Level 2: Mid-level evidence
Covering of the head during sleep was associated with an increased risk of sudden infant death syndrome (SIDS), based on a systematic review of 10 case-control studies with data on prevalence of head covering during sleep in 1,234 cases and 3,822 controls (Arch Dis Child. 2008;93:778-783). All studies distinguished covering of the head, i.e., infant discovered or observed with head covered by bedclothes, from other forms of facial occlusion. Covering of the head was observed in 24.6% of cases vs. 3.2% of controls in a meta-analysis of 10 trials (P <.05); all studies showed significantly increased prevalence among cases. There were no significant differences in observation of head covering on at least one previous night in meta-analysis of four studies with 3,819 infants.
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