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Many of us whose children were babies a decade or more ago will recall lazy weekend afternoons sleeping on the sofa with a baby lying on top of us – a practice that is now strongly discouraged to due to the risk of SIDS and accidental infant deaths on sofas and in arm-chairs. Just as our parents’ normal practice to place us prone for sleep a generation previously was strongly discouraged in the 1990s on the basis of new research into unexpected infant deaths, sleeping with a baby on a couch or in an arm-chair is now known to be a particularly hazardous sleep environment for babies, accounting for 16% of SIDS deaths in the UK, an increase from 6% the previous decade.

Blair et al. 2009. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ. 339:b3666.

Compared to sleep on other surfaces, it appears that sleeping on sofas increases the risk of SIDS between 49 and 67 times (Blair et al., 1999, Tappin et al., 2005; Rechtman et al., 2014; Blair et al 2014.

Blair et al. 2014. Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? PloS One, 9(9), e107799.

Why sofa-sharing deaths have increased is presently unknown, but researchers have suggested that it may be that recommendations to avoid bed-sharing have led parents to take their babies to the living room for night-time feeds, where they may have inadvertently fallen asleep with the baby (Blair et al. 2009). The use of drugs or alcohol has also been implicated or confirmed in many sofa-sharing deaths where adults fell asleep or passed out accidentally on top of babies.

Who is most at risk?

In a study of night-time infant care in Bradford (Ball et al. 2012) researchers investigated which families from this predominantly bi-ethnic community (Pakistani and White British) were most likely to sofa-share with their infants, and which other behaviours were associated with sofa-sharing. Although Pakistani babies were more likely to bed-share than white British infants, they never slept with an adult on a sofa. Pakistani mothers explained in a subequent study that this was because the living room is a formal social space in a South Asian household where mothers would feel uncomfortable lounging around during the day. Lying with a baby on the sofa would be considered disrespectful to other family members and simply wasn’t done (Crane & Ball 2016). In contrast white British infants were more likely to sleep on sofas, and to have mothers who consumed alcohol and smoked. Among the white British mothers who were breastfeeding there were two clear groups – those who bed-shared but didn’t sofa-share, and those who didn’t bed-share, but who had slept with their babies on a sofa.

More widely, sofa-sharing is associated with many other dangerous infant practices. Rechtman et al. (2014) in a huge study, across 35 US states and eight years, found that infant sofa deaths were much more likely to sleep nonsupine, particularly on their side having rolled into a corner of a sofa. They are also more likely to be sharing the sleeping surface. These are both risk factors for SIDS. However, as Ball et al. (2012) found, the sofa-sharing demographic continues to be distinct, mothers being more likely to be using tobacco and drugs prenatally. This is an additional danger to the infant than those who were not sofa-sharing.

Given the high potential for accidental suffocation on sofas it is important to warn families of the risks of sleeping with their babies in this location.Parents feeding their infants at night often find themselves in a catch-22 situation. They are advised not to bring their babies into bed, so they go downstairs to feed on the sofa where they sometimes accidentally fall asleep. For most families, falling asleep with the baby in the bed would be the safer option to the sofa — for this reason all families should be given information about how to make bed-sharing as safe as possible, in order to avoid hazardous co-sleeping on sofas.