Bed Sharing and SIDS risk

st.augbride · July 2013

Hi ladies, I came across this article today and read through the entire thing. I'm an epidemiologist, and this study seems to be quite well done, so I wanted to share it. I currently bed share with dd, so I always try to read up so I can be as safe as possible. Essentially, even without any added risk factors and keeping things as safe as possible, LOs appear to be at a significantly greater risk for SIDS if you bed share when they are younger than 3 months of age. After 3 months, assuming you BF, don't smoke and don't drink, that risk goes away and is no longer significantly different from those who don't bed share, UNLESS they sleep on their bellies, but back sleeping and side sleeping for babies >3 months old without any other risk factors was just as safe. This definitely brought me comfort. Some things that this study couldn't assess that I think are also relevant include maternal BMI and the sleep environment (i.e. loose bedding, etc...). I am sure these things increase the risk, which would only make the lack of significance in that group even more relevant if practiced safely. Still, the risk for LOs under 3 months of age is substantial, which is sad and hard since many moms find it hard to sleep any other way during that time. Anyhow, I think it's good to be aware of these studies and their findings.

https://www.ncbi.nlm.nih.gov/pubmed/23793691

Emerald27 · July 2013

Here are some reaponses to the carpenter study:

[url]https://www.attachmentparenting.org/parentingtopics/bedsharinganalysis.php[url]

[url]https://www.prweb.com/releases/2013/5/prweb10762126.htm[url]

My main concern with carpenter is the lack of differentiation between SIDS and suffocation. They're not the same thing, and it seems as though this study does not take that into account. If your baby suffocates because of blankets, 3rd hand smoke, or whatnot, it's tragic and awful buy it's NOT SIDS.

Also, cosleeping can be very safe and beneficial to moms and babies, and I see it as so so sad that this study provides mistaken information that might scare mothers out if cosleeping, or cause them to do it in a different, more dangerous way, like sleeping with baby in a recliner rather than putting her in the parents' deadly bed.

st.augbride · July 2013

It's really not mistaken information though. While SIDS is different from suffocation, both are just as terrible when they occur, no? I think studies like this are very important to remind us that you are taking on some risk potentially, so to be as safe as possible if you are doing it. In a sleep-deprived state, I think some end up taking on extra risks. I've worked with research using death certs before, and they are often coded incorrectly. So while it would be great to have studies that completely differentiate between SIDS and other causes (there are separate ICD codes for suffocation, but they probably aren't always used properly), that just isn't as feasible at the population-level to conduct large-scale analyses. So while the risk may be way less for SIDS versus other causes (or no added risk if safe conditions are met) we just don't know that right now and can't say that. But the research that has been done suggests that there is a risk.

I wanted to post this because if you google bed sharing, often posts on AP boards come up, so many moms might read about bed sharing seeming super safe without taking the time to really understand all the issues as they aren't practicing APing.

I think we can use articles like this to help reduce the risk. While there are coding issues, as an epidemiologist, this study is pretty solid.

st.augbride · July 2013

Also, here is a quote from the first link you posted:

"The low-risk breastfeeding, non-smoking mother who hears such anti-bedsharing messages is likely to move from her relatively safe bed to a truly unsafe sofa or recliner to breastfeed at night, putting her baby at significantly higher risk. Breastfeeding is also likely to end sooner when mothers have to get up at night to nurse, and babies who aren’t breastfed have a higher risk of SIDS. "

I completely disagree with this. Why would I educate myself on risks and then move to an even less safe environment? Why wouldn't I just co-sleep with a crib next to the bed if I didn't want to take on any extra risk? Also, I don't see why this would make me stop BFing earlier. That is a choice and in a study released in Norway, they found the opposite: they have experienced a decrease in bed sharing with an increase in breastfeeding. So this is definitely not a given. Also, the information provided here is logical, but it is not evidence-based.

I love bed sharing with dd, though I do want to move her to the crib because I do ultimately believe that it is safer.

Emerald27 · July 2013

When DS was born we had a pack'n'play next to the bed. He wouldn't sleep there...he fussed and cried. I had been told that cosleeping was super dangerous and never to do it, so I moved our recliner into the bedroom and slept with him there for a week. My thinking was that I couldn't "roll" on him in the recliner, so it must be safer. And I had to do something so that we could all sleep.

After a week of discomfort and frustration I started researching cosleeping. We've done it safely ever since, and I wished that I had learned about it in advance so that I did not put DS at risk in the recliner.

