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Caroline Vemulapalli, MS; Katherine Grady, BA; James S. Kemp, MD

Arch Pediatr Adolesc Med. 2004;158:286-289.

Background  Impoverishment and crowding are associated with an increased risk of sudden unexpected death among infants. Bed sharing likely increases this risk, particularly among African American infants.

Objectives  To compare the sleep environment of African American infants who bed share with that of infants who do not share sleep surfaces and to compare access to a safe crib, and the space available for it, in the sleeping rooms of both groups of infants.

Methods  Home visits were made at approximately age 2 weeks to the homes of serially enrolled African American infants born between July 15, 2001, and November 1, 2001. Questionnaires were used to survey sleep practices, especially sleep surface used. The area of the floor space of rooms used for sleeping was calculated. A portable crib was provided for infants lacking access to safe sleep surfaces.

Results  Of these infants, 42 (41%) usually bed shared and 60 (59%) slept alone. The areas of the floor spaces were similar (mean ± SD, 13.8 ± 3.3 m² for bed sharers vs 12.7 ± 3.7 m² for those who slept alone; 95% CI for difference, -0.34 to 2.51 m²). Infants sleeping alone were much more likely to have access to a safe crib (51 of 60 vs 13 of 42; P<.001), and 53 cribs were provided. Follow-up telephone calls made at approximately age 7 months to 43.4% of recipients suggested that the cribs were used on most nights, were durable, and were enthusiastically received.

Conclusions  Crowding is not a strong explanation for bed sharing among impoverished African American infants in St Louis, Mo, who often bed share because there is not a safe crib available. Providing safe cribs may reduce the prevalence of bed sharing.

From the Division of Pulmonary Medicine, Department of Pediatrics, St Louis University School of Medicine, St Louis, Mo.

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