Think bed-sharing is safe? So did the mother whose twins died.

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It is a truly horrific tragedy.

Brisbane baby girl dies days after twin sister died at Sunnybank Hills home:

A second baby girl who was found unresponsive in a Brisbane home has died in hospital overnight.

Police were called to the Sunnybank Hills home on Wednesday morning.

One of the six-week-old twins was declared dead at the scene.

The second girl was taken to hospital in a critical condition on Wednesday morning.

Police said preliminary investigations suggested the newborns had been sleeping together throughout the night.

Bed-sharing is a known risk factor for suffocation and sudden infant death syndrome. Every major pediatric health organization warns against it … except many breastfeeding organizations. Why? Apparently it’s more important to make breastfeeding easy than to ensure infants are safe.

Every major pediatric health organization warns against it … except many breastfeeding organizations.

Consider Dr. Melissa Bartick’s irresponsible and hypocritical opinion piece in Maternal Child Nutrition, Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Bartick promotes the deadly practice of co-sleeping in order to support breastfeeding. Apparently she is blind to the absurdity of letting babies die in order to breastfeed them.

Recommendations enforcing separate sleep are based on 20th century Euro‐American social norms for solitary infant sleep and scheduled feedings via bottles of cow’s milk‐based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance…

Seriously? How natural is the soft surface of a manufactured mattress? When in nature did bedding that can cover babies‘ heads evolve? If even the Bible mentions a bed-sharing death from a mother rolling onto an infant how is that fear based on 20th Century Euro-American norms?

La Leche League promotes a deadly policy of flat out denial:

It can be hard to continue your breastfeeding relationship if you are told you are not safe for your baby for a full third of the day! LLL believes there are many safe sleep options available to parents with infants. Education and accurate information are the keys to unlocking Sweet Sleep solutions!

Really, La Leche League? How sweet is a dead baby? Are two dead babies even sweeter?

The parents of the twins are “in a dark place.” It’s difficult to comprehend the grief, anguish and self-blame the parents will carry for the rest of their lives.

In an interview with the Courier Mail, their father revealed that the couple is in a “dark place” and their 2-year-old son has been distraught, searching the house for his baby sisters.

“We’re in a very dark place. But we have to try to keep going for our other children,” the father said.

“Our daughter is almost five, we told her the truth. We didn’t say they had fallen asleep … we told her they had died.”

However, he added that his daughter still hasn’t fully comprehended what has happened yet.

The twins’ father, who is a chemical technician, revealed he and his wife understood the dangers of co-sleeping, but they were struggling with the sleep deprivation after the birth of their twins.

He added that they are “educated people” and that it was only the second time her wife had co-slept with their children.

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My heart goes out to these parents. They never, ever thought their babies would die … but neither does anyone else who practices bed-sharing.

Thinking about bed-sharing with your precious baby? Think again!

  • Michael Ray Overby

    This is a terrible, heartbreaking tragedy, here. Dad himself says they were “Sleep-Deprived” at the time. Twins are hard to take care of, & we are sorry for this fam’s Losses. The Threat posed by co-sleeping is a very Real one. mabelcruet, thank you for your excellent, comprehensive Elucidation of this issue from the standpoint of a Professional…

  • Are you nuts

    My heart breaks for this family. It’s so difficult when you have a baby who won’t sleep and no one to relieve you. My second baby would only sleep on my body for the first few nights. And now you can’t use a rock n play or anything like that. Neither of my babies would sleep flat on their backs in a crib for a very long time and it’s a horrible position to be in.

  • PeggySue

    This is just the most heartbreaking story. That poor family. I can imagine how tired they must have been, but what a price to pay. And the poor little boy searching for his sisters…

  • mabelcruet

    I’m just waiting for the parachutists complaining about the failure to distinguish between co-sleeping and bed-sharing. Co-sleeping in the same room with baby and parent/parents in separate beds is the safest way to sleep. Bed-sharing with the baby in the same bed as the parent/parents is not the safest way. But when we talk about co-sleeping, we generally use the term to mean sleeping together in the same bed. I suspect that lack of precision about the term could potentially confuse some parents and lead them to believe that co-sleeping is safe, and I also wonder if some lactivists use the confusion to their advantage.

