should have honest, well-researched information on both risks and benefits. Bed sharing, even with no other risk factors, dramatically increases the risk that your baby will die of SIDS.

Roy Benaroch is a pediatrician who blogs at The Pediatric Insider. He is also the author of Solving Health and Behavioral Problems from Birth through Preschool: A Parent’s Guide and A Guide to Getting the Best Health Care for Your Child.

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  • Barefootmeds

    Very interesting. I wonder if we have reached stability with these recommendations, or if they will change with time? When I was a baby, my mom only had us sleeping on our stomachs, because that’s what the literature at the time recommended…
    I assume these recommendations are for healthy babies though, right? For example, KMC would still be indicated in VLBW babies?

  • Ron Smith

    You know, the problem with having practiced for 30 years means that there are long memories of similar ‘breakthrough studies’ propounding that the cause of SIDS has been discovered.

    I remember the 5 original studies that were published about sleeping babies on their backs some 15 or more years ago. There were two problems I think now with those studies.

    The first is that none of the studies were done in the US. Having been many times to do medical clinics overseas, I can’t tell you some of the sleep strangeness that young children have to endure. Even in developed countries, there was little to adequately compare the sleeping position of children in those countries to children here in the US.

    The second problem was none of the downsides of sleeping children on their backs were discussed. A whole medical industry has cropped up around the plagiocephaly (flattened posterior occiputs) that resulted from this. Helmut prosthetics to correct this problem are common and you have to initiate them early in order to prevent the ophthalmic plane asymmetry that can become permanent as the sutures fuse and the fontanels close.

    Needless to say, we still have SIDS today and sleeping position changes were not the final word as we all hoped. I personally doubt sleeping position or co-sleeping is that real answer we are looking for.

    Personally I believe the SIDS for which there is clearly no obvious cause for is the one whose cure still eludes us. I think that these children may well have a Cardiac dysrhythmia like long QT syndrome. I wish there was a large scale study of infants or young children with consistent and high quality ECGs read by Pediatric cardiologists who care for those with long QT syndrome. Better yet, it might be better to simply screen newborns with ECGs like we do for hearing.

    New insights into long QT are apparent in my own practice as I have an adolescent who has type III long QT for which there is no treatment save an implanted defibrillator which itself may or may not work. Without a doubt we will discover more types as time goes on. Infants and children have not garnered the same concern that we give athletes who collapse and die in a sports arena, and that is unfortunate.

    Time, maybe, will tell.

    Ron Smith, MD
    www (dot) ronsmithmd (dot) com

  • Gina Paisley

    I tried to leave a comment days ago, but nothing came up. As an experienced nursing mother of three children, and a retired La Leche League Leader who’s been thoroughly trained and educated in the process of mothering the nursing baby.

    Families have been sleeping together in heaps since the beginning of time, and the notion that infants need their own set-apart space to sleep is a modern idea. For a nursing mother & baby, cribs make little sense. To awaken mother in the middle of the night for nursing, baby must wake sufficiently to cry, wake everyone up, usually causing mother to have to stumble out of bed to meet baby’s needs.

    But when co-family sleeping is practiced, mother has only to reposition herself against a baby barely stirring and beginning to root for mother’s breast. The baby latches on, and soon has finished the late-night nursing – without ever having to wake up enough to get upset and cry. This keeps everyone in the family so much happier, because everyone is getting more sleep.

    I haven’t seen this particular study, but we were taught as LLL Leaders that unless either of the parents are impaired in some way when they retire for the night – on alcohol or drugs of any kind – it is perfectly safe for baby to sleep nestled next to mother, the source of all comfort and life for the first year. An impaired parent might conceivably roll over onto, and perhaps suffocate, a baby in bed with him or her; but that would be pretty rare; I mean, how often do husbands and wives roll over each other during sleep?

    In addition, there have been medical and psychological benefits proven to be caused by a family bed. The baby’s heartbeat synchs to the mother’s, and with baby that close, even the hint of a possible problem for baby would be immediately appreciated by the mother, who could deal with it instantly, instead of perhaps noticing it eight or more hours later, when she’s risen from her own bed and made her way over to the baby’s crib.

    Years ago, I was at a LLL State Conference, where I attended a Grief seminar because of the loss I’d recently experienced of a close family member. In my group, there was a mother who, despite nursing, a family bed, home birth, and all other elements of what is called “natural mothering”, lost her infant to SIDS.

    There is no way to predict which little souls will simply slip away from us, and it always hurts that much more because we don’t know what caused it. But blaming the closeness of mother and father with the baby during sleep, at a time when historically, babies absolutely needed that closeness in order to protect them from predators, seems off-kilter and simpleminded to me – as though an agenda went looking for an answer which suited it. According to my own experience, and that of hundreds of thousands of other LLL mothers worldwide, sleeping close to your baby brings nothing but good to all concerned. SIDS deaths will continue until we’re able to figure out how to prevent them; they will happen to babies raised all along the spectrum of modern American ideas of how baby care should be handled, whether close each night in a warm heap of safety & comfort, or with baby segregated in a separate box with bars (a crib), often even in another room.

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