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The Family Bed: The Risks and Rewards of Co-Sleeping

EDITOR'S NOTE: Make sure you know the Guidelines for Safe Sleeping, whether placing your child in his or her own bed, or in your adult bed with you.

By Cate Coulacos Prato

Family BEdFew parenting issues are as volatile as the family bed. In one camp are the parents and experts who believe co-sleeping – or sharing their bed with their children – is the best way to nurture and provide security for their kids. On the other side are those who contend that the safest and most developmentally appropriate place for children to sleep is in a crib apart from their parents.

Family bed proponents, led by pediatrician and child-development expert Dr. William Sears – the father of a child-rearing philosophy known as “attachment parenting” – are often nursing mothers who say that taking their infants into bed with them not only makes breastfeeding easier, it allows them to be more responsive to their baby’s needs in general.

Many mothers report that they get more rest and their babies sleep better in the family bed. The practice, which certainly encourages bonding and security, has been a cultural norm all over the world for centuries, and it’s still practiced widely outside of North America.

Yet many U.S. parents and pediatricians shun the family bed for several reasons – the top one being that they consider it unsafe: a parent could roll over onto the child, or the child may get caught up in the bedding and be smothered or strangulated.

The American Academy of Pediatrics (AAP), in fact, cautions against co-sleeping for safety reasons. In the American Academy of Pediatrics Guide to Your Child’s Sleep: Birth Through Adolescence (Villard, 1999), the group warns that “tiny infants can be smothered under bedclothes or the weight of a much larger body.”

While acknowledging that co-sleeping is widespread in many cultures, the AAP notes that “what’s often overlooked is that in countries where co-sleeping is routinely practiced, families almost never sleep in beds with soft mattresses and bulky covers. A baby may be less likely to smother when the family sleeps on a floor mat with only a light coverlet.”

Many parents who opt not to have a family bed also want to maintain privacy or are unable to sleep well with the baby in bed with them. They also worry about fostering independence in their child, wondering how they would transition the child to his own bed when he gets older.



I’m Right, You’re Wrong!”

Parents on both sides of the family bed debate often report feeling persecuted by the other side. Many co-sleeping parents say they don’t talk about their sleeping arrangements – even with their pediatrician – for fear of being admonished.

That’s not surprising when you consider how far the AAP goes in its cautions about the family bed. In its Guide to Your Child’s Sleep, the academy asserts that some reasons for co-sleeping “may give cause for concern.”

“If the reasons are economic – the parents can’t afford a bed for the child – they may benefit from information about financial aid programs. If a parent sleeps with the child to offset loneliness, counseling may be helpful,” the academy writes. “Occasionally, a co-sleeping child becomes the buffer between partners in a troubled marriage. Again, counseling could help to identify and resolve the problem.”

While the divide between opponents and proponents may seem unbridgeable, many child-development and safety experts – as well as parents – say that if you look at the facts and follow some basic guidelines for safety and emotional attachment, there is no right or wrong – just a matter of personal family choice.

“The problem is, people tend to take the position that ‘I’m right and you’re wrong,’” as opposed to seeing the issue as two different approaches that work differently for different families, says Kathleen Ramos, Ph.D., a researcher who has studied this issue since 1998. Besides being an assistant adjunct professor of family medicine at the Fresno Medical Education Program of the University of California in San Francisco, Ramos is also the mother of three children with whom she and her husband share a bed.

The issue, she says, is so polarizing that when she first started studying co-sleeping, “it took years to get below the veneer.” People feel so strongly about their position, neither side wants to reveal the downside of its stance, she explains.



Safety First

The debate over which method is safest fuels much of the controversy. Last year, a study published in the journal Pediatrics set off a firestorm of protest from family bed proponents. The study maintained that infants who sleep in adult beds are approximately 40 times more likely to suffocate than babies who sleep in cribs. It concluded that cribs are safer, based on a review of all accidental suffocation deaths among infants less than 11 months of age that were reported to the U.S. Consumer Product Safety Commission (CPSC) from 1980 through 1983 and 1995 through 1998.

Many family bed proponents, including Dr. Sears, doubted the study’s validity, citing international research that has found that infant sleep-related deaths are much more likely to occur in a crib than in a family bed.

“Our bottom line is, there are hazards for babies who sleep in adult beds and hazards for babies who sleep in cribs,” says CPSC spokesman Ken Giles. “We want people to know about the hazards of both.”

The commission, he adds, does not take a position on where children should sleep, but rather lays out the facts and provides safety guidelines for each circumstance so that parents can make an informed decision.

Ramos notes that if you consider the research together with the presence or absence of safety precautions, there is very little evidence that one method is safer than the other.

The AAP, the CPSC and Dr. Sears generally agree on how to provide safe sleeping conditions for infants and children. Some of the guidelines are similar whether you’re co-sleeping or putting your child in her own crib or bed. Principal among these are to remove soft bedding and place babies to sleep on their backs on a firm surface.

