| Bed Sharing with Siblings, Soft
Bedding, Increase SIDS Risk
Infants who share a bed with other children are at a
higher risk of sudden infant death syndrome (SIDS) than
are other infants, according to the most recent analysis
of a study of predominantly African American SIDS deaths
in Chicago.
The analysis, appearing in the May, 2003
Pediatrics, also found that two known risk factors
for SIDS — sleeping on soft bedding and sleeping on the
stomach — pose a far greater risk of SIDS when they
occur together than the sum of both risk factors added
together would indicate. This analysis confirms several
international studies reporting that SIDS risk was lower
among infants put to bed with a pacifier and reinforced
earlier findings that sleeping on a sofa also increases
infants' risk of SIDS.
The study was supported by the National Institute of
Child Health and Human Development (NICHD) and the
National Institute on Deafness and other Communication
Disorders (NIDCD), both at the National Institutes of
Health (NIH), as well as the Centers for Disease Control
and Prevention (CDC). NIH and CDC are agencies of the
U.S. Department of Health and Human Services.
The researchers studied all infants from the ages of
birth to one year who had died of SIDS in Chicago,
Illinois, between November 1993 and April 1996. There
were 260 SIDS deaths during that time.
"This study provides important new information
regarding SIDS risk factors," said Duane Alexander,
M.D., Director of the NICHD. "The next step is to get
this information to the parents and families who can use
it to reduce the risk of SIDS among their own infants."
"The SIDS rate for African-American babies is more
than twice that for white infants," said CDC Director
Dr. Julie Gerberding. "Families need counseling on ways
to reduce the risk of SIDS. For example, they need to
know they should avoid putting an infant to sleep with
other children."
The research is part of the Chicago Infant Mortality
Study, designed to identify risk factors for SIDS that
place African American infants at roughly double the
SIDS risk of Caucasians. Earlier findings of the study
appear at
http://www.nichd.nih.gov/new/releases/infant_sids.cfm.
The Chicago Infant Mortality Study was directed by Fern
R. Hauck, M.D. M.S., currently of the University of
Virginia Health System.
"Our study found a dramatic increase in SIDS risk for
prone sleeping on soft surfaces, highlighting the need
to eliminate these unsafe sleep practices," said Dr.
Hauck. "Additionally, infants should never be placed to
sleep on a couch with anyone or in a bed with other
children."
The researchers compared information about each SIDS
case to information about a control infant — a living
infant of comparable age, who was from the same racial
and or ethnic group, and who had a similar birth weight.
All of the SIDS deaths were evaluated by the Cook County
Medical Examiner's Office; autopsies had been conducted
to rule out other causes of death. Death scene
investigators conducted interviews about circumstances
surrounding the deaths. The researchers used the NICHD
definition of SIDS: "the sudden death of an infant under
one year of age, which remains unexplained after a
thorough case investigation, including performance of a
complete autopsy, examination of the death scene, and
review of the clinical history."
Infants who died of SIDS were 5.4 times more likely
to have shared a bed with other children than were the
control infants. Sleeping with the mother alone or
mother and father was associated with an increased risk
of SIDS, but this finding was not statistically
significant. The study concluded "the risk was primarily
associated with bed sharing when the infant was sleeping
with people other than the parents." The researchers
also reported that sleeping with the mother alone did
not reduce infants' risk of SIDS, as some researchers
have concluded on the basis of earlier studies.
The researchers noted that sleeping on the stomach,
and sleeping on soft bedding — both known to increase
the risk of SIDS independently — posed a much greater
risk for SIDS when occurring together than might be
expected. For example, soft bedding appeared to pose 5
times the risk of SIDS as firm bedding; sleeping on the
stomach increased the risk of SIDS 2.4 times. Yet
infants who slept stomach down on soft bedding had 21
times the risk of SIDS as infants who slept on the back
on firm bedding.
Of the SIDS cases, 15 were found to have slept on a
sofa the last time they were placed to sleep. The
researchers do not know why sleeping on a sofa would
increase the risk of SIDS more than would sleeping on a
bed, yet warn that the practice appears to be highly
dangerous.
The study authors concluded that physicians should
counsel new parents not only about the benefits of
placing infants to sleep on their backs, but also about
the risk their study had uncovered.
"Parents are influenced strongly by their physicians
in choosing the sleep position for their infants," they
wrote. "Other infant care practices, such as bed sharing
and use of soft bedding, may also be influenced by
medical providers, particularly if reinforced by the
media."
To reduce the racial disparity in SIDS rates, the
authors advised taking families' economic circumstances
into consideration. For example, some parents may not be
able to afford firmer mattresses or to have enough beds
for all their family members. The authors called for
research on how best to meet these needs.
"On the basis of the findings of this study, they
[parents] should receive instruction that emphasizes
supine sleeping, firm bedding, not using pillows, and
not sharing a bed with other children or sleeping with
another person on a sofa, while being sensitive to
parental concerns and cultural traditions."
The current study is part of a body of research
sponsored by the NICHD on infant sleep practices and the
causes of SIDS. This large body of research, together
with compelling scientific evidence from around the
world, confirmed the safety and effectiveness of placing
infants to sleep on their backs. Based on this evidence,
the NICHD formed a coalition of national organizations
to launch a national public awareness campaign called
Back to Sleep in 1994. (See chart at
http://www.nichd.nih.gov/sids/sidsrates.pdf.)
Since the start of the NICHD-led campaign in 1994,
the SIDS rates for African American infants and white
infants have declined by about 50 percent, but a
significant disparity still remains. To help eliminate
this disparity, the NICHD joined with the non-profit
National Black Child Development Institute in a program
to reduce SIDS among African American infants in Chicago
and around the country. The NICHD has also partnered
with three African American women's groups to conduct a
series of "Summits" on SIDS risk reduction training and
outreach activities in communities around the country.
The first Summit, held jointly with the National
Coalition of 100 Black Women took place in Tuskegee,
Alabama,
http://www.nichd.nih.gov/new/releases/sids_risk.cfm.
The second Summit, held with the Women of the NAACP,
took place in Los Angeles,
http://www.nichd.nih.gov/new/releases/reduce_sids.cfm.
The next summit will be held May 30-31 in Detroit in
partnership with the Alpha Kappa Alpha Sorority, Inc.
The NICHD is part of the National Institutes of
Health, the biomedical research arm of the Department of
Health and Human Services. The Institute sponsors
research on development, before and after birth;
maternal, child, and family health; reproductive biology
and population issues; and medical rehabilitation. NICHD
publications, as well as information about the
Institute, are available from the NICHD Web site,
http://www.nichd.nih.gov, or from the NICHD
Information Resource Center, 1-800-370-2943; e-mail
NICHDClearinghouse@mail.nih.gov.
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