There has been a four-fold increase in infants dying after falling asleep with a parent on a sofa, research shows.

A team at Bristol's Royal Children's Hospital warns "cot death" does not always mean a cot - about 30 babies die in the UK a year after sharing a sofa.

The researchers say parents should never snuggle up with very young children on a sofa if they feel tired.

The Lancet study also found more deaths are occurring among poor families, and among those where the mother smokes.



The researchers said a very successful public education campaign had helped to slash cot death rates by 75% since 1991.

However, their study suggested the appropriate messages had still not got through to many poor young mothers.

HOW TO REDUCE COT DEATH RISK:

* Cut smoking during pregnancy - fathers too
* Do not expose your child to smoke
* Put your baby to sleep on its back
* Keep your baby cool, with its head uncovered
* Parents should not share a bed with their baby if they are very tired, smoke or have been drinking or taking drugs which make you drowsy, but the baby should be in a cot in the same room for at least the first six months
* Never sleep with a baby on a sofa or armchair
* If your baby is unwell, seek medical advice promptly

It is already known that the risk of sudden infant death syndrome (SIDS) is higher for babies that are born premature, or have a low birthweight.

Male babies also appear to be more at risk, as do those who sleep on their side or front.

Smoking during pregnancy, or in the house after a child is born, is another risk factor.

And the latest study, led by Professor Peter Fleming, underlines that sharing a sofa with a child is also a significant risk.

The Bristol team examined data on 369 SIDS cases that occurred between 1984 and 2003 in Avon.

These were compared to information on 1,300 healthy babies from a study carried out between 1993 and 1996.

Deprivation link

The researchers found that although the number of deaths in the parental bed had fallen by 50%, the number of deaths on a sofa shared with a parent increased four-fold in recent years.

However, there are still about 135 bedsharing deaths a year in the UK, compared to the 30 linked to sharing a sofa.

Professor Fleming said: "Although the reasons for the rise in deaths when a parent sleeps with their infant on a sofa are unclear, we strongly recommend that parents avoid this sleeping environment."

The study also found that that the proportion of SIDS deaths among poorer families increased from 47% to 74%.

The proportion of deaths in which the mother smoked during pregnancy also rose, from 57% to 86%.

The researchers are calling for a standard protocol to aid the investigation of cot deaths and to enable as much relevant information to be collected as possible.

Joyce Epstein, director of the Foundation for the Study of Infant Death, said: "Over 14,000 lives have been saved in the UK since the advice to reduce the risk of cot death was introduced in 1991.

"But still over 300 babies every year in the UK are dying as cot deaths - that's more babies over one month old than from any other cause.

"The battle against sudden infant death is far from over.

"It is absolutely vital that we get our safe infant care messages across more forcefully, especially among the more vulnerable sections of society, and that we continue our lifesaving research into the causes of cot death."