Is it safe to sleep with your baby?

What the experts have to say about your bed sharing questions

That’s a huge emotionally and politically charged question for many parents, one that’s been hotly debated in North America in recent years. Supporting the No side are headlines such as “Suffocation risk 40-fold for babies in adult beds” (National Post, October 2003) and Canadian Paediatric Society guidelines released in November 2004 that recommend against bed sharing. On the other side are proponents who point out that in countries like Japan, where sleeping with baby is the norm, sudden infant death syndrome (SIDS) is extremely rare. Then there’s the simple reality playing out in so many Canadian households, where, as a recent Todaysparent.com report found, two-thirds of respondents said they sleep with their babies “sometimes,” “often” or “always.”

So does sharing a bed with your infant put her life at risk, or is it a completely healthy — even beneficial — practice when done right?

Here’s what the experts have to say about these and other bed sharing questions:

1. Is it safe to bring my baby into bed?
That depends on how you do it.

The concern about bringing babies into bed stems from a few studies during the 1990s that linked infant deaths with babies sleeping in adult beds. Obscured in much of the discussion is the distinction between deaths of babies in adult beds that occurred because babies encountered a fatal hazard — for instance, getting wedged between a bed frame and mattress — and sudden infant death syndrome, which is the unexpected death of a baby for which no cause can be found.

One study that received a lot of media attention was a 1999 report, by the Consumer Product Safety Commission (CPSC) in the US, attributing 64 infant deaths a year to suffocation or strangulation hazards associated with sleeping in an adult bed.

Shortly after the CPSC warnings, the Canadian Paediatric Society (CPS) community paediatrics committee, led by Montreal paediatrician Denis Leduc, sat down to develop guidelines for safe bed sharing. “Based on the evidence, we weren’t able to recommend the family bed,” says Leduc. Instead, in November 2004, the CPS recommended that, “for the first year of life, the safest place for babies to sleep is in their own crib.” It further recommended co-sleeping for the first six months, which it defines as a baby sleeping in a crib in her parents’ bedroom.

“What’s good about the CPS statement,” says anthropologist James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame in Illinois, “is the acknowledgment that babies are safer when sleeping proximate to their mothers, which reduces the risk of SIDS by half. No one would argue with this.”

But McKenna does argue that sweeping prohibitions against bed sharing ignore the complexity of the evidence about risk factors for SIDS. “Bed sharing can be inherently protective. It’s how it’s done that overrides the protectiveness.”

Linda Smith, a lactation consultant and childbirth educator in Dayton, Ohio, and author of several textbooks on breastfeeding, puts it this way: “You can’t paint with the same brush a sober, non-smoking, breastfeeding mother, on a safe sleeping surface, and an intoxicated uncle, sleeping with the baby on a couch.”

Unfortunately, no one knows yet how to prevent SIDS, and these deaths do occur in both cribs and family beds. Parents have to make an informed decision weighing the odds, the evidence, their parenting goals and the reality of family life.

 2. How can I make having my baby in bed with me as safe as possible?
Minimizing risk factors is the key to safely sharing a bed with baby. The CPS’s Leduc says it’s likely that in the past, some deaths recorded as SIDS were actually caused by risk factors — like sleeping in waterbeds or with parents who were inebriated. So how does he respond to those who wish to bring their babies into bed? “I’d probably say, the evidence we have doesn’t allow me to recommend bed sharing, but if you eliminate all the risk factors that have been identified, then bed sharing is in all likelihood safe. So be comfortable with what you’re doing.”

Don’t sleep with your baby if you are impaired in any way by alcohol or drugs — even prescribed medications or things like over-the-counter cold remedies that could deepen your sleep.

Also, there must be no chance of the baby falling from the bed, or getting caught in cracks between the mattress and bed frame or wall. “If you’re going to bed-share,” suggests McKenna, “take your bed apart. Put the mattress on the floor in the middle of the room. That way you eliminate entrapment risks and height so that baby can’t fall.” (McKenna says that 92 percent of the infant deaths analyzed by the CPSC actually happened when babies were sleeping alone in an adult bed and got trapped in the furniture.)

Don’t allow puffy comforters, bumper pads, pillows, duvets and pillow-like items near your sleeping baby. Babies should sleep on a firm mattress — never on a waterbed, air mattress, couch, recliner or padded chair.

And no matter where your baby sleeps, it’s imperative to eliminate what the CPS calls “potent risk factors for SIDS” — tummy sleeping and exposure to second-hand smoke. Put your baby to sleep on her back until she can roll over on her own. Leduc specifically advises mothers who smoke or who smoked during their pregnancy not to bed-share.

3. What are the benefits of bed sharing?
When their first baby was born, Anita and Jim MacDonald never planned to share a bed with her. In fact, says Anita, “we planned not to.” But when she was six months old, teething made Hannah much more wakeful at night, so Anita began bringing her into bed. She found that not only was breastfeeding easier, but everyone got a better sleep.

These Stouffville, Ont., parents liked sharing a bed with their daughter so much that when Stephen was born a few years later, they decided that he’d bunk in with them from the start. “I felt better having Stephen close by, and it was easier to nurse,” says MacDonald. “I couldn’t face having to get up in the night to feed Stephen when I would be chasing a toddler the next day.”

That’s a sentiment shared by many. When British anthropologist Helen Ball asked mothers why they chose to bring their babies into bed, the most common reason given was that it made breastfeeding easier. The moms reported that they barely awoke for feedings and had longer and more restful sleep, even though their babies fed more frequently and for longer periods than their solo-sleeping peers.

