Sweet Dreams! Sharing Sleep With Your Baby

BY Ida Kiley

This fall Boston Children’s Hospital released a report that every mom of a newborn has been waiting to read. In a study of 71 sudden and unexpected infant deaths between 1997 and 2008, researchers found that all infants whose deaths could not be attributed to anything other than SIDS had the same kind of brain stem abnormalities (Randall, et al., 2013). This study just might have moved us one step closer to eradicating SIDS because if we can determine which infants may be most susceptible, we can hopefully find a way to also keep those infants safe in the near future possibly through a safety screen. This study also falls in line with much of the recent research that suggests that SIDS may be caused by an infant’s inability to rouse while sleeping and the American Academy of Pediatrics’ recommendation for parents to room share with their babies because research has repeatedly revealed that infants who slept in the room with their parents roused more easily and were less susceptible to SIDS than infants who slept alone (Pediatrics, 2011).

Surprisingly, the 2013 study further revealed infants who had died of SIDS in both bedsharing situations (grouped as “unsafe sleeping environments”) and independent sleeping situations (grouped as “safe” environments) had the exact same brain stem abnormality. It seems, at least according to this specific study which needs further research to substantiate the brain stem abnormality possibility, that sleep environment did not correlate with these SIDS deaths, but that brainstem abnormality did. As a mother, I am hopeful that this research will lead to early SIDS protection and prevention. In the meantime, that correlation between brain stem abnormalities and SIDS (and lack of correlation between sleep environment and SIDS) makes me really question our cultural ideas about safe infant sleep.

While correlation does not equal causation and while neither the American Academy of Pediatrics nor the Boston Children’s Hospital researchers have recommended bedsharing with infants, these recent scientific studies seem to suggest what many parents have already suspected instinctively for generations: babies may be safer sleeping with their parents, where they are more likely to be kept in a lighter sleep state, than they are in their own rooms alone.

Such a suggestion would hardly be considered surprising in most areas of the world. According to anthropologist Dr Meredith F. Small of Cornell University, a study that included 186 nonindustrialized cultures revealed 67% of the world’s cultures have children sleep in the same room (46% in the same bed) with their parents (Small, 1998). Additionally, in that same study, 100% of those cultures do not have their infants sleep in a separate room until they are at least one year old (Small, 1998).

It would seem that our western, industrialized culture’s insistence of a separate room as a sleep space for our infants makes us very unique and that much of the world considers room sharing and even bedsharing perfectly normal and safe. Small suggests in her work that the issue is not necessarily just a concern of “safety,” but is part of a larger cultural obsession about independence and a fear of letting our infants be dependent for too long (Small, 1998). If that’s true, is cosleeping or even bedsharing really as dangerous as it is made out to be or is our drive to make our children independent as quickly as possible what makes us resistant to it?

We are frequently told by our doctors, friends, and media that research has revealed that sharing beds with our babies make them more at risk for SIDS. How do we reconcile this new research that suggests that SIDS is really a brain stem malfunction and not related to sleep environment and the popularity of this age old practice with the widespread insistence that bedsharing is dangerous?

First, the connection between cosleeping and SIDS in the research that leads the AAP to discourage bedsharing is ambiguous because it does not distinguish between bedsharing safely and sharing sleep in environments with high asphyxiation risks (such as overstuffed couches, a bed with overstuffed pillows or one on a frame against a wall, or a bed with a heavy comforter that is shared over the baby). Dr. James McKenna (director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame) has done extensive work separating the idea of “cosleeping:” having at least one adult (usually a breastfeeding mother) sleeping near enough to an infant (on separate surfaces) to monitor the infant in at least two ways either by touching and hearing, hearing and seeing, or touching and seeing from “bedsharing:” where an infant or child shares the adults bed; he further recommends “cosleeping” universally and “bedsharing” under specific safety guidelines to control for asphyxia risks (McKenna & McDade, Why babies should never sleep alone: A review of the cosleeping controversy in relation to SIDS, besharing and breast feeding, 2005).

A professor of anthropology and a father, McKenna has made a lifetime of studying infant sleep and, specifically, the safety of cosleeping and bedsharing spurred by his and his wife’s experience with their own newborn in 1978. An expert in the fields of both cosleeping and bedsharing, he has concluded after decades of study that “no scientist who has actually ever studied bedsharing, either in the home or laboratory, or who has studied the physiology and associated behavior involved in bedsharing, has ever recommended against it” (McKenna, Sleeping with Your Baby: A Parent’s Guide to Cosleeping, 2007, p. 57).

McKenna’s findings (and those of Dr. Peter J. Fleming Ph.D., the researcher who led the implementation of the very successful “Back to Sleep” campaign in the 1990s that lowered the SIDS rate in many countries including the U.S., and Dr. William Sears, M.D.) have found that cosleeping is actually very beneficial particularly for young newborns who cannot regulate their own bodies (McKenna, Sleeping with Your Baby: A Parent’s Guide to Cosleeping, 2007). Bedsharing mother/child pairs have been shown to enjoy greater breastfeeding success, increased sleep, lower stress levels for both mother and baby, better temperature regulation in newborns and infants, increased sensitivity in communication, increased attachment bonds, and greater ease with losing weight for the mother after birth (McKenna, Sleeping with Your Baby: A Parent’s Guide to Cosleeping, 2007).

