By Michael Breus, PhD, ABSM
Here’s some disturbing news: despite well-documented safety risks, the number of infants sleeping in bed with parents is on the rise, and has been for some time. Infant sleep position and bed sharing are important risk factors for SIDS (Sudden Infant Death Syndrome) as well as other accidental sleep-related infant deaths, including suffocation. To protect against these deaths, the American Academy of Pediatrics recommends that infants sleep on their backs, and that they not share a bed with parents, caregivers, or other children. (The AAP does encourage parents and caregivers to sleep in the same room with their infant children, just not the same bed.) SIDS, although rare, is a leading cause of death among infants in the United States.
Despite these recommendations, the practice of sleeping with infant children has grown more common, not less. The National Institutes of Health has released a study of infant bed sharing that found rates of bed sharing with babies less than 8 months have more than doubled in the past two decades. A group of researchers funded by the National Institute of Child Health and Human Development examined data from the National Infant Sleep Position study, an annual telephone survey conducted from 1992 to 2010. The national survey collected information from approximately 1,000 parents and caregivers of children younger than 8 months, interviewing them about infant sleep habits and sleep environment, including sleep position, bed sharing, and guidance they received from physicians about infant sleep safety. The survey also gathered demographic information about parents and caregivers. Approximately 85% of survey respondents were mothers.
For the current study, researchers used data from 1993-2010 that included information from 18,986 parents and caregivers from around the United States. Their analysis revealed that rates of infant bed sharing increased dramatically over this time period. Researchers found that some racial and ethnic groups experienced sharper increases than others. And they discovered some important information about the impact of physician advice on the practice of bed sharing with infants. Here are some of the study’s most significant findings:
- Bed sharing with babies less than 8 months more than doubled over the 17-year study period. In 1993, 6.5% of respondents reported bed sharing with infants. By 2010, that figure rose to 13.5%.
- In 85% of cases, bed sharing took place with parents. In other cases, babies shared beds with another family or household members, including older children.
- Bed sharing with infants rose among all ethnic and racial groups, but rose more sharply among some than others. Among whites, rates rose from 4.9% in 1993 to 9.1% in 2010. Rates for Hispanic infants rose more significantly, from 12.5% in 1993 to 20.5% in 2010. Researchers also found a dramatic rise among African Americans, where rates of infant bed sharing rose from 21.2% in 1993 to 38.7% in 2010.
- Advice and opinions from physicians had a significant impact on parents’ and caregivers’ choices about infant bed sharing. Parents who reported their physicians had a negative attitude toward bed sharing were significantly less likely to engage in the practice, according to the study results. Those who perceived a neutral attitude from their physicians, on the other hand, were actually more likely to bed-share with their infants.
- Many caregivers reported not receiving any advice from doctors about bed sharing with babies. More than 50% of those surveyed between 1993-2010 said they had not been given advice from their doctors about bed sharing.
There is some important information here for doctors, educators, and policymakers as well as for parents and caregivers. Despite 20 years of public education about SIDS and other sleep-related infant deaths, the practice of sleeping with infants and babies has become more common—especially in the Hispanic and African-American communities. This study is not the first to show a disparity between racial and ethnic groups when it comes to infant sleep practices. Other studies have shown rates of infant bed sharing among these populations to be higher, in some cases reaching nearly 50%. African-American infants are at greater risk for SIDS—according to research, African-American infants are twice as likely to die from SIDS as white infants. We’ve all got to do more to make sure the message about safe sleep for infants is heard.
It is disturbing to find more than half of parents and caregivers reporting having received no advice from their physicians about infant bed sharing. This study indicates the positive impact that advice from doctors can have on parents’ choices. The American Academy of Pediatrics has been clear in its recommendations to parents and physicians: with infants and babies, parents and caregivers can and should share a room, but should not sleep in the same bed. In 2011, the AAP released updated and expanded guidelines for infant sleep safety. They did so after research showed that although SIDS deaths had decreased, other types of sleep and crib-related deaths were on the rise. The newest recommendations include breast feeding, immunizations, and advising against the use of bumper pads and padding in cribs. All these practices have been shown to reduce the risks of SIDS and other sleep-related infant deaths.
It’s important for parents to follow these safe sleep guidelines for infants. And it’s critical that doctors, nurses and child-health professionals get the message out about safe and healthy sleep practices. The first months of a baby’s life are the right time to begin to create healthy sleep routines—and that includes not just sleeping well, but sleeping safely.
Michael J. Breus, PhD
The Sleep Doctor®