Overlaying, co-sleeping, suffocation, and sudden infant death syndrome: the elephant in the room

Excerpt

Despite numerous publications over decades on the issues surrounding shared sleeping of infants with adults [1, 2], it appears that there is still no clarification or consensus on how deaths in these circumstances should be classified. In particular, the possibility of accidental suffocation is often overlooked, with, for example, two recent meta-analyses and reviews classifying all infant deaths in shared sleeping situations as SIDS [3, 4]. This included deaths that occurred with shared sleeping on the narrow, soft and often sloped surfaces of sofas, and in beds with intoxicated parents. In fact, it has even been asserted that an intoxicated or drugged adult sleeping with an infant increases the risk of SIDS, rather than suffocation [4, 5]. This seems a rather odd conclusion, as intoxication or a reduced conscious state due to drugs in a parent would surely be more likely to impair parental, rather than infant, arousal [6]? Templeman in 1892 had no doubt that parental intoxication increased the number of deaths due to overlaying [7] but, over a century later, his observation is still being ignored. Thus, despite situations such as sofa sleeping and breast feeding being clearly associated with a risk of infant suffocation [8‐11], these deaths are still being attributed to SIDS. …