Sleep Tight Baby

TORONTO - Parents who allow their infant children to share a bed with them are putting those children’s lives in danger, one of Ontario’s top coroners said Wednesday as he released an annual review of child deaths in the province.

The report states 41 infants, ranging in age from 11 days to 13 months, died in 2006 and 2007 while sharing their parents′ beds.

“Our view is there are still kids dying of this, and we would like to see it not happen,” said Dr. Bert Lauwers, associate deputy chief coroner of Ontario.

“You really don’t want that little, wee vulnerable child to be sleeping in a bed with an adult. You want them in an approved crib sleeping in the same room as an adult.”

Lauwers is also chairman of the Paediatric Death Review Committee and the Deaths Under Five Committee, which issued a joint annual report Wednesday.

The report came down hard on the practice of bed-sharing, also known as co-sleeping. He says the practice is a growing worry among professionals, who believe it’s leading to a high number of preventable deaths.

Autopsies are often unable to determine a cause of death in bed-sharing cases.

“But (upon further review), it’s our belief that… a parent has accidentally put an arm or a leg over a child and obstructed the airway or the ability of the child to breathe,” said Lauwers.

The committee found more than 40 per cent (77 of 186) of child death cases reviewed in 2006 and 2007 involved unsafe sleeping environments. Forty-one of those involved bed-sharing.

Unsafe sleeping environments include adult beds, couches, armchairs and infant swings, according to the report. Any surface cluttered with pillows, blankets, toys, duvets and other objects is also considered unsafe.

In nearly all the cases reviewed by provincial authorities, the cause of death was initially undetermined. Six of the deaths were deemed accidental.

“In some cases… a parent walks into the room and sees that the other parent has an arm laying on top of the child,” Lauwers said. “Alternatively, and more frequently, what we find is that the child is found deceased lying between the parents and it is unclear what transpired through the night.”

Nearly one out of every five deaths attributed to unsafe sleep environments involved parents who reported using drugs or alcohol, the report states. Nearly one-third involved parents who were breastfeeding.

The report cites a number of recent studies that come out against bed-sharing, including a study in Baltimore that found 91 per cent of the 81 infants who died suddenly during sleep between 2002 and 2006 were in unsafe sleeping environments. Almost three-quarters of those children were bed-sharing.

Proponents of co-sleeping persist nonetheless. They argue the practice is more natural for infants, promotes bonding between the child and parents, and facilitates breastfeeding.

“Baby sleeps well and in comfort and trust, lessening their need for night nursing until they sleep as the rest of us do - in their own time,” is how one site, tribalbaby.org, describes it.

“This sleeping arrangement permits mothers (and fathers) to respond quickly to the infant if it cries, chokes, or needs its nasal passages cleared, its body cooled, warmed, caressed, rocked or held,” writes author James McKenna on the website The Natural Child Project (naturalchild.org).

While no Canadian statistics exist to establish the prevalence of bed-sharing, American statistics show an increase: between 1993 and 2000, the number of parents who said they shared a bed with their babies more than doubled, from 5.5 per cent to 12.8 per cent, according to one study.

Warnings against co-sleeping are relatively new in North America and only began surfacing in the past decade. Wednesday′s report acknowledges what Lauwers called “pushback″ on the matter, particularly from breastfeeding proponents.

“Although a controversial issue, we believe it would be irresponsible not to report the number of these deaths reviewed in Ontario,” the report states. “This message is meant to raise the awareness… as it is critical in the prevention of future deaths. Further research in this area is warranted and is ongoing.”

The report recommends placing an infant less than one year old on its back, in an uncluttered crib that has a firm mattress.

About 550 children under the age of 18 die in Ontario every year - a number that has remained constant over time, Lauwers said.