I disagree with the carpenter study and think both that there are mistakes in its conclusions and that it ultimately will complicate the lives of moms just trying to get themselves and their babies some good sleep by making them feel guilty and afraid when in reality they are doing what is most natural and good.

st.augbride · July 2013

Did you get to read the complete article? I mean, the methods and results? It's pretty robust. I know the abstract is just a glimpse of it, but there's a ton of information and analysis that was done by leading SIDS researchers (they all collaborated to combine their data). The discussion is just that: the authors' interpretations of the results, but the odds ratios generated are from multivariate models controlling for all known risk factors (except BMI, which I think should be in there, and a variable to measure the bedding conditions; it would also be nice to have a variable to measure knowledge of safe practices) are very large, which is pretty statistically convincing from a methods standpoint.

You are right though that there is misinformation out there as to what is and is not safe, but an article like this only helps people critically think about their choices and actively seek out a safer sleep environment. I don't see why you would be 'against' it when it is only shedding light on a problem that clearly does exist and takes the lives of many babies. Not everyone bed shares safely--and 'safe' has not been 100% defined by research. There are pro-bed sharing experts who have ideas as to what contributes to a safe sleep environment, but let's face it, there are still some unknowns and many do make bad decisions in a sleep-deprived state (as evidenced by this study).

So even if you don't like the definitions used (SIDS versus other death of unknown cause), all infant deaths are terrible and I think it's good to make sure we are as educated as possible. It's not to judge what anyone does--raising a LO is hard enough! But I do think there are some lessons to be learned from studies like this, like to remind ourselves not to get overly confident and stop paying as much attention to safe practices, and to still be very wary of belly sleep in the bed.

I guess that's what prompted my post more than anything. On a babycenter AP message board, I saw an older post where a mom asked if it was safe for her baby to belly sleep in the bed and everyone said yes and made it seem like it was backed by research/known safe practices. But that's not true. Even in the article you posted they talk about back sleep. I think belly sleeping in the crib once they are old enough to do it on their own is different than in the bed, because side sleeping and back sleeping infants in the bed were NOT at added risk in older babies (so this isn't about suffocation risk but something else going on). I myself was worried about this b/c dd is now wanting to go on her belly and I keep flipping her while on the bed because it just didn't feel safe to me there, so I started doing some research on it.

At least for me, because of this article, if dd still insists on flipping over to belly, she is off to the crib, even though it won't be an easy transition.

ncbelle · July 2013

Of course all infant sleep deaths are tragic. But scare tactics don't save lives. All parents should be educated on SAFE bedsharing practices. Because the majority of parents will fall asleep with a baby at some point and those who do it in an unsafe sleep space (which generally means they've not planned on ever bedsharing) are the most likely to have a tragic outcome. I've seen numerous times on the bump and elsewhere a tired mama who is too afraid to put baby in her bed sleeping on a sofa or recliner - and that's not safe period.

The answer is education.

It's also worth noting that in countries where bed sharing is the norm, SIDS is unheard of. It is very important to differentiate between a suffocation death and a SIDS death - they have different causes.

st.augbride · July 2013

It's not a scare tactic to do epidemiologic research to identify risks. It's just research. Maybe that's not what you meant, but that's all this is. Research is a good thing because otherwise you can't identify the best 'safe practices'. We have an idea, but without the right research, you just truly don't know.

Also, can you cite where you are getting the info that SIDS is unheard of in countries that routinely bed share? Because even in Japan, where that is common, SIDS occurs (read a recent case report on it). If you are talking about countries in Africa, I have a hard time believing the right research has been done given how many other issues are present that confound any studies that could be done, and the conditions are so different that it would be almost impossible to extrapolate those findings to the United States.

ncbelle · July 2013

No research in and of itself isn't a scare tactic. But research is frequently presented with an angle - and used for particular purposes. The fact that the study doesn't distinguish between suffocation deaths and SIDS deaths makes its conclusions suspect at best as those are two different issues with two different causes and two different (although sometimes overlapping) preventions.

Sorry I don't recall where I got the statement about SIDS being unheard of in many countries. Maybe something from McKenna's work. Probably shouldn't have thrown it in there without something to substantiate it

starshineamator · July 2013

ncbelle said:
It's also worth noting that in countries where bed sharing is the norm, SIDS is unheard of. It is very important to differentiate between a suffocation death and a SIDS death - they have different causes.
...
Sorry I don't recall where I got the statement about SIDS being unheard of in many countries. Maybe something from McKenna's work. Probably shouldn't have thrown it in there without something to substantiate it

I don't have a source to cite either, but we learned that in a child psychology class I took in college. It was in our textbook and other articles/research we studied as well. I just don't have my book or my notes anywhere to back it up. But I knew immediately from that class that I'd be bed sharing with any children I had. And I do!

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