Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 1073 (doi:10.1542/peds.2008-0142)

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LETTER TO THE EDITOR

Cobedding Twins and Higher-Order Multiples

Eileen Tyrala, MD, FAAP
Cribs for Kids,
Pittsburgh, PA 15212,
SIDS of PA,
Pittsburgh, PA 15212

Esther K. Chung, MD, MPH, FAAP
Department of Pediatrics,
Jefferson Medical College,
Philadelphia, PA 19107,
Department of Pediatrics,
Alfred I. duPont Hospital for Children,
Wilmington, DE 19803

To the Editor.—

We read with interest the commentary "Cobedding Twins and Higher-Order Multiples in a Hospital Setting" by Tomashek, Wallman, and the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn.¹ The recognition and discussion by the committee of this all-too-common practice in newborn nurseries and NICUs across the United States highlight several important points. First, the published literature shows no proven benefits of cobedding twins or multiples in the hospital setting.

Second, the safety of cobedding of twins or multiples has not been established and may actually place infants at increased risk, because bed sharing with other children has been associated with an increased risk for sudden unexpected infant death and sudden infant death syndrome (SIDS).^2–4 In 2005, the AAP Task Force on SIDS concluded that "the evidence is growing that bed sharing, as practiced in the United States and other Western countries, is more hazardous than the infant sleeping on a separate sleeping surface and, therefore, recommends that infants not bed share during sleep."⁵ The AAP Task Force on SIDS also encouraged all health care providers who were responsible for organizing the hospital discharge of infants from the NICU to be vigilant about endorsing and modeling SIDS risk-reduction recommendations before the infant's anticipated discharge. This is essential, because there is strong evidence demonstrating that infant sleeping practices used in the hospital are highly likely to be duplicated by parents in the home setting.^6,7

In the absence of a proven benefit of cobedding, all those who provide care to infants in newborn nurseries and NICUs should model separate bedding as one aspect of safe sleep practice to parents of twins and multiples.

REFERENCES

1. Tomashek KM, Wallman C; American Academy of Pediatrics, Committee on Fetus and Newborn. Cobedding twins and higher-order multiples in a hospital setting [published correction appears in Pediatrics. 2008;121(1):227]. Pediatrics. 2007;120 (6):1359 –1366[Free Full Text]
2. Tappin D, Ecob R, Brooke H. Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. J Pediatr. 2005;147 (1):32 –37[CrossRef][Web of Science][Medline]
3. Kemp JS, Unger B, Wilkins D, et al. Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: results of a four-year, population-based, death-scene investigation study of sudden infant death syndrome and related deaths. Pediatrics. 2000;106 (3). Available at: www.pediatrics.org/cgi/content/full/106/3/e41
4. Unger B, Kemp JS, Wilkins D, et al. Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics. 2003;111 (2). Available at: www.pediatrics.org/cgi/content/full/111/2/e127
5. American Academy of Pediatrics, Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005;116 (5):1245 –1255[Abstract/Free Full Text]
6. Colson ER, Bergman DM, Shapiro E, Leventhal JH. Position for newborn sleep: associations with parents' perceptions of their nursery experience. Birth. 2001;28 (4):249 –253[CrossRef][Web of Science][Medline]
7. Brenner RA, Simons-Morton BG, Bhaskar B, et al. Prevalence and predictors of the prone sleep position among inner-city infants. JAMA. 1998;280 (4):341 –346[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Tyrala, E. Articles by Chung, E. K. Search for Related Content PubMed PubMed Citation Articles by Tyrala, E. Articles by Chung, E. K. Related Collections Premature & Newborn Social Bookmarking                         What's this?