The Do's and Don'ts of Co-Sleeping

By Tracy Cassels, from Evolutionary Parenting

It's come to my attention that there are places in the US that are ramping up their fight against co-sleeping. In some areas of the country, there seem to have been a rash of infant deaths that have been attributed to co-sleeping and so those in charge have decided to campaign against the practice. For example, in Cincinnati, the police are taking up the cause in hopes of educating parents about the dangers of sleeping with your child[1]. In Jefferson County, IL, five babies have died in the past year due to co-sleeping and their mothers are joining forces with "healthcare providers" to speak out against sleeping with your child[2]. Now, no one wants to see babies die, least of all me. It's probably the most heart-wrenching experience, especially if it happens in your arms or because of something you've done. BUT, and this is a huge but, banning co-sleeping is NOT the answer. In fact, at the same time that these articles came out, Dr. James McKenna from the University of Notre Dame, a preeminent sleep researcher who has studied infant sleep for over 30 years, spoke out in favor of co-sleeping. His and others' research that has found that at the very least, co-sleeping in the form of having your baby next to the bed reduces the risk of SIDS by about 50%. While accurate numbers for bedsharing are harder to obtain because few studies covary for the risk factors, places like Japan boast some of the highest rates of bedsharing in developed nations (close to 40%) and some of the lowest rates of SIDS in the world; thus, bedsharing can not only be safe, but you and your baby can reap immense benefits from it[3][4].

It is worth noting that Dr. McKenna is not some crackpot, but a well-respected, highly intelligent researcher whose work has been published in top journals like Sleep and Pediatrics. He is also not some crazed co-sleeping advocate. His articles suggest a balanced examination of the issues pertaining to infant sleep which includes being considerate of cultural issues and the problems surrounding the definitions of co-sleeping[4], while also noting the evolutionary purpose of co-sleeping for infant sleep patterns[5][6]. And in all of his work, he consistently finds large benefits to having infants and mothers sleeping together or, at the very least, having infants and mothers in the same room[4][7][8]. For example, one of McKenna's studies found that infants who co-sleep show greater arousal patterns during sleep than solitary sleepers, predominantly due to mom's presence and breastfeeding while sleeping[7][8]. Why is this important? Well, the failure to arouse during sleep is hypothesized to be a part of the etiology of SIDS, and so babies who fail to arouse are at a greater risk of dying from SIDS. It seems that mom's arousal affects baby's, lending protective support against SIDS. As put so beautifully in one of his articles:

"If anthropological evidence on infant sleep and development were integrated and used as a starting point to inform infant sleep research, there is no doubt that the question we would be asking is not if it is safe for an infant to sleep next to its breast feeding mother, but rather, is it safe not to!"[4]

So we have research touting the benefits of co-sleeping and how it protects infants on one hand and certain mothers and health care "authorities" saying it's dangerous and women shouldn't do it on the other. How do we reconcile this? Well, it seems that the health care authorities would prefer to throw the baby out with the bathwater instead of trying to educate people about the do's and don'ts of co-sleeping. We've evolved to co-sleep and thus it is an expected part of an infant's life and development, but our environment has undergone some rather dramatic changes over the past couple hundred years or so and we need to account for that.

Here you will find a summary of some of the things that you should and should not be doing in order to safely co-sleep with your child.

Do's

• Place your child on his back cuddled in to you. This is the safest position for baby and with you cuddled around (or spooning) your child, he will feel very safe and secure at night. This is also an easy breastfeeding position once your child adapts. He's able to turn his head and your breast is right there for the taking. It makes night time waking much less intrusive and makes for better sleep for everyone.
• Use a swaddling blanket or a sleep sack instead of sheets and place your infant on top of the sheets next to you, not under them. This prevents sheets from covering your baby's face as they are too weak and uncoordinated to move them off their face to keep from suffocating.
• Make sure your infant is not too close to the edge of the bed. You don't want a baby falling off (although it has been known to happen and babies are generally fine). Also make sure you don't have bedside tables that could be in baby's way if she does fall off. You do not want her head hitting anything while falling. (Of course, not falling is best, but you can never go wrong having that extra level of precaution.)
• Use a firm mattress. If you examine a baby mattress you'll find it's quite firm and it's for a reason - babies can easily get their mouths covered by a mattress if they sink into it too much (it's the same reason you don't use a waterbed with a baby). The firmer the mattress, the better!
• Keep the temperature in the room at around 68 degrees Fahrenheit or just under 20 degrees Celsius. This is the optimal temperature for babies; any higher or lower and they run the risk of overheating (which can cause death) or freezing.

Don'ts[9][10][11][12]

