Sleep researcher Helen Ball asked me to forward this because she is having
trouble posting to the list at the moment.
From: Helen Ball [mailto:[log in to unmask]]
Subject: FW: co-sleeping when parents are smokers

Arly asks some very relevant questions about smoking and co-sleeping in
follow up to Elises's original post asking:
I would like to know more about the exact parts of co-sleeping that are more
dangerous for these babies than sleeping alone in a crib is.  Proximity of
adult(s)?  Proximity of adult who smokes?  Pillows?  Mattress type?
Blankets?  Is there a way to modify the sleep arrangements to lessen the
risk?  This study was done in a Maori population -- do the results hold true
in other groups?  I suspect no one knows any of these answers yet...  Has
anyone else been following this aspect of the co-sleeping research, and what
do you say to parents who are smokers?

As a researcher these are questions I am asked after every talk I give on
bed-sharing -- but the only current 'answers' are to use common sense --
there is as yet no research data to clearly address these issues. There are
very few of us working directly on bed-sharing research. Yesterday my
research staff and I tried to work out when we could realistically start a
project on smoking and bed-sharing (something that has been on our 'list'
for a couple of years already) -- and given our current project load it
didn't look likely for another 2 years at the soonest -- which would mean 4
years from now before we had any real answers!

In the UK the nationwide CESDI study found a 12x risk of SIDS in babies who
bed-shared with parent(s)who smoked compared to babies who bed-shared with
parents who didn't smoke (bed-sharing babies of parents who didn't smoke had
basically the same risk of SIDS as babies who slept in cots in the rooms of
parents who didn't smoke -- room-sharers of smokers had a 5x increased risk
of SIDS). A recent paper in Archive of Disease in Childhood (James et al
2003) reported that of 9 bed-sharing infant deaths in Wirral, 7 were to
babies of smokers, and 11/14 non-bedsharing infant deaths were to babies of
smokers. In some bed-sharing cases alcohol and sofa-sleeping were also
involved.

That there is an increased risk of SIDS (and possibly accidental
suffocation) to babies of smokers who bed-share compared with bed-sharing
non-smokers is clear. What we don't know is why. We don't know whether it is
to do with environmental contamination (on clothes, skin, breath of smokers
etc). We don't know whether the relevant chemicals (if there are any) are
transmitted via breastmilk also (perhaps bed-sharing breastfed infants
receive the highest dose -- getting it via breastmilk and via close physical
contact all night??). We don't know if the 'mechanism' is behavioural rather
than chemical (e.g. one question we hope to answer is whether smoking
parents and their infants differ in their sleeping/bed-sharing
characteristics fron non-smoking parents and their infants -- e.g. sleep
more deeply, reduced awareness of infant etc.) The only published info I
know of so far is a paper by Franco et al (1999) who reported that prenatal
exposure to cigarette smoking was associated with decreased arousal during
sleep in infants. This suggests to me that smoke exposure prenatally (and
postnatally?) is affecting infant neurophysiology controlling sleep. I think
(from memory) that there are some publications reporting that smokers
generally sleep more deeply than non-smokers -- if so we maybe have a
situation of a less-responsive-than-normal baby sleeping with a
less-responsive-than-normal parent giving rise to situations where
SIDS/suffocation might arise.

What do I say to parents who are smokers -- well first off, don't smoke!  If
they can't/won't do that, don't bed-share unless they are willing to accept
a 12x increase in the risk of SIDS (in the UK this means going from 1 chance
in 2000 to 1 chance in 167). Some parents are willing to accept this level
of risk. Do the benefits of breastfeeding (which generally implies at least
some bed-sharing)outweigh the increased risk of SIDS for babies of smokers??
Who knows?!

There are no easy answers to these questions -- so the safest options at the
moment seem to be
a) if you have a baby don't smoke
b) if you have a baby and you smoke don't bed-share
c) if you have a baby and you smoke and you choose to bed-share -- you are
on your own -- there is no research data yet that can demonstrably help you
further reduce the level of risk you have chosen to accept.

Sorry this is a long post -- as Elise originally suspected -- there are more
questions than answers.

Helen
__________
Dr Helen Ball, Parent-Infant Sleep Lab, Dept Anthropology, University of
Durham.

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