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Background Debate about mother and infant bed sharing has been polarized between supporters of bed sharing and public health policies that attempt to mitigate the risk of Sudden Infant Death Syndrome. Differences in group demographics may be an important aspect in co-sleeping acceptability. Research aims The first aim of this study was to investigate infant sleeping location in a dataset of mothers with strong breastfeeding outcomes. The second aim was to investigate the association between infant sleeping location and breastfeeding (exclusive breastfeeding to 6 months and total breastfeeding duration). Finally, we aimed to investigate predictors of breastfeeding duration. Methods Participants comprised 174 women who had applied to train as counselors with the Australian Breastfeeding Association. Data were compiled from a survey of the participants’ lactation histories, including questions related to the exclusivity and duration of breastfeeding, concerns about and problems encountered during breastfeeding, type of birth, medications during birth, demographics, and infant sleeping location. The study design was a cross-sectional, one-group survey design. Results A high proportion of participants in this study bed shared and room shared: At 0–1 month ( n = 58), 33% of participants bed-shared, which increased to 58% by 6–12 months ( n = 80). Infants who co-slept were more likely to be exclusively breastfed at 6 months (χ2 (2, n = 116) = 4.83, p = .03) and had longer breastfeeding duration ( t (62.61) = 3.81, p < .001). Conclusions Breastfeeding targets have been difficult to achieve globally, and innovative ideas are required to improve breastfeeding outcomes through public health messaging. There was a strong association in the current study between breastfeeding outcomes and degree of closeness of the infant to the mother at night. This finding should be brought into the discourse on breastfeeding and infant sleep arrangements, accompanied by evidence-based advice about safe sleeping and the promotion of breastfeeding.

Objective/Background: Our primary objective was to describe and identify predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum among Chinese-Canadian mothers. Participants: We ...

Objective. Despite educational outreach, bed-sharing prevalence is rising. Mothers’ and fathers’ bed-sharing practices, prevention message source, perceived source credibility, and the effectiveness of the prevention message were evaluated. Methods. Data were collected from 678 community parents via an online survey. Results were analyzed using descriptive statistics and phi tests. Results. Bed-sharing reasons focused on comfort and ease. Mothers were more likely to receive prevention messages from individual professionals or organizations, whereas fathers were more likely to hear prevention messages from spouses/coparents and grandfathers. Physicians were the most common source, and physicians and grandmothers were rated as the most credible and effective. Conclusions. Prevention message source varies between mothers and fathers, highlighting the need for continued research with fathers. Grandmothers and physicians are effective and credible sources of prevention messages. Although less frequent, prevention messages from grandmothers were most effective. There was no evidence of effective messages from educational campaigns.

Background In infancy, fatal events associated to sleep and bedding may occur. While in industrial countries accidents and suffocation have become rare due to manufacturing regulations for infant beds and bedding materials, the Sudden Infant Death Syndrome (SIDS) is still a relevant ‘cause’ of death in infancy. Although the final pathway of SIDS has not been clarified thus far, soft mattresses and cushions may represent a risk factor. Furthermore, materials compromising thermoregulation may play a major role. The same holds true for environmental conditions like excessive temperature and nicotine exposure. Recently, also bedsharing and sleeping on sofas have been identified as factors potentially contributing to SIDS risk. Recommendations for safe infant sleep Worldwide, paediatric societies and other health professionals have launched campaigns for a ‘safe infant sleep’ by promoting recommendations how to bed babies. These recommendations include (slogans of individual campaigns in brackets): - Same room, but individual beds for baby and parents (avoidance of bedsharing) - Infant beds according to safety regulations - Avoidance of soft underbedding and (soft) cushions - Bedding in supine position for every sleep (‘Back to sleep’) - Avoidance of overheating (‘Keep cool, baby’) - Preferably sleeping bags instead of blankets (‘Bag to sleep’) - Neutral thermal environment (16°C–20°C) - Consideration of pacifier use for every sleep - Avoidance of nicotine exposure - Only small toys if any Consequences of campaigns Recent recommendations have led to a significant reduction of SIDS incidence in many countries. While between 1970 and 1990 SIDS rates were in some countries as high as 2 per 1000 liveborn infants, the introduction of preventive measures have significantly reduced the incidence of this fatal event. In some countries and regions (eg. Netherlands, Styria/Austria) SIDS incidence is now as low as 0,1 per 1000 liveborn infants. Today, SIDS occurs almost exclusively in families not adequately following the recommendations mentioned above. Conclusion Altogether, it remains unsolved in which way the different preventive measures are able to modify the fatal cascade leading to SIDS. Nevertheless, due to the proven effects, as many of these preventive measures as possible should be applied. By doing so, the risk to experience SIDS in an individual infant can be reduced to almost zero and thousands of lives can be saved worldwide in this way every year.

