On September 29, 1999 the United States Consumer Product
Safety Commission (CPSC) warned parents and caregivers about the
danger of placing their babies to sleep in adult beds. A CPSC study
published in the October issue of the Archives of Pediatrics and
Adolescent Medicine found that placing babies in adult beds puts
them at risk for strangulation and suffocation. 1 CPSC's
study was described as the "first to quantify the number of
fatalities resulting from the practice of co-sleeping with
babies. "2 "Largely preventable" were the
words used by the CPSC to describe 515 deaths of children under 2
years of age that occurred between January 1990 and December 1997.
"Don't sleep with your baby or put the baby down to sleep in an
adult bed," said CPSC Chairman Ann Brown. "The only safe
place for babies is in a crib that meets current safety standards and
has a firm, tight-fitting mattress. Place babies to sleep on their
backs and remove all soft bedding and pillow-like items from the
crib."
Critics cite deficiencies in study
The CPSC recommendations generated tremendous controversy.
Professionals were quick to identify the many deficiencies in the
study.
The data was not controlled for demographic variables and
therefore cannot be extrapolated to the general population.
The researchers could not identify how many of the children were
sleeping alone, with another child, or with an adult when death
occurred.
No comparison was made between the number of deaths that
occurred in adult beds and the number of deaths that occurred in
cribs or cots during the study period.
No information was provided on how many children under two years
of age bedshare and for what period of time, therefore relative
risk could not be calculated.
No distinction was made between deaths due to Sudden Infant
Death Syndrome (SIDS) and deaths due to an adult rolling on top of
or next to the baby and smothering him or her, often referred to
as "overlying."
No distinction was made for deaths that occurred because of
known risk factors like bedsharing with older siblings, sleeping
in waterbeds, or sleeping face-down (prone).
Death certificates provided little information on the use of
alcohol or other drugs known to impair adult arousal.
The limitations of the study notwithstanding, for the CPSC to
recommend changes in nighttime parenting behaviors based on one study
was viewed by critics as irresponsible at best. In addition, noted
anthropologists were quick to point out that the CPSC ignored the fact
that in many cultures throughout the world bedsharing is the norm.
"How we sleep, with whom we sleep, and where we sleep is molded
both by culture and custom."3
The "myth" of overlaying
Until 200 years ago, all babies slept with adults. During the 18th
century infant and child mortality rates were nearly 20 percent in
Europe, and while most of the deaths were due to problems during
childbirth or disease, "overlaying" was often reported
though seldom substantiated. The myth of overlaying persists today as
a result of social, emotional, and cultural influences. Dr. Benjamin
Spock, a recognized child care expert, recommended solitary sleep for
babies. Parents were taught that bedsharing promotes emotional
dependence, a negative trait in a society that values independence.
In
1985, Dr. Richard Ferber promoted the use of bedtime rituals for
helping babies sleep. "Ferberization" is still popular among
American parents. McKenna and Mosko rekindled the bedsharing debate in
1986 when they investigated the relationship between bedsharing and
SIDS. They suggested that the Western definition of "normal"
infant sleep patterns, where an infant sleeps alone and for extended
periods of time, creates unrealistic expectations about where and how
infants should sleep. 4 Only in industrialized, Western
cultures has sleep become a solitary activity and early weaning an
accepted norm.
Nevertheless it is interesting to note, that while many parents
state during pregnancy that they do not intend to bedshare, many
inevitably do so for a variety of reasons including ease of feeding,
desire to monitor infant, parent's need for more sleep, desire for
closeness, and inability to settle baby alone.5
How to make bedsharing safe
So how do parents choose? Each parent must weigh the known benefits
and the potential risks. Bedsharing promotes breastfeeding, decreases
infant crying, increases parent's rest, and may reduce the risk of
SIDS. 6 But if parents who bedshare are truly going to
"keep their babies safe," they need to know the behaviors
and conditions that make bedsharing less risky.
Place your baby on his back. Do not put your baby on his tummy
or his side.
Use a lightweight cover or blanket. Do not use comforters,
duvets, quilts, or pillows.
Keep your baby comfortable. Do not let your baby get too hot or
too cold.
Use a bed with a firm mattress that fits tight against the bed
frame. Do not use waterbeds.
Do not sleep with your baby on sofas or overstuffed chairs.
Do not place your baby alone in an adult bed.
Do not place your baby in an adult bed with older siblings.
Parents who smoke should not bedshare. In addition, because
smoking increases the risk of SIDS, if you must smoke, do not
smoke in the house or car or near your baby.
Parents should not bedshare if they have used alcohol or drugs.
Parents who are extremely overweight should not bedshare.
From the CPSC study we know that some babies do die in adult beds.
What we don't know is why each baby died. Was the baby placed
face-down? Did either parent smoke? Did the death occur on a sofa
rather than a bed? Were other siblings sharing the bed? Was the baby
placed in the adult bed alone? Where a baby sleeps when death occurs
is no more or less significant than how a baby sleeps or with whom.
In 1999, the major cause of death among children was motor vehicle
accidents. Nonetheless, parents place children in automobiles every
day, in effect putting them at risk. But parents keep their children
safe by using car seats and seatbelts and observing the traffic laws
and the speed limit.
Bedsharing is one of many sleep strategies. Recognizing that no
choice is risk free, each family must choose the strategy that best
meets their needs and the needs of their child. Every parent should be
reassured that the best choice is an informed choice
References:
Consumer Product Safety Commission. CPSC Warns Against Placing
Babies in Adult Beds; Study finds 64 deaths each year from
suffocation and strangulation, September 29, 1999. http://www.cpsc.gov/cpscpub/prerel/prhtml99/99175.html
Nakamura S et al: Review of Hazards Associated with Children
Placed in Adult Beds, Archives of Pediatric and Adolescent
Medicine October, 1999 153:1019-1023.
Small M: Our Babies, Ourselves. New York: Anchor Books,
pp. 111-137, 1998.
McKenna JJ et al: Sleep and arousal patterns of co-sleeping
human mother-infant pairs: a preliminary physiological study with
implications for the study of the sudden infant death syndrome
(SIDS). Am J Phys Anthropol 82:331-347, 1990.
Ball HL et al: Where Will the Baby Sleep? Attitudes and
Practices of New and Experienced Parents Regarding Cosleeping with
Their Newborn Infants. American Anthropologist
101(1):143-151, 1999.
McKenna JJ et al: Bedsharing Promotes
Breastfeeding. Pediatrics 100(2):214-219, 1997.
The
