Cobedding Twins and Higher-Order Multiples

To the Editor.—We read with interest the commentary “Cobedding Twins and Higher-Order Multiples in a Hospital Setting” by Tomashek, Wallman, and the American Academy of Pediatrics (AAP) Committee on Fetus and Newborn.1 The recognition and discussion by the committee of this all-too-common practice in newborn nurseries and NICUs across the United States highlight several important points. First, the published literature shows no proven benefits of cobedding twins or multiples in the hospital setting.Second, the safety of cobedding of twins or multiples has not been established and may actually place infants at increased risk, because bed sharing with other children has been associated with an increased risk for sudden unexpected infant death and sudden infant death syndrome (SIDS).2–4 In 2005, the AAP Task Force on SIDS concluded that “the evidence is growing that bed sharing, as practiced in the United States and other Western countries, is more hazardous than the infant sleeping on a separate sleeping surface and, therefore, recommends that infants not bed share during sleep.”5 The AAP Task Force on SIDS also encouraged all health care providers who were responsible for organizing the hospital discharge of infants from the NICU to be vigilant about endorsing and modeling SIDS risk-reduction recommendations before the infant's anticipated discharge. This is essential, because there is strong evidence demonstrating that infant sleeping practices used in the hospital are highly likely to be duplicated by parents in the home setting.6,7In the absence of a proven benefit of cobedding, all those who provide care to infants in newborn nurseries and NICUs should model separate bedding as one aspect of safe sleep practice to parents of twins and multiples.