Accidental suffocation and strangulation in bed is a leading cause of preventable infant death. Bed sharing, teen motherhood, and Hispanic ethnicity have been associated with infant sleep suffocation death. Fifty-five Hispanic teen mothers were surveyed regarding acculturation/demographic characteristics and their infants' sleep behaviors. Most participants had 2 foreign-born parents from Latin America. Participants with 2 US-born parents were less likely to bed share than their less-acculturated peers. Many participants reported not always placing their infant in a supine sleep position. There is a significant need to reach out to Hispanic teen mothers, particularly from newer immigrant families, with culturally and linguistically appropriate multigenerational clinical messaging on the risks of infant bed sharing and nonsupine sleep positioning.

Objective: Bed-sharing is associated with sudden infant death syndrome and accidental suffocation and strangulation in bed. The purpose of this study was to identify risk factors for newborn bed-sharing. Methods: Postpartum mothers from a university maternity service were contacted by phone to complete a survey. Demographic and environmental data were collected; newborn bed-sharing and sleep environment were self-reported. Results: A total of 1261 mothers completed surveys; bed-sharing was reported by 79 mothers (6.3%). Multivariate logistic regression identified referral to a nurse (odds ratio [OR] = 10; 95% confidence interval [CI] = 4.5-30) and sleep location “other” than a crib, bassinet, or Pack and Play (OR = 7.1; 95% CI = 1.9-25.9) as factors associated with an increased risk of bed-sharing; formula feeding (OR = 0.4; 95% CI = 0.20-0.77) and crib sleeping (OR = 0.49; 95% CI = 0.26-0.86) reduced this risk. Conclusion: Infants with no identifiable places to sleep, significant health issues, and who are breastfed are more likely to bed-share. Interventional studies should be directed at these factors.

OBJECTIVE To describe a unique experience providing critical care to infants and children in Haiti 3 months after a major earthquake. DESIGN Observational. SETTING Field medical facility in a developing country. PATIENTS Infants and children admitted to a combined neonatal and pediatric intensive care unit between April 17 and 24, 2010. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Nine infants and 20 children were admitted to an intensive care unit with eight cots and ten infant beds over a 1-wk period. Central nervous system and infectious diseases were the most common reasons for intensive care unit admission. Nine of 20 (45%) children died before hospital discharge. Survivors represented a cohort of children with acute, reversible disease. CONCLUSIONS Pediatric critical care can be implemented in low-income countries but requires significant resource use and careful patient selection. Consideration should be paid to the costs of delivering critical care in developing countries, which can inadvertently appropriate resources that have a larger impact on pediatric public health.

Bed sharing has been promoted as facilitating breastfeeding but also may increase risks for sudden, unexpected infant deaths. This prospective cohort study was performed to determine the prevalence of adult and infant bed sharing and its association with maternal and infant characteristics. Demographic data were collected from 10,355 infant-mother pairs at birth hospitals in Eastern Massachusetts and Northwest Ohio, and follow-up data were collected at 1, 3, and 6 months by questionnaire. Associations with bed sharing were estimated using odds ratios and 95% confidence intervals from multiple logistic regression models while adjusting for confounding variables. At 1, 3, and 6 months, 22%, 14%, and 13% of infant-mother pairs shared a bed, respectively. On multivariate analysis, race/ethnicity and breastfeeding seemed to have the strongest association with bed sharing. These factors need to be considered in any comprehensive risk to benefit analysis of bed sharing.

