If you mention “bedsharing” to many nurses or doctors or even other parents, they will often tell you exactly how dangerous it is.  Haven’t you heard that it’s pretty much tantamount to trying to kill your child?  I’ve had people comment on other pages they think parents should be charged for bedsharing.  They really believe it’s that dangerous.

With last year’s Carpenter et al study[1] declaring a massive risk for bedsharing based on old data, Australian and New Zealand coroners calling for it to be illegal, and massive ad campaigns in the US trying to scare families away from it, it’s no wonder people have a rather frightful view of the matter.  The problem is that, as far as we can tell, this is one of those cases where there’s more bark than bite.

In most of the research, children who died of SIDS or suffocation (often they are lumped together) are compared to “controls” and then we factor out known risk factors (known as a case-control study).  This gives us an odds-ratio of the risk of any given activity while controlling for others.  It’s dependent upon the control group you select and the questions asked.  It’s immensely valuable, but also has, like all tests, it’s limitations.  For example, in the Carpenter et al analysis, many variables were not assessed (e.g., the tog value of the bedding which is known to be a huge risk factor for infant overheating and SIDS) or assessed improperly (e.g., alcohol in one of the samples was assessed as having had a drink at all in the 24 hours previous thus a glass of wine at lunch put you as a “yes” and in that same study, drinking alcohol did not significantly interact with bedsharing as a risk factor… does that seem wrong to anyone else?).

Why can’t we just look at all the deaths and see the actual risks?  Primarily because it’s a heck of a lot more work.  I mean, an insane amount of work.  You have to go through all autopsy and death records and hope that all of the details are there and accurately recorded.  Many places don’t even have that kind of data so it’s just easier to do it the other way.

 

However, in Alaska, they recently decided to advise that bedsharing was an appropriate sleeping arrangement provided it was done safely, which they outlined as being with an unimpaired, non-smoking caregiver on a standard, adult, non-water mattress.  This was in contrast to the campaigns and national recommendations being given in the rest of the USA.  Because of this contrast, a member of the government and a medical doctor decided to do the real legwork and actually look at every single infant death on record for a period of 13 years to see the real risk of bedsharing[2].  It was made easier by the fact that Alaska has a committee that reviews all infant deaths which ensured the nitty gritty details were there for analysis.  This is what they found…

  • In Alaska between the years of 1992 and 2004 there were 939 deaths although only 891 had been through the review process of the Maternal-Infant Mortality Review and were available for analysis.  Of these 891 deaths, 291 were SIDS or asphyxiation and were thus the deaths of interest for this research.
  • Of the 291 SIDS and asphyxiation deaths, 246 had bedsharing information and 126 occurred while bedsharing.
  • Of the 126 bedsharing SIDS/asphyxiation deaths, 119 had at least 1 “big five” risk factor which were defined as tobacco use, sleeping with a non-caregiver, prone sleep position (i.e., on baby’s stomach), impairment of bedsharing partner, and sofa or waterbed use.  Of these, 39 had one risk factor, 44 had two risk factors, and 36 had more than two risk factors.
  • Of the 7 remaining deaths, 2 had severe underlying medical illnesses and 4 had other risk factors including heavy smoke in the house by the non-bedsharing partner or multiple inappropriate items in the bed or sleeping on a nonstandard surface (non-sofa or waterbed).

If you can do your math, this leaves ONE infant death while bedsharing due to SIDS/asphyxiation in 13 years in the state of Alaska.  ONE.

Now, I don’t know if situations in Alaska can be generalized to the rest of the US or other countries, but it seems to me that we might be barking up the wrong tree when it comes to the risks of bedsharing.  Other research that has controlled for planned versus unplanned bedsharing found that when bedsharing was planned (likely leading to no risk factors), it was a non-significant risk (or no risk) compared to room-sharing[3].

It seems we should be educating people instead so that everyone can create a safe sleep environment for their children regardless of where that is.

 For more information on how to bedshare safely, you can download this safe bedsharing pamphlet or read an article here.
For more information on bedsharing and SIDS, you can read this.
For a wonderful book on safe co-sleeping, please check out this one from Dr. James McKenna.

Safe Bedsharing

 

[1] Carpenter RG, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies.  BMJ Open 2013; 3: e002299.

[2] Blabey MH, Gessner BD.  Infant bed-sharing practices and associated risk factors among births and infant deaths in Alaska.  Public Health Reports 2009; 124: 527-34.

[3] Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA.  Sleep environment risk factors for Sudden Infant Death Syndrome: the German Sudden Infant Death Syndrome study.  Pediatrics 2009; 123: 1162-70.

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