You've probably heard about the AAP's updated safe sleep policy by now, but you might have wondered about the evidence behind it. Here's some science to answer your questions.
Posts tagged ‘SIDS’
Health organizations recommend roomsharing without bedsharing as the safest place for babies to sleep. Some parents love roomsharing, but others find it too disruptive to sleep next to a noisy baby. In this post, I look at the science to see how roomsharing affects sleep - both yours and the baby's - and how roomsharing protects infants from SIDS.
I’m not going to even try to pretend that this was not a HUGE deal to me. I grew up listening to NPR every single day. We lived in a very small house, where the bedrooms were all basically right off of the kitchen, and the sounds of Morning Edition woke me up just about every morning. We listened to NPR in the car on the way to and from school and then back at home while we made dinner. The familiar voices of NPR hosts and the opening jingle were a part of my childhood. And while some kids might dream of being a professional athlete or famous actor, I dreamed of being on NPR. I figured that a good life goal was to do something interesting or useful enough to justify an NPR interview. I never dreamed that it might come out of a parenting blog, but life is full of unexpected surprises. Read more
A recent study concludes that bed-sharing may be safe, even in young infants, provided the baby sleeps in a bed (rather than a couch or chair) with a non-smoking parent who hasn't had more than 2 alcoholic drinks.
I’ve been thinking about bedsharing and sleep safety for the last few months. I have devoted an entire chapter of my book to this topic. Not only is it an important question for parents, but it’s an issue with so much complexity — wrinkles and folds of factors like breastfeeding, bonding, instinct, culture, and just plain reality.
I think it is vitally important to understand the relationship between bedsharing behavior and risk of SIDS and accidental deaths. But our ability to tease apart every factor that might impact sleep safety is imperfect; there will always be factors that aren’t quantified in these studies, not to mention the fact that case control studies have some inherent limitations. You’ve probably heard about the study published this week by Carpenter et al. in BMJ. It combines 5 historic case control data sets from Europe, the U.K., and Australasia to specifically look at the risk of bedsharing in breastfed babies in nonsmoking households. It concludes that bedsharing poses an increased risk of SIDS, even in these ideal situations. I think it’s an important study, but it also has some limitations and doesn’t answer all of our questions with certainty. In fact, no study will probably ever do that. (You can read some critiques of the Carpenter study here and here.)
But even if we accept that bedsharing increases a baby’s risk of dying unexpectedly during sleep, we still have to answer the bigger question of how we translate this information to families living in the real, difficult world of infant sleep. Many families value bedsharing as a cultural practice; others choose it because it feels right. Still others bedshare because it is the only way that anyone gets any sleep at night, and we all know that sleep deprivation carries some risk, too, as does falling asleep on a couch with your baby. This is the reality.
Pediatricians face this reality in their clinics every day, when they talk with parents of new babies about sleep. In my book, one of the questions I explore is how pediatricians handle this conversation, given that their professional organization, the American Academy of Pediatrics, recommends against bedsharing. Several months ago, I sent some questions to one of my favorite pediatrician bloggers, Dr. Melissa Arca of Confessions of a Dr. Mom. She had initially agreed to a Q&A, but then she didn’t respond with her answers. It was the height of the busy flu season, and I figured that she was just busy. Then, this week, she surprised me with her responses. She had been thinking about bedsharing given the news of this recent study, and she was inspired to restart this conversation. We’ve cross-posted our Q&A on both our blogs. Check out her post for more about her initial hesitancy to address these questions, and please feel free to share your experiences in the comments below.
Alice: How did sleep look for your two children?
Melissa: My first child was a challenge to say the least. He is the one who made me question the safety of bed-sharing in the first place. For the first 6 months of his life, sleep was virtually non-existent (or at least that’s the way it felt to me) because he needed my arms and constant soothing throughout the night. But I was terrified to bedshare. I was literally at the end of my sleep deprivation rope. I had tried everything. And instead of listening to my instincts, I was fighting them. Because I was scared.
I never envisioned myself as a bedsharing parent. As a pediatrician, I was adamantly against it. But it was exactly what my baby needed and we struggled and limped along until I finally realized that.
My second child was a breeze and that’s no lie. She was always (and still is) an “easy sleeper”. She needed her space and showed clear signs of being tired. When she was tired, that was it. I didn’t need to bedshare with her. She slept in her own bassinet next to our bed during her first few months of life before being transitioned to her own room.
They could not have been more different in the sleep department. Same parents. Same environment. Different children.
