Sleeping With Your Baby - Is it Time to Tell the Truth?

As if a secret society had been exposed, the NPR article released earlier this week on parents who share beds with their babies, has parents coming out of the woodwork to talk about their covert practices in co-sleeping, and the experts are weighing in too.

In "Is Sleeping With Your Baby as Dangerous as Doctors Say?" reporter Michaeleen Doucleff dives into the realities, the research, and the guidelines given for infant sleep practices in the United States. The reality is: many parents are sleeping with their babies. The guidelines from pediatricians and the American Academy of Pediatrics (AAP) say: don't do it, no matter what. The research and statistics, however, tell a different story that runs somewhere in between.

But why are we having this discussion in the first place -- why is bedsharing so prevalent? Well, for one -- and it's a big one -- co-sleeping with an infant helps everyone get more sleep, the one thing that's so scarce and so incredibly vital to the family unit's health and well-being. In fact, this may belie one of the reasons why humans and babies are hard-wired to sleep together. James McKenna, Notre Dame anthropologist, weighed in on NPR's article: "Human babies are contact seekers. What they need the most is their mother's and father's bodies. This is what's good for their physiology. This is what their survival depends on." As it turns out, we've been co-sleeping as a species for more than 200,000 years.

So what gives? If we're biologically wired to sleep next to our babies in the same bed, then where's the debate? With our body of research on sudden infant death syndrome (SIDS) -- though there is still so much we don't understand -- we are able to look at the statistics and risks for this phenomenon. Bedsharing being one of the risks attributed to SIDS. But there are key differences between the evolution of infant bedsharing and modern co-sleeping. "Babies may have evolved to sleep with their moms on the ground ' or on a thin mat ' but they did not evolve to thrive in a modern bed, with a 6-inch pad on top of a mattress and giant goose-down pillows," says Doucleff.

The reality is that while bedsharing does increase a baby's risk of SIDS, the risk for most babies (without additional risk factors like prematurity, parents who drink/smoke, and sleeping on soft/fluffy surgaces) is very low -- 1 in 16,400 (a .004% increase in the risk of SIDS when not bedsharing, or 1 in 46,000). To put that in perspective, you have a greater chance of being hit by lightening in your lifetime. To understand the comparative risks of death from bedsharing, NPR created the following graphic:

It's also important to understand that not all bedsharing is created equally. In other words, there are many risk factors that make sleeping with your baby much more risky. These include:

• Parents who use drugs, drink, or smoke
• Premature babies, or babies who are underweight
• Sleeping on a couch, recliner, chair, or water bed
• Babies who are not breastfed (formula-fed babies are at higher risk)
• Toddlers or older children in bed with baby
• Heavy/fluffy blankets, bedding, mattress toppers, excessive pillows
• Overheating/over bundling baby

Ideal safe conditions for bedsharing are on a firm mattress on the floor, with healthy, term babies, and with only parents who do not drink, smoke, or do drugs, according the the article.

The author suggests that instead of a blanket "don't do it" statement from pediatricians, there should be an assessment of each baby's individual risk for SIDS and parents can then understand and weigh that risk in their decision to sleep in the same bed with their baby.

In other countries, like New Zealand and the UK, doctors are doing just that and have seen a reduction in the incidence of SIDS. The University of Bristol's Peter Blair says, "We recognize and acknowledge that bed-sharing happens. We don't promote it, but neither do we judge people about it. By doing that, you can open up a conversation with the parents about the really dangerous circumstances when you shouldn't do it."

Many parents in the United States don't tell their doctors about the practices they're following with their babies at night, for fear of judgement and reprimand. When this happens, there is a missed opportunity for an informed discussion about risk factors and what constitutes safer bedsharing.

Dr. Lori Feldman-Winter, a pediatrician at Cooper University Health Care and a member of the AAP's Task Force on SIDS, agrees that there's an issue at play: "We don't want families to feel uncomfortable telling doctors what they're doing," because then you take away the opportunity to provide education around what we do know about SIDS ' and to be honest about what we don't know."

If you have not read the article, I encourage you to hop over to NPR and do so. There are many more important pieces that I didn't cover here, like commentary on the studies used to evaluate safe sleeping practices, other countries where sleeping with infants is the accepted norm, details on the study that showed the instinctive behaviors from mothers and babies who co-sleep, and more.

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