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Most physicians don’t bring up infant bed sharing

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AAP overreaches with bed sharing position

The report by Dr. Colson and her colleagues, which calls for increased efforts by pediatricians to discourage bed sharing, is "disquieting" because it ignores both the potential benefits of the practice and the lack of evidence linking bed sharing per se to an increased risk of infant death, according to Dr. Abraham B. Bergman.

The studies used to support the AAP’s position against bed sharing share a common flaw – nonuniform and unverifiable information on the causes of death, Dr. Bergman wrote in an editorial.

"When condemning a widespread cultural practice, the supporting data should be clear," he wrote.

In fact, questions have been raised about whether the decline in the rate of sudden infant death between 1994 and 2004 reflects a true decline or a change in certifier practices (with medical examiners moving away from classifying deaths as SIDS and moving towards classifying the deaths as accidental suffocation or unknown causes). This question is particularly pertinent beacuse the overall postneonatal mortality rate did not decline during that period.

Given the lack of convincing data supporting its position, the AAP has overreached.

"Equal time in counseling should be given to the benefits to bed sharing, such as more sleep for the parent, easier breast-feeding when the infant is nearby, ease of pacifier reinsertion, and the intangible satisfaction of skin-to-skin contact," he wrote.

Dr. Bergman is a physician in the department of pediatrics at Harborview Medical Center in Seattle. He reported having no disclosures.


 

FROM JAMA PEDIATRICS

While black and Hispanic race were associated with an increase in infant bed sharing between 1993 and 2010, those whose physicians did not agree with the practice were less likely to engage in bed sharing, according to findings from the National Infant Sleep Position study.

Of 18,986 participants who took part in the annual telephone survey, 11.2% reported infant bed sharing as a usual practice, with the percentage increasing from 6.5% in 1993 to 13.5% in 2010, Dr. Eve R. Colson of Yale University, New Haven, Conn., and her colleagues reported Sept. 30 in JAMA Pediatrics.

©michaeljung/thinkstockphotos

While black and Hispanic race were associated with an increase in infant bed sharing between 1993 and 2010, those whose physicians did not agree with the practice were less likely to engage in bed sharing.

Based on findings from 2006-2010, when questions about physician communication were added to the survey, less than half (46%) of participants reported talking with a physician about bed sharing; and most (72.6%) said their physician was against bed sharing, while 21.3% reported that their physician was neutral and 6.1% reported their physician was supportive of the practice.

Survey respondents with a physician who had a negative attitude about bed sharing were less likely to engage in the practice (odds ratio, 0.66), while a neutral attitude on the part of the physician was associated with increased bed sharing (OR, 1.38), the investigators noted. No significant association was seen between positive physician attitude toward the practice and bed sharing.

This finding could have particular implications for changing behavior, as the results suggest there needs to be more consistent physician advice in line with AAP recommendations – infants should share a room with parents without sharing a bed when sleeping – might reduce bed sharing, the investigators noted.

Among white respondents, the percentage reporting bed sharing increased significantly from 1993 to 2000, but not from 2001 to 2010. For black and Hispanic respondents, the percentage increased progressively across the study period.

After the researchers adjusted for changes in bed sharing over time, black and Hispanic maternal race was significantly associated with bed sharing (OR, 3.47 and 1.33, respectively), as was "other" maternal race (OR, 2.46), the investigators reported (JAMA Pediatr. 2013 Sept. 30 [doi:10.1001/jamapediatrics.2013.2560]).

Significant associations were seen between bed sharing and maternal educational level less than high school, compared with college or greater (OR, 1.42); household income of less than $20,000 and $20,000-$50,000, compared with income greater than $50,000 (OR, 1.69 and 1.29, respectively); living in the West, South, or mid-Atlantic, compared with the Midwest (OR, 1.61, 1.47, and 0.77, respectively); infant age younger than 8 weeks and infant age 8-15 weeks, compared with age 16 weeks or older (OR, 1.45 and 1.31, respectively); and preterm birth, compared with full-term birth (OR, 1.41).

The National Infant Sleep Position study is a cross-sectional study that tracks infant care practices through annual telephone surveys. About 1,000 nighttime caregivers of infants born within 7 months of the survey administration participated; the respondent was the infant’s mother in 84% of cases.

The findings are important because of the strong association between infant bed sharing, sudden infant death syndrome, and unintentional sleep-related infant death. While quilt and comforter use – another risk factor for sleep-related infant death declined over time, it is also strongly associated with bed sharing.

Though limited by a number of factors – such as survey responses may not reflect actual practice; there was a declining response rate in the later years of the study; and the sample was not nationally representative when compared with nationally collected vital statistics – the findings provide valuable information about trends associated with bed sharing, the investigators noted. "The data may be useful in evaluating the impact of any broad intervention to change behavior."

This study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors reported having no disclosures.

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