Abstract
ObjectiveThe risk of sudden infant death syndrome (SIDS) among infants who co-sleep in the absence of hazardous circumstances is unclear and needs to be quantified.DesignCombined individual-analysis of two population-based case-control studies of SIDS infants and controls comparable for age and time of last sleep.SettingParents of 400 SIDS infants and 1386 controls provided information from five English health regions between 1993–6 (population: 17.7 million) and one of these regions between 2003–6 (population:4.9 million).ResultsOver a third of SIDS infants (36%) were found co-sleeping with an adult at the time of death compared to 15% of control infants after the reference sleep (multivariate OR = 3.9 [95% CI: 2.7–5.6]). The multivariable risk associated with co-sleeping on a sofa (OR = 18.3 [95% CI: 7.1–47.4]) or next to a parent who drank more than two units of alcohol (OR = 18.3 [95% CI: 7.7–43.5]) was very high and significant for infants of all ages. The risk associated with co-sleeping next to someone who smoked was significant for infants under 3 months old (OR = 8.9 [95% CI: 5.3–15.1]) but not for older infants (OR = 1.4 [95% CI: 0.7–2.8]). The multivariable risk associated with bed-sharing in the absence of these hazards was not significant overall (OR = 1.1 [95% CI: 0.6–2.0]), for infants less than 3 months old (OR = 1.6 [95% CI: 0.96–2.7]), and was in the direction of protection for older infants (OR = 0.1 [95% CI: 0.01–0.5]). Dummy use was associated with a lower risk of SIDS only among co-sleepers and prone sleeping was a higher risk only among infants sleeping alone.ConclusionThese findings support a public health strategy that underlines specific hazardous co-sleeping environments parents should avoid. Sofa-sharing is not a safe alternative to bed-sharing and bed-sharing should be avoided if parents consume alcohol, smoke or take drugs or if the infant is pre-term.
Highlights
In the last 25 years the number of deaths due to Sudden Infant Death Syndrome (SIDS) in England & Wales has fallen from around 1600 deaths a year in 1988 to around 250 deaths a year in 2010 [1]
The question remains as to whether there is still a residual risk of bed-sharing in the absence of these hazardous circumstances. This question is important as it is central to public health strategy in terms of whether one should take a blanket approach to advise against bedsharing in any circumstances as chosen for example by the American Academy of Paediatrics [9], or acknowledge that bedsharing is a common practice and target hazardous circumstances as adopted by UNICEF UK in their ‘Caring for your baby at night’ leaflet [10]
Of the 405 SIDS infants and 1387 controls in the two studies we had data on the sleep environment in which the infant was found for 400 SIDS infants (98.8%) and 1386 controls (99.9%)
Summary
In the last 25 years the number of deaths due to Sudden Infant Death Syndrome (SIDS) in England & Wales has fallen from around 1600 deaths a year in 1988 to around 250 deaths a year in 2010 [1]. This 85% fall in SIDS rates has been accompanied by changes in the characteristic profile of these deaths. This question is important as it is central to public health strategy in terms of whether one should take a blanket approach to advise against bedsharing in any circumstances as chosen for example by the American Academy of Paediatrics [9], or acknowledge that bedsharing is a common practice and target hazardous circumstances as adopted by UNICEF UK in their ‘Caring for your baby at night’ leaflet [10]
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