    In the UK, babies who die unexpectedly in the first year of life are classified as SUDI (sudden unexpected death in infancy). SUDI can be natural or unnatural-we use the term SIDS extremely infrequently, because very few infant deaths fulfill the criteria for the diagnosis of SIDS. Babies who die in bed with their parents (co-located co-sleeping) do not die of SIDS because they don’t fit the diagnostic criteria. Neither do they die of vaccine injury, or mold spores, or temporary vitamin C deficiency or any of the other crackpot theories that have been circulated. Some die of asphyxiation, either by overlaying, or by occlusion of airways by bedding or adult bodies, or by rolling out of bed and getting stuck in compromised positions. Some die through a less well understood mechanism, probably a combination of ambient temperature with microenviromental changes and relative hypoxia.

    In my experience, it’s getting to the stage that if I have a baby who died in their own cot or basket, I generally find a definite natural cause of death, and generally if a baby was sleeping with their parent (whether in bed, on a chair or on a sofa), we don’t find any signs of natural disease. This mirrors the experience of many of my paediatric pathology colleagues. The other significant issue is that by far and away the most common scenario I am now seeing is that the “co-sleeping in the same bed episode” that resulted in death was a spontaneous episode and not the normal arrangement used in that family. The baby normally slept in their own cot, but for some reason the parent decided to bring the baby into bed with them. It is possible to reduce the risks of co-sleeping, it is never going to be completely safe, but the risks can be reduced by forward planning: not smoking, not being over-tired, not drinking or being on medication, keeping the room 16-18 degree C, not using heavy duvets or pillows etc . Planned co-sleeping is certainly safer than unplanned co-sleeping, but safest of all is a sleeping platform adjacent to the parental bed, or a separate cot in the same room.

    • Griffin

      “I have a baby who died in their own cot or basket, I generally find a definite natural cause of death, and generally if a baby was sleeping with their parent (whether in bed, on a chair or on a sofa), we don’t find any signs of natural disease. This mirrors the experience of many of my paediatric pathology colleagues.”

      Interesting. Have you thought about setting up a prospective study where participating pathologists analyze the bodies of neonates in the absence of background information, affix a suspected cause, and then check the background info? Your posts are always so informative, interesting, and eye opening, I wonder if the view of pathologists on these matters has ever been investigated. I guess pathologists are not generally seen to be on the ‘front-line’ so it would be really interesting to read studies based on things they see.

      • mabelcruet

        There’s some data in a similar sort of vein-they wrote a few scenarios about theoretical cases, including the sleeping arrangements and then listed the autopsy findings, along with the results of microbiology and virology, and asked different types of pathologists (paediatric, forensic, general adult) how they would classify the death. For example, case A-6 month old infant, sleeping in own cot, found dead in the cot, autopsy showed interstitial pneumonitis but no viral organisms identified; case B, 2 month old, recently diagnosed with upper respiratory tract infection, found dead face down in parents bed, at autopsy-no histological anomalies noted, no bacterial organisms cultured. It turned out that forensic pathologists were more likely to say that case A could be signed out as SIDS, whereas a paediatric pathologist would have called it SUDI, unascertained with evidence of pre-existing viral infection, and a general adult pathologist would have called it ‘Viral infection’. For case B, all pathologists would plump for SUDI, un-ascertained, but do a commentary describing the known risk factors. In general, paed paths tend to be more verbose in their reporting, and more descriptive with their formulation of the cause of death.

        There is often very little to find in babies who have been bed-sharing, with or without a history. There may be no physical marks at all-occasionally you might see marks on the skin where parental clothing was pressing on the baby (I’ve seen lines on a baby’s chest that could have been caused the raised seam of his father’s jeans, and button imprints from a pyjama top on the baby’s skin, caused by the mum falling asleep on her, partially covering her face). There are some very non-specific findings of acute asphyxia by upper airways occlusion, like petechial haemorrhages on the thymus gland, around the coronary arteries of the heart and over the lungs, but these aren’t much use really in determining the cause of death, so that means a lot of these cases go out as SUDI, unascertained, and the circumstances of death, which are hearsay really, end up being used to assist in determining the cause.

        I use ‘overlaying’ very infrequently, even though its a possibility in every bed-sharing death. The reason for that is there is no objective evidence specifically for overlaying and we have to rely on what the parents tell us, unless there is an independent witness. We always do a clinicopathological comment, and I go into detail in that about risks, and how I can’t conclude overlaying occurred, so its then up to the coroner to decide-his threshold is ‘on the balance of probabilities’ rather than ‘beyond all reasonable doubt’ like they use in criminal cases. So he might decide that there is sufficient history to indicate that overlaying was the most likely cause of death.

        • Griffin

          Thank you for the extended answer, I didn’t realize that the circumstances of death are so important in pathology. So my proposed study would be completely unfeasible!

