Original Article
Bedsharing, Roomsharing, and Sudden Infant Death Syndrome in Scotland: A Case-control Study

https://doi.org/10.1016/j.jpeds.2005.01.035Get rights and content

Objective

To examine the hypothesis that bedsharing with an infant is associated with an increased risk of sudden infant death syndrome (SIDS).

Study design

A 1:2, case:control study in Scotland UK, population 5.1 million, including 123 infants who died of SIDS between January 1, 1996 and May 31, 2000, and 263 controls. The main outcome measure was sharing a sleep surface during last sleep.

Results

Sharing a sleep surface was associated with SIDS (multivariate OR 2.89, 95% CI 1.40, 5.97). The largest risk was associated with couch sharing (OR 66.9, 95% CI 2.8, 1597). Of 46 SIDS infants who bedshared during their last sleep, 40 (87%) were found in the parents' bed. Sharing a bed when <11 weeks (OR 10.20, 95% CI 2.99, 34.8) was associated with a greater risk, P = .010, compared with sharing when older (OR 1.07, 95% CI 0.32, 3.56). The association remained if mother did not smoke (OR 8.01, 95% CI 1.20, 53.3) or the infant was breastfed (OR 13.10, 95% CI 1.29, 133).

Conclusions

Bedsharing is associated with an increased risk of SIDS for infants <11 weeks of age. Sharing a couch for sleep should be strongly discouraged at any age.

Section snippets

Ethics

Ethics committees for the 15 Health Boards in Scotland gave approval.

Population

Between January 1996 and May 2000, pathologists notified us of all sudden unexpected infant deaths that history, police death scene investigation, and initial postmortem dissection had failed to explain. A standard necropsy protocol9 with agreed diagnostic criteria was used to provide consistent classification, and 94% of cases were examined by an expert pediatric pathologist. Parental home visits were arranged for 156 cases,

Results

Last sleep was “night” for 107 of 119 (90%) SIDS cases and “day” for 12 (10%) SIDS cases; 4 were not recorded. “Day” deaths were all found between 9:30 am and 6:30 pm. Only 2 of 12 (17%) “day” deaths co-slept (both bed).

Parental bed was the normal sleep place (the infant did not normally sleep in a cot or elsewhere) for 11% (13/123) of SIDS infants and 5% (13/263) of controls. Overall, 64 of 123 (52%) SIDS infants shared the same sleep surface (bed, couch, chair or cot) during their last sleep

Discussion

We confirm that sharing a couch to sleep2 is associated with an increased risk of SIDS and that sleeping in the same room as parents is associated with a lower risk compared with sleeping in a separate room.13 However we cannot confirm that bedsharing is only associated with SIDS if a parent is a smoker.1, 2 As suggested by the recent ECAS study,14 we found an association between bedsharing and SIDS for young infants even if parents did not smoke. Novel findings from this study are that

Conclusion

Sharing a couch for sleep, sleeping in a room alone, and bedsharing with smoking parents are associated with an increased risk of SIDS. In Scotland, the association with bedsharing remains for young infants even if mother is a nonsmoker or the infant is breastfed. We support the revised UK Department of Health advice that the safest place for your baby to sleep is in a cot in your room for the first six months.17

Table A and Table B are available online at www.us.elsevierhealth.com/jpeds.

References (17)

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Cited by (0)

The Scottish Cot Death Trust provided funding for this project.

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