The NACManchester Asthma and Allergy Study is a prospective study of the development of asthma and allergies in childhood. The subjects (995 children at age 3 years) were recruited in utero by screening parents in the antenatal clinic using skin prick testing and a questionnaire regarding allergic diseases. Children were assigned to risk groups according to parental atopic status (high risk, both parents atopic; medium risk, one parent atopic; low risk, neither parent atopic). A subgroup of those at high risk (with no pets in the home) was randomized to stringent environmental control (allergen impermeable covers for the parental and infant bed, hot washing of bedding weekly, HEPA vacuum cleaner, hard floor for the nursery), and the remainder followed a normal regime. The children have been followed prospectively. The environmental influences are very clearly defined. Measurements of environmental exposures include levels of house dust mite; cat and dog allergens during pregnancy and early life; pet ownership and exposure; childcare arrangements; number of siblings; vaccination uptake; thorough dietary questionnaire; and endotoxin exposure. Further unique objective outcome in the cohort is the assessment of lung function in preschool children using specific airways resistance, which at age 3 years clearly reflects both genetic and environmental influences.

Summary Background To avoid allergen exposure of newborn babies, the use of a new mattress for the baby bed may be recommended. However, it is not certain that new mattresses are always free of allergens. Objective In the present study the allergen content of new infant mattresses was investigated. Methods Dust samples were vacuumed from 90 new mattresses for infant beds bought in 50 different Dutch shops, and the concentrations of Der p 1, Der f 1, Fel d 1 and Can f 1 were determined by radioimmunoassays. Results Most mattresses contained some allergen and often the allergen concentrations were surprisingly high. Only 15 of the 90 mattresses contained no detectable amounts of any of the four allergens. The highest concentration found for each allergen was 3.1, 46.5, 20.2 and 95.7 µg/g of dust, respectively. However, the total amount of allergen in a mattress was still rather low because the new mattresses contained only modest amounts of dust. Baby mattresses more often contained an increased allergen load than the larger, standard-sized, infant mattresses. This may be caused by differences in manufacturing procedure. Also, mattresses that were sold without a plastic encasement more often contained an increased allergen load. Conclusions It is advisable to buy a mattress that is wrapped in plastic, but it may still contain a substantial amount of allergen. Thorough vacuuming of a newly bought mattress before it is installed on a child's bed, is also advisable. After instalment, regular vacuuming of the mattress and washing of the bed linen as well as measures to eliminate allergen reservoirs in other parts of the house are important, because our observations indicate that mattresses easily pick up allergens from the environment.

This research provides data on behavioral issues associated with the design of neonatal intensive care units (NICUs). Behavior was examined utilizing both predesign research (PDR) and postoccupancy evaluation (POE) techniques; data were collected prior to the remodeling of a NICU and after the remodeling was completed. Infants in the original unit were located in closed bays. Infant beds in the new unit were distributed in an open floor plan with 60% more area. Behavioral mapping, interview, and questionnaire methods were used to examine medical staff activity patterns and perceptions of the modified environment. One hundred twenty-four hours of predesign and postconstruction mapping data were gathered. The hypothesis that the total amount of time staff spent walking from activity to activity would be reduced was not supported, although when the data were weighted to reflect the impact of the size of the large unit, the ratio of time spent traveling to a total unit area was found to be less in the open-ba...

Archival cerebral tissue from infants whose deaths were attributed to sudden infant death syndrome (SIDS) from South Australia and Western Denmark were stained for β-amyloid precursor protein (β-APP) and graded according to a simple scoring chart. The resulting APP scores were correlated with sleeping situation (shared vs. alone) showing a significantly higher amount of β-APP staining in the non-bed-sharing, than in the bed-sharing infants (Mann-Whitney, Australia: p = 0.0128, Denmark: p = 0.0014, Combined: p = 0.0031). There was also a marked but non-significant difference in sex distribution between bed-sharers and non-bed-sharers with a male to female ratio of 1:1 in the first group and 2:1 in the latter. Of 48 Australian and 76 Danish SIDS infants, β-APP staining was present in 116 (94%) cases. The eight negative cases were all from the Danish cohort. This study has shown that the amount of β-APP staining was significantly higher in infants who were sleeping alone compared to those who were bed-sharing with one or more adults, in both an Australian and Danish cohort of SIDS infants. Whether this results from differences in the speed with which these infants die, differences in lethal mechanisms involving possible accidental asphyxiation in shared sleepers, or differences in the number of previous hypoxic-ischemic events, remains to be clarified.

