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A Systematic Review

Tanya Horsley, PhD; Tammy Clifford, PhD; Nicholas Barrowman, PhD; Susan Bennett, MB, ChB, FRCP; Fatemeh Yazdi, MSc; Margaret Sampson, MLIS; David Moher, PhD; Orvie Dingwall, MLIS; Howard Schachter, PhD; Aurore Côté, MD

Arch Pediatr Adolesc Med. 2007;161(3):237-245.

Objective  To examine evidence of benefits and harms to children associated with bed sharing, factors (eg, smoking) altering bed sharing risk, and effective strategies for reducing harms associated with bed sharing.

Data Sources  MEDLINE, CINAHL, Healthstar, PsycINFO, the Cochrane Library, Turning Research Into Practice, and Allied and Alternative Medicine databases between January 1993 and January 2005.

Study Selection  Published, English-language records investigating the practice of bed sharing (defined as a child sharing a sleep surface with another individual) and associated benefits and harms in children 0 to 2 years of age.

Data Extraction  Any reported benefits or harms (risk factors) associated with the practice of bed sharing.

Data Synthesis  Forty observational studies met our inclusion criteria. Evidence consistently suggests that there may be an association between bed sharing and sudden infant death syndrome (SIDS) among smokers (however defined), but the evidence is not as consistent among nonsmokers. This does not mean that no association between bed sharing and SIDS exists among nonsmokers, but that existing data do not convincingly establish such an association. Data also suggest that bed sharing may be more strongly associated with SIDS in younger infants. A positive association between bed sharing and breastfeeding was identified. Current data could not establish causality. It is possible that women who are most likely to practice prolonged breastfeeding also prefer to bed share.

Conclusion  Well-designed, hypothesis-driven prospective cohort studies are warranted to improve our understanding of the mechanisms underlying the relationship between bed sharing, its benefits, and its harms.

Author Affiliations: Departments of Pediatrics and Epidemiology and Community Medicine, University of Ottawa and Department of Pediatrics, the Children's Hospital of Eastern Ontario (CHEO), Ottawa (Drs Horsley, Clifford, Bennett, Moher, and Schachter); Chalmers Research Group at the CHEO Research Institute, Ottawa, Ontario (Drs Horsley, Barrowman, and Moher and Mss Yazdi and Sampson); Department of Psychiatry, University of Ottawa (Dr Bennett); Canadian Patient Safety Institute, Edmonton, Alberta (Ms Dingwall); Respiratory Medicine Division, Montreal Children's Hospital, McGill University, Montreal, Quebec (Dr Côté); Department of Epidemiology and Community Medicine, University of Ottawa (Drs Clifford and Moher); and Canadian Coordinating Office Health Technology Assessment, Ottawa (Dr Clifford).

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