Study: Mother-infant room-sharing can lead to bed-sharing
MelissaJenco, News Content Editor
Parents who share a room with their infant are more likely to engage in unsafe sleep
practices, according to a new study that questions the Academy’s sleep recommendations.
However, AAP sleep experts continue to recommend room-sharing without bed-sharing for at least the first six months of life, but ideally one year, citing research
that doing so can reduce the risk of sudden infant death syndrome (SIDS).
Each year, about 3,500 infants die from sleep-related deaths including SIDS, and 90%
of SIDS deaths occur before 6 months of age, according to the study “Mother-Infant
Room-Sharing and Sleep Outcomes in the INSIGHT Study” (Paul IM, et al. Pediatrics. June 5, 2017, https://doi.org/10.1542/peds.2017-0122).
Researchers analyzed 230 mother-infant pairs participating in the Intervention Nurses
Start Infants Growing on a Healthy Trajectory study from January 2012 to March 2014,
which included home visits from nurses.
Roughly 62% of the infants were sleeping in their own room by 4 months (early independent),
27% started sleeping on their own between 4 and 9 months (later independent) and 11%
were still sharing a room with their mother at 9 months.
The team found infants were more likely to sleep with unapproved objects like blankets
and pillows at 4 months if they were sharing a room. Parents also were about four
times more likely to bring their infant into bed with them at both 4 and 9 months
if they were sharing a room.
The amount of sleep they got also differed at some ages. At 4 months, the groups slept
about the same amount of time each night, but at 9 months, the early independent sleepers
slept 26 minutes longer than later independent sleepers and 40 minutes more than those
sharing a room.
At 12 months, the groups slept about the same amount at night, but the differences
returned at 30 months when those who had shared a room at 9 months got about 45 minutes
less sleep than the infants who transitioned to their own room sooner.
Authors questioned the studies the Academy used in making its sleep recommendations
and called on it to reconsider its advice on room-sharing for the first year.
“… the AAP recommendation that parents room-share with their infants until the age
of 1 year is not supported by data, is inconsistent with the epidemiology of SIDS,
is incongruent with our understanding of socioemotional development in the second
half of the first year, and has the potential for unintended consequences for infants
and families,” they wrote.
Two members of the AAP Task Force on Sudden Infant Death responded in a related commentary saying they welcome the new research, but sharing a room makes it easier to breastfeed
and they stood by studies showing it decreases the risk of SIDS.
They advised parents to establish bedtime routines and to remove pillows and blankets
from their bed if they believe they may move the infant there in the middle of the
night for a feeding.
“We strongly support more research, both about the physiology of infant sleep and
arousal for room-sharing infants and about the consequences of room-sharing on parental
and child sleep,” they wrote. “However, the primary objective of safe sleep recommendations
will always be to minimize risk of SIDS and other sleep-related infant deaths.”
Two additional studies related to SIDS and sudden unexpected infant death (SUID) also
were published Monday in Pediatrics. In the study “Variations in Cause-of-Death Determination for Sudden Unexpected Infant Deaths,” researchers gave medical examiners and coroners hypothetical infant death scenarios
and asked how they would investigate and classify them. They found variability in
the way the same scenarios were classified, including determinations of SIDS, which
they said could impact future research on causes of death.
“The risk for SUID associated with prematurity likely has multiple etiologies requiring
continued investigation, including increased biological vulnerabilities to risk factors
at earlier GAs and the efficacy of NICU (neonatal intensive care unit) education programs,”
authors wrote. “Prenatal smoking, inadequate prenatal care use, and poverty-related
factors were also strongly associated with SUID, suggesting that intervention strategies
to reduce SUID should be multifaceted and broad-based.”