The Family Bed

An evolutionary approach to family sleep

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What, then, about safety? Haven't strong admonitions against the family bed been rooted in fear of smothering in the literal as much as the figurative sense? The worry that a sleeping mother will "overlie" her baby and cause his death dates back to a Biblical reference found in the Book of Kings. Pediatricians and others often advise new mothers to avoid sleeping with their babies as a protective measure against infant suffocation. However, parents who enjoy a family bed and doctors who advocate its use point out that the same internal signals that prevent a sleeping adult from rolling out of bed and injuring herself will also prevent a parent from rolling on top of her infant. In the rare cases where overlying has occurred, it has generally been the result of inappropriately soft bedding or a parent whose sleeping awareness was impaired by alcohol or medication. "The average, typical parent sleeping on a good mattress will be very aware and will not roll over on (her infant)," asserts Dettwyler.

In fact, the family bed may even offer protection against infant death. In his latest peer-reviewed medical research conducted at the University of California, Irvine School of Medicine and funded by the National Institutes of Health, Dr. McKenna theorizes that infants who sleep alone are at a significantly increased risk of Sudden Infant Death Syndrome (SIDS). According to the National SIDS Alliance, one in every 500 American infants, or 7,000 to 8,000 babies a year, die of this still-mysterious phenomenon. This number represents a larger proportion of the U.S. infant mortality rate than cancer, heart disease, pneumonia, child abuse, AIDS, cystic fibrosis and muscular dystrophy combined.

McKenna and co-researcher Dr. Sarah Mosko, a psychobiologist and sleep specialist at the University of California Sleep Disorders Laboratory, performed two pilot projects on the physiological influences that sleep-sharing mothers and babies exert on one another. McKenna monitored the breathing patterns, heart rates, brain waves, and chin and eye movements of mothers and their infants in various sleeping arrangements, and, using infrared cameras, videotaped mothers' and infants' sleeping behavior. Results from these tests showed that mothers and babies who sleep together are extremely attuned to one another even while asleep. Neither partner disturbed the other's rest. Mothers and babies seemed to move simultaneously through the various sleep stages, and yet co-sleeping infants spent less time overall in the deepest state of sleep -- the period most dangerous to SIDS-vulnerable infants. In one of the observed pairs, the infant spent eighty-seven percent of her time within twelve inches of her mother's face. This behavior allows co-sleeping babies to breathe in some of the parent's expelled carbon dioxide. According to McKenna, when this carbon dioxide is mixed with oxygen, it induces stable breathing.

McKenna's studies demonstrate that American parents may heighten the risk of SIDS by expecting their babies to sleep alone at too tender an age. Vulnerable infants, he posits, need to "learn" safe sleep habits, such as moving through varying sleep-states and breathing patterns, or they risk falling into a period of heavy, uninterrupted slumber from which they might not awaken. McKenna's research suggests it may be through sleeping alongside an adult that an infant develops these skills and receives the continuous contact and stimulation that can protect against SIDS. Additionally, a mother who sleeps with her infant has been shown to be keenly aware of her child's breathing and temperature throughout the night, and is thus able to quickly respond to any significant changes.

Data collected from other countries supports McKenna's theory. In Hong Kong, Japan and China, where mothers almost always sleep with their infants, SIDS rates are a fraction of what they are in the United States. SIDS rates remain low among communities of Asians who immigrate to the United States. However, the number of SIDS deaths rises in direct relation to the amount of time an Asian parent lives in the United States, possibly due to the adoption of American-style customs, such as separate sleeping quarters for mothers and babies.

Joseph Gilhooly, M.D., newborn specialist and advisor to the Oregon SIDS Alliance, views the emerging research on co-sleeping and SIDS as promising, stating, "We have to wake up and look at family sleeping customs. It's a natural way to be. Babies have slept beside a parent for millions of years. Other mammals sleep with their parents -- it's unique for humans to force infants to be independent, like babies being forced into a strict feeding schedule."

Dr. William Sears strongly concurs in his recent top-seller, SIDS: A Parent's Guide to Understanding and Preventing Sudden Infant Death Syndrome. Sears contends that based on his experience as a physician and the father of eight children, a family bed is the safest place for an infant to sleep.

Other criticisms of the family bed abound, however. Some, such as T. Berry Brazelton, M.D., does on a Pampers web site (www.pampers.com), claim that when children sleep with their parents "sexual abuse is more likely (Freudian emphasis)..." Family-bedders are incensed and offended by this unsubstantiated accusation.

