Provider Advice Matters: A Few Words Could Save a Life


Advising soon-to-be or new mothers against bed-sharing can cause them to think twice about the potentially deadly practice, whereas saying nothing or being impartial has little effect.

Provider advice matters. Clearly stating the risks of bed-sharing, which is associated with infant suffocation, and advising patients against the practice has more of an effect than saying nothing or indicating indifference, according to researchers from Yale School of Medicine.

The practice of bed-sharing is controversial. According to Attachment Parenting International, bed-sharing (or co-sleeping) can promote physiological regulation, confidence, self-esteem, and intimacy in children. Co-sleeping also can help parents become more attuned to the needs and patterns of their baby. Although the organization states that existing studies do not prove that co-sleeping is inherently dangerous, no one can argue that bed-sharing has been the source of tragedies involving exhausted parents accidentally smothering their infants.

Sharing a bed with an infant is a common practice in many countries, and health care providers may want to avoid giving advice about something that is culturally acceptable to many patients. However, there is a strong link between bed-sharing and sudden infant death syndrome (SIDS), according to the researchers. They explained that in an effort to prevent sleep-related infant deaths, even the American Academy of Pediatrics recommends against infants sharing a bed with their parents and instead suggests that infants share a room but have their own sleeping space.

Since the Back to Sleep campaign was implemented in 1994, the rate of SIDS in the United States has decreased 50%. Unfortunately, there has been an increase of other unexpected infant deaths resulting from such incidences as accidental suffocation or smothering, entrapment in bedding material, and other causes. Many of the factors for this increase remain unknown, but at least part of this increase in other unexpected infant deaths may be a result of bed-sharing.

In 2011, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) expanded the Back to Sleep campaign, and this expanded campaign is called Safe to Sleep. In addition to having infants sleep on their backs in their own beds, the Safe to Sleep campaign focuses on providing a firm sleep surface for infants and eliminating loose bedding, pillows, and fluffy stuffed animals from their sleep environment.

Despite these campaigns, however, the number of infants sharing a bed with their caregivers increased from 1993 to 2010, especially among black and Hispanic families, according to new study findings. The researchers explained that this was concerning because black infants are already at greater risk for dying from SIDS than white or Hispanic infants.

Study participants included the nighttime caregivers of infants participating in the National Infant Sleep Position Study, which involved annual phone surveys of 18,896 nighttime caregivers in 48 US states. Most (85%) of the caregivers surveyed were the infants’ mothers. Nearly half of the participants were 30 years or older, had at least a college education, and had an annual income of at least $50,000. More than 80% of participants were white.

According to the researchers, from 1993 to 2010, the incidence of bed-sharing more than doubled, from 6.5% to 13.5%. Although this increase occurred across all ethnic groups, black and Hispanic infants were more likely to bed-share than white infants. For white infants, bed-sharing increased from 4.9% in 1993 to 9.1% in 2010. During that same period, the reported incidence of bed-sharing increased from 12.5% to 20.5% for Hispanic infants and from 21.2% to 38.7% for black infants.

Of note is that more than half of the participants reported that since 2006 they received no advice from healthcare providers about bed-sharing. Those that did receive advice to not bed-share were about 34% more likely to report following that advice than caregivers who received no advice. If a healthcare provider was indifferent, the participants were more likely to bed-share.

Whether you are for or against bed-sharing, these results indicate that physician advice can have a meaningful effect. A brief discussion about the dangers of bed-sharing during prenatal care could help reverse the trend of increased bed-sharing. Knowing the risks, parents may choose to forgo the practice and implement safer sleep habits.


Colson ER, Willinger M, Rybin D, et al. Trends and factors associated with infant bed sharing, 1993-2010: the National Infant Sleep Position Study.

JAMA Pediatr.

September 30, 2013. doi:10.1001/jamapediatrics.2013.2560.

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