The Journal of Pediatrics
Volume 147, Issue 1 , Pages 6-7, July 2005

Where Should Baby be Put Back to Sleep?

  • Bradley T. Thach, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Dr Bradley T. Thach, Washington University Department of Pediatrics, 660 S. Euclid, Campus Box 8208, St. Louis, MO 63110.

Washington University Department of Pediatrics, 660 S. Euclid, Campus Box 8208, St. Louis, MO 63110

See related article, p 32.

Article Outline

SIDS, Sudden infant death syndrome

 

Avehement debate currently exists regarding the merits as opposed to the dangers of infant parent bedsharing.1, 2, 3 The stakes are high as studies suggest that up to 50% of sudden infant death occur in infants sleeping on adult beds or the equivalent (about 2000 deaths per year in the United States) with an even higher percent of these deaths (67%) occurring in the African-American population.4, 5, 6 It is difficult to remember a clash of this magnitude between pediatricians and lay advocates. Also seemingly unprecedented is the publicly acknowledged rift between the investigators of a prominent research team who conducted a large multinational sudden infant death syndrome (SIDS) epidemiological study.7 The basis for the disagreement concerns the study's finding on bedsharing. It is described as a “serious disagreement among the study authors about the statistical methods employed, the significance of these findings and their implications for parents.”8 The debate exists primarily because a coalition of lay and professional groups that promotes breastfeeding maintains that bedsharing is essential for optimal breastfeeding and in addition enhances mother infant bonding.3 Opposing this view are pediatric researchers who have documented the risks associated with bedsharing.4, 9

Public health agencies caught between these often warring factions have taken a middle position. The Academy of Pediatrics Task Force on Infant Positioning and SIDS has advised that “while bed sharing may have certain benefits (breast feeding) there are no scientific studies demonstrating that bedsharing reduces SIDS risk. Conversly, there are studies suggesting that bedsharing under certain conditions may actually increase the risk of SIDS.”10 Such public health advisories have been based on the risk for SIDS while bedsharing. However, the overall risk for death is substantially higher than that for SIDS alone, since medical examiners often use the diagnosis overlaying accidental suffocation and cause of death undetermined for infant deaths occuring while bedsharing.4, 5, 9 Therefore, a strong arguement can be made for making bedsharing warnings more emphatic.

One big issue in this debate is that the breastfeeding advocates are promoting the concept that bedsharing can be made safe.3 For those on the other side of the debate it is perceived that this is virtually impossible in the United States and Europe. To make bedsharing safe the anti-bedsharing faction contends a mother would have to sleep on a thin floormat without pillows or blankets as is still practiced by some traditional societies. Important in this regard is that until now both the pro and con groups have been in general agreement that bedsharing by mothers who do not smoke is relatively safe. In fact numerous studies have found no evidence of bedsharing risk among nonsmoking mothers.7, 10

Accordingly, the most important finding of the study reported in this issue of the Journal is that there is a substantial SIDS risk associated with bedsharing in nonsmoking mothers even in those who also breastfeed.11 Because the controversies regarding bedsharing often center on the methods and data analysis in studies, it is noteworthy that a group of experts with pre-publication access to the manuscript found no serious flaws in the design or data analysis techniques employed in the study. Relevant to the mechanism of bedsharing deaths the authors conclude that the risk occurs when the parent is sleeping and hence putting an infant back into a crib before the parent falls sleep should make bedsharing virtually risk free.

The present report comes on the heels of the controversial collaborative European Study showing a risk for SIDS in infants of nonsmoking bedsharing mothers, albeit much lower than reported in the present study.7 Doubtless a debate will ensue concerning why these two studies are so dissimilar in their assessment of the magnitude of bedsharing risk. Do Scots have more risk modifiers when they bedshare (eg, alcohol consumption, pillows or bulky comforters in the bed) than European bedsharers? Certainly, further studies of bedsharing risks in different ethnic, socioeconomic, and cultural groups are warranted.

Without doubt the bedsharing controversy will continue, yet we feel certain that the present study will provide much needed sound scientific evidence. Such evidence is essential for the ongoing bedsharing debate and perhaps one day will facilitate a coming together of the various parties involved.

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References 

  1. Barone M. Sleeping like a baby: how bedsharing soothes infants. Mothering: The Magazine of Natural Family Living. Issue 114, Sept/Oct 2002. Available online at http//www.mothering.com/articles/new_baby/sleep/barone.html.
  2. Donohue-Carey, P. Solitary or shared sleep: what's safe? Mothering: The Magazine of Natural Family Living. Issue 114 Sept/Oct 2002. Available online at http//www.mothering.com/articles/new_baby/sleep/Donahue-carey.html.
  3. Mckenna J. Consumer safety group warns of new lethal danger to babies: are warning labels for mommy next? Available online at Redflagsweekly.com/features/2002_sept09_2.html.
  4. Nakamura S, Wind M, Danello M. Review of hazards associated with children placed in adult beds. Arch Pediatr Adolesc Med. 1999;153:1019–1023
  5. Unger B, Kemp JS, Wilkins D, Psara R, Ledbetter T, Graham B, et al. Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics 2003;111:e127-31. Available online at http:www.pediatrics.org/cgi.content/full/111/2/e127.
  6. Drago D, Dannenberg A. Infant mechanical suffocation deaths in the United States, 1980-1997. Pediatrics 1999;103:e59.
  7. Carpenter R, Irgens L, Blair P, England P, Fleming P, et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 2004;363:185–191Accessed online January 17, 2004. Available online at www.thelancet.com
  8. Unicef UK. Statement on mother infant bedsharing and response to Lancet publications on sudden infant death among bedsharing babies. Available online at http:www.babyfriendly.org.uk/press.asp#040903. Posted 2/16/2004 and 1/16/2004.
  9. Scheers NJ, Rutherford G, Kemp JS. Where should infants sleep? A comparison of risk for suffication of sleeping in cribs, adult beds, and other sleeping surfaces. Pediatrics. 2003;112:883–889
  10. Kattwinkel J, Brooks J, Keenan M, Malloy M. American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Does bed sharing affect the risk of SIDS?. Pediatrics. 1997;100:272
  11. Tappin D, Ecob R, Stat S, Brooke H. Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: A case control study. Pediatrics. 2005;147:34–37

PII: S0022-3476(05)00280-5

doi:10.1016/j.jpeds.2005.03.049

The Journal of Pediatrics
Volume 147, Issue 1 , Pages 6-7, July 2005

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