SIDS

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Pediatric Politics: How Dire Warnings Against Infant Bed Sharing ‘Backfired’

sundaykofax/flickr

sundaykofax/flickr

By Dr. Melissa Bartick
Guest Contributor

Every new parent has heard the dire warning: Never sleep with your baby.

State and local health departments in Massachusetts and around the U.S. have prioritized this message. Millions of dollars have been invested in promoting it, and millions more spent on giving away cribs to poor families. It all comes from the official recommendations of the influential American Academy of Pediatrics published in 2011.

Some localities have even backed this message up with scary ads: a baby in an adult bed with a meat cleaver, stating “Your baby sleeping with you can be just as dangerous,” and another ad that says “Your baby belongs in a crib, not a casket.”

Studies Misrepresented

The problem with this widespread advice is that the AAP’s statement from which it comes is based on just four papers. Two of the studies are misrepresented, and actually show little or no risk of sharing a bed when parents do not smoke, and two of the studies do not collect data on maternal alcohol use, a known and powerful risk factor.

In addition, the AAP statement ignores many other more recent excellent papers that are not even mentioned or cited. My colleague, Linda J. Smith, and I recently published an analysis of all AAP’s statement and all the literature to date, “Speaking out on Safe Sleep: Evidence-Based Sleep Recommendations.” Along with this dissection of the AAP statement, we found that that any risk of death from a parent sharing a bed with an infant is greatly overshadowed by other risks that get far less attention.

Dangerous Sofas

We concluded that the only evidence-based universal advice to date is that sofas are hazardous places for adults to sleep with infants; that exposure to smoke, both prenatal and postnatal, increases the risk of death; and that sleeping next to an impaired caregiver increases the risk of death.

Formula feeding increases the risk of Sudden Infant Death Syndrome. No sleep environment is completely safe. But public health efforts must address the reality that tired parents must feed their infants at night somewhere and that sofas are highly risky places for parents to fall asleep with their infants.

The fact is, across the United States and the world, across all social strata and all ethnic groups, most mothers sleep with their infants at least some of the time, despite all advice to the contrary, and this is particularly true for breastfeeding mothers.

When You Avoid Bed Sharing

Unfortunately, we also know that parents who try to avoid bed sharing with their infants are far more likely to feed their babies at night on chairs and couches in futile attempts to stay awake, which actually markedly increases their infants’ risk of suffocation. Continue reading

Co-Sleeping Controversy, And Tips For Making Bedsharing Safer

bedshareBy Sarah Kerrigan
Guest Contributor

Over the last week, my post on co-sleeping and public policy has generated a huge, passionate response.

Comments ranged from heartfelt, personal stories of family bedsharing to adamant opposition to the practice, from questions about terminology to pleas for more information about safe bedsharing.

Riobound wrote: “I like the idea of ‘educate’ but don’t ‘dictate.’ The State should inform not impose.”

And PilgrimOnTheJames posted that “we shared our bed with each of our seven babies…for the first several months of their post-partum lives…because it allowed my wife to breast-feed them without her having to greatly disturb her much needed rest, and also, because the little tikes smelled so good and were so cute to watch sleeping. We moved them into a separate bed in our room once they were able to consistently sleep through the night. The bonds that were begun then have only grown and strengthened over the past 30+ years of family life. I thank God that we ignored the advice of many well-meaning, but totally scandalized family members and friends.”

Amelia Oliver commented, “Thank goodness the scientific community is finally considering moving away from trying to scare people out of bed-sharing and co-sleeping. The comparison with the policy of advocating abstinence instead of sex-ed is strikingly appropriate since almost everyone does it but we are all afraid to talk about it, let’s start teaching the safe way to do it.”

Molly pointed out “This article…conflates the issues of cosleeping in bed sharing, which are not the same thing. Cosleeping is risk free, end of story. Bed sharing does have risks if not done carefully and correctly.”

So in an effort to shed more light on the topic, I’ll try here to clarify the terms, explain why the research linking SIDS to bedsharing is inherently flawed, and provide some tips to make sleep as safe as possible for all babies.

1. Terminology

In the scientific community, “co-sleeping” is a general term for a child sleeping in close proximity to a caregiver, within sensory range.  “Room-sharing” is when a child sleeps in the same room as her caregiver.  Under this definition are two sub-categories: “separate-surface cosleeping,” in which the child has his own bed, and “same-surface cosleeping,” also known as bedsharing.   “Bedsharing” is the term that describes what most Americans think of when they hear “co-sleeping:” a child sleeping in an adult bed with his caregivers.  This sort of close proximity is natural to the human species.

2.  ‘Shaky Evidence’ And A Shift In Thinking

The AAP, a highly influential professional group of pediatricians, opposes bedsharing and has led the charge to promote the idea that sleeping in the same bed as your infant is dangerous. “The American Academy of Pediatrics (AAP) does not recommend any specific bed-sharing situations as safe,” the organization says in its latest statement on the matter, which then goes on to list what it characterizes as particularly unsafe bed sharing practices to be avoided “at all times,” including, “when the infant is younger than 3 months,” or with a smoker. The AAP also says bed sharing should be avoided “with someone who is excessively tired,” which makes us wonder if any of them have ever actually been parents.

But many researchers, medical professionals and worldwide organizations question the AAP’s position on bedsharing, in large part due to ‘shaky evidence’ as the basis of the academy’s position, and also given the benefits of the practice. Dr. Abraham Bergman, a prominent SIDS researcher and pediatrician said in an email that “the evidence linking bed sharing per se to the increased risk for infant death is shaky, and certainly insufficient to condemn a widespread cultural practice that has its own benefits.”  The WHO, UNICEF, La Leche League International, the Breast Feeding section of the AAP, and Academy of Breast Feeding Medicine all disagree with a sweeping recommendation to avoid bedsharing.

In an editorial published earlier this month in JAMA Pediatrics called “Bedsharing per se Is Not Dangerous” Bergman wrote: Continue reading