Importance A strong association between infant bed sharing and sudden infant death syndrome or unintentional sleep-related death in infants has been established. Occurrences of unintentional sleep-related deaths among infants appear to be increasing. Objectives To determine the trends and factors associated with infant bed sharing from 1993 through 2010, including the association of physician advice on bed sharing. Design National Infant Sleep Position study conducted with annual telephone surveys. Setting The 48 contiguous states. Participants Nighttime caregivers of infants born within 7 months of each survey administration. Approximately 1000 interviews were completed annually. Main Outcomes and Measures Infant bed sharing as a usual practice. Results Of 18 986 participants, 11.2% reported an infant sharing a bed as a usual practice. Bed sharing increased from 1993 (6.5%) to 2010 (13.5%). Although bed sharing increased significantly among white respondents from 1993 to 2000 ( P P = .48). Black and Hispanic respondents reported an increase in bed sharing throughout the study period, with no difference between the earlier and later periods ( P = .63 and P = .77, respectively). After accounting for the study year, factors associated with increase in infant bed sharing as a usual practice included maternal educational level of less than high school compared with college or greater (adjusted odds ratio, 1.42 [95% CI, 1.12-1.79]); black (3.47 [2.97-4.05]), Hispanic (1.33 [1.10-1.61]), and other (2.46 [2.03-2.97]) maternal race or ethnicity compared with white race; household income of less than $20 000 (1.69 [1.44-1.99]) and $20 000 to $50 000 (1.29 [1.14-1.45]) compared with greater than $50 000; living in the West (1.61 [1.38-1.88]) or the South (1.47 [1.30-1.66]) compared with the Midwest; infants younger than 8 weeks (1.45 [1.21-1.73]) or ages 8 to 15 weeks (1.31 [1.17-1.45]) compared with 16 weeks or older; and being born prematurely compared with full-term (1.41 [1.22-1.62]). Almost 46% of the participants reported talking to a physician about bed sharing. Compared with those who did not receive advice from a physician, those who reported their physicians had a negative attitude were less likely to have the infant share a bed (adjusted odds ratio, 0.66 [95% CI, 0.53-0.82]), whereas a neutral attitude was associated with increased bed sharing (1.38 [1.05-1.80]). Conclusions and Relevance Our finding of a continual increase in bed sharing throughout the study period among black and Hispanic infants suggests that the current American Academy of Pediatrics recommendation about bed sharing is not universally followed. The factors associated with infant bed sharing may be useful in evaluating the impact of a broad intervention to change behavior.

Summary Background Allergen exposure in early childhood is thought to be important for sensitization and subsequent development of asthma. Not much is known, however, about exposure of young children to allergens in the home. Objectives This study was designed to document dust mite allergen exposure in young children, and to determine wheither infants from atopic mothers (=‘high-risk’ infants) are exposed to lower concentrations of house dust mite alkrgen than infants from non-atopic parents (=‘low-risk’ infants). Methods Dust samples were taken in the homes of 104 infants (48 ‘high-risk’ and 56 ‘low-risk’ infants, selected by questionnaire) aged 3–15 months, from floors in different rooms and from the child's mattress surface. Results The majority of the infants were found to be exposed to Der p I concentrations of more than 2000 ng/g in dust collected from the surface of their mattresses. Lower Der p I concentrations were found in mattress surface dust from the beds of infants from atopic mothers than of infants from non-atopic parents. Also, lower Der p I concentrations were found in floor dust from the homes of infants from atopic mothers, Infant beds equipped with new mattresses, new blankets and top plastic sheeting had significantly lower Der p I concentrations than beds equipped with used mattresses and blankets, without top plastic sheeting. Conclusions Young children in the Netherlands are exposed to significant concentrations of Der p I in mattress surface dust. Allergic parents appear to provide their children with environments somewhat less rich in mite allergen than non-allergic parents.

Sir,We read with interest the article by Edwards and Arthurs [1]about the methodological challenges of acquiring high-quality MRI in young children. Although the use of anaes-thesia and sedation is often a possibility, parents are oftenhesitant. Consequently, we have developed a protocol forperforming MRI in infants at 12 ± 2 months corrected age[12.4 months corrected age (range 10 months-14 months)]born prematurely or at term, both with and without intra-uterine growth restriction [2, 3]. The protocol involvesparents, clinicians and nurses. The main steps are: (1) todecrease anxiety in parents through explaining and address-ing questions about the procedure, (2) to habituate parentsand child to the noise of the scanner (parents are providedwith aCD ofthescanner sounds to play athome duringtheirchild’s sleep), and (3) to define a sleep plan according to theneeds, sensitivities and regular bedtime routine of the indi-vidual child. On the day of the scan, morning naps arerestricted and the feeding schedule is adjusted according tothe time of the MRI examination. After reception in thedepartment, a quiet room is provided, close to the scanner,with an infant bed, adjustable lighting, soft music, toys andbooks. The child is fed just before the scan and then carriedsleeping into the scanner by the parents. The order of thepulse sequences is ordered according to noise level to coin-cide with the child’s depth of sleep.We have attempted 237 examinations using this proce-dure with successful outcome in 190 (80%) and concludethat high-quality MRI can be performed without sedation at12 ± 2 months corrected age in infants.

