It was one of the toughest phone conversations I have made in my 15 years as a forensic pathologist. I had just completed the autopsy of a three month-old infant. He had spent the night sharing an adult bed with his mother and six year-old brother. In the morning they found him prone, with his face against the pillow, dead. During the autopsy I found that blood had pooled under the skin of the baby’s face and abdomen after death, and I documented characteristic areas of pallor where the pillow had pressed against his nose and mouth. He had asphyxiated. After leaving the morgue I had to go pick up the phone and tell a mother she had accidentally smothered her son.
I investigate sudden infant deaths three or four times a year. Parents who lose a child to a bed-sharing accident inevitably ask me why the cause of death isn't SIDS, sudden infant death syndrome. I have to explain that SIDS is a diagnosis of exclusion: the autopsy and scene investigation rule out injury, and we can't find any fatal natural disease. A child who is found face-down with his nose and mouth covered has been injured. The cause of death in such a case is positional asphyxia, and the manner of death is accident. Accidents are avoidable, which makes that postmortem conversation all the harder. The parents blame themselves. I frequently end up in tears along with them. I have three children who were babies not that long ago, and though I’m a doctor I am not made of stone.
My medical colleagues and I were dismayed to read the Los Angeles Times Op-Ed of September 18, 2016 titled "It's OK to sleep next to your infant child. In fact, it's beneficial," showing a photo of a smiling mom sharing an adult bed—with soft blankets and pillows—with her three month-old. The authors, two professors of human development, cite anthropological research while dismissing the recommendations for safe sleep promulgated by medical professionals, including those in the CDC and the American Academy of Pediatrics. This article operates under the fallacy that cross-cultural anecdotes trump hard scientific data. It conflates SIDS deaths with all sudden infant deaths, betraying an ignorance about asphyxial death in unsafe sleep environments. It also ignores differences in death investigation and certification between countries. For instance, the authors cite Japan’s low rate of reported infant mortality while ignoring the fact that fewer than 30% of infant deaths in Japan are autopsied. (Taylor BJ, et al. Arch Dis Child 2015;100:1018–1023. doi:10.1136/archdischild-2015-308239). They press the absurd and dangerous assertion that "the proven benefits of mother-infant co-sleeping far outweigh the largely imaginary risks." These are not imaginary risks. They are real and they are tragic. According to the CDC, infant asphyxia is the leading accidental cause of death in infants under one year of age. Parents who lose a child to a preventable death and parents whose children end up in a vegetative state after an anoxic brain injury suffer grievously. They have created support organizations like Charlie's Kids and First Candle to educate others about safe sleeping, including co-sleeping without bed-sharing.
There are safe ways of sleeping next to your child in the same room without sharing the same bed, but most parenting websites and magazines do not distinguish between co-sleeping and bed-sharing. Self-appointed parenting experts who actively advocate for bed-sharing ought to recognize the recklessness of such a position. According to ICAN, the Inter-Agency Council on Child Abuse and Neglect, sudden infant deaths in unsafe sleep environments dropped from 69 per year to 35 after a 2013 safe-sleeping campaign in Los Angeles County. Public health outreach saves lives. Misleading parents about published death statistics in the interest of promoting unprovable life-balance benefits is irresponsible, and the endorsement of bed-sharing as a safe approach to co-sleeping is dangerous. Do not share a bed with your infant. It isn't worth the risk of an autopsy.