"I have heard people say this and frankly, I find it absurd," says James Wilshok, a married father of two from Boston, Massachusetts. "My wife and I have been sleeping with our kids since they were babies and being close to them at night is no different than hugging them close during the day." Wilshok and other parents say that sharing sleep with children simply calls for moving the marital relationship out of its traditional locus and into other areas of the house. Many couples claim the necessity of seeking alternative locations for intimacy adds creativity and spontaneity to their lovemaking.

The late Robert Mendelssohn -- well-known pediatrician and author of several books -- noted that when confronted by mental health specialists who feared sexualization of the family bed, he sarcastically agreed that "psychiatrists should not take their children to bed with them, but it is quite alright for everyone else!"

But what about the long haul? Western opposition to co-sleeping has always been rooted in the perceived need to promote autonomy and independence. Isn't it true that an older child who has been allowed to sleep with parents won't ever want to move into his own bedroom? Won't you regret it if you allow your baby or young child into your bed now? "You probably will," surmises Brazelton, aptly reflecting what has been the dominant school of thought on the matter, "and it may be harder to wean her from your bed later. But it is difficult to make that decision these days. Our culture really doesn't accept co-sleeping even though most other cultures do. In Japan, mothers have a big futon and all children sleep with her. The father sleeps alone in another part of the house. In our culture, there are taboos...but I find working parents who are away all day can't stand to give their babies up at night...Parents today feel we are pushing our children too hard and they need the comfort of being close at night...You must decide which path to follow. I must warn you that giving them up later becomes more and more difficult."

Although no substantive studies have looked at this issue, long-term family-bedders say this concern is without merit, and springs from the same obsession American society has with rushing children through developmental milestones such as weaning and toilet training. Children who sleep with their parents leave the family bed when they are ready: earlier for some children and later for others, just as with other stages of maturity. "Of all the families we know who sleep with their kids, I have never seen a teenager who still wanted to sleep with her parents on a regular basis," notes James Wilshok.

For families opting for the family bed, practical solutions for sharing sleep are numerous. Many parents invest in the largest size bed available and everyone sleeps together there. If the children are infants or toddlers, the bed is pushed firmly against the wall, leaving no space into which a baby could roll. A bedrail is then fastened to the other side of the bed. If a bed is very high, the frame can be packed away until the children are older and the boxsprings and mattress can sit directly on the floor.

Other parents of younger children employ a "sidecar" arrangement by securely attaching a crib to one side of the parents' bed, usually next to the mother. Three sides of the baby's crib are left intact, but the side next to the parents' bed is lowered or removed so that mother and baby have easy access to one another. Some larger families or households with older children place futons or mattresses all over the bedroom floor so that everyone has plenty of room to stretch out. As with all bedding for infants, family beds should be firm and smooth, without an excess of blankets, pillows or stuffed animals.

When parents remain undecided about a full-scale family bed, but wish to have their children nearby at night, family members can sleep in separate beds in the same bedroom. An infant's bassinet or crib can remain within an arm's length of resting adults. Another version of the "modified" family bed provides a child with her own bedroom, but allows free access to the parents' bed at any time. For every household in which the children spend the entire night in the family bed, there is another in which children start their overnight hours in a separate sleep-space, but are welcomed into the parents' bed after a night waking.

Co-sleeping is often discussed as if it were a discrete, all-or-nothing proposition (i.e., should baby sleep with parents?)," Mckenna writes in a recent report entitled, "Rethinking "Healthy" Infant Sleep." He goes on, "Many parents fail to realize that infants sleeping in proximity alongside their bed, or with a caregiver in a rocking chair, or next to a parent on a couch, in a different room other than a bedroom, or in their caregiver's arms all constitute forms of infant co-sleeping. I studied the location of infants and parents in their homes between six p.m. and six a.m. and found more infant-parent contact than parents describe." McKenna prefers to conceptualize infant-sleep arrangements in terms of a continuum ranging from same-bed contact to the point where infant-parent sensory exchanges are eliminated altogether, as for example, infants sleeping alone in a distant room with the door closed. "We might want to question," McKenna concludes, "why infants protest sleep isolation. They may be acting adaptively, rather than pathologically. Perhaps these infant "signalers"...have unique needs and require parental contact more than do some other infants. It's worth considering."

copyright, 1997, 1998, Katie Allison Granju.

About the Author
Katie Allison Granju is a writer and mother living in Knoxville, TN. Her book, Attachment Parenting: Instinctive Care for Your Baby and Young Child.

Breastfeeding.com would like to express our thanks to Katie for allowing her fine article to be reprinted here.

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