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Cosleeping myths vs. research realities, Part II

In Part I, we discussed various claims made about cosleeping (by which I mean sharing a bed with your baby) and its supposed benefits, and what the reasearch actually shows (or, more often, doesn’t show). This installment discusses major studies which checked the connection between cosleeping and the risk of SIDS, what are the conditions for safe cosleeping (and how well AP/NP websites communicate these risks), and how can they best be implemented.

A few large studies have shown that young, small infants – particularly those under 8-20 weeks of age, or small-for-dates babies – have an X1-2 elevated risk for SIDS when cosleeping. For older babies in non-smoking environments, the association between bedsharing and SIDS did not reach statistical significance, unless they were sharing a bed with siblings as well as a parent (Hauck et al, 2003). This risk is greatly increased if either of the parents, but especially the mother, smoked during the baby’s pregnancy. Evidence for older babies’ risk of SIDS being elevated is mainly in the presence of a smoking parent. A good illustration of this can be found in a study that examined SIDS cases in 20 European locales (Carpenter et al, 2004):

A recent systematic review of 40 studies on the subject came to similar conclusions.

The presumptive reason for bedsharing children to die in an adult bed is suffocation. It’s important to state that we don’t really know what causes SIDS, but there is no way to reliably differentiate between SIDS and suffocation deaths. Some researchers refer to them collectively as SUDI (Sudden unexpected death of an infant). It’s been noted that bedsharing babies who die of SIDS/SUDI tend to die younger than those who crib-sleep.

A bedsharing infant can be smothered by the people cosleeping with him (parents or siblings), or alternatively, by the bedding or nooks and crannies in a bed which isn’t specifically designed for infant use. Accordingly, it’s been found that at-risk infants are those cosleeping with people other than Mom (in addition to Mom, not instead of her), if Mom is obese (over 79.5kg or 175lbs. – Carroll-Pinkerton et al, 2001), on sleeping pills, alcohol or just overly fatigued, if the bed has a soft mattress, thick pillows or duvet covers on it, or if the bed is a waterbed or a sofa.

To their credit (or at least, in response to the CPSC’s and AAP’s warnings about sharing a bed with one’s baby), various AP/NP sites started posting guidelines for safe cosleeping. However, the issue of not sleeping with very small babies, or if a parent smokes, is often absent – see Doc Sears or Attatchment Parenting International on the subject. Are they afraid that not enough parents will bedshare as a result of an honest warning?

Let’s look at some of the other warnings against bedsharing that are mentioned in those websites and elsewhere:

Never leave an infant or toddler unattended on an adult bed. Sounds great in rpinciple, until you remember that small infants sleep up to 16 hours a day. Most parents don’t. I suppose some of those sleep hours could be spent sleeping in a crib or a sling, but if there is no crib and you need to put the infant down to drink something hot or attend to another child…it could very well happen that an infant is left alone on a bed.

Never let another sibling sleep next to your baby. Realistically, older children in bed with you (and I speak from experience ;) ) are all over the place when they sleep, including climbing over you to your other side. Unless you banish your older child(ren) from your bed where the newborn is, it’s very hard to prevent all contact between them, especially when there’s more than one older child in your bed.

Avoid using thick comforters or blankets near your sleeping baby. I wonder how feasible this is in most of North America in January. I doubt most cosleeping parents shun pillows, duvets or blankets.

To sum up, I think some parenting ‘experts’, in their zeal to promote cosleeping for largely unproven benefits, tend to understate the real risks of the practice. Is it really worth the warm fuzzies you get from cosleeping, or even the (maybe) increased breastfeeding, if your baby ends up dead as a result?

I think it would be far more honest to promote, instead, a sleeping arrangement that would allow parents to both have their cake and eat it, so to speak – that of encouraging use of a sidecar arrangement, or a separate sleeping surface within the bed, such as this one, for the first few months. It may not be “natural”, but surely infant survival is more important?

Let’s recap the oft not-mentioned sleeping advice that IMO should be given:

Despite what others may tell you, there is no proof sharing a bed prevents SIDS.And in certain cases, it may even be a risk factor for it.

Roomsharing should be encouraged in the first few months. There is ample evidence that roomsharing can reduce SIDS by as much as 50% (some of the studies linked above relate to this).

Bedsharing should be discouraged in the first 8 weeks of life (at least) or very small infants, obese parents, or when other siblings are in the bed. There is also the issue of “overly fatigued parents” – which is probably fairly universal among mothers of very small babies.

Don’t share a bed if you or your partner smoke…no matter what any AP advocate may tell you.

A good way to both share sleep and keep your baby safe is to provide a separate, but adjacent, sleeping surface for her, with separate, lightweight bedding.