McKenna has concluded that while the risk of asphyxiation is real and safety protocols should be enacted to limit that risk, much of the warnings against bedsharing based on fears of asphyxiation and SIDS are often “grossly exaggerated” and fails to differentiate asphyxiation risk environments from safe bedsharing environments while simultaneously ignoring the increased SIDS risk presented by sleep environments such as a separate room for the baby (McKenna, Sleeping with Your Baby: A Parent’s Guide to Cosleeping, 2007, p. 58). Thus, while bedsharing may be a risk (a risk that is lessened by following the guidelines suggested by Dr. McKenna), its benefits are not often mentioned by mainstream media. The data from the Sudden Unexpected Deaths in Infancy study (the largest study of SIDS) found that infants left sleeping in their own rooms and not with their parents were twice as likely to be lost to SIDS as infants who sleep in the same room (or with) their parents (McKenna, Sleeping with Your Baby: A Parent’s Guide to Cosleeping, 2007).

The choice to cosleep or to bedshare is, of course, up to individual parents, but the research clearly suggests that it is at least as safe and might be a safer option than the culturalized norm of a baby sleeping in a crib in his or her own room. There are, of course, many personal factors that go into your family’s sleeping arrangement and your options are really as unique as your family needs them to be and it might be that cosleeping is not the best option for you or maybe bedsharing or cosleeping is exactly the right fit for your family. It’s important that you can make that decision for yourself with unbiased research and a survey of your needs as well as those of the rest of your family.

If you do decide to cosleep (or to try out cosleeping), your cosleeping options can include a separate firm mattress for your infant or child next to your own bed, a raised attached-to-your-bed cosleeper, a separate surface cosleeping “nest” in your bed, or even a traditional crib or bassinet in the room near the bed. All of these options would fulfill the AAP recommendation to keep infants “near” sleeping adults, in lighter stages of sleep where they are easier to rouse. If you are interested in further introducing the safe practice of bedsharing in your home with your infant or children, make sure to research how to do so safely, and follow Dr. McKenna’s suggested safety guidelines. Let us hope that SIDS one day soon becomes a risk that we need not fear because of early detection and intervention made possible by future research.

Dr. James McKenna’s Safe Bedsharing Guidelines

(adapted from his book)

Make the surface the baby sleeps on with you a clean, firm surface (memory foam or a quilted bed top would be considered a bit too soft). Never bedshare on a waterbed with an infant.
Make sure your sleeping surface does not have any spaces where a newborn might risk getting lodged against the wall or between the bedframe and the mattress. Taking the mattress off the bedframe and placing it in the center of the room would be an ideal example.
Do not smoke. Smoking for either parent (even if it is not in the bedroom, in the house, or near the baby) is a risk factor for both SIDS and asphyxiation.
Have baby sleep on his or her back. (If the baby nurses to sleep and falls asleep on his or her side, gently shift him or her to her back while asleep.)
No adult should bedshare with a baby if s/he has had any sleeping medications, sedatives, or has been drinking.
Allow only adults to sleep next to infants. Because children have not yet developed the ability to sense boundaries when asleep, and therefore are more prone to falling out of bed, they cannot be next to infants because they might accidentally roll on top of them.
Sleep with one light blanket and try not to share your blanket with the baby. (The baby will likely sleep snugly next to you and will be warm without the layers needed if s/he were in a crib). Likewise, dress the baby lightly. Because babies tend to warm themselves with adult body heat (they are instinctually hardwired to do so), they do not need a lot of warm clothing. The room should not be too warm for the same reason.
Do not sleep in clothes that have a lot of strings that might pose as a strangulation risk for the baby and keep long hair in ponytails.
Be aware that an adult who is significantly obese might be a suffocation risk for the baby. Make appropriate accommodations such as a sleep nest or some other form of separate space in the bed to keep the baby safe from potential unintentionally roll overs.
Breastfeed exclusively if possible. McKenna’s research has shown that breastfeeding mother and infant pairs are the most in sync in their sleep routines and respond the most sensitively to one another. Breastfed infants rouse more easily than exclusively formula fed or mixed sustenance fed babies and are more responsive to their mothers’ sleep movements.

Works Cited

McKenna, J. (2007). Sleeping with Your Baby: A Parent’s Guide to Cosleeping. Washington D.C.: Platypus Media, LLC.
McKenna, J., & McDade, T. (2005, March 6). Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, besharing and breast feeding. Retrieved from Paediatric Respiratory Reviews: https://cosleeping.nd.edu/assets/31970/mckenna_why_babies_should_n.pdf
Pediatrics, A. A. (2011, October 18). AAP Expands Guidelines for Infant Sleep Safety and SIDS Risk Reduction. Retrieved from American Academy of Pediatrics: http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk-Reduction.aspx
Randall, B. B., Paterson, D. S., Haas, E. A., Broadbelt, K. G., Duncan, J. R., Mena, O. J., . . . Kinney, H. C. (2013). Potential Asphyxia and Brainstem Abnormalities in Sudden and Unexpected Death in Infants. Pediatrics, 1616-1625.
Small, M. F. (1998).
Our Babies, Ourselves. New York: Anchor.

Sweet Dreams! Sharing Sleep With Your Baby

Dr. James McKenna’s Safe Bedsharing Guidelines

Works Cited

Suggested Reading