The article by Colvin et al, “Sleep Environment Risks for Younger and Older Infants,” incorrectly concludes that bed-sharing is the top risk factor for sleep-related deaths.
The authors fail to include any of the other major known risk factors for these deaths in their analysis besides sleep location and position. By far the other leading risk factors for sudden infant death syndrome (SIDS) are maternal smoking,1 infants sleeping unattended,1 and formula feeding.2 The risk of infant death from bed-sharing is strongly potentiated by maternal prenatal and/or postnatal smoking.3 The use of alcohol and sedating substances by parents/caregivers poses the greatest risk of suffocation death3 but was not included in the study. The smoking variable was actually available in the authors’ data set, and their failure to use it is inexplicable and concerning, because it would have likely significantly altered their results.
The authors also failed to distinguish adult beds from far riskier types of sleeping surfaces, although the literature clearly reveals that most accidental smothering/entrapment deaths involve sofas, recliners, or chairs.3
Because the authors did not use a control group, or population statistics regarding the prevalence of all factors stratified by age and smoking status at a minimum, it is impossible to draw any conclusions about the cause of sleep-related deaths from their study. Furthermore, 25% of the infants in this study actually died in cribs.
Increasing evidence reveals that one of the major risk factors for SIDS is infant formula feeding, but infant feeding was not reported in this article. A 2010 cost analysis links formula feeding to 911 excess infant deaths per year, 447 of which are from SIDS.4 The best, most recently conducted meta-analysis on SIDS and infant feeding method indicates that the number of SIDS deaths related to formula feeding is likely much higher than in the 2010 study.2
Evidence suggests blanket advice against bed-sharing may be ineffective and may be counterproductive, directly contributing to infant deaths in at least some cases. A survey of nearly 5000 US mothers revealed that sleepy parents are taking nighttime feedings to the sofa to avoid falling asleep with their infants in bed, and large numbers of these parents are unintentionally falling asleep there.5 Experts agree that sofas pose a much higher risk for infant death than beds.1,3 Parents of 2 SIDS infants described exactly this scenario, unaware that couches are far more dangerous places for infants to sleep than parental beds.3
The conclusions of this flawed study may be used to support the American Academy of Pediatrics’ recommendation against all bed-sharing. Instead, public health efforts must address the reality that tired parents must feed their infants at night somewhere, and that sofas are very dangerous for all infants, but especially for those of parents who are smokers or under the influence of alcohol or drugs. Public health messages must also acknowledge that breastfeeding infants and formula feeding infants do not sleep the same way when bed-sharing, and that formula feeding infants have a higher risk of death.
- Hauck FR,
- Thompson JM,
- Tanabe KO,
- Moon RY,
- Vennemann MM
- Bartick M,
- Reinhold A
- Copyright © 2014 by the American Academy of Pediatrics