EDITOR—Blair et al investigated the factors influencing the risk of the sudden infant death syndrome.1 In an increasing number of infant deaths that we have investigated over recent years we have found several recurring themes: infant under 3 months; shared sleeping arrangements, particularly sharing a sofa; young carer; consumption of alcohol the night before the infant was found dead. Typically, the infant is found between the adult and the back of the sofa, often covered by a duvet. Sharing a sofa seems to be particularly common in single parent households with poor socioeconomic support, in which the mother sleeps on the sofa, often with more than one child, simply because it is the warmest place in the house. Some of the risk factors highlighted by Blair et al have long been recognised in law in the Children and Young Persons Act 1933.

We are concerned with the use of the term sudden infant death syndrome in this paper because it is potentially misleading in deaths associated with cosleeping. In such cases the infant may have been accidentally overlaid, smothered by the bedclothes, or squashed between the adult and back of the sofa. We accept that this cannot, at present, be proved beyond reasonable doubt, but we found in a recent study that intra-alveolar haemorrhage was increased in infants who died in the context of bed sharing and that this may be a marker of accidental asphyxia.2 This often manifests as bloodstained fluid issuing from the nose and mouth with consequent bloodstaining of the bedding and infant's clothing. Examination of the clothing and bedding is therefore essential.

It is inappropriate to accuse a carer unjustly in a cosleeping death. Nevertheless, it strikes us as being more honest to raise the suspicion that accidental upper airway obstruction may be a …