A loving embrace with deadly consequences

Increasingly, authorities see children die while sharing a sleeping space with an adult.

By MELANIE AVE, Times Staff Writer
Published January 6, 2008

On July 6, 2006, Briannah Nobles and her family were visiting relatives in Hernando County. So when nighttime came, they all camped out on a sofa bed.

The parents tucked 2-month-old Briannah safely between them. Or so they thought.

Some time during the night, Briannah stopped breathing.

Her cause of death? Co-sleeping, according to the Florida Department of Children and Families.

The Webster baby was one of at least 20 children in Florida who died from co-sleeping that year. It was the second leading cause of death, behind drowning, in cases of child deaths that the state considers the result of neglect.

"Co-sleeping for some reason has become more common and less safe," said Andrea Moore, director of the Coral Springs child advocacy group Florida's Children First. "For some parents it's an issue where the parents want the warmth and contact, but it's based on more of the parent's need, not the child's need."

The DCF is now considering a public awareness campaign to alert parents and caregivers to the dangers of co-sleeping, as well as drowning.

"Co-sleeping is a very preventable death," said George Sheldon, an assistant DCF secretary.

"A lot of times these co-sleeping deaths are occurring on couches," he said. "You fall asleep. You've got a child in your arms. You're watching TV. These are not parents who don't love their children."

Most of the medical community, including the American Academy of Pediatrics, discourages bed sharing. But some parenting groups, like the La Leche League International, say if done properly, it encourages breast-feeding and bonding between parent and child.

All Children's Hospital's Dr. M. Michael Eisenfeld said he believes many parents realize the dangers of co-sleeping but continue to do it.

He doesn't believe it's cultural issue as some advocates assert.

"People just out of habit, when the baby is crying, they bring them into bed," the St. Petersburg pediatrician said. "It's a convenience. It takes a lot of effort to break them out of the habit."

Bed sharing increased from 5.5 percent to 12.8 percent between 1993 and 2000, according to a 2003 study by the National Institute of Child Health and Human Development.

Often parents choose to share a bed, sometimes known as a "family bed," with infants to be more attuned and responsive to their needs. But many other parents, exhausted from the rigors of caring for a newborn, simply fall asleep with their babies in their arms.

It's not known exactly how many children die as a result of co-sleeping. Many of the deaths are labeled as sudden infant death syndrome, which, nationally, is the leading cause of death among infants.

Unexplained deaths

Each year, more than 4,500 infants die suddenly in the United States with no obvious cause, according to the Centers for Disease Control and Prevention. Half of those deaths are attributed to SIDS.

Dr. William Brooks said he has noticed an increase in co-sleeping deaths.

He's not sure if more children are dying from sharing their parents' bed or if it's being better labeled by medical examiners and investigators.

"It's a comfortable thing," said Brooks, medical director of the University of South Florida's child protection team. "But in reality, it's very dangerous. I just wouldn't recommend it at all."

In Manatee County, a study of child autopsy reports from 2000 to 2006 showed 26 children died from co-sleeping, said sheriff's Maj. Connie Shingledecker.

There, co-sleeping deaths surpassed even drownings.

Most of the children were 2 months or younger. The deaths were spread among all races and ethnicities, although African-American children were overrepresented.

The families had cribs or other places for their infants to sleep.

"It really wasn't about them not having a safe environment," said Shingledecker, who chairs the state's Child Abuse Death Review Committee. "They were not using the right environment."

Shingledecker believes the total number of children who die from co-sleeping, if properly classified, would be "huge."

The state does not consider all child deaths from co-sleeping neglect. But those where drugs, alcohol or other issues - including severe obesity - are involved are often labeled as such.

After 2-month-old Karma Brown of New Port Richey died Dec. 8, 2006, investigators concluded that her mother fell asleep and rolled on top of her while under the influence of a pain drug. Her death was labeled neglect.

As for Briannah Nobles, investigators found the mobile home where she died to be "filthy" and unfit for a child, according to a state report.

And 1-month-old Dasani Robinson of Hillsborough County died after her foster mother took her into her bed. When another 2-year-old child in the home climbed into the bed in the night, without the foster mother's knowledge, the baby rolled off a pillow and suffocated.

Dasani's death was considered neglect.

In 2006, 170 Florida children died from abuse or neglect, an 80 percent increase over the year before. The marked increase is the result of a renewed state effort to classify many deaths such as Briannah's as neglect.

Child advocates hope the change will bring more awareness about abuse and neglect and ultimately, prevent even more children from dying.

If more people were aware of the dangers of co-sleeping, Shingledecker said, fewer children would die.

"These deaths," she said, "are preventable."

Times researcher Caryn Baird contributed to this report. Melanie Ave can be reached at mave@sptimes.com.


Safety tips

The child abuse prevention groups, Healthy Families Florida and the Ounce of Prevention Fund of Florida, encourages parents to put babies to sleep in their own cribs, near their parents.

For those parents who insist on co-sleeping, experts offer these safety tips:

-Avoid co-sleeping when extremely tired or if severely obese.

-Use firm, clean surfaces.

-Avoid fluffy pillows, stuffed animals and loose bedding.

-Avoid heavy blankets or quilts.

-Place infant on his or her back.

-Abstain from alcohol and drugs.

-Waterbeds, recliners and couches are not considered safe places for babies to sleep.

-Avoid placing infants in bed with other children.

Source: National Institute of Child Health and Human Development and the Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame