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Safe Co-Sleeping with Your Baby

SIDS UPDATE ADVISORY:
CO-SLEEPING RULED UNSAFE

The American Academy of Pediatrics (AAP) has revised its guidelines and recommendations for the prevention of sudden infant death syndrome (SIDS).

The AAP's new policy does not recommend that infants sleep in the same bed as a parent. Read more

Whether you plan to sleep with your infant or it just happens to work out that way once you get him or her home, there are some important steps to make sure co-sleeping is safe for your baby.

By Jennifer Newton Reents

The clothes are folded, the diaper stacker is stocked and the bassinet is put together, waiting to hold your peacefully sleeping baby. But some parents-to-be never buy a bassinet or a crib, planning to co-sleep with their babies in their own bed. For them, it is a choice made ahead of time. Others, however, discover that once they get their little one home from the hospital, he or she won't sleep anywhere but with Mom and Dad.

Whether you plan to sleep with your infant or it just happens to work out that way once you get him or her home, there are some important steps to make sure co-sleeping is safe for your baby.

"The most important safety factor to keep in mind while bedsharing is to be alert to what could endanger the baby, and when you enter a bed, and when asleep, keep in your mind the thought 'baby in bed,' just like 'baby on board,'" says James McKenna, Ph.D., a renowned expert on co-sleeping and director of the Mother and Baby Behavioral Sleep Laboratory at the University of Notre Dame.

The concept of co-sleeping, which families have been practicing for centuries, came under fire by the Consumer Product Safety Commission (CPSC) in 1999. The CPSC published a report claiming that placing babies to sleep in adult beds put them at risk for suffocation and strangulation and noted that over an eight-year period an average of 64 babies under age 2 died each year because they were placed to sleep in adult beds.

The CPSC reviewed death certificates from 1990 to 1997 and found 515 deaths of children younger than 2 occurred after they were placed to sleep on adult beds. Of those deaths, 121 were reported to be due to a parent, caregiver or sibling rolling on top of or against the baby while sleeping, the report states. The other 394 deaths were attributed to suffocation or strangulation caused by entrapment of the child's head in various structures of the bed, according to the report, such as between the mattress and the wall, bed frame, headboard or other structures. More than 75 percent of the deaths were to infants younger than 3 months old.

However, proponents of shared sleep, including McKenna and well-known attachment parenting advocate William Sears, M.D., author of numerous books on parenting, refute the CPSC's findings.

While Sears writes on his Web site that the CPSC report brings an awareness to parents and acts as a reminder for parents to co-sleep safely, he contends that it also created an unnecessary fear in millions of parents who safely and responsively sleep with their babies.



Moms and Babies Designed to Sleep Together

Sears notes that co-sleeping, in and of itself, is not inherently dangerous and that, in fact, many more infants die when sleeping alone in a crib than when sleeping in their parents' bed.

While no infant sleep environment is entirely risk free, McKenna says, both mothers and babies were designed biologically and psychologically to sleep next to one another for nocturnal infant breastfeeding and nurturing throughout the night.

"In the worldwide ethnographic record, mothers accidentally suffocating their babies during the night is virtually unheard of except among western industrialized nations," he says. "But here there are, in the overwhelming number of cases, explanations of the deaths that require reference to dangerous circumstances."

According to McKenna's research on co-sleeping, babies who sleep alone are at a significantly increased risk of Sudden Infant Death Syndrome (SIDS). He has also found that mothers and babies who sleep together are extremely attuned to one another, even while asleep, and infants learn safe sleep habits, such as moving through various sleep-states and breathing patterns when sharing sleep.

McKenna has also found that mothers who sleep with their infants have been shown to be keenly aware of their child's breathing and temperature throughout the night and are able to quickly respond to any significant changes.

"The baby will know that you are there and (you) can respond emotionally and physiologically in potentially beneficial ways," he says. "Babies arouse more frequently, but for shorter average durations than if the baby slept apart, and they spend less time in deeper stages of sleep, which may not be beneficial for babies with arousal deficiencies."

The key to making the family bed safe is "two alert parents," says Liz Vazquez, who decided co-sleeping was right for her family before their now 19-month-old daughter was even conceived.

"We both learned early on to be aware of the baby at all times - her position, her breathing, everything," she says. "We generally keep the baby between us for safety, and the mattress is on the floor. We found it particularly important to have the mattress on the floor once our daughter starting rolling over. We also have some pillows on the floor next to the bed in case she were to roll out of bed. It's also important, of course, to make sure that the bedroom is child safe, since the baby is not in any sort of enclosure as she would be in a crib."



Keeping It Safe

McKenna recommends parents follow these guidelines when co-sleeping:

  • Infants should sleep on their backs on firm, clean surfaces, in the absence of smoke, under light, comfortable blanketing, and their heads should never be covered.
  • The bed should not have any stuffed animals or pillows around the infant and an infant should never be placed to sleep on top of a pillow.
  • Infants should never sleep on couches or sofas, with or without adults, because they can slip down into the crevice or get wedged against the back of a couch. They also should not sleep on beanbags or waterbeds.
  • Avoid crevices between mattress and wall or mattress and side rail. Avoid side rails, headboards and footboards that have slats that could entrap your baby's head.
  • Infants 1 year old or younger should not sleep with other children.
  • Parents on sedatives, medications, drugs or who have consumed alcohol or those who are excessively unable to arouse because of sleep disorders should not co-sleep on the same surface with the infant. This is also true if your partner has or takes no responsibility for the baby.
  • Mothers with excessively long hair should tie it up to prevent infant entanglement around the infant's neck.
  • Extremely obese persons, who may not feel where exactly or how close their infant is, may wish to have the infant sleep alongside but on a different surface.
  • Avoid putting your bed near curtains or blinds that have dangling strings that could strangle your baby.

Jacquelyn O'Brien says she uses an infant-safe side rail on her bed to protect her 9-month-old son.

"When I nurse my son on my husband's side of the bed I put a pillow between me and my husband so my husband won't roll onto our side," she explains. "Usually, my son sleeps on his back between me and the guard rail. I sleep on my side facing the baby with my arm resting on him. When he changes position or starts waking up to nurse, I am instantly aware. Sometimes he sleeps right on my chest, tummy to tummy. We keep pillows to a minimum. I make sure I never become intoxicated or take medication that will make me too sleepy. If I do, I put the crib right next to my bed and keep my hand on the baby. That way he is near me, but in a safe place."



Doing What's Best for You

While these strategies may work for some parents, they may not work for everyone, so O'Brien suggests doing what works best for you.

"Co-sleeping doesn't always mean the child has to be right there in bed with you," she says. "It could mean in the same room, etc."

Parents who are unsure about co-sleeping but want to have their baby nearby may want to consider using a crib-like co-sleeper - infant beds that securely attach to the parents' bed.

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