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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