Rachel Y. Moon, MD, of Children's National, Says Sleeping on Sofas Pose Dangers for Infants

Washington, DC—Sleeping on sofas is hazardous to your baby’s health.

Rachel Y. Moon, MD, Associate Chief of the Diana L. and Stephen A. Goldberg Center for Community Pediatric Health at Children’s National Health System, says that sofas or other soft surfaces are “extremely hazardous sleep surfaces for infants.” 

With their soft surfaces, sofas create an environment that can lead to suffocation for infants, even during a short nap, Dr. Moon and other researchers, including Lauren R. Rechtman, MD, a pediatric resident at Children’s National, write in a study published in the November 2014 issue of the journal Pediatrics. It’s extremely important that parents and caregivers are aware of the dangers and are educated about safe sleep practices, she says.

“People should never put babies on sofas because they are a high risk environment,” Dr. Moon says in an interview. “They are very cushioned, and babies sink in. Sofa cushions are not flat but curved. Babies are more likely to roll onto the back of a sofa, where they can get stuck and can’t move.”

Other studies have shown that, compared to other surfaces, sleeping on a sofa places a baby at a 49 to 67 percent increased risk for death, says Dr. Moon, who is also Associate Chief of the Division of General Pediatrics and Community Health for Children’s National and professor of pediatrics at the George Washington University School of Medicine and Health Sciences.

In an extensive study of 24 states from 2004 through 2012, Dr. Moon and the other researchers found that of 9,073 sleep-related infant deaths, 1,024 occurred on sofas. About 72 percent of the deaths involved babies aged 0 to 3 months, and 59 percent were boys. The information was mined from the National Center for the Review and Prevention of Child Deaths Case Reporting System database.

“Soft bedding, sleeping somewhere other than in a crib, (e.g. sofa), surface sharing (when an infant is sleeping on the same surface as another person), and bumper pads contribute to an unsafe sleep environment,” the report stated.

The findings underscore the problem that many infants continue to be placed in unsafe sleep environments, even though in 2011 the American Academy of Pediatrics released expanded recommendations to reduce the risk of all sleep-related infant deaths.

“These results may help to explain why sofa sleeping is a hazardous practice for infants,” Dr. Moon writes. “Although it is unclear why deaths on sofas are associated with these factors, these data indicate that the sofa may be considered by many parents and caregivers to be a safe environment in which the infant can sleep while remaining within sight and sound.”

“Given that the risk of death for infants sleeping on sofas is so high, it is important that parents and caregivers be educated about safe sleep guidelines, and more specifically, the dangers of placing infants for sleep on sofas and similar surfaces, and sharing these surfaces with an infant.”

In their study, infants who died on sofas were more likely to be found on the side position than others. If an infant is on the side with his or her face against the back cushions of the sofa or against another person, this can result in suffocation, the researchers found.  The infants who died on sofas also were more likely to be placed facedown or on their sides compared to other sleep locations. Those positions increase “the risk of sudden and unexplained infant death during any sleep, including napping,” they found.

Infants who died on sofas were also more likely to have mothers to have used tobacco in their pregnancy, according to the study.

“Too many people simply don’t know the risks of having infants sleep on sofas,” Dr. Moon says.

“I don’t think most parents know that the sofa is a dangerous place,” she adds. “They see it as a logical place to put the baby. If they are in the living room, and doing other things such as watching TV, or talking to other people, it feels like it makes sense for them to put the baby right there. In other instances, parents may come home from work, and they want to snuggle with the baby, put the baby on the couch, or have the infant on top of them. Then they fall asleep and the baby rolls off the parent’s chest and gets stuck between the parent and the sofa.”

While there have been previous studies documenting hazards of sofas, this is the first large analysis comparing factors associated with infant deaths on sofas, with factors associated with other sleep-related infant deaths. Parents may think it’s “cute” for babies to be on sofas with them, but “it’s dangerous,” Dr. Moon says.

“We knew there was a big risk, but didn’t know how to quantify it before,” she says. “This was one way to quantify and try to understand the mechanics of what happened.”

Sudden infant death syndrome (SIDS) is the leading cause of infant mortality after the first 30 days of life in the U.S., with the rate of 53.9 percent of deaths per 100,000 live births. Since 1992, however, the incidence of SIDS has declined more than 50 percent when the national “Back to Sleep” campaign was launched after research demonstrated the association between SIDS and prone sleep position. 

Contact: Emily Hartman or Joe Cantlupe at 202-476-4500.