There has been a four-fold increase in infants dying after falling asleep with a parent on a sofa, research shows.
Sleeping with a baby can be dangerous
A team at Bristol's Royal Children's Hospital warns "cot death" does not always mean a cot - about 30 babies die in the UK a year after sharing a sofa.
The researchers say parents should never snuggle up with very young children on a sofa if they feel tired.
The Lancet study also found more deaths are occurring among poor families, and among those where the mother smokes.
The researchers said a very successful public education campaign had helped to slash cot death rates by 75% since 1991.
However, their study suggested the appropriate messages had still not got through to many poor young mothers.
HOW TO REDUCE COT DEATH RISK
Cut smoking during pregnancy - fathers too
Do not expose your child to smoke
Put your baby to sleep on its back
Keep your baby cool, with its head uncovered
Parents should not share a bed with their baby if they are very tired, smoke or have been drinking or taking drugs which make you drowsy
But the baby should be in a cot in the same room for at least the first six months
Never sleep with a baby on a sofa or armchair
If your baby is unwell, seek medical advice promptly
It is already known that the risk of sudden infant death syndrome (SIDS) is higher for babies that are born premature, or have a low birthweight.
Male babies also appear to be more at risk, as do those who sleep on their side or front.
Smoking during pregnancy, or in the house after a child is born, is another risk factor.
And the latest study, led by Professor Peter Fleming, underlines that sharing a sofa with a child is also a significant risk.
The Bristol team examined data on 369 SIDS cases that occurred between 1984 and 2003 in Avon.
These were compared to information on 1,300 healthy babies from a study carried out between 1993 and 1996.
The researchers found that although the number of deaths in the parental bed had fallen by 50%, the number of deaths on a sofa shared with a parent increased four-fold in recent years.
However, there are still about 135 bedsharing deaths a year in the UK, compared to the 30 linked to sharing a sofa.
Professor Fleming said: "Although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are unclear, we strongly recommend that parents avoid this sleeping environment."
The study also found that that the proportion of SIDS deaths among poorer families increased from 47% to 74%.
The proportion of deaths in which the mother smoked during pregnancy also rose, from 57% to 86%.
The researchers are calling for a standard protocol to aid the investigation of cot deaths and to enable as much relevant information to be collected as possible.
Joyce Epstein, director of the Foundation for the Study of Infant Death, said: "Over 14,000 lives have been saved in the UK since the advice to reduce the risk of cot death was introduced in 1991.
"But still over 300 babies every year in the UK are dying as cot deaths - that's more babies over one month old than from any other cause.
"The battle against sudden infant death is far from over.
"It is absolutely vital that we get our safe infant care messages across more forcefully, especially among the more vulnerable sections of society, and that we continue our lifesaving research into the causes of cot death."
Have you been affected by issues discussed in this story? Send us your comments and experiences.
This is a personal choice. My daughter (now 2.5) slept in our room for only the first 3 months because I woke to her every shuffle, cough or sneeze. I had to move her into her own room for my health!
With regards to SIDS, I think there is more to the cause of falling asleep with your baby/child on a sofa chair. I used to do this with my daughter all the time to get her to slow down relax and sleep when she was tired.
Having said that I am 6ft5 and weigh 19 stone, so I am not moving anywhere and my 12kg daughter is a tiny shell in comparison.
I never slept with my daughter, only napped. There could be a difference in the "type" of sleep also.
She never slept in our bed either.
Obviously education is the key to avoid similar deaths in the future.
Ceri G, Cardiff, Wales
I am shocked that in your article there is no mention of SIDS being caused by the chemicals that are in most mattresses - mainly the fire retardants that the mattresses are treated with. A study was done in New Zealand where fire retardants were proven to be a cause of SIDS and they were removed from all mattresses. Since then, SIDS has decreased significantly in NZ.
Susan MacLeod, Norwalk. CT, US
Our son has recently passed the six month mark and has just started sleeping in his own room. I was made to feel like a paranoid mother for following the advice from SIDS that the safest place for a baby to sleep for the first six months is in the same room as the parents. The message has clearly not reached the wider public so please continue the campaign to raise awareness.
I have worked for IKEA in Sweden and remember the how horrified we were when the UK decided to massively increase the fire retardants in UK sofas following several cases of deadly fires from smokers in the mid 1980s. One of the problems with these retardants is that they give off even more deadly (and carcinogenic) gasses. Unfortunately it appears the political "quick-fix" is coming home to roost. Very, very sad.
Agustin Serra, Malmö, Sweden
On the birth of my baby girl I was advised to have her sleeping in my room until she was 6 months old. I found it convenient just to take her out of her cot and feed her in bed with me, where it is so easy to fall back to sleep with her next to me instead of putting her back in her own bed. When she was 6 weeks old I was worried about this so put her in her own room to ensure I had to get out of bed to feed her then put her back in her own bed before I went back to sleep. I thought this was much safer and found we both had better sleeps.
Caron Longden, Barnoldswick, Lancs
I agree with above. I lost my son Sean to SIDS in 1998. I believe that the dangers of SIDS should be advertised more. I know when you're expecting a baby the last thing you want to read about is cot death but it is a reality that must be faced.
As a psychology student I have read literature on sudden infant death, and I think it should be noted that in countries where parents sleep with their baby in the bed, there is little or no 'cot death' compared to countries where cots or cradles are used. These countries, for example Guadeloupe, have no societal taboos about having your child sleep in the same bed as the mother, even up to the age of 8 or 9. The findings regarding cot death has been linked to the baby using the mother (or father's) breathing to regulate their own. I think the advice you have given on the article is good, although it should also be noted that leaving a new born baby in a cot in another room has also been shown to be a higher risk than sleeping in the same bed (dependent upon the parent being under no influence of drugs, alcohol or otherwise.
Caroline Knights, London, England
Our son has recently passed the 6 month mark and has just started sleeping in his own room. I was made to feel like a paranoid mother for following the advice from SIDS that the safest place for a baby to sleep for the first 6 months is in the same room as the parents. The message has clearly not reached the wider public so please continue the campaign to raise awareness.
As a father, I can understand how parents feel comfortable cuddling up to their children on a sofa but we must always be aware of the dangers and risks that surround our children. By feeling tired we are actually one of those risks.
Keith O'Brien, Rushden, UK
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