When baby’s sleeping isn’t safe
Bed sharing has been a factor in nine Hamilton infant deaths from 2010 to 2016; five more babies have died in an unsafe sleep environment. A moment borne out of love too often turns tragic.
THEY WANTED TO DO everything right for their baby.
Parenting books were stacked around their home. They bought a special nursing chair, and mom was working hard at breastfeeding, despite some setbacks.
She was up during the night to do a feeding and cuddle her newborn, skin-on-skin. And — as so often happens in those exhausting, early weeks — she fell asleep in the nursing chair, child in her arms. When she woke, her baby was dead.
Its position shifted while mom slept and its face pressed against her body or the chair. The baby was too young to turn its head for air.
This tragic story is told by Det. Sgt. Peter Thom, a Hamilton police homicide investigator. He went to that call, as the major crimes unit does any time a child under five dies unexpectedly.
“I was fairly certain almost immediately that this was a terrible accident,” he says. “But you only have one shot at preserving a potential crime scene.”
Protocol dictates that every death first be looked at as a possible homicide.
That grieving family had to be interviewed. Police had to move them out of the house and seize the scene while forensic work was done. The baby needed to be autopsied.
Thom recalls unopened baby gifts from a shower held to welcome the newborn home just hours before the death.
In the end, the cause of death was ruled as a sudden unexpected death with shared sleeping as a contributing factor.
WHAT DOES THAT MEAN?
It means the coroner was unable to determine for certain why the infant died. Which is often the case with children under the age of one. But babies sleeping with other people or with pets have an increased risk of death.
Bed sharing has been a factor in nine infant deaths in Hamilton from 2010 to 2016, according to the Office of the Chief Coroner. In just six years, nine otherwise healthy — so far as post-mortem tests can tell — babies have died while sleeping with someone. In each of those deaths there has also been an “unsafe sleep environment” — which can include anything from pillows and blankets or a soft mattress to a plush toy being with them at the time of death.
In that same six-year span, an additional five Hamilton infants have died with a unsafe sleep environment as the sole contributing factor in the death.
“Bed sharing” or “co-sleeping” or a “family bed” happens, usually, out of love.
A doting, sleepy parent falls asleep while holding baby on the couch or in a chair. Or they bring their precious newborn into bed to breastfeed and bond.
They may consciously decide that a shared bed is the best way to raise their child. Or they may have intended to put their baby back into the crib after feeding or soothing, but fell asleep before doing so.
“What we know is they die in an unsafe sleeping environment. We don’t know they die from an unsafe sleeping environment,” says Dr. Dirk Huyer, Ontario’s chief coroner.
Determining the cause of death in these situations is complicated and often impossible, says Huyer. An infant may have died from SIDS — Sudden Infant Death Syndrome — before a parent inadvertently rolls on top of them.
“It is challenging to know all of the specifics of each infant death,” says Huyer.
So the best that can be done is to determine what factors may have contributed to the sudden death.
An editorial published in June in the Journal of American Medical Association Pediatrics says that in the U.S., bed sharing is commonly practised by parents from all race and ethnicity groups.
Thom and Det. Sgt. Dave Oleniuk, also a homicide investigator with Hamilton police, say the cases they get called to include families from diverse backgrounds and all socioeconomic levels.
“Often we hear that parents are following the ways of their own parents,” says Oleniuk. “That generations of their family have done their bonding connection a certain way. Bonding is great, but address it in some other areas, not in the sleep environment.”
Thom is a member of Ontario’s Deaths Under Five Committee, a group that includes detectives, doctors, a Crown attorney and a product safety officer from Health Canada. The group reviews paper files of children’s deaths to determine causes and trends. He says it’s frustrating that there are still groups advocating that a shared bed is the gold standard for bonding with a child. Investigating a death that stems from it is “the most awful thing,” he says.
BRINGING BABY into bed is one sharing scenario, but the exhausted parent who falls asleep on the couch or in a chair while holding the wee one is adding an even greater risk, according to a U.S. study published in the American Academy of Pediatrics in 2016.
“The AAP acknowledges that parents frequently fall asleep while feeding the infant,” the study says. “Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep.”
Where each scenario falls on a continuum of risky behaviour is hard for researchers to determine, says Huyer, though the best practice is for children aged one and under to sleep on their back in a crib with a firm mattress covered with a fitted sheet. The crib should meet regulations and should not contain anything else at all — no blankets, stuffed toys, pillows or bumper pads.
Shared beds and unsafe sleep environments put babies, particularly those seven months of age or younger, at an “increased risk,” says Huyer. Until that age, babies are unlikely to have the motor ability or strength to move themselves out of danger if they end up in a position that hampers their ability to breathe or becomes too hot.
Also adding to the risk is an infant sharing a bed with someone who is impaired by drugs or alcohol and sharing on a soft surface such as a waterbed, couch or armchair.
In 2014, 16 infants under the age of one died in Ontario with bed sharing as a factor, representing half of all deaths of children under one reviewed that year by the Deaths Under Five Committee.
In 2015, sleep circumstances were identified in 42 per cent (25) of the 59 pediatric deaths in Ontario where the manner of death was classified as undetermined.