Alcohol and Co-Sleeping Affect Risk for SIDS

Oct. 14, 2009— -- Dave Taylor, a Boulder, Colo. father of three school-age kids, is one of the growing number of people who ignored pediatricians' warnings against bed-sharing as a way to reduce Sudden Infant Death Syndrome, or SIDS.

"I have three kids and they have all survived their babyhood and we co-slept with all three of them," Taylor, author of the Attachment Parenting Blog, APParenting.com, said of his children who are now 12, 9 and 5. "It started out with baby cuddling with mamma and, as they got bigger, they took over the bed. The real issue is room in the bed."

Since the 1990s "Back to Sleep" campaign reduced SIDS deaths by 50 percent, a laundry list of new advisories for parents such as removing pillows or blankets has halved the rate of SIDS once again.

But new research out of England suggests that the risks for SIDS are more nuanced than once thought.

"The findings suggest that much of the risk associated with co-sleeping may be explained by the circumstances in which the SIDS infants were found," Peter S. Blair of the University of Bristol said in a study published Tuesday in the British Medical Journal.

Blair and his colleagues followed all babies born in a southwest region of England from 2003 to 2006 to identify the common behaviors and circumstances surrounding a SIDS death.

Of the 184,800 infants tracked in the study, 90 of them died from SIDS and 80 families agreed to detailed interviews and investigation shortly after the children's deaths.

Researchers found that 54 percent of the infants who died of SIDS had been co-sleeping with parents at the time of death, while 21 percent of infants in the control groups had recently co-slept with parents.

Given the large number of children who were co-sleeping yet did not succumb to SIDS, the authors wondered whether co-sleeping alone had put children at risk for sudden death or a combination of behaviors.

When Sharing a Bed With Baby Is Most Dangerous

While children who died of SIDS also were more likely to be co-sleeping with a parent than a random selection of children, they were far more likely to be sleeping next to a parent who recently drank alcohol or did drugs (31 percent of children who had SIDS vs. 3 percent of children in the control groups), and were more likely to be sharing a sofa than a bed with an adult (17 percent of children who has SIDS vs. 1 percent of children in the control groups).

"What's really interesting to me about this study is how it shows we need to have a better idea about what infant-care practices are," said Dr. Eric Gibson, a neonatologist at the duPont Hospital for Children at Thomas Jefferson University in Wilmington, Del.

Gibson was also pleased to see more investigation because doctors still don't understand why factors such as sleep position, whether the mother smoked during pregnancy or whether the baby was born prematurely actually cause SIDS.

Bristol's Blair and his colleagues wrote, "The safest place for an infant to sleep is in a cot [crib] beside the parents' bed. Based on evidence from research into SIDS, it is questionable whether advice to avoid bed sharing is generalizable and whether such a simplistic approach would do no harm.

"Parents of young infants need to feed them during the night, sometimes several times, and if we demonize the parents' bed, we may be in danger of the sofa being chosen."

Upon hearing of the additional risks listed in the study such as a combination of co-sleeping and parental alcohol use, blogger Taylor wondered if parents' reasons for bed sharing may be part of the nuanced finding in the new study.

"With co-sleeping, it's really a matter of whether because it's conscious parenting, or whether it's just, 'We don't want to get a crib because it's a hassle,'" Taylor said.

Taylor said he eventually built a smaller bed, the family's "side car," at the same height as the parent's bed for the new additions to the family.

In an editorial published Tuesday in the British Medical Journal, Dr. Edwin Mitchell, professor of child health research at the University of Auckland in New Zealand, wrote, "So what needs to be done? We have learnt that SIDS is largely preventable. Further epidemiological studies will provide only relatively small gains and some clarification of the risk factors."

Mitchell proposed surveys to keep doctors up to date about parental behavior, saying, "Educational research is needed, in particular, how to change behavior."

But Linda Tantawi, executive director of the CJ Foundation for SIDS in Hackensack, N.J., took issue with the notion that SIDS is preventable, especially because doctors do not know what causes it.

"We don't want to mix up risk factors with causes -- say that SIDS is largely preventable. Can you imagine a SIDS mom reading this, one who found her baby on her back, dead?" Tantawi said.

Tantawi pointed out that a variety of behaviors can affect the risk of SIDS.

"We know that breastfeeding reduces the risk, but are we making mothers breast feed?" Tantawi said. "We know that putting a fan in the room reduces the risk, but do we have to make everyone put a fan in the room?"