Bed-sharing and SIDS: an evidence-based approach

We read with interest the viewpoint article ‘Bed-sharing is a risk for sudden unexpected death in infancy’ written by David Tappin and his colleagues1 and feel the issues raised and some of the claims made need contextualising. Essentially this is a public health debate about which approach to use when the evidence gets more nuanced. Initial observations of an increased risk of sudden infant death syndrome (SIDS) associated with bed-sharing have come under scrutiny and revealed the risk is mainly limited to the particular circumstances in which bed-sharing occurs (if parents smoke, drink alcohol, take drugs or use sofas).2 The public health question is whether we advise against bed-sharing completely or advise parents about the specific circumstances that make bed-sharing more risky. The American Academy of Paediatrics (AAP) in the USA has advised against bed-sharing completely for nearly two decades, but despite some states using hard-hitting campaigns such as depicting bed headboards as tombstones and mothers as meat cleavers lying next to their infant (https://city.milwaukee.gov/health/Safe-Sleep-Campaign), state-wide health authorities in the USA along with the AAP have met with little success in reducing bed-sharing prevalence3 or reducing the sudden unexpected death in infancy (SUDI) rates. Using Taylor’s newly proposed set of seven International Classification of Diseases codes,4 the US SUDI rate of 0.95 deaths per 1000 live births in 2000 has fallen just 2% by 2017 to 0.93. Whether these two trends are linked is difficult to assess. In the same period, the SUDI rate in England and Wales fell 48% from 0.61 to 0.33 per 1000 live births. The approach in England and Wales is different and is supported by the Lullaby Trust, UNICEF UK, Public Health England, the Scottish Government and the careful evidence review conducted by the National Institute for Health and Care Excellence (NICE).5 We advise health professionals to acknowledge that bed-sharing can happen by accident or through parent choice, and to inform parents about the particular circumstances when it would not be advisable to do so.