Not using the infant back sleep position is an established risk factor for sudden unexpected infant death (SUID). Infant bed sharing may also increase SUID risk, particularly under certain circumstances. Both of these infant sleeping behaviors are disproportionately higher among Black mothers. We explored the relationship between not using the infant back sleeping and infant bed sharing, developed separate risk factor profiles for these behaviors, and identified maternal characteristics contributing to racial differences in their practice. Merged 2004-2005 birth certificate and Pregnancy Risk Assessment Monitoring System data for 2,791 non-Hispanic Black and White Florida women were evaluated using univariable and multivariable analyses to develop risk factor profiles for infrequent back sleeping and frequent bed sharing. Cross-product interaction terms were introduced to identify factors contributing to racial differences. Infrequent back sleeping and frequent bed sharing were reported by two-thirds of Black women and one-third of White women. There was no association between the infant sleeping behaviors when adjusted for race (adjusted odds ratio [aOR], 1.04; 95% CI, 0.83-1.31). The infant sleeping behaviors shared no common independent maternal characteristics. Father acknowledgement on the birth certificate was a strong contributor to racial differences in infrequent back sleeping while breastfeeding, trimester of entry to prenatal care, and maternal depression revealed notable racial differences for bed sharing. Behavior-specific and race-specific public health messages may be an important public health strategy for reducing risky infant sleeping behaviors and decreasing SUIDs.

In 2005 the American Academy of Pediatrics published new recommendations on infant sleep environment which advised against infants bed-sharing. A retrospective study was done to determine the prevalence of infant bed-sharing and its associations in a clinical practice. Demographic data were collected from 2,405 infants from a large family practice residency program, which included OB care, in Missouri between March 2002 and February 2008. Data were extracted from electronic medical records at the first four well-child visits: 1 month, 2–3 months, 4–5 months, and 6–8 months of age. Data analysis was performed using SPSS statistical software package, version 12.0 and 15.0 (SPSS, Inc, Chicago, Ill). At the first, second, third, and fourth well-child visit 19, 18, 12, and 11% of infants bed-shared with an adult. Bed-sharing was associated with an infant missing one or more well-child visits (first and third visits only), breastfeeding (first and second well-child visits only), and low SES. Stratified analysis by residence showed that over the 6-year study the decrease in the rate of bed-sharing, in the urban and non-urban areas, was statistically significant (P = 0.005, 0.04, respectively). Infants born 2006–2007 had a decreased rate of bed-sharing compared to infants born 2002–2005 (0.22, 0.30, respectively, P = 0.00). In light of the high rate of bed-sharing recorded at the first well-child visit, the researchers recommend an increased emphasis on safe sleeping education during the third trimester of pregnancy.

Objective.The Alaska Division of Public Health has stated that infants may safely share a bed for sleeping if this occurs with a nonsmoking, unimpaired caregiver on a standard, adult, non-water mattress. Because this policy is contrary to recent national recommendations that discourage any bed sharing, we examined 13 years of Alaskan infant deaths that occurred while bed sharing to assess the contribution of known risk factors.Methods.We examined vital records, medical records, autopsy reports, and first responder reports for 93% of Alaskan infant deaths that occurred between 1992 and 2004. We examined deaths while bed sharing for risk factors including sleeping with a non-caregiver, prone position, maternal tobacco use, impairment of a bed-sharing partner, and an unsafe sleep surface. We used Pregnancy Risk Assessment Monitoring System data to describe bed-sharing practices among all live births in Alaska during 1996–2003.Results.Thirteen percent ( n=126) of deaths occurred while bed sharing; 99% of these had at least one associated risk factor, including maternal tobacco use (75%) and sleeping with an impaired person (43%). Frequent bed sharing was reported for 38% of Alaskan infants. Among these, 60% of mothers reported no risk factors; the remaining 40% reported substance use, smoking, high levels of alcohol use, or most often placing their infant prone for sleeping.Conclusions.Almost all bed-sharing deaths occurred in association with other risk factors despite the finding that most women reporting frequent bed sharing had no risk factors; this suggests that bed sharing alone does not increase the risk of infant death.

