Are cribs the safest place for infants to sleep? Yes: bed sharing is too hazardous.

The safest sleep environment for an infant is a crib that meets federal and industry standards. Evidence shows that children younger than 2 years placed to sleep in adult beds are exposed to several potentially fatal hazards. A US Consumer Product Safety Commission (CPSC) study found that 515 deaths of children younger than 2 years occurred in adult beds during the period from 1990 to 1997.1 Although most deaths resulted from suffocation or strangulation caused by entrapment of the infant's head in structures of the bed, 121 deaths (24.5%) were reported as mechanical asphyxia due to “overlying” of the child by an adult or sibling sleeping in bed with the child. A follow-up investigation of deaths from January 1998 through July 2000 using the same case selection criteria identified 164 additional deaths of infants younger than 2 years (CPSC unpublished data). Of these, 88 (53.7%) were attributed to suffocation from overlying. The numbers included only those cases in which the death certificate gave sufficient evidence for a determination of overlying to be made and reported by the medical examiner. The safest sleep environment for an infant is a crib These deaths illustrate the real danger from an adult or sibling rolling on top of or next to an infant and smothering the baby. But these deaths are largely preventable. Some authors argue that warnings against bed sharing do not take into account the benefits of the practice.2 Proponents of bed sharing suggest that it encourages more frequent breast-feeding, which has clear health benefits to the child. The warning against bed sharing, however, should not be considered as an overwhelming impediment to the practice of breast-feeding. Rather, in view of the potential hazard, mothers who breast-feed should be alerted to the danger and should be encouraged to return the baby to the crib after breast-feeding. Parents can also place the crib near their bed. Mosko and colleagues have suggested that co-sleeping may be protective against sudden infant death syndrome (SIDS), based on inferences derived from differences in sleep patterns.3 There is, however, no direct evidence for this assertion. On the contrary, a 4-year study of infants dying of SIDS, “accidental” suffocation, or undetermined causes showed that bed sharing was associated with 47.1% of such deaths.4 The American Academy of Pediatrics Task Force on Infant Position and SIDS has stated, “There is no basis at this time to encourage bed sharing as a strategy to reduce SIDS.”5 Advocates of bed sharing acknowledge its dangers when it involves an adult who is a smoker or misuses alcohol or drugs but tend to minimize its hazards when drinking and smoking are not involved. Little evidence exists, however, that such environmental factors play a significant role in overlying deaths. Placing children younger than 2 years to sleep in adult beds exposes them to potentially fatal hazards. The decision for bed sharing should be left to the parents, in consultation with their pediatrician. Parents should make their own decisions about their children's welfare, but they should be fully informed of the hazards of bed sharing, based on the best knowledge available.