Someone's Been Sleeping in My Bed!

by Amy Spangler

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 18^th 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.