There’s also evidence suggesting that breastfeeding in combination with safe bed sharing may offer babies an optimal sleeping environment. Ball observed that breastfeeding mothers face their babies in the fetal position, their bottom arm above the baby’s head and their thighs drawn up, preventing the baby from sliding down the bed. This position gives the baby easy access to the breast, and makes rolling over onto the baby difficult for the mother.

“Both breastfeeding mothers and their infants are extremely sensitive throughout the night, across all sleep stages, to the movements and physical condition of the other,” says McKenna. When mothers and babies sleep side by side, their sleep cycles and arousal patterns synchronize so babies spend less time in deep sleep — a pattern researchers believe may protect against SIDS. In addition, the presence of the mother helps to regulate the baby’s breathing and body temperature.

For MacDonald, providing her son with the comfort of knowing his parents are close by is important as well. “He doesn’t have to cry to get our attention through the night. That’s the big one,” she says.

4. How do I know if the family bed is right for us?
You may not know until you try. Some parents find they sleep better knowing the baby is close by; others lie awake listening to their child’s breathing.

Jane Williams, a Toronto mom of two, says her first child, Amy, started out sleeping with her in bed for the first few days: “I worried that the blanket would be over her face or that she would get caught under the pillow.” She also found breastfeeding difficult in bed: “I was never able to get the latch right lying down.” Neither Williams nor her husband were getting any sleep, so after a few weeks they moved Amy into a crib. Now six and three, both Amy and her little brother, Robert, sleep well in their own beds and go to sleep easily, she says. “I don’t regret our decision, and I don’t see any evidence of my children not being attached to us as parents because they weren’t allowed to sleep with us.” Parents who, like Williams, feel that everyone is better off in their own beds — and aren’t encountering stiff resistance from their kids — should feel good about opting for separate quarters.

A baby’s temperament can be a factor as well. Some settle well in a crib or bassinet; others seem to fuss unless they are in contact with a parent. And nighttime routines can change. Toddlers are notorious early-morning visitors to their parents’ beds, an arrangement that may afford everyone a few extra hours of sleep. And if you’re returning to work and your baby is starting daycare, you might appreciate the extra closeness and contact the family bed can provide.

5. Will sharing a bed with us interfere with my baby’s sense of independence?
If what we mean by independence is unbroken nights in a child’s own bed, it’s true that the family bed doesn’t speed that process along. On average, bed sharers will get there about a year and a half later than solo sleepers.

If independence means emotional autonomy, then the fear is that kids who bed-share will grow up to be needy, clingy kids. There’s no research to support this idea, says McKenna, who points to six different studies which suggest that bed sharing — within a context of nurturing, loving care during the day — may contribute to strong independence, social competence, an enhanced ability to handle stress, strong gender identities and good self-esteem.

6. At what age should I start encouraging my child to sleep in his own bed?
There’s no magic age at which any baby can be moved to a crib without a fuss; nor is there a window that you can miss, after which your child will surely be in your bed until high school.

Alex Roslin and his wife, Rhonda Sherwood, from Montreal, decided to move their daughter, Odessa, out of their bed when she was about two months old because they were both finding it difficult to sleep. Odessa slept in a bassinet beside their bed for several weeks and then, by three months, was in her crib.

Not all babies will be ready to leave the family bed as soon as Odessa. Some have a higher need for touch or extra sucking than others, and pushing these kids to go solo at night too quickly can backfire, says Smith. So take your time with the transition.

“It’s best not to ask young children to cope with too many big changes at a time,” says Jan Waldbillig, a family educator and support worker with the West Coast Family Resources Society in Port Coquitlam, BC. If, for instance, you’re expecting another baby and want your toddler to move to her own room, don’t leave the transition until you’re eight months pregnant. That’s probably going to be too much pressure on everyone.

“If you’re feeling resentful or frustrated with the baby in bed, pay attention to those cues,” advises Waldbillig. Those feelings may signal that it’s time to think about making a change — just ask a parent whose toddler thrashes around at night or takes up two-thirds of the bed. “Do it in a positive, affirming way,” says Waldbillig. A toddler can participate in choosing his new bed and perhaps start napping in it as a first step in the transition.

One strategy that works well for many parents is to put the child’s mattress next to their own on the floor to begin with and move it gradually away from the bed, and eventually into the child’s bedroom. The MacDonalds did this when Anita was expecting their second baby. By the time Stephen was born, 2½-year-old Hannah was happy in her own bed.

An open-door policy where children are welcome to come into bed with their parents in the early morning, or if they need some extra cuddling, may also ease the transition. Hannah, now three, occasionally visits her parents’ bed at night, but usually asks to go back to her own room after a couple of hours. (Don’t allow both your toddler and the baby in the same bed to sleep; this is considered unsafe. Early-morning cuddles when mom and dad are awake are fine.)

7. Won’t having a baby in bed crowd out our sex life?
If this were the case, laughs Smith, there would be few families with more than one child. Determined parents find time and space for intimacy — in the shower, in another room — despite the demands of young children.

But jokes aside, says Jack Watkins, executive director of Family Counselling and Support Services for Guelph-Wellington in Ontario, couples who opt for the family bed may have to be a bit more mindful about making time for each other. “It’s very important for a healthy relationship to maintain that connection. I always tell people to think about what brought them together in the first place — that attraction,” he says.

A little practicality may have to replace spontaneity. Perhaps your baby can start out in a crib and join you later in your bed when she wakens for a feeding. If your baby’s crib is in your room and you’re nervous about waking her, Watkins suggests designating another “conjugal bed” somewhere in the house.

Want to know more?
Visit the Canadian Paediatric Society’s guidelines on safe sleep at cps.ca.

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