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11 Responses

  1. I have read your last three posts about this horrible co-sleeping mess. Thing is, why are you talking about it like its some huge finding? Are you saying that it is wrong for co-sleeping advocates to defend themselves with reactive science? It’s easy to see who cast the first stone in this situation. I love how you misquote Jim McKenna to help out your point, nice. The adult bed has dangers, and preventions for anyone who cares. The crib has dangers, and preventions. Why are people who experience child death at the hands of a crib told to just keep on doing it with their next child? I would have to say that cribs alone have abductions, most fire related deaths, unexplained deaths (properly diagnosed SIDS which require it to be UNATTENDED and UNEXPLAINABLE,…uhhh not possible in the adult bed!), and any other problem that a present adult might have prevented.
    The big question…why are crib advocates so damn insistent to say NO, Never in an adult bed, when cribs have their share of problems? Stay out of the Family Bed if it’s not for you. Properly identify parents bed-sharing for belief and those out of neccesity (you will find most bed-sharing deaths in the latter category)Give people info, not your hangups.

    • Abductions? Really? I’m paranoid, certainly, but that’s a little extreme. If kidnapping and crib fires (which are also extremely rare) are the primary dangers in a crib, then I’d have to say there’s not a whole lot of evidence to support not putting your kid in one.

      Now, I’m not tossing out the idea that cribs are ideal, certainly. They too have their dangers. I think some more realistic concerns are things such as getting a limb stuck in a slat opening, falls (when kids get old enough to crawl out themselves), bumps and bruises (occur when a child attempts to stand up and falls), pulling a mobile down, etc. However, I don’t necessarily think that these are events that a present adult could entirely prevent in the family bed, particularly if that “present” adult is unconscious.

      I’m don’t mean to sound like I have hangups over cribs (my kid is sleeping in one right now), but, seriously, when you’re trying to give reasons for not doing something they should be realistic concerns, not the most random conglomeration of “what ifs” you can think of.

    • Hello Hugh,

      thank you so much for stating the obvious! I love my baby endlessly, am also big Jean Liedloff fan, and could not bear to let it sleep all by itself in a crib, suddenly no heartbeat, no warmth from mum, no small noises aound it, no mummy smell.. suddenly being put into a crib for me feels like putting baby away. Does baby have any way of knowing I am still there? Jean Liedloff described it well when she called it a ‘dead’ outside world.

      Another indescribable plus for me in bed-sharing is that I absolutely always have control over my baby’s body temperature and state of wellness. How do you monitor that in a crib? I feel so sorry for all those poor babies all alone out there.

      And is it not a crazy ‘warning’ to say in the same context you should not cosleep with your baby if you are under the influence of drugs and/or alcohol? As if this ethical decision was made by a pro-co-sleeping parent because they are all druggies! What an insult! I think those people should go ahead and make it a bit clearer – stay away from and do not have children if you are under those influences! How would a crib improve such a parent??

      I believe a baby is, and always will be, as safe as its parents are.

  2. Hugh, I suggest you reread what I wrote. Cosleepers have very little evidence to stand behind when claiming benefits for cosleeping (except maybe the breastfeeding issue, and it’s no better than a sidecar arrangement). And there are real dangers in certain, prevalent, cosleeping conditions – regardless of intent when choosing to cosleep, not that you can prove parental intent anyway- that are glossed over by some of the biggest ‘pushers’ of cosleeping. If you have FACTS to the contrary (and by that I mean real studies which show a decreased incidence of SIDS in cosleepers which can be attributed to the cosleeping, not some vague theories), feel free to post them here.

    I have not misquoted James McKenna, nor quoted him out of context. I realized I omitted the link to the quote, though; that’ll be fixed immediately.

    There is no definition of SIDS / SUDI which requires the death to be unattended – however, a sleeping parent by definition is not witness to the death, no matter how you try to spin it.

    Your point – ‘. The adult bed has dangers, and preventions for anyone who cares.’ – is irrelevant, unless you can demonstrate that most cosleepers who care practice them. Do they forgo pillows and duvets in midwinter? Do they sleep on a firm mattress? Do they give their newborn a separate sleeping surface, and unceremoniously kick out their 2-year-old who’s been cosleeping with them from day 1? Do no cosleepers ‘who care’ ever smoke?

    Not buying it. And your defensiveness (which I’ve seen from many APers) is evidence towards this.

  3. Hi Easter,
    I did re-read your post. It’s as I thought, and sophomorically I will respond to keep this going… I know you want to be able to call me defensive. I’m not expecting you to change your focus because you obviously have some issues surrounding other people’s parenting capabilities that exceed your own. Your false admiration of Jim McKenna is one of the more disturbing points. In your words…“Even Jim McKenna has conceded”. Your choice of the word “conceded” is crystal clear with your intent. Here is Jim’s email (James.J.McKenna.25@nd.edu ). You do realize that he has recently written a book on how to bed-share safely? Ask him how he feels about it. As a scientist who has been charged with the ultimate defense of a human parenting practice, he provides space in his statement to allow for people who don’t take the adult bed dangers seriously. Those people should not be the representative sample, like the popular media you use self-serving examples to support your thoughts. One of my more favorite media tricks is using examples of obviously unintentional co-sleepers, to explain the adult bed dangers… as you say “not that you can prove parental intent anyway”. What do you think this woman’s intent was…http://www.foxnews.com/story/0,2933,248840,00.html….and why did the media run this as a co-sleeping story? I would say it’s a platform to tell people not to co-sleep. Ok, give people who don’t want to co-sleep a crib (in this woman’s case give her a new apartment), maybe save that life. However, if you are someone that expects health officials to save you, the help will come too late, but at least you will have someone else to blame. Intentional co-sleeping families don’t have these problems…you do.