Sleep in a supine position and in a bed separate from but proximate to adults is recommended in several Western countries to prevent Sudden Infant Death Syndrome (SIDS). Cultural differences and a lower rate of SIDS in Asian populations may affect concern with this problem and thus infant sleeping arrangements. The objective was to study bed sharing and sleep position in Thai neonates and the relationship to infant and maternal characteristics. Methods A cross-sectional survey based on interviews with parents of infants aged 21 days old was conducted under the Prospective Cohort Study of Thai Children. Of the total sample 2236/3692 (60.6%) infants shared a bed with their parents. Sixty per cent of the parents placed their infants to sleep in a supine position 32.2% on their side and 4.9% in a prone position. Bed sharing was associated with older maternal age higher education Muslim mother and with work status of professional career or unemployed. Placing the infants to sleep in a prone position was associated with infant birth weight of greater than 2500 g older maternal age higher education Buddhist mother mother with professional career and middle-class household economic status. Infant bed sharing is a common practice in the Thai culture as in other Asian countries. The prone sleep position is less common than in Western populations. The main factor associated with both bed sharing and putting infants to sleep in the prone position was a higher maternal socioeconomic status (SES) in contrast to previous studies in some Western countries in which both practices were associated with low maternal SES. Cultural differences may play an important role in these different findings. (authors)

An evolutionarily informed perspective on parent-infant sleep contact challenges recommendations regarding appropriate parent-infant sleep practices based on large epidemiological studies. In this study regularly bed-sharing parents and infants participated in an in-home video study of bed-sharing behavior. Ten formula-feeding and ten breast-feeding families were filmed for 3 nights (adjustment, dyadic, and triadic nights) for 8 hours per night. For breast-fed infants, mother-infant orientation, sleep position, frequency of feeding, arousal, and synchronous arousal were all consistent with previous sleep-lab studies of mother-infant bed-sharing behavior, but significant differences were found between formula and breast-fed infants. While breast-feeding mothers shared a bed with their infants in a characteristic manner that provided several safety benefits, formula-feeding mothers shared a bed in a more variable manner with consequences for infant safety. Paternal bed-sharing behavior introduced further variability. Epidemiological case-control studies examining bed-sharing risks and benefits do not normally control for behavioral variables that an evolutionary viewpoint would deem crucial. This study demonstrates how parental behavior affects the bed-sharing experience and indicates that cases and controls in epidemiological studies should be matched for behavioral, as well as sociodemographic, variables.

Aims: To investigate the characteristics of parent–infant bed-sharing prevalence in England. Methods: Data on night-time sleeping practices from a two year, local, longitudinal study and a three-year, national, cross-sectional study were obtained. A total of 261 infants in North Tees were followed up at 1 and 3 months of age, as were 1095 infants aged 1 week to 1 year from five English health regions. Results: Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants. Conclusion: Bed-sharing is a relatively common practice in England, not specific to class, but strongly related to breast feeding.

To the Editor .— The Section on Breastfeeding of the American Academy of Pediatrics welcomes the new policy statement from the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome1 regarding measures that may further reduce the risk of sudden infant death syndrome (SIDS), especially the recommendation for proximate sleeping arrangements for all infants. We must take exception, however, to the global recommendation against all bed sharing, because the data supporting this recommendation are relatively weak and not specific to the breastfeeding population. We would, for the same reasons, not promote bed sharing at this time. It is our opinion that a neutral position acknowledging the still-controversial nature of this issue would have been more appropriate. With approximately half of all mothers in the United States practicing infant bed sharing at some …

