A debate over whether parents should share beds with infants has been ignited online following the death of a 36-day-old baby last week.
Her parents discovered she was not breathing after she spent the night on their bed. She was taken to KK Women's and Children's Hospital (KKH), but pronounced dead soon after. Police investigations are ongoing.
In most cases, it can be difficult to ascertain whether a sleep-related infant death is caused by Sudden Infant Death Syndrome (Sids) or accidental suffocation, even with an autopsy, said Dr Michael Lim, a consultant at National University Hospital (NUH).
Sids is an unexplained infant death resulting from an unknown cause and Dr Lim said NUH sees a "small" number of such cases.
"There is little published local data, although there was one published paper from 1996, where one can infer there were about 30 deaths from Sids over a five-year period here from 1989 to 1993," he said.
The topic of bed-sharing has long been a source of debate on parenting forums, with strong advocates on both sides. There has also been a lot of discussion on co-sleeping - parents sleeping in close proximity to but not necessarily on the same surface as the infant.
Local paediatricians The Straits Times spoke to said infants should not share a bed with parents.
Keeping babies safe while they sleep
During their first year, babies will spend most of the day sleeping and this can range from 14 to 20 hours. While sleep-related infant deaths are uncommon, there are steps that parents can take to help ensure the safety of their little one.
• Generally, young infants should not share a bed with their parents. Studies show that doing so can raise the risk of sudden infant death syndrome in the first three months of a baby's life, compared to infants sleeping in a supine position in a cot in their parents' room.
• For parents who choose to sleep with their baby, get a firm mattress and make sure the infant is not overdressed. Pillows, comforters and soft items should also be removed from the bed.
• While there are many bedtime options for babies on the market, including co-sleeping cots and self-rocking cradles, experts say that the safest option would be a traditional crib with a firm mattress, with no drop sides or wide gaps between slats. To prevent babies from slipping through, get cots with slats no bigger than 4.5cm to 6cm.
• Avoid giving babies stuffed toys, pillows and other loose items as there is a risk of suffocation, especially to babies younger than five months, who cannot yet roll and push items away. These objects are also not safe for older babies as they may use them to clamber out of the cot.
Dr Lim said bed-sharing puts babies younger than four months old or born prematurely at risk of suffocation, strangulation and Sids.
KKH's Dr Arun Kumar Pugalenthi said studies have shown that bed-sharing is associated with a fivefold increase in the risk of Sids in the first three months of a baby's life, as compared with infants sleeping in a supine position in a cot in the parents' room.
He said: "Currently, there is insufficient evidence to recommend any bed-sharing situation as safe."
Dr Anita Menon, who is in private practice, said: "There are some parents who share their bed with their baby as they feel that it's easier to feed the baby during the night... However, the risks from bed-sharing far outweigh any perceived benefits."
Dr Lim said there are ways to minimise risks involved in bed-sharing. It includes sleeping on a firm mattress, ensuring the infant is not overdressed and removing pillows, comforters and soft items from the bed.
Parents who practise bed-sharing told ST they chose the arrangement as it allows them to feel physically and emotionally closer to the child.
Mrs Petrina Pang's two children both shared a king-sized mattress with her and her husband until they turned three. The 36-year-old accounts executive, whose children are now aged five and nine, said she did her research before deciding that bed-sharing was suitable for her family.
She also took precautions to reduce the risk of incidents.
"It can be done safely. I understood the risk of Sids and I also realised that having them sleep on their own has its risks as well."
Besides making it easier to monitor the infant and breastfeed, mothers said they feel bed-sharing helps their babies to feel more secure.
But other mothers believe having separate sleeping surfaces helps the child to become independent.
Madam Genevieve Foo, 53, said she chose to have her two children sleep in a cot when they were young, not out of fear of the risks of bed-sharing.
"We've never shared a bed with our children, we always chose to have our baby sleep in a separate cot at night. I don't think sleeping with parents on the same bed is good, sleeping separately helps them build character and independence," she said.