Unexpected infant deaths on sofas were twice as likely to be from accidental suffocation and strangulation as deaths on beds or cribs.

The incidence of sudden death syndrome (SIDS) has declined while more than 50% since the national “Back to Sleep” campaign was launched in 1992, while the incidents of other sleep-related infant deaths (accidental suffocation, strangulation, ill-defined causes) has not declined and may have increased. Sleeping on a sofa has been shown to increase the risk for infant death at least 50 times compared with sleeping on other surfaces (e.g., beds, cribs). To determine what makes sleeping on a sofa so hazardous, researchers analyzed¬† a database of infant deaths in 24 states from 2004 to 2012.

Of 7,934 sleep-related deaths, 1,024 occurred on sofas and 6,910 on other surfaces. Deaths on sofas were twice as likely to be classified as accidental suffocation or strangulation. Infants who died on sofas were less likely to be Hispanic and to be in an environment where other objects were present. They were more than twice as likely to be sharing the surface with another person, twice as likely to be found on their sides and more than 6 times as likely to not be in their usual sleep location. Infants who died on sofas were more likely to have had prenatal smoke exposure.


That sofas can be deadly sleep surfaces to infants is inherent to their design (soft cushions, a downward slope to the back cushion) and function (sharing). The temptation to lie down with one’s infant for a brief rest on the sofa can be deadly and should be avoided. At the first visit, along with the “back to sleep” advice, parents should be given anticipatory guidance warning them of the dangers of sofa sleeping.

Louis M. Bell, MD reviewing Rechtman LR et al.Pediatrics 2014 Nov.


Rechtman LR et al. Sofas and Infant Mortality. Pediatrics 2014 Nov;134:e1293.