Study: Mother-infant room-sharing can lead to bed-sharing

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.

Another study, “Prematurity and Sudden Unexpected Infant Deaths in the United States,” found that gestational age (GA) and SUID rates were inversely associated, even after the Academy’s 2011 policy on SIDS provided guidance.

“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.”