Does cosleeping have benefits? Definitely. It is a good idea? The American Academy of Pediatrics says no. After several comments last week from parents who support cosleeping, I thought it would be a good idea to find out why cosleeping is not recommended. Is it based on good research?
Dr. John Kattwinkel from the AAP SIDS Task Force said,"There certainly is a contingent that feels that bedsharing can be done safely, but the AAP SIDS Task Force that I chair felt that there was insufficient evidence of that to endorse it."
Bed sharing between an infant and adult(s) is a highly controversial topic. Although electrophysiologic and behavioral studies offer a strong case for its effect in facilitating breastfeeding and the enhancement of maternal-infant bonding,epidemiologic studies of bed sharing have shown that it can be hazardous under certain conditions.
Several case series of accidental suffocation or death from undetermined cause suggest that bed sharing is hazardous. Some of these studies have found the correlation between death and bedsharing to reach statistical significance only among mothers who smoked. However, the European Concerted Action on SIDS study, which was a large multisite study, found that bed sharing with mothers who did not smoke was a significant risk factor among infants up to 8 weeks of age.
Similarly, a more recent study conducted in Scotland found that the risk of bed sharing was greatest for infants younger than 11 weeks, and this association remained among infants with nonsmoking mothers. The risk of SIDS seems to be particularly high when there are multiple bed sharers and also may be increased when the bed sharer has consumed alcohol or is overtired.
There is growing evidence that room sharing (infant sleeping in the parent’s room) without bed sharing is associated with a re-duced risk of SIDS. Data from the European Concerted Action on SIDS study led to the recommendation by its authors that the most protective sleep setting for an infant is in a crib in the parents’room. On the basis of their study results, investigators in Scotland endorsed the United Kingdom Department of Health’s advice that the safest place for an infant to sleep is in a crib in the parents’ room for the first 6 months of life.
Jen: Attachment Parenting International says there is no good research that shows cosleeping is dangerous. It says the research that had been done on this topic was done by the companies who make cribs. Do you know if there is any truth to this and can you respond?
Dr. Kattwinkel: "The studies cited in our report were done by very reputable epidemiologists that as far as I know were not supported by manufacturers. Certainly no one on our task force receives any such support.
Jen: Some moms believe cosleeping deaths occur when parents are drunk or on drugs. One mom said, "Very often when a co-sleeping death happens, it is related to drugs, alcohol, or obesity. But those things rarely make the news stories - either because of a fear of making the parents feel guilty or because it wouldn't make for the same kind of headline."Can you please respond.
Dr. Kattwinkel:"It is true that all of the factors you mention increase the risk of SIDS and of bed-sharing significantly. However, controlling for these variables in several of the studies still show the adjusted risk to be increased. The most controversial variable is smoking, where a few found that removal of smoking eliminated the risk of bedsharing, but several others did not, particularly during the first 6 weeks after birth."
Jen: Can you respond to this statement from a local mom, "Some studies have shown the risk of SIDS greatly decreases when babies sleep next to their mothers - not only are mothers more in tune and likely to notice breathing disruptions in their baby, but babies' little bodies tend to mimic the breathing pattern of their mother next to them."
Dr. Kattwinkel: "The physiological observations cited by this mother are correct and the investigator has SPECULATED that this may protect from SIDS. However, he has published or presented no evidence that it actually does so."
Jen: Another comment from a local mom, "I still struggle to understand why co-sleeping is considered dangerous when about 50 babies a year die in bed with their parents, but cribs are considered safe and 3,000 babies die in cribs alone every year. "
Dr. Kattwinkel: "The numbers quoted by this mother are not quite correct, or the facts are unknown