Let co-sleeping families lie

Certain experts are waging a war against the family bed. The American Academy of Pediatrics says it’s “hazardous” to let your baby sleep in your bed. And last June, as part of a report on deaths in children under the age of five, the assistant chief coroner of Ontario said the only safe place for an infant was a proper crib, no “ands, ifs or buts.”

This simplistic message is the single worst piece of expert advice foisted on parents since the 1950s, when doctors told mothers that formula was superior to breastmilk and that infants should be fed on schedules.

The campaign against co-sleeping has its origins in research on the causes of sudden infant death syndrome (SIDS). There are numerous risk factors associated with SIDS — the two most important are babies not sleeping on their backs and parental smoking. But bed sharing seems to get most of the attention. Co-sleeping comes in several forms, including sidecar infant beds and kids sleeping in their parents’ bed for part of the night. But the form most relevant to this discussion is an infant under six months in the parent’s bed, full- or part-time.

Co-sleeping can be risky, as is the case with any infant sleeping arrangement (including cribs). But under evolving criteria used by coroners and others who review infant deaths, it’s considered SIDS (that is, an unpreventable, mysterious tragedy) only when the baby dies in a proper crib with nothing in it but a little blanket. So a baby who dies in a family bed, even in the absence of other risk factors, would be presumed not to have died if she’d been alone in a crib. They would never think that a baby found dead in a crib might have survived if she’d been sleeping next to her mom and dad.

That’s a stunning bias. Most babies who die in their sleep are alone at the time, including 16 of the 27 deaths reviewed in the Ontario report. Some were in cribs, although it’s striking that the authors failed to state exactly how many. In virtually all deaths attributed to bed sharing, other risk factors like parental smoking, substance abuse, unsafe sleep surfaces and, especially, socially disadvantaged households are also present.
Anthropologist James McKenna, who runs an infant/mother sleep lab at the University of Notre Dame in Indiana, untangles the issue in his new book, Sleeping with Your Baby. A Parent’s Guide to Co-sleeping. It ought to be required reading for all paediatricians and coroners.

McKenna is clearly pro co-sleeping. But unlike the bed-sharing police, he’s willing to treat parents like intelligent adults. Why not, he argues, educate about risk factors, rather than condemn co-sleeping willy-nilly.

Almost anything human beings do can be risky — like riding in cars and boats. But experts don’t say, “Travel by car and boat should be discouraged.” They tell us what the risk factors are, how to drive safely, to wear seat belts in cars and life jackets in boats. Why is infant sleep so different? I suspect it’s because some people think bed sharing is weird (even kinky) and see no need for it. So they think, what could be the harm in discouraging it?

I’d say that there is ample potential for harm.

Human infants need lots of physical contact with parents, not just for warmth and security, but for the sensory stimulation that helps brains to mature and neurological systems to work properly. Close contact also helps infants regulate their breathing and body temperature.

Babies’ need for physical contact doesn’t magically end at 10 p.m. I don’t mean all parents should co-sleep or be glued to their babies 24/7. But I would say it is “hazardous” to give advice that might undermine parents’ natural inclinations to notice and respond to their infants’ biological need for closeness and touch.

The medical and public health world needs to treat bed sharing like other safety issues. Explain the specific risks and help parents avoid them. A sweeping edict against co-sleeping tampers with nature. That’s always risky.