          • mabelcruet

            The circumstances of death sometimes takes almost as long as doing the actual autopsy! Whenever we have an infant death, the coroner (who is a legal body, not a medical one) appoints an investigating officer and they go off and get statements, medical records from the family doctor, health visitor, hospital etc, and there is a police photographer and CSI dispatched to the scene for evidence gathering and photos. These are generally investigated with a certain level of concern-the vast majority aren’t suspicious or criminal, but the initial investigation has to be thorough so that we don’t compromise evidence collection or identification if the death does turn out to be suspicious.

            Once they’ve got all the information (generally very quickly, usually the same day or 24 hours of death being reported), we meet with the investigating officer to do a formal ID of the body and get all the background information, and the baby gets a full skeletal survey and CT scan looking for injuries. All of this generally guides us as to whether this is non-suspicious or not, so they are double doctored with paediatric and forensic pathologists together, but with forensic lead for suspicious ones, and paed lead for non-sus. We’ve got a very well embedded national protocol for these deaths. 20 years ago there was much more variation nationally, with some areas covered by paeds, and others covered by forensic or by general adult coronial pathologists, and there were a few high profile cases where verdicts were overturned because the pathology findings were in dispute, but that has lead to much more uniform, and hopefully much higher standard of investigations.

            Each year there are big headlines claiming the cause of SIDS has been found, but what actually is being found are various paediatric conditions that can cause sudden infant death in some babies, so we are chipping away at the natural causes slowly. A few years ago, we couldn’t test for cardiac arrhythmia at post-mortem, but nowadays, we can test for genetic aberrations that can cause prolonged QT syndrome, a not uncommon cause of sudden death. These means we can target investigations more precisely, and families get followed up more thoroughly.

    • E.C.

      If it could be called “room-sharing” rather than cosleeping, the distinction would be clearer.

      • mabelcruet

        Definitely, but there is no internationally agreed terminology in the literature. Sometimes you have to be very careful to scrutinize a paper to determine if the co-sleeping was in the same bed or in the same room, and I honestly think is a problem. Co-sleeping in the same room in separate beds is the very safest arrangement, so if parents hear co-sleeping is safe, do they assume this is co-sleeping in the same bed, or co-sleeping in the same room in different beds? There is a very real risk of misunderstanding and mis-comprehension, and when you are looking at national statistics and epidemiology of infant deaths, not knowing precisely the sleeping arrangements leads to errors.

        The definition of SIDS is the sudden and unexplained death of an infant under the age of 12 months, where the cause of death cannot be determined despite a full autopsy examination and a death scene examination. Bed sharing is automatically excluded, because the possibility of death as a result of overlying/asphyxia cannot be excluded, therefore you can’t say the cause of death is entirely undetermined. There was a move to divide these into SIDS type I and II-type I would be the traditional SIDS, and type II would be SIDS with some additional factors, so if you have an infant co-sleeping in the same bed, or if you found a minor infection that wouldn’t normally have caused major health issues, you could classify that as SIDS type II. It hasn’t caught on at all, certainly not in the UK because its seen as an imprecise non-diagnosis. All it really means is ‘we don’t know why this baby died’, but by calling it a syndrome, that gives it a spurious uniformity of causation, when actually there are many causes of sudden and unexpected infant death that could potentially present as SIDS. That’s why we prefer SUDI-sudden unexpected death in infancy, its far more descriptive, and can be modified according to your findings, so we can classify as SUDI-natural or unnatural causes, causes determined or undetermined. It should help us capture all infant deaths more accurately, so if I do an autopsy and find a pneumonia, I can say SUDI-natural, bronchopneumonia. The infant died suddenly and unexpectedly, but of natural causes. Just recording it as pneumonia may mean the case gets excluded from infant death statistics.

        But because different countries classify differently, its quite difficult to compare rates. In USA, the use of the term SIDS is still very prevalent. Some countries use SUID, others classify solely by the pathological diagnosis. One of the biggest issues in sudden infant deaths is the claim that bed-sharing is common, for example, in Japan, and their SIDS death rate is very low. But we don’t actually know that, because classification depends on which type of pathologist does the autopsy, and what the preferred classification system in that country is. For all we know, there may be lots of bed-sharing deaths in some countries that are being ‘masked’ by being classified as ‘interstitial pneumonitis’ (a vague viral chest irritation that happens extremely commonly whenever children get the sniffles, and its not usually serious, but some pathologists would prefer to say ‘interstitial pneumonitis’ than say ‘unknown/undertermined’).

