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Bed Sharing When Parents Do Not Smoke: Is There a Risk of SIDS? An Individual Level Analysis of Five Major Case-Control Studies


Bed Sharing When Parents Do Not Smoke: Is There a Risk of SIDS? An Individual Level Analysis of Five Major Case-Control Studies

Robert Carpenter et al. BMJ Open.


Objective: To resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed.

Design: Bed sharing was defined as sleeping with a baby in the parents' bed; room sharing as baby sleeping in the parents' room. Frequency of bed sharing during last sleep was compared between babies who died of SIDS and living control infants. Five large SIDS case-control datasets were combined. Missing data were imputed. Random effects logistic regression controlled for confounding factors.

Setting: Home sleeping arrangements of infants in 19 studies across the UK, Europe and Australasia.

Participants: 1472 SIDS cases, and 4679 controls. Each study effectively included all cases, by standard criteria. Controls were randomly selected normal infants of similar age, time and place.

Results: In the combined dataset, 22.2% of cases and 9.6% of controls were bed sharing, adjusted OR (AOR) for all ages 2.7; 95% CI (1.4 to 5.3). Bed sharing risk decreased with increasing infant age. When neither parent smoked, and the baby was less than 3 months, breastfed and had no other risk factors, the AOR for bed sharing versus room sharing was 5.1 (2.3 to 11.4) and estimated absolute risk for these room sharing infants was very low (0.08 (0.05 to 0.14)/1000 live-births). This increased to 0.23 (0.11 to 0.43)/1000 when bed sharing. Smoking and alcohol use greatly increased bed sharing risk.

Conclusions: Bed sharing for sleep when the parents do not smoke or take alcohol or drugs increases the risk of SIDS. Risks associated with bed sharing are greatly increased when combined with parental smoking, maternal alcohol consumption and/or drug use. A substantial reduction of SIDS rates could be achieved if parents avoided bed sharing.

Keywords: Bed sharing; Epidemiology; Prevention; Public Health; Sids.


Figure 1
Figure 1
The age distribution of the cases in the combined study.
Figure 2
Figure 2
Adjusted ORs (AORs; log scale) for Sudden Infant Death Syndrome by age for bed sharing breast-fed infants, when neither parent smokes and both smoke versus comparable infants sleeping supine in the parents’ room. AORs are also adjusted for feeding, sleeping position when last left, where last slept, sex, race, and birth weight, mother's age, parity, marital status, alcohol and drug use.

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