There are lots of names for it. Within some social circles, it is often kept secret. As many as 45 percent of parents report that they have done it at some point within the first eight months of their child’s life.
Some mothers blog about the benefits of it; while most pediatricians warn against it.
What is this taboo?
Whether it’s called bed sharing, co-sleeping or the “family bed,” it boils down to an infant in bed with someone else; usually his or her mother, sometimes the father and possibly even siblings.
Is it safe? Is it dangerous? Could it be both? It depends on who you ask and how you qualify “safe.”
The American Academy of Pediatrics has been consistent for some time in its stance that bed-sharing should be discouraged. This stems from concerns that the practice places infants at risk for dying from Sudden Infant Death Syndrome or suffocation.
In place of bed sharing, the AAP recommends room sharing, where infants sleep in the same room as parents but in their own crib or bassinet.
Hand-in-hand with that recommendation are others regarding a firm sleeping surface in a cooler room without pillows, loose bedding, stuffed toys or bumper pads. AAP’s recommendation also reinforces the need for infants to sleep on their backs.
While the debate about sleeping arrangements is perhaps not as polarizing as the one with respect to vaccinations, many advocates of the family bed are quite critical of the AAP’s recommendations. They feel that having child and mother in the same sleeping space is more conducive to breastfeeding, promotes maternal/infant bonding and, at least according to some, could even be protective against SIDS. They view it as less of a medical issue and more of a personal preference that is outside of the scope of what we as pediatricians should be discussing with parents.
The reasons parents sometimes choose to share a bed with their infants are varied. Some are cultural — rates are higher within some racial and ethnic groups. Some are personal choices to make breastfeeding more convenient and to facilitate bonding. For others it is seen as a safety practice where parental vigilance during the night seems to offer the infant a level of protection that is missing if sleeping separately.
When discussing the best and safest practice, both physicians and parents come to the table with data and experiences to support their position. Bed sharing proponents point to co-sleeping practices in the Eastern world (Japan for example) as well as recent studies that show no long-term psychological harm to bed sharing with parents. Physiologic and behavioral studies also exist showing that bed sharing with mothers likely does indeed improve breastfeeding success.
Pediatricians, on the other hand, are aware that almost two decades of published data show that bed sharing can increase the risk of SIDS by as much as 50 percent, while a separate sleeping surface has been shown to reduce that risk along with risks of suffocation, strangulation and entrapment —all known hazards of bed sharing.
While features in some cultures might allow less risky bed sharing, many characteristics of Western life make it difficult to universally recommend the practice. Our beds tend to be soft to accommodate adult sleep, but too soft to be protective of an infant’s airway and breathing. Bed height could lead to a dangerous fall. Headboards and position with respect to the wall may also increase danger. Plush quilted bedding—blankets, duvets, and top sheets—along with pillows that are the norm in most of our bedrooms are additional hazards. Closely related is the risk of SIDS contributed by overheating. In addition, none of this takes into account décor such as draperies, blinds and cords that could entangle a sleeping infant.
Maternal smoking, use of alcohol and drugs — prescription or otherewise — and other health conditions add to the likelihood of a bad bed-sharing outcome. Sleep apnea in the mother and interventions like propping and use of breathing equipment to counteract the disorder, or simply the exhaustion factor of all that comes with motherhood can make for very restless or overly heavy sleep.
Risk also increases with the number of bodies in the bed. While mothers may be inherently “safer” bed-sharers by nature of their maternal instincts, as representative of the “brethren of fatherhood” I can say that more often than not we are as close to comatose in our sleep as one can be and still have a pulse. Young children in bed with an infant is an even more dangerous proposition.
So, what do we pediatricians tell well-rested, non-smoking, non-medicated mothers sleeping on firm mattresses placed on the floor in the center of the room with only a fitted undersheet, no pillows and the thermostat set at 68 degrees while dad is on the couch, siblings are in their own rooms and the animals are outside? I tell them, as I do any other parent, that there is no safe, risk-free scenario for bed sharing.
As a practicing pediatrician, I can recall two cases of infant suffocation in the past 15 years, and I can sadly recall two more SIDS fatalities. And based on current data, I cannot with a clear conscience recommend sharing a sleeping space with an infant.
I strongly recommend to families that they place infants on their backs on a firm, but separate, sleeping space devoid of bedding, pillows, and stuffed toys and also without excess sleepwear in a cool but comfortable temperature room with the parents.
I discourage routine sleeping in swings, reclining seats and car seats. I remind parents that sleeping on couches or in recliners with infants is highly dangerous. I tell parents that sleep-positioning devices have not been shown to be safe, may in fact be dangerous, and are not recommended.
I do occasionally mention commercially manufactured co-sleeping beds that can be installed adjacent to, but separate from the parents’ bed, but also advise that these have not been proven to be effective and, if poorly fitting or installed improperly, can potentially add the risk of death.
Because the topic holds within it passion on both sides, it doesn’t necessarily lend itself to friendly dialog. Some physicians can come across as paternalistic and alarmist; likewise the zeal of some parents for a practice can cloud their objective assessment of risk. Perhaps by improving the lines of communication we can all rest easier about the issue of infant sleep safety.
For more information on sleep safety you can contact your child’s physician or go to www.healthychildren.org/safesleep.
Dr. Trent Rogers is a pediatrician with Walla Walla Clinic.