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Ruth A. Brenner, MD, MPH; Bruce G. Simons-Morton, EdD, MPH; Brinda Bhaskar, MS; Mary Revenis, MD; Abhik Das, PhD; John D. Clemens, MD

Arch Pediatr Adolesc Med. 2003;157:33-39.

Background  In the United States, infant-parent bed sharing is a controversial and poorly understood practice. Proponents site potential advantages such as increases in bonding and facilitation of breastfeeding, whereas opponents site potential increases in risks of suffocation and sudden infant death syndrome, particularly among mothers who smoke. Few studies have examined normative practices in low-income populations.

Objectives  To describe sleep practices in a cohort of infants born to predominantly low-income, inner-city mothers, to examine stability in sleep practices during the first 7 to 12 months of life, and to identify factors associated with bed sharing.

Design and Setting  Prospective birth cohort study in the District of Columbia, with recruitment taking place between August 1995 and September 1996 and follow-up from November 1995 to September 1997.

Participants  Maternal-infant pairs were systematically selected from 3 hospitals. We interviewed 394 mothers shortly after delivery and at 3 to 7 months post partum. Of these, 369 were interviewed again at 7 to 12 months post partum.

Main Outcome Measure  Usual bed sharing.

Results  At age 3 to 7 months (mean age, 129 days), 201 infants (51%) usually slept alone and 191 (48%) usually slept in a bed with a parent or other adult. Similarly, at age 7 to 12 months (mean age, 262 days), 190 infants (51%) usually slept alone and 175 (47%) usually slept in a bed with a parent or other adult. Of the infants who slept with a parent or other adult at age 3 to 7 months, 75% continued to do so at age 7 to 12 months. Similarly, of infants who usually slept alone at age 3 to 7 months, only 22% were reported to be usual bed sharers at age 7 to 12 months. In multivariate analyses, factors associated with bed sharing at both follow-up interviews included single marital status of the mother (first interview: odds ratio [OR] = 1.90; 95% confidence interval [CI], 1.11-3.27; second interview: OR = 1.81; 95% CI, 1.02-3.25) and 1 or more moves since the birth of the infant (first interview: OR = 1.82; 95% CI, 1.10-3.01; second interview: OR = 1.73; 95% CI, 1.05-2.86). Breastfeeding and household crowding were not significantly associated with bed sharing.

Conclusions  Bed sharing was common in this inner-city population, and sleep practices were relatively stable during the first 7 to 12 months of life. These findings underscore the need for additional research clarifying the benefits and risks of bed sharing.

From the National Institute of Child Health and Human Development, Bethesda, Md (Drs Brenner, Simons-Morton, and Clemens); Research Triangle Institute, Rockville, Md (Dr Das and Ms Bhaskar); Children's National Medical Center, Washington, DC (Dr Revenis); and the International Vaccine Institute, Seoul, Korea (Dr Clemens).

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