I was contacted last week by the CBC to conduct an interview in regards to some new research released about infant sleep related deaths. The study revealed that 69% of deaths in infants under the age of four months was due to "bedsharing".
Of course many aspects surrounding the context of the bed-sharing was not taken into consideration. The purpose of my interview, as well with my colleague and friend Taya Griffen, was to show how bed-sharing can be done safely, if proper precautions are followed.
When I was phoned by the show’s producer, she had this to say to open our conversation, “Have you heard of the study that is being released that states that most infant deaths under four months are due to co-sleeping? But would you say that there are many sides to consider?” –she suggested socio-economic factors would play a role, and that there is a difference when a mother shares sleep conscientiously in a minimal risk environment. A great example of this point can be found when you look at remarkably low instances of SIDS in other countries which commonly practise bed-sharing (1), (2), (3), (4), (5).
I agreed to take part in the interview, and also to find a bed-sharing mother who could also take part in the segment. Unfortunately, the result of the edited show had a predictably one sided angle. As professionals in assisting mothers achieve health and wellness, my colleagues and I are not aiming to suggest bed-sharing to all families, since we have no idea what the specific situation is within each home.
However, we do feel that ethically, we have a responsibility to get safe sleep information to parents in a way which respects their intelligence and ability to look at data critically.
This blog shares what the recent CBC news report failed to include, and our hope is that it rounds out the angle of the North American mass media’s perspective.
Our biggest concern is the stigma attached to bed-sharing, making the information on how to do it safely, hard to access. Unless you consider yourself part of the Attachment Parenting movement, parents aren’t likely to seek out safe sleep guidance. They may have every intention on using the crib, but the reality is that the baby does not want to be put down, and the parents are exhausted.
Add to the mix that breastfeeding produces a flood of oxytocin to the mother’s brain (6), and you have a recipe for unintentional bed-sharing (which could be on the couch, rocking chair or glider). When the tired parent vows to rest their eyes for ‘just a minute’, is where I see the real danger. Rather than keeping it seemingly simple and vilifying bed-sharing, as a society we need to factor in that the majority of infants are bed-sharing with a parent at one point or regularly (7).
This is likely to continue as many factors including basic biology are working in the favour of sharing sleep. Anyone who has ever fallen asleep with their baby even once, NEEDS to go to educate themselves on how to set up a safe sleep environment for the whole family.
Recognizing that there are many undeniable benefits to sleeping next to an exclusively breastfeeding mother (mother acts as a natural pace-maker and regulates breathing and sleep cycles (8), (9), (10), (11), (12), (13)), government officials recommend the crib be placed next to the parents bed, for at least the first six months.
It sounds like the safest option, however, when the baby wakes up every hour, and the caregiver stands up and bends over to pick the baby up for the umpteenth time, in an exhausted stupor vows to lay down with baby *just for a couple minutes*, we have unintentional bed-sharing and a host of possible hazardous factors.
Sleep training infants by way of leaving them to “cry-it-out” is also not recommended (14), (15), (16), (17), (18), (19), (20), (21), (22), so parents are left in an unsupported situation, without the tools to handle the job of night-time parenting.
We must arm parents with the knowledge and tools to deal with the demands of caring for an infant. There is critical information that needs to be shared with new parents, regardless of whether they identify with all of the principals of Attachment Parenting. It is never recommended to share the same sleep surface with your infant:
- if you currently smoke or smoked during pregnancy
- if you are obese
- if you are using formula
- if you have long hair it should be tied back
- if you are sleeping anywhere but a bed set up for safe sleep
Many professionals would agree that mother sleeping next to baby is worth the extra conscientious effort for optimal infant development –physically, mentally and emotionally (23) (24).
Guidelines for safe bed-sharing include:
- A smoke-free gestation and home environment
- Both partners in agreement to the sleeping choices of the family, and committed to respecting babies fragility
- Parents striving for a healthy diet and clear of drugs and alcohol or any substances that may alter mood and/or sleep
- Ensuring babies never share a sleep surface with anyone other than their breastfeeding mother
- Baby should be positioned next to nursing mother and not in between parents
- Bed should be firm and placed on the floor in a space that is free and clear.This means not next to another bed, other furniture or wall where a crevice could open up.