Alice: As a pediatrician, how did you feel about bedsharing before having children? Did becoming a mother change that?
Melissa: I didn’t think it was safe. At all. I had read the studies and the official recommendations. Back to sleep, crib and/or bassinet in the same room with no hazards such as loose bedding, pillows, etc.
I never thought in a million years I would have become a bedsharing parent. But kids don’t have our same agendas. Read more
I’m working on the sleep chapters of my book right now. I had originally planned one sleep chapter, but I’m realizing that it’s such a huge topic that it needs to be split into two chapters: one on the question of where baby should sleep and one on sleep strategies and sleep training.
I have been focusing on the question of bedsharing for the last several weeks. I have read the major studies associating bedsharing with SIDS and suffocation and studied the professional opinions of those recommending against bedsharing from a public health perspective. I have also read the studies coming from James McKenna, Helen Ball, and others that take a more holistic view of bedsharing. These authors talk about bedsharing as the cultural and physiological norm for human infants, particularly in the context of breastfeeding. They advocate for a more tempered view of bedsharing safety, one that recognizes that all bedsharing situations are not alike and that, though not proven, it is certainly possible that a safe bedsharing environment can exist.
I’m trying to understand both the science and the controversy of this topic. There are the data, and there are the people analyzing it and interpreting it. Reading these papers, I get the feeling that it is difficult to find someone conducting research in this field who isn’t at least a little invested in the outcome. I wonder if these guys ever sit in the same room together and talk it out, because it feels like they are coming from different planets. There’s the epidemiology planet, where numbers rule and nuance is scorned. (And don’t get me wrong – I’m a numbers girl – but I can see the limitations in them here.) Then there’s the anthropology planet, a beautiful land of skin-to-skin, breast milk, and perfect physiological attunement between mother and babe. In my opinion, neither world completely represents the reality facing new parents in today’s world.
I wonder, for example, if the members of the AAP committee, which recommends against bedsharing, have ever cared for a baby who had extreme difficulty sleeping alone. And I wonder if the anthropologists have ever cared for a baby who wanted her own space, perhaps needing a break from all that day-and-night sensory input. I have met both types of babies, and as parents, I think we have to recognize that their needs are not the same.
In the real world, lots of factors determine how different families handle sleep. Infant temperament is one of them. Safety is another. There are also cultural expectations, family dynamics, work schedules, parenting styles, and feeding methods to factor in. Where baby sleeps is a complex parenting decision, one that is exceedingly difficult to study in a quantitative manner.
As I’m writing this chapter, I’m trying to present the science in a balanced way. I also recognize that this parenting decision – and most of them for that matter – can never be reduced to science and statistics. Parenting is about people and their stories. I know that I need to understand those stories as well as the science to write a worthwhile book.
So, I’m hoping you can help me.
Help me understand WHY your babies slept where they did – in your bed or in a crib or some combination of the two. What factors were important in your decision? Did your baby sleep where you had planned, or did you have to adjust your expectations? What worked well about your arrangement, and what didn’t?
I may be interested in including some of your stories in my book, but I’ll send you a direct email if that’s the case. Thank you – as always – for sharing your stories!
This is the fifth post in my sleep series. In my last post, I discussed how my view of infant sleep has evolved to be more inclusive of a wide range of solutions that can work in different families. In this post, I look at what the research tells us about infant sleep across the spectrum of nighttime parenting philosophies.
[Please note: It is beyond the scope of this article to discuss the bedsharing/crib/SIDS/suffocation debate, but suffice it to say that parents should pay careful attention to making baby’s sleep environment safe, whether the baby bedshares or sleeps in a crib.]
Bedsharing Infant Sleep
Let’s say that you choose to bedshare. You feel that the best place for your baby is right by your side, in your own bed. (I use the term “bedsharing,” because the more commonly used “cosleeping” can also mean sharing a room but sleeping on separate surfaces.) Many parents choose to bedshare because it just feels right, even if they had carefully prepared a crib before the baby’s arrival. BabyC slept in my bed for a couple of weeks early in her life, though it was not my plan and ultimately ended up not being the choice that Husband and I made. Still, in those weeks, I felt a real shift in my bond with BabyC. It certainly made breastfeeding during the night easier, and it was sweet to wake up and watch her sleeping next to me. I understand the choice to bedshare, and I think that for many families, it can have numerous benefits. These benefits are not well-defined by research, however. For example, I have yet to find study that investigates if bedsharing actually increases infant attachment. Read more