Is Co-Sleeping Child Neglect? A Case Study of Sleep—Related Death Investigations from the Illinois Department of Children and Family Services

Background: In 2011, Illinois DCFS began investigating and indicating caregivers for Death by Neglect when an infant died while co-sleeping or in unsafe-sleep environments, if the caregiver had previously received information about safe sleep. This happened even when no evidence of substance use or other factors suggesting abuse or neglect was found. The policy, which was suspended in 2014, in effect labeled co-sleeping parents as “negligent,” despite the absence of legal precedent and ongoing debate in the health community about the risks and benefits of co-sleeping. 

Methods: We reviewed public records for all allegations of Death by Neglect due to unsafe sleep practices in 2011-13, along with subsequent administrative appeals. We also used publicly available data sources from 2012-14 to assess the impact of this policy.

Results: From 2012-2014, the OIG reinvestigated 143 cases involving infant deaths, of which 75 (52%) were sleep-related deaths, and 55 (38.5%) involved co-sleeping.  In 35 (64%) of the co-sleeping deaths, caregivers were indicated for abuse or neglect. 6 of the 35 caregivers appealed the decision and had their indicated findings overturned. Scrutiny of the case summaries revealed inconsistencies in how guidelines for indicating caregivers were applied. DCFS did not collect systematic data on all AAP-recommended safe-sleep practices, including breastfeeding and room-sharing. 

Conclusion: The 2011 policy did not have legal standing, was a narrow interpretation of the AAP safe-sleep guidelines, and unfairly burdened poor families who often lacked access to safe-sleep environments. Preventing sleep-related deaths should be addressed as a public health issue.