Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome
Commentary: Cot death - the story so far
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While the benefits of babies sleeping on their backs are now clear in relation to sudden infant death syndrome, there is conflicting evidence on the effect of infants sharing a bed with their parents. A study in this week's BMJ concludes that it is not bed sharing per se that is hazardous, but rather the particular circumstances in which bed sharing occurs. However, commenting on these findings a paediatrician from New Zealand argues that the greatest risk of all is when mothers who smoke or smoked in pregnancy sleep in the same bed as their infant and he says that "it is time to recommend that mothers who smoke should not share a bed with their babies."
Dr Peter Blair from the Royal Hospital for Children in Bristol, along with colleagues from Leeds and Newcastle, investigated the risks of sudden infant death syndrome and the factors that might contribute to unsafe sleeping environments. They studied a population of 17 million people, which included 325 babies who died and 1,300 infants who did not.
They found that sleeping with an infant on a sofa was associated with a particularly high and previously unrecognised risk of sudden infant death syndrome but that sharing a room with parents was associated with a lower risk. They also found that there was no increased risk associated with bed sharing when an infant was placed back in his or her cot for the remainder of their sleep.
They conclude that there is no evidence that bed sharing is hazardous for infants of parents who do not smoke, however among those infants who died and who had shared a bed with parents (the majority of whom smoked), the risk seemed to be associated with recent parental consumption of alcohol, overcrowded housing conditions, extreme parental tiredness and the infant being under a duvet.
In a commentary on Blair's paper Professor Ed Mitchell from the University of Auckland in New Zealand says that infants who suffer sudden infant death syndrome while sharing a sofa with a parent account for only six per cent of cases in contrast to the 23 per cent of deaths which occurred among cosleeping infants of mothers who smoke.
He also notes that a recent review of studies found that infants of mothers who smoked during pregnancy are at almost a fivefold increased risk of the sudden infant death syndrome compared with infants of non-smokers. This review also found that when the mother did not smoke, but the father did, the risk was increased 1.4-fold, says Mitchell. "Now that few infants sleep prone [on their fronts], maternal smoking is the major risk factor" for sudden infant death syndrome, he says.
"The challenge is to develop effective strategies to reduce smoking in pregnancy, as simply telling mothers that their babies are at increased risk of the sudden infant death syndrome is ineffective in changing behaviour," claims the author and he concludes that "it is time to recommend that mothers who smoke should not share a bed with their babies."
Contact:
Professor Peter Fleming, Professor of Infant Health and Developmental Physiology, Royal Hospital for Children, Bristol
Tel: 44-0-976-704320 or 0-117-928-5221
peter.fleming@bris.ac.uk
Professor Ed Mitchell, Associate Professor in Paediatrics, Department of Paediatrics, Faculty of Medicine and Health Sciences, University of Auckland, New Zealand
Tel:64-9-373-7599 Ext 6431
Fax: 64-9-373-7486
ed.mitchell@auckland.ac.nz