• Smoke. Evidence suggests that what we might as well call 'third-hand smoke' (the residual smoke on your clothes and skin) affects infants and is related to an increase in risk of SIDS. So if you're a smoker, try and quit because it's horrible for your infant anyway, but definitely do not co-sleep. Keep your child in the room, but do not have them close enough to be breathing in third-hand smoke.
• Use drugs or alcohol. This should really be a no-brainer, but sadly does account for infant deaths each year. The gist is, do not sleep next to a baby while intoxicated. I don't know how else to state it to make people aware that this is really not a bright idea. It does not mean you can't have a glass of wine with dinner, but if you're drinking more than that, or close to bedtime, you should not be sleeping next to a young infant. And you shouldn't be doing any drugs that compromise your judgment or mental state, especially ones that make you drowsy (so yes, this includes over-the-counter meds).
• Co-Sleep when extremely tired. This is one of the hardest ones and seems to actually affect a fair few people based on articles I've read. Sadly because people have to return to work so shortly after giving birth in the USA, they return while their baby is still waking regularly for feedings. But if you're working, you can't take that extra time during the day to nap with your infant and catch up on your sleep. This means you can end up extremely tired and it's as bad as if you drank a bottle of wine and got into bed with your child. Think of it this way, if your baby is screaming and you don't wake up, you're overtired. We all know that women are more tired with a newborn, but that doesn't necessitate that you're too tired to co-sleep. Use your common sense and your knowledge of yourself to decide how tired you are and if you can't keep your eyes open, you're better off avoiding co-sleeping.
• Sleep with siblings nearby or in cramped quarters. Young children tend not to be calm sleepers. If you've seen a young child sleep, they sleep deeply and they flail and roll everywhere. If you have a younger child in a cramped bed, you should not also have a young infant there too. Siblings can roll over onto an infant and will not wake up or be aware of what they are doing.
• Sleep on waterbeds or sofas. Both of these surfaces are much more malleable than a bed and they both have plenty of spaces where a baby can get her face squished in and can suffocate. Parents resting on sofas also tend to cradle their infant and if you fall asleep, your infant can be pressed into your body and can suffocate that way.
• Place your infant under a duvet or near a pillow. Duvets are too soft and too large for an infant to get it off his face if it happens to cover him. In fact, infants should not have any heavy sheet covering them at all. Pillows are also a suffocation risk for the same reason.
• Sleep with anyone other than mom. As much as fathers may want to sleep with their baby too, evidence suggests that only mothers really have the instincts needed to safely sleep with a baby. Fathers don't rouse with small movements whereas mother's do and this can be the difference between life and death for a baby.
• Cover your baby's head. This is the primary way in which your baby releases heat if he or she starts to overheat. Wearing a hat or covering the head reduces baby's ability to cool down and can lead to overheating and death.
• Co-sleep if you are obese. Unfortunately, if mom is obese there is the chance that baby could suffocate by getting stuck in the folds of fat or mom's breasts. Young babies are unable to turn their heads and so being stuck up against a non-porous surface, like skin, is a death-trap.
• Co-sleep if you are not breastfeeding. The positioning of infants in adult beds with breastfeeding and bottle feeding moms is remarkably different, the former associated with a safe sleep position for baby, the latter associated with many of the risks outlined above (e.g., close to pillows and blankets, failure to rouse by mom during the night). If you are not breastfeeding, it is safest to find an alternate arrangement.

Now, the fact remains that many people will do some of these things some of the time and be fine (though some, like being intoxicated, should never be done). For example, some fathers will sleep with their infants and by and large everyone will live. It's important to remember that these are factors that are associated with a higher risk of infant death, but they do not guarantee it. When you think about how we evolved as a species and the drastic changes we've made to our society in the last couple hundred years, it's no wonder these particular factors are the ones that raise the risk. We didn't used to abuse drugs and alcohol (though they have obviously been around for ages), we didn't have waterbeds or sofas or duvets. And the 'family bed' has always been on a large enough surface that other siblings didn't run the risk of rolling over a baby. But times have changed and so we need to make sure we work to keep everyone safe. If you cannot do that, the next best thing is to buy a Co-Sleeper which attaches to your bed and allows you to be close and touching your baby, but without having the baby right in your bed.

Despite the fear that has been created by health professionals surrounding co-sleeping, it remains something we were evolutionarily built to do. Infants thrive when sleeping close to their mothers, and mothers benefit as well by being able to breastfeed without much disruption which leads to better sleep which reduces the risk of post-partum and contributes to overall well-being. It's a win-win. But it needs to be done safely and our society has made significant changes to our general lifestyles that do put infants at risk. However, instead of throwing the proverbial baby out with the bathwater, we need to focus on teaching people how to safely co-sleep with their infants. By doing that, everyone will benefit.

References

[1] http://www.local12.com/news/local/story/Program-Announced-To-Curb-Infant-Deaths/jDxzpN2VJEmTbOo5L3iaLA.cspx

[2] http://www.wsiltv.com/p/news_details.php?newsID=12704&type=top

[3] http://www.dailytelegraph.com.au/lifestyle/forget-the-cot-sleep-with-your-baby-accordng-to-sids-researcher-doctor-james-mckenna/story-e6frf00i-1226020681833

[4] McKenna JJ & McDade T. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Pediatric Respiratory Reviews (2005); 6: 134-152.

[5] McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VL, & Glotzbach SF. Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome. Sleep (1993); 16: 263-282.

[6] McKenna JJ & Mosko S. Evolution and infant sleep: an experimental study of infant-parent co-sleeping and its implications for SIDS. Acta Paediatrica (1993); 82: 31-36.

[7] Mosko S, Richard C, McKenna JJ, & Drummond S. Infant sleep architecture during bedsharing and possible implications for SIDS. Sleep (1996); 19: 677-684.

[8] Mosko S, Richard C, & McKenna JJ. Infant arousals during mother-infant bed sharing: Implications for infant sleep and sudden infant death syndrome research. Pediatrics (1997); 5: 841-849.

[9] Blair PS, Fleming PJ, Smith IJ et al. Babies sleeping with parents: case control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group. British Medical Journal (1999); 319: 1457-1462.

[10] Carpenter RG, Irgens LM, Blair PS et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet (2004); 363: 185-191.

[11] Drago DA, Dannenberg AL. Infant mechanical suffocation deaths in the United States, 1980-1997. Pediatrics (1999); 103: e59.

[12] Fleming P, Blair P, Bacon C et al. Environment of infants during sleep and the risk of the sudden infant death syndrome: results of 1993-1995 case control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. British Medical Journal 1996; 313: 191-195.

Notes

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