For co-sleeping, guidelines from various experts take a number of other factors into account. They recommend NOT sleeping in a family bed if:

• Parents are obese (to avoid the possibility of smothering a child).

• Parents are under the influence of alcohol or drugs (which can dull an adult’s sensitivity to an infant or child in the same bed).

• The bed is a waterbed, sofa or other surface not specifically designed for infants, or if the baby would be sleeping on soft bedding, such as pillows, comforters, quilts or sheepskin.

One alternative to the family bed, experts suggest, is a three-sided “sidecar” crib that attaches to an adult bed (or a bassinet placed next to the parents’ bed) to give the baby his own safe space while keeping him within arm’s reach of his parents.



“You Can’t Have Too Much Bed”

Many parents cite other practical reasons for not co-sleeping with their children, including that there isn’t enough room in the bed itself or that having a baby or child in bed with them keeps parents from getting the rest they need.

Melissa and Jason Lamb have shared a family bed with their daughter, Sarah, since she was born 11 months ago. Melissa says that before she became pregnant, she never would have considered co-sleeping with her husband and a baby – primarily for safety reasons. But once Sarah was born and Melissa started nursing, it made sense to give it a try. “Now, I can’t imagine doing it any other way,” she says.

The Lambs already had a king-size bed, so space wasn’t an issue. “You can’t have too much bed,” Melissa says. Initially, they put Sarah between her mother and a bed rail attached to the side of the bed. Melissa says the arrangement did not hinder her rest and relaxation, as some parents have experienced with the family bed.

Another practical consideration is how parents can find “alone time” when their children sleep with them. Many co-sleeping couples say they carve out time (other than bedtime) to be alone with each other, either for intimacy or simply to enjoy themselves as a couple.

Now that Sarah is older, the Lambs put her down in a crib when she goes to bed at about 7 p.m., allowing the parents some time alone. When Sarah wakes during the night, they bring her into the bed with them where she stays until morning.

Marcella Hain and her husband, John Conway, have already addressed this issue with their three co-sleepers, Trisston, 7, Carollyne, 4, and Marlowe, 21 months. All five family members sleep in a wall-to-wall bed made up of a queen-size mattress and two twin mattresses. Though the older children have begun thinking about having “theme” bedrooms like their friends, neither is willing to sleep alone. Hain says she and her husband won’t push them out until they’re ready.



Intended or Reactive?

A harmonious family bed assumes that everyone is up for the lifestyle changes it brings. If couples don’t agree on whether the child should sleep with them, or if neither really wants to start the practice but they give in to a toddler who insists on snuggling in, it can create discord that affects the family negatively.

“It’s very divisive for some families,” says Ramos, whose recently published research evaluates “intentional” versus “reactive” co-sleepers. “People send in e-mails saying, ‘This nearly caused a divorce for us.’”

Another consideration is what the parents believe is best developmentally for their children. Intentional family bed proponents tend to believe that sleeping with the children until they are ready, of their own accord, to move into a separate room, strengthens the familial bond and makes the child feel more secure, Ramos explains. Proponents of separate sleeping arrangements tend to believe that children who sleep with their parents become too dependent and will have a harder time separating.

As part of her research, Ramos is conducting a systematic review of parenting advice books and, so far, concludes that when it comes to co-sleeping, “there is not a single point on which there is clear evidence that one [way] is better than another,” she says. “It has to be personal preference.”

“It’s hard for me to say that, as a co-sleeper,” she admits, noting that she began her research in part to find a difference in attachment between co-sleepers and independent sleepers.

What Ramos’ research has revealed is that the way a parent responds to a child’s needs makes a difference. For example, if a baby begins to show signs of hunger and a parent meets that need quickly, or if the baby cries out and a parent goes immediately to the infant’s side to comfort her, that is what makes children grow up feeling more secure.

“The actual location is not as important as how responsive the parents are to the child,” Ramos says. “Responsiveness is key.”



RESOURCES

American>strong>Academy>strong>of Pediatrics (AAP) – www.aap.org – The AAP’s Web site offers news articles and tips on health for families.

American Academy of Pediatrics Guide to Your Child’s Sleep: Birth Through Adolescence, by theAmerican Academy of Pediatrics, Villard, 1999. A complete look at the sleep issues children deal with, including co-sleeping, bedtime resistance and changing sleep needs.

The Baby Book: Everything You Need to Know About Your Baby – From Birth to Age Two, by William Sears, M.D., and Martha Sears, R.N., with Robert Sears, M.D., and James Sears, M.D. This book devotes significant space to sleep issues and Sears’ attachment parenting philosophy.

U.S. Consumer Product Safety Commissionwww.cpsc.gov – Collects information about consumer goods and issues recalls on unsafe products.

Safe Sleeping

Click here for Guidelines for Safe Sleeping, whether placing your child in his or her own bed, or in your adult bed with you.

Cate Coulacos Pratois a freelance writer and parent who writes frequently on family issues.

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