BMJ 1999;319:1457-1462 ( 4 December )

Papers

Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome

Peter S Blair, medical statistician, a Peter J Fleming, professor of infant health and developmental physiology, a Iain J Smith, senior lecturer in health research and honorary consultant in child health, b Martin Ward Platt, consultant paediatrician and senior lecturer in child health, c Jeanine Young, research nurse, a Pam Nadin, research health visitor, a P J Berry, professor of paediatric pathology, a Jean Golding, professor of paediatric and perinatal epidemiology, a the CESDI SUDI research group. 

a Institute of Child Health, Royal Hospital for Children, St Michael's Hill, Bristol BS2 8BJ, b Nuffield Institute for Health Services, Leeds LS2 9PL, c Newcastle Neonatal Service, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

Correspondence to: P Blair p.s.blair{at}bris.ac.uk

Objective: To investigate the risks of the sudden infant death syndrome and factors that may contribute to unsafe sleeping environments.
Design: Three year, population based case-control study. Parental interviews were conducted for each sudden infant death and for four controls matched for age, locality, and time of sleep.
Setting: Five regions in England with a total population of over 17 million people.
Subjects: 325 babies who died and 1300 control infants.
Results: In the multivariate analysis infants who shared their parents' bed and were then put back in their own cot had no increased risk (odds ratio 0.67; 95% confidence interval 0.22 to 2.00). There was an increased risk for infants who shared the bed for the whole sleep or were taken to and found in the parental bed (9.78; 4.02 to 23.83), infants who slept in a separate room from their parents (10.49; 4.26 to 25.81), and infants who shared a sofa (48.99; 5.04 to 475.60). The risk associated with being found in the parental bed was not significant for older infants (>14 weeks) or for infants of parents who did not smoke and became non-significant after adjustment for recent maternal alcohol consumption (>2 units), use of duvets (>4 togs), parental tiredness (infant slept =<4 hours for longest sleep in previous 24 hours), and overcrowded housing conditions (>2 people per room of the house).
Conclusions: There are certain circumstances when bed sharing should be avoided, particularly for infants under four months old. Parents sleeping on a sofa with infants should always be avoided. There is no evidence that bed sharing is hazardous for infants of parents who do not smoke.


Key messsages

  • Cosleeping with an infant on a sofa was associated with a particularly high risk of sudden infant death syndrome

  • Sharing a room with the parents was associated with a lower risk

  • There was no increased risk associated with bed sharing when the infant was placed back in his or her cot

  • Among parents who do not smoke or infants older than 14 weeks there was no association between infants being found in the parental bed and an increased risk of sudden infant death syndrome

  • The risk linked with bed sharing among younger infants seems to be associated with recent parental consumption of alcohol, overcrowded housing conditions, extreme parental tiredness, and the infant being under a duvet



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Rapid Responses:

Read all Rapid Responses

Why the danger in sharing a sofa?
Sarah Milne
bmj.com, 16 Dec 1999 [Full text]
RE: Why the danger in sharing a sofa?
Peter Blair
bmj.com, 20 Dec 1999 [Full text]
Down with smoking and separate-room sleeping
Cory A Mermer
bmj.com, 22 Dec 1999 [Full text]
Smoking: a residual confounder in the risk of SIDS when bed-sharing
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