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Thomas J. Porter, MD, FAAP
President, Alaska Chapter
American Academy of Pediatrics
Anchorage, AK 99524
To the Editor.—
Recently, the American Academy of Pediatrics (AAP) released new sudden infant death syndrome (SIDS) prevention recommendations.1 Among much appropriate advice, the Task Force on Sudden Infant Death Syndrome "recommends that infants not bed share during sleep." Several controlled studies have documented that infants who share a bed with a parent have an increased risk of SIDS. However, these studies have not taken into account the entire context in which SIDS events occur, including parental impairment at the time of the infant's death, the infant's sleep position, and whether the infant slept on an inappropriate surface such as a water bed or couch. The few controlled studies and case series that have adjusted for maternal tobacco and alcohol use have found little2,3 or no4–6 independent association between bed sharing and SIDS.
Furthermore, SIDS rates in Alaska have decreased by 50% to 70% and infant mortality rates by 33% since 1993. During this same period, the proportion of mothers who reported always or almost always sleeping with their infants increased from 16% to 40%.7 Mothers whose race is Asian have the highest prevalence of sleeping with their infants, yet their infants have the lowest SIDS and infant mortality rates.
Although data supporting important adverse effects directly related to bed sharing are lacking, substantial data exist that bed sharing confers benefits to the infant,8 including improved breastfeeding, less infant crying, improved parent and child sleep, and improved parent-child bonding. Some of these factors, in turn, may relate directly to decreased risk of child abuse, one of the greatest health issues in pediatrics.
Even if some marginal excess risk exists, it is likely to be small. The AAP does a disservice by not quantifying this risk, particularly when addressing an issue of such potential cultural and positive health importance as maternal-infant bed sharing. Consistent with other studies,2,3 in Alaska, data from infant mortality reviews and surveys of new mothers (Alaska Pregnancy Risk Assessment Monitoring System [PRAMS]) suggest that the maximum potential risk among nonsmoking mothers is likely <1 in 10000.6,7
The Alaska Division of Public Health and the Alaska Chapter of the AAP continue to recommend that (1) parents always put their infants to sleep on their back unless told otherwise by a medical provider, (2) infants never sleep on a water bed or couch, and (3) infants sleep in an infant crib or with a nonsmoking, unimpaired caregiver on a standard adult non–water mattress. Among parents who do not use tobacco, alcohol, or other drugs, sleeping with their infant is a perfectly reasonable and potentially beneficial option. We call on the AAP to revise their recommendations to reflect the scientifically defensible position that bed sharing is only a risk if the parent is impaired or the sleeping surface is inappropriate.
REFERENCES
This article has been cited by other articles:
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  P Fleming, P Blair, and J McKenna New knowledge, new insights, and new recommendations Arch. Dis. Child., October 1, 2006; 91(10): 799 - 801. [Full Text] [PDF]
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