    Jim McKenna has this fail-safe position because he understands there is no absolute when dealing with humans who will do what they do. Can you imagine him saying blatantly “it’s safe for everyone” knowing there are people like you out there? Do you have anyone saying that cribs are absolutely safe without any precautions? Do you have anyone studying crib sleeping, at least people who aren’t selling cribs? I didn’t see that unspun, impartial, important link….hmmm. Crib advocates don’t talk about their own dangers, but they do find a way to say that co-sleeping is unsafe, why? Guilt is a huge motivator and when you hear someone claiming that they feel they nurtured their child more than you with co-sleeping…it pisses you off and you attack.

    I understand your need for scientific reference, because without it, a statement can seem to just be opinion. Are you questioning your parenting choices? Sometimes, science is used to support an idea that you fully don’t believe for yourself. I have studied research design at a university level, have you? There are different types or research, and there are people like YOU who do with it what you will….you have a point you want to make. You pile up supportive stuff while ignoring non supportive stuff, wow that is really an original tactic. Your blog is an excellent example of that (with all the links and all).

  4. Very nice blog! Enjoyed reading it!

  5. Hugh, you’d be a wee bit more convincing if you’d actually clicked on more of the links in my posts, other than the McKenna one. You claim to have “studied research design at a university level”, but you have yet to even look at the research, much less critique it!

    No, I am not a fan of James McKenna. I have no reason to believe he’s anything but a sincere researcher even if I don’t agree with him (and especially don’t agree with the hard-sell version of pro-cosleeping he’s peddling for laypeople – by this I mean what he writes at LLL and Mothering; I haven’t read his book) and I don’t think he’d in any way agree with you that he’s proven that cosleeping is safer than not. He was one of the first to make a list of practices for “safe cosleeping”; unfortunately, in practice and no matter what the ideology behind it is, very few people live up to those standards, and the results are clear. I also know – as does he, apparently -that he’d be rightly laughed at if he didn’t stick to facts when writing for professionals.

    The woman in the Fox article had a Hobbesian choice before her – one, in fact, that every primitive mother faces and the reason primitive cultures cosleep – let your baby be eaten by wild animals, or cosleep. Obviously in this situation, cosleeping is the safer option; however, it’s not safer when you have the baby nearby but not cosleeping, in most cases.

    And the CPSC is not a crib manufacturer, and their job is to examine and remove defective cribs. To claim that they, or the AAP, must be getting payoffs from the crib manufacturers is resorting to the most juvenille of conspiracy theories.

  6. Nascarmax, thank you! :)

  7. Hi Estherar:

    I’ve been reading along too as we just had a beautiful new baby girl a couple weeks ago…

    I’m just curious about this last sentence in your response:

    “And the CPSC is not a crib manufacturer, and their job is to examine and remove defective cribs. To claim that they, or the AAP, must be getting payoffs from the crib manufacturers is resorting to the most juvenile of conspiracy theories.” (Estherar)

    Is it really all that “juvenile” or unreasonable to question whether any government organization has received payoffs from industry lobbying groups representing industries with a financial stake involved???

    For instance, we have the following announcement back in 2002:

    CPSC, JPMA Launch Campaign About the Hidden Hazards of Placing Babies in Adult Beds”

    Now JPMA is the Juvenile Products Manufacturers Association, and aren’t they a lobbying group that might just represent some of those crib manufacturers in question? Of course the presence of a lobbying group representing an industry that just happens to include crib manufacturers doesn’t equate to payoffs, but certainly, it wouldn’t be the first time either.

    What are your thoughts?

  8. I guess I wasn’t able to link that title of the campaign using HTML, so here is the URL for reference:

    http://www.cpsc.gov/cpscpub/prerel/prhtml02/02153.html

  9. Congratulations on the birth of your baby girl, Steven!

    Thanks for the link. However, as you pointed out, just because the two organizations are collaborating on this one issue doesn’t mean the CPSC is getting payments from the JPMA to lie about their research – which, to remind you, was published a full 3 years before this campaign (and they were accused already then of pandering to the crib manufacturers).

    I don’t think anyone’s under the illusion that the JPMA is in this campaign for altruistic reasons; however, it and the CPSC are more often at cross-purposes than not . After all, the CPSC are usually those Mean Bullies who keep on making the JPMA’s members recall all those “perfectly good” baby products! The straightforward reason for the cooperation would be that this is one issue where the CPSC and the JPMA have similar interests, albeit for very different reasons.

    If someone actually had any evidence that the JPMA had any say in the results of the CPSC’s research, you might be able to make a case for some unkosher goings-on; instead, the APers simply assume with no supporting evidence whatsoever…a standard tactic, and as I said, I think it’s juvenille, akin to pouting in fact.

    HTH!

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