    • rational thinker

      The parachutists will be here eventually.
      I did room sharing with my kids, I did not ever let them sleep in my bed until they turned one year. I know someone who lost a baby that way. Baby was napping on moms chest in middle of the day and mom fell asleep. When she woke up the baby was dead. Baby was only a month old.

      • mabelcruet

        In my experience, its the unplanned co-sleeping/bed-sharing episode that we should be looking at. Peter Fleming looked at this in his huge CESDI SUDI study, 300+ infant deaths with 4 matched controls each from a population of over 17 million. It was an enormous undertaking and it fundamentally changed how we investigate these deaths in the UK. One of his findings was the frequency of the fatal co-sleeping bed/sofa/chair sharing episode being unplanned and spontaneous, as opposed to planned, and I think that was the first time I actually became aware of the distinction.

        I don’t have any stats to hand, but certainly in the last few years, I’ve become increasingly aware of cases where normally the baby was in their own space, and for some reason, was brought into bed where they weren’t normally sleeping. It’s so easy to do-I’ve had cases where dad had been out celebrating, came home rather drunk, swooped baby up for a cuddle and fell asleep with them in their arms. Where mum was feeding baby, was too cold feeding in the chair so she got back into bed, fell asleep and the baby rolled down her body and landed face down on the soft duvet. Where mum brought baby into bed for an early morning cuddle and made a sling-like arrangement with the bed sheet over her raised knees, and she laid baby in that so they were face to face, but mum fell asleep and when she awoke she had slipped down flat in bed and turned over, so the baby was trapped and folded into the sheet between her legs.

        It’s these spontaneous episodes that parents have to be most careful about I think-if you plan to bedshare, I think most parents do so with forethought and planning-checking the bedding, checking the environment around the bed (no wastebaskets etc-I had a case where baby rolled out of bed and fell headfirst into a wastebasket that had been lined with a plastic bag), making sure the temperature is suitable and so on. If you don’t smoke, that is a huge safety boost for your baby. I find it very hard to say ‘do not, under any circumstances, sleep with your baby’, because I know many parents do, and many parents do so with careful planning to reduce the risk. The risk can be reduced somewhat-it’s never completely eradicated, and it will never be zero, but I think we need to get the message that spontaneous bed-sharing is also dangerous, and probably more so, because its usually not been considered or planned, and its usually done when there is a reason why its happened that particular day-parent may be unusually sleepy, baby may be difficult to settle, parent may be drink or drug impaired. Whatever the reason, if you don’t normally share your bed with the baby, don’t share it as a one-off would be my advice. I’d love to see if there is any up to date data on this-Fleming’s original study is nearly 20 years old now and the safe sleeping environment has been really hammered home nationally, so I think we are seeing more spontaneous bed-sharing deaths, and fewer planned bed-sharing deaths.

        • Banrion

          I also can’t help but notice the parallel with the deaths of children who are left in cars. They are usually forgotten about because of a change in parental routine.

          • mabelcruet

            Yes, very much so-I hadn’t thought of that, but I can definitely see its a similar sort of issue.

          • Who?

            November was a bad month to be a little girl in Brisbane, with two young sisters found dead in their mother’s car in the front yard of the family home, during the same week that the twins died.

            Unfortunately, it appears the mother may have been drug-affected, and she is on remand in prison awaiting trial over the deaths.

            But yes, on the whole, a lot of leaving kids in cars seems to be a change in routine.

        • nobunnies

          I think this point about spontaneous bed-sharing cannot be overstated. I have been to an ante-natal parenting class which, paraphrased, said ‘you may not expect to co-sleep (bed-share, or worse, couch-share) with your baby, but realistically most parents do at some point or another, so do some investigation and preparation about the safest way to do it before you get sleep-deprived’. I thought this was an excellent way to put it, and I suspect for many families the safest way would be not at all, due to various risk factors.

          • StephanieJR

            To me, it’s a harm reduction situation, much like sex education in teens – it’s greatly preferable that you never do it, but if you must, here’s how to do it safely.

  • Desiree Scorcia

    I’ve said this here before, but I called the editors of The Womanly Art of Breastfeeding and said I was concerned about their co-sleeping recommendation. I can’t remember who I talked to, but she got ANGRY. She said she had spoken at WHO conferences about breastfeeding and safe sleeping, and who did I think I was telling her she was wrong. I was patient, explained the research, but she was not hearing any of it. She was adamant that she knew best. I offered to help re-write that section for free (I’m have a masters in science journalism). She didn’t take me up on it!

    • rational thinker

      I wonder how many babies that womans ego has killed.