Despite dramatic reductions in sudden unexpected deaths in infancy (SUDI) during the last 20 years in Australia, the same relative reductions have not been seen in Indigenous infant mortality. While forms of co-sleeping may reduce SUDI risk in some cultural groups and enhance breastfeeding, some bed-sharing environments are extremely hazardous for infants. Innovative strategies which allow for benefits of bed-sharing, respect cultural norms and infant carepractices, whilst enabling the infant to sleep in a safe environment are necessary if a reduction in SUDI is to be achieved amongst Aboriginal and TorresStrait Islander communities. The Pepi-Pod initiative is an innovative safe sleep enabler combined within a targeted safe sleeping health promotion initiative for families with known risk factors for SUDI. The Pepi-Pod initiative is a polypropylene box transformed into an infant bed through addition of aculturally suitable fabric cover and fitted mattress. The Pepi-Pod initiative draws attention away from problems of vulnerable babies in unsafe sleep situations and instead focuses on a solution: support for parents; protection for baby. Breaking the ‘smoking and bed-sharing’ combination is a major benefit. Interim findings of this initiative in New Zealand Maori families and displaced earthquake victims are positive. There is limited literature evaluating practical safe sleep enablers which allow for close parent–baby proximity and bed-sharing, within a safer infant sleep environment. An exploratory descriptive design will be used to report parent experiences the Pepi-Pod initiative in fiveAboriginal and Torres Strait Islander families; the first trial of the Pepi-Podin Australia. Health services have a responsibility to follow through from simply informing about safe infant sleep practice to enabling safe infant sleep action. Novel approaches are required if we are to achieve further reductions in sudden infant deaths. Evaluating innovative and culturally respectful strategies to reduce SUDI risk will better inform the evidence-base used by educators, clinicians, researchers and policy makers in supporting parents to use safe infant sleeping strategies.

Given the current interest in potential carcinogenic and developmental effects of exposure to extremely-low-frequency electromagnetic fields, there is a need to identify cohorts of exposed female workers for future epidemiologic investigations. This study was designed to test the hypothesis that nurses working in neonatal intensive care units (NICU) may be significantly exposed to power-frequency magnetic fields. An electromagnetic field monitor was used to measure magnetic fields at distances of 5, 15, 30, and 60 cm from the surfaces of each device used in the NICU. Six female nurses assigned to the NICU (the "exposed" group) and six female nurses working in the normal newborn nursery (the "referent" group) wore EMDEX dosimeters for the entire duration of their 12 h shifts. An investigator kept a detailed log of each NICU subject's whereabouts for the first one-third of her shift. Magnetic fields at 5 cm from the front (defined by the nurses' usual work area) of the NICU devices ranged from less than 0.1 to 114 microT and in all cases decreased considerably with increasing distance. The geometric mean of the shift-time-weighted average exposure of the NICU nurses was 0.17 microT compared with 0.11 microT for the normal newborn nurses. The percentage of time when subjects were exposed to magnetic fields of 0.4 microT or greater ranged from 5.8% to 15.6% for the NICU nurses, 0.4% to 2.9% for five of the comparison group nurses, and was 9.4% for one of the normal newborn nurses with unidentified aberrantly high exposures. Log data revealed that the vast majority of observed peaks among NICU nurses occurred while subjects were in close proximity to infant bed units. We conclude that NICU nurses represent one female-intensive job sector with intermittent high exposures to ELF magnetic fields and encourage larger exposure studies of nurses in a variety of medical settings.

OBJECTIVES--To investigate why sharing the bed with an infant is a not consistent risk factor for the sudden infant death syndrome in ethnic subgroups in New Zealand and to see if the risk of sudden infant death associated with this practice is related to other factors, particularly maternal smoking and alcohol consumption. DESIGN--Nationwide case-control study. SETTING--Region of New Zealand with 78% of all births during 1987-90. SUBJECTS--Home interviews were completed with parents of 393 (81.0% of total) infants who died from the sudden infant death syndrome in the postneonatal age group, and 1592 (88.4% of total) controls who were a representative sample of all hospital births in the study region. RESULTS--Maternal smoking interacted with infant bed sharing on the risk of sudden infant death. Compared with infants not exposed to either risk factor, the relative risk for infants of mothers who smoked was 3.94 (95% confidence interval 2.47 to 6.27) for bed sharing in the last two weeks and 4.55 (2.63 to 7.88) for bed sharing in the last sleep, after other confounders were controlled for. The results for infants of non-smoking mothers were inconsistent with the relative risk being significantly increased for usual bed sharing in the last two weeks (1.73; 1.11 to 2.70) but not for bed sharing in the last sleep (0.98; 0.44 to 2.18). Neither maternal alcohol consumption nor the thermal resistance of the infant's clothing and bedding interacted with bed sharing to increase the risk of sudden infant death, and alcohol was not a risk factor by itself. CONCLUSION--Infant bed sharing is associated with a significantly raised risk of the sudden infant death syndrome, particularly among infants of mothers who smoke. The interaction between maternal smoking and bed sharing suggests that a mechanism involving passive smoking, rather than the previously proposed mechanisms of overlaying and hyperthermia, increases the risk of sudden infant death from bed sharing.

