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A clinical report of adverse health effects due to bed sharing in two children with spinal cord injury and traumatic brain injury.

Article Excerpt
Abstract: This paper explores the possibility that bed sharing may carry particular risks for children with special healthcare needs (CSHCN). Two cases of CSHCN who may have sustained adverse health effects from bed sharing are described. These two case reports indicate that CSHCN may be particularly susceptible to risks associated with bed sharing. Healthcare providers for CSHCN may need to inquire about patients' sleeping arrangements and, when bed sharing is acknowledged, provide counseling regarding the potential risks and benefits. They may need to monitor more closely for adverse events when bed sharing is a factor and should consider reporting health problems that may have occurred in concurrence with bed sharing.

Key Words: disability, bed sharing, cosleeping, sleep, risk factors

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The issue of bed sharing or cosleeping involving adults and children has been an ongoing matter of debate in the medical literature in regards to both cultural practices and the potential risks and benefits associated with the practice. (1-7) Technically, "cosleeping" refers to multiple persons sleeping in the same environment, whether in the same bed or in the same room, while "bed sharing" specifically refers to two or more persons occupying the same sleeping structure (bed, mat, etc.). However, the literature frequently equates cosleeping and bed sharing. To date, debates as to whether bed sharing presents benefits or risks, and whether the possible benefits outweigh the potential risks, have not been resolved. In addition, the majority of the discussion has focused on children without special healthcare needs. The following case reports indicate the possibility that children with special healthcare needs (CSHCN) may be a subgroup that is at greater risk for potential adverse effects of bed sharing than "normalized" children

Case Reports

Case Report 1

A previously healthy 22-month-old female sustained multiple traumatic injuries, including traumatic brain injury and a thoracic level 2 (T2) spinal cord injury (SCI), resulting in complete paraplegia, with no sensation below the T2 dermatome area and with no volitional movement in the bilateral lower extremities.

Three months after the initial injury, the patient developed an elevated temperature to 39.1 [degrees]C. After obtaining blood and catheterized urine cultures, the patient was started on IM ceftriaxone. Urine culture subsequently showed more than 100,000 colonies per high-power field of Citrobacter diversus with only 6 white blood cells per high-power field in the urinalysis. Pre-antibiotic blood cultures X 2 had no growth. The next day, her temperature had returned to normal and examination revealed no swelling of the legs (the child had been specifically assessed for deep vein thrombosis, an increased risk in SCI patients). Early the next morning, she developed a temperature of 40.0 [degrees]C. Examination revealed a swollen left lower extremity. A white blood count showed only 9.6 X [10.sup.3]/[mm.sup.3] with a nonspecific differential, and a catheterized urine culture showed no growth. X-rays showed a transverse fracture through the distal shaft of the left femur involving the metaphysis without callus. The knee joint was aspirated with negative culture results and no evidence of significant white cell elevation. Duplex Doppler ultrasound showed no evidence of deep vein thrombosis. A one-phase, whole body technetium 99m-bone scan was performed and showed no evidence of heterotopic ossification. The radiologist believed that this was a new fracture, and review of x-rays made during her initial trauma evaluation did not show evidence of a fracture in the same area. The child had no active physical therapy since the onset of the first fever, and neither the hospital staff nor the patient's mother reported any traumatic event occurring during that period. The new, acute lower extremity swelling had not been noted on the two previous examinations.

This history is significant because the mother, who has a weight of 100 kg, often slept with the child in her hospital bed. She had been sleeping with her child during the night that the swelling and fever were noted on routine nursing check, which prompted the call to the physician for an examination. Although other possible sources of trauma--including falls, medication injection, procedures, and therapy--were investigated with the parent and the staff, none could be ascertained. The fracture did not exhibit the classic features for nonaccidental trauma, such as a spiral fracture or a chip fracture of the corner of the metaphysis, according to the radiologist. No emotional or behavioral...