More than half of sudden unexplained infant deaths occur while the infant is sharing a bed or a sofa with a parent (co-sleeping) and may be related to parents drinking alcohol or taking drugs, suggests a study published on bmj.com today.
Although the rate of cot death in the UK has fallen dramatically since the early 1990s, specific advice to avoid dangerous co-sleeping arrangements is needed to help reduce these deaths even further, say the researchers.
The term sudden infant death syndrome (SIDS) was introduced in 1969 as a recognised category of natural death that carried no implication of blame for bereaved parents. Since then, a lot has been learnt about risk factors, and parents are now advised to reduce the risk of death by placing infants on their back to sleep, placing infants in the “feet to foot” position at the bottom of the cot, and keeping infants in a smoke-free environment.
But it is not clear which risk messages have been taken on board in different social or cultural groups, and little is known about the emergence of new or previously unrecognised risk factors.
So a team of researchers at the Universities of Bristol and Warwick studied all unexpected infant deaths from birth to two years in the southwest region of England from January 2003 to December 2006. This four-year study* was funded by The Foundation for the Study of Infant Deaths (FSID).
To investigate a possible link between SIDS and socioeconomic deprivation, they compared these deaths with a control group at ‘high risk’ for SIDS (young, socially deprived mothers who smoked) as well as a randomly selected control group.
Parents were interviewed shortly after the death and information was collected on alcohol and drug use. A detailed investigation of the scene and circumstances of death was also conducted by trained professionals.
Of the 80 SIDS deaths analysed, more than half (54 per cent) occurred whilst co-sleeping compared to 20 per cent co-sleeping rate amongst both control groups.
Much of this risk may be explained by the combination of parental alcohol or drug use prior to co-sleeping (31 per cent compared with 3 per cent random controls), and the high proportion of co-sleeping deaths on a sofa (17 per cent compared with 1 per cent random controls), say the authors.
A fifth of SIDS infants were found with a pillow for the last sleep and a quarter were swaddled, suggesting potentially new risk factors emerging.
The risk factors were similar whichever group the SIDS cases were compared with, suggesting that these risk factors for SIDS apply to all sections of the community and are not just a consequence of social deprivation.
Some of the risk reduction messages seem to be getting across and may have contributed to the continued fall in the SIDS rate, say the authors. However, the majority of the co-sleeping SIDS deaths occurred in a hazardous sleeping environment. The safest place for an infant to sleep is in a cot beside the parental bed in the first six months of life, they write.
Parents need to be advised to never put themselves in a situation where they might fall asleep with a young infant on a sofa. They also need to be reminded that they should never co-sleep with an infant in any environment if they have been drinking or taking drugs.
We have learnt that SIDS is largely preventable, says Edwin Mitchell, Professor of Child Health Research at the University of Auckland, in an accompanying editorial. It is important to monitor parents’ knowledge and infant care practices to inform health education and promotion. Implementing what we already know has the potential to eliminate SIDS, the challenge now is how to change behaviour, he concludes.
Please contact Joanne Fryer for further information.
*Case-control study of SIDS in Southwest England dangerous co-sleeping environments and risk factors amenable to change Fleming et al January 2003 – December 2006.
The Foundation for the Study of Infant Deaths is the UK’s leading baby charity working to prevent sudden deaths and promote infant health. FSID funds research (nearly £10 million to date), supports bereaved families, promotes baby care advice, and works to improve investigations when a baby dies.
The helpline also supports bereaved families. Advice for parents and professionals can also be found at www.fsid.org.uk
Advice for parents to reduce the risk of cot death:
· Cut smoking in pregnancy – fathers too! And don’t let anyone smoke in the same room as your baby.
· Place your baby on the back to sleep (and not on the front or side).
· Do not let your baby get too hot, and keep your baby’s head uncovered.
· Place your baby with their feet to the foot of the cot, to prevent them wriggling down under the covers or use a baby sleep bag.
· Never sleep with your baby on a sofa or armchair.
· The safest place for your baby to sleep is in a crib or cot in a room with you for the first six months.
· It’s especially dangerous for your baby to sleep in your bed if you (or your partner):
· are a smoker, even if you never smoke in bed or at home
· have been drinking alcohol
· take medication or drugs that make you drowsy
· feel very tired;
or if your baby:
· was born before 37 weeks
· weighed less than 2.5kg or 5½ lbs at birth
· Don’t forget, accidents can happen: you might roll over in your sleep and suffocate your baby; or your baby could get caught between the wall and the bed, or could roll out of an adult bed and be injured.
· Settling your baby to sleep (day and night) with a dummy can reduce the risk of cot death, even if the dummy falls out while your baby is asleep.
· Breastfeed your baby. Establish breastfeeding before starting to use a dummy.