- Baby should be on their back and never surrounded by anything that could cover their head, such as pillows, blankets and stuffed animals.
Since SIDS is still considered a tragic mystery, infant deaths can happen anywhere. Every parent needs to consider their confidence in their sleep environment choices, research them diligently, and make a decision that they are confident with. If you would like to learn more, and have an opportunity to ask me a question about you and your families’ sleep, please join me for a free webinar on Healthy Family Sleep, Monday, July 21st at 9pm EST.
“SIDS Global Task Force Child Care Study” E.A.S. Nelson et al., Early Human Development 62 (2001): 43-55A. H. Sankaran et al., “Sudden Infant Death Syndrome and Infant Care Practices in Saskatchewan, Canada,” Program and Abstracts, Sixth SIDS International Conference, Auckland, New Zealand, February 8-11, 2000.D. P. Davies, “Cot Death In Hong Kong: A Rare Problem?” The Lancet 2 (1985): 1346-1348.N. P. Lee et al., “Sudden Infant Death Syndrome in Hong Kong: Confirmation of Low Incidence,” British Medical Journal 298 (1999): 72.S. Fukai and F. Hiroshi, “1999 Annual Report, Japan SIDS Family Association,” Sixth SIDS International Conference, Auckland, New Zealand, 2000.E. A. S. Nelson et al., “International Child Care Practice Study: Infant Sleeping Environment,” Early Human Development 62 (2001): 43-55.Panksepp, Jaak, Eric Nelson, and Steve Siviy. "Brain opioids and mother—infant social motivation." Acta paediatrica 83.s397 (1994): 40-46.Whiting, J. W. M. (1981). "Environmental constraints on infant care practices." Handbook of Cross-Cultural Human Development. R. H. Munroe, R. L. Munroe, and B. B. Whiting, editors. New York: Garland STPM PressMcKenna, J. J. and Mosko, S. S. (1994), Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine. Acta Paediatrica, 83: 94–102. doi: 10.1111/j.1651-2227.1994.tb13271.xMcKenna, J. J., Mosko, S., Dungy, C. and McAninch, J. (1990), Sleep and arousal patterns of co-sleeping human mother/infant pairs: A preliminary physiological study with implications for the study of sudden infant death syndrome (SIDS). Am. J. Phys. Anthropol., 83: 331–347. doi: 10.1002/ajpa.1330830307McKenna, J. (1996) Babies Need Their Mothers Beside Them, http://www.naturalchild.org/james_mckenna/babies_need.htmlSears, W., et al. (1993) The effect of co-sleeping on infant breathing – implications for SIDS. Paper presented at the Eleventh Apnea of Infancy Conference, Rancho Mirage, CaliforniaElias, M. F. 1986. Sleep-wake patterns of breastfed infants in the first two years of life. Pediatrics 77: 322-329Stifter, C., and T. Spinrad. (2002) The effect of excessive crying on the development of emotion regulation. Infancy 3, no. 2: 133-152Brazy, J. E. (1998) Effects of crying on cerebral blood volume and cytochrome aa#. Journal of Pediatric 112, no. 3: 457-461Blunt Bugental, D. et al. (2003). The hormonal costs of subtle forms of infant maltreatment. Hormones and Behaviour, January, 237-244.Bremmer, J.D. et al. (1998). The effects of stress on memory and the hippocampus throughout the life cycle: Implications for childhood development and aging. Developmental Psychology, 10, 871-885.Dawson, G., et al. (2000). The role of early experience in shaping behavioral and brain development and its implications for social policy. Development and Psychopathology, 12(4), 695-712.Heim, C. et al. (1997). Persistent changes in corticotrophin-releasing factor systems due to early life stress: Relationship to the pathophysiology of major depression and post-traumatic stress disorder. Psychopharmacology Bulletin, 185-192.Henry, J.P., & Wang, S. (1998). Effects of early stress on adult affiliative behavior, Psychoneuroendocrinology 23( 8), 863-875.Schore, A.N. (2001). The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22, 201-269.Stam, R., et al. (1997). Trauma and the gut: Interactions between stressful experience and intestinal function. Gut.