Disparities by race/ethnicity exist in sudden infant death. Bed sharing has been shown to increase risk of sleep-related infant deaths. Objective To quantify infant bed sharing in Dallas, Texas from 214 pilot surveys. We anticipate additional surveys to analyse for the final presentation. Methods Parents completed a self administered survey regarding their infant9s ( Results Over half (56.6%) of infants were Hispanic. Mean age: Infant=4.1 months; Mother=28 years. Bed sharing occurred among 44% of infants, for an average of 4.5 h. The majority of bed sharing was with a parent. Other findings: prone placement (4.7%), pacifier use (33%), crib in home (81.2%) and fan presence (60%). Bed sharing was more common among breastfed infants (OR=2.4; 95% CI 1.3 to 4.4) and premature infants (OR=2.38; 95% CI 1.2 to 4.8). Families without a crib were more likely to bed share (OR=2.5; 95% CI 1.2 to 5.2) and bed share for more hours (6.6 h vs 3.8 h). Conclusions Infant bed sharing is common in Dallas. Families without a crib had a higher prevalence of bed sharing. Local data offers the potential to quantify bed sharing risk and measure efficacy of community interventions.

Background Bed sharing with parents has been described as both beneficial to infant well-being and as a potentially lethal situation. Objective To examine trends in bed sharing between infants and caregivers, and the factors that influence this behavior. Design Annual nationally representative telephone surveys conducted between 1993 and 2000. Setting The 48 contiguous United States. Participants Nighttime caregivers of infants born within 7 months prior to interview between 1993 and 2000. Approximately 1000 interviews were conducted each year for a total sample of 8453 nighttime caregivers. Main Outcome Measures Where and with whom the infant usually slept at night in the preceding 2 weeks. Results Forty-five percent of infants spent at least some time at night on an adult bed in the last 2 weeks. Between 1993 and 2000, the proportion of infants usually sharing an adult bed at night increased from 5.5% to 12.8%. More than 90% of infants who "usually" slept on an adult bed shared it with their parents. In a multivariate analysis, factors associated with increased probability of routine bed sharing included: maternal age less than 18 years (odds ratio [OR] = 2.26; 95% confidence interval [CI], 1.22-4.21), maternal race or ethnicity reported as black (OR = 4.04; 95% CI, 3.04-5.36) or as Asian or "other" (OR = 2.72; 95% CI, 1.74-4.22), household income less than $20 000 (OR = 1.49; 95% CI, 1.15 = 1.92), living in the Southern states compared with living in the Midwest (OR, 1.59; 95% CI = 1.23, 2.06), and infant age less than 8 weeks (OR = 1.60; 95% CI, 1.10-2.33). Living in the Mid-Atlantic compared with the Midwest (OR = 0.63; 95% CI, 0.44-0.90), and being born with low birthweight and preterm (OR = 0.32; 95% CI, 0.14-0.74) were associated with decreased probability of routine bed sharing. Conclusions Bed sharing as a routine practice is growing in the United States. Given that this practice seems to be widespread and strongly influenced by cultural factors, more studies of the consequences of bed sharing are needed to inform health care providers and parents on the risks and benefits.

Sixteen accidental deaths of infants occurred in Wayne County (Detroit) during 1974-1975 as a result of unsafe sleeping environments. Thirteen of these deaths resulted from different modes of asphyxia, two were due to falls, and one drowned. Differential diagnoses are pointed out. It is estimated that over 600 infants die each year in the United States due to unsafe sleeping conditions. Despite the magnitude and importance of this problem, little has been provided to the public in the form of preventive education. Federal regulations, passed in 1974, control the manufacture of new cribs but do not affect the existing unsafe cribs. Suggestions for the prevention of such fatal accidents are outlined, in cluding a safety check list for infant beds. The cooperation of all health professionals is required to educate the public of these dangers to their infants.