Wednesday, April 20, 2011

SIDS and room sharing - the evidence

All new parents know (or at least they should) that it is recommended to keep their infants sleeping in the same room with them for the first six months of life.  This is because "research" shows that the risk of Sudden Infant Death Syndrome (SIDS) is lowered when your baby sleeps close to you.  Or to put it another way - when your baby is not sleeping in your room, they are at an increased risk of dying suddenly.    Scary, huh?


The problem is that many babies are noisy sleepers and keep their poor parents awake by grunting, snorting and farting through the night.   Other parents find that their baby sleeps lightly or startles easily and they end up creeping about the bedroom, dodging creaky floorboards in the blackness, afraid to cough, sneeze or even breathe wrong in case baby wakes and a terrible night's sleep for all ensues.   A loud snorer and a jumpy baby are particularly unfortunate roommates for a sleep-deprived mammy.


So it's common to see parents (generally mothers) ask on internet message boards about moving their baby to their own room before the recommended 6 months of age.   And generally, they find many parents who say they did so, to the benefit of all concerned.   But here's the thing - is it ok to move your baby just because others have done so?    And just how big is the risk to your baby if you do ship them out on their own?  


Rather than just accept that "research says...", I decided to take a closer look at some of the evidence relating to the current SIDS prevention recommendations.     A number of research papers cited by the Australian charity SIDS and Kids have shown that when a parent or other caregiver sleeps in the same room with a baby, the chance of the baby dying from  SIDS is reduced by up to 50% (1,2,3,5) when compared to babies sleeping in a separate bedroom (2,3,4).   Three studies reported that babies sleeping in separate rooms had three times the risk of SIDS (3-5),  while another study claimed that babies sleeping alone had a 10-fold risk of SIDS (2).     In fact, one of the papers also found that unsupervised day naps were equally as dangerous as solitary nightime sleeps (6).



The protective effect seems to be attributable to the parent or caregiver's presence in the room so the substitution of a baby monitor in loco parentis doesn't protect the baby in the same way.


Of course, it goes without saying that keeping your baby in your room with you is only one factor in protecting them from SIDS.   Nevertheless, it is a significant one.    It's funny how often you blindly accept guidelines because you hear that "research says....".   Having trawled through those papers,  I can say from an informed perspective that the evidence against moving your little one before the prime SIDS danger period is up is resounding.    I've had my scholars hat on this evening in order to stay objective while dealing with a highly emotive subject  - but I know that when my daughter calls for me tonight, I'll be going to her willingly and holding her a little more tenderly.



1. Mitchell EA, Thompson JMD. (1995) Co-sleeping increases the risk of SIDS, but sleeping in the parents' bedroom lowers it. In: Rognum TO. (Ed.) Sudden Infant Death Syndrome: New trends in the nineties. Scandinavian University Press: Oslo: 266-269.
2. Blair PS, Fleming PJ, Smith IJ, Ward Platt M, Young J, Nadin P, Berry PJ, Golding J and the CESDI SUDI research group. (1999) Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. British Medical Journal 319(7223): 1457-1462.
3. Carpenter RG, Irgens LM, Blair PS, England PD, Fleming PJ, Huber J, Jorch G, Schreuder P. (2004). Sudden unexplained infant death in 20 regions in Europe: case control study. The Lancet 363 (9404):185-91.
4. Scragg RKR, Mitchell EA, Stewart AW, Ford RPK, Taylor BJ, Hassall IB, Williams SM, Thompson JMD. (1996) Infant room-sharing and prone sleep position in sudden infant death syndrome. The Lancet 347(8993): 7–12.
5. Tappin D, Ecob R, Stat S, Brooke H. (2005) Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. The Journal of Pediatrics 147(1): 32-37.
6.  Blair PS, Ward-Platt M, Smith IJ, Fleming PJ and the CESDI SUDI Research Group. (2006) Sudden infant death syndrome and the time of death: factors associated with night-time and day time deaths. International Journal of Epidemiology 35(6): 1563-1569.

5 comments:

  1. Don't studies also show that the SIDS risk drops dramatically after 4 months though? So the additional risk from moving after 6 months should be fairly statistically insignificant (compared to moving after 1 year). I remember watching a programme a while back where a UK SIDS "expert" claimed that almost all SIDS deaths now are as a result of explainable environmental factors - smoking, bed sharing, etc. He went so far as to say that its now almost entirely confined to more disadvantaged socio-economic groups. Having said that, both of ours stayed in the room with us until they were over 1 year.

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  2. As a worrier, I was happy to keep my son sleeping in our room as long as possible; I found the monitor to be a poor substitute in calming my anxieties when he went into his cot in his own room. I am wondering what the distinction regarding safety is there, though, why the actual parental presence is more safe. Because you are more aware when the child is physically closer? I worry that, even if the child is with me in the same room, that sleep will prevent me hearing things, being as aware as I should.

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  3. Mel, the studies do show that the risk falls after 4 months. I guess with any recommendation, the number chosen is arbitrary to a degree because it's not as though they wake up one morning and suddenly have passed the danger period. I guess 6 months leaves a bit of margin for error, for want of a better word. I would imagine also that the danger varies from baby to baby because once they can turn over themselves and can raise lift their heads in the prone position then they are safer.

    You are right to say that the links between smoking and SIDS and socio-economic disadvantage and SIDS are very strong. Giving up smoking seems to be the single most important thing you can do to protect your baby from SIDS, other than placing them to sleep on their backs. However, in at least one of the studies (no 2 above), the figures when adjusted for socio-economic disadvantage showed a significantly increased risk of SIDS when not room sharing. I wanted this post to focus on the importance of room sharing rather than confusing the issue with other factors.


    Fiona, it seems to be your presence in the room, monitoring them to check their temperature, that blankets haven't gone over their heads or that they haven't accidentally rolled onto their belly if they have been placed on their side that makes the difference. I know that when C was in my room, if she stirred and woke me I always checked to make sure all was as it should be in the cot and this would happen a few times a night. I moved her out at 9 months and really missed her dreadfully for ages afterwards.

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  4. That's interesting re. study no. 2 - I was wondering if the study had taken that into account. To be honest, all things considered, I definitely think six months is too early to ship them out - though on the other hand, its absolutely fantastic to be able to make noise and turn the lights on at night once the room is your own again!

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  5. I missed C terribly after I moved her but I do enjoy being able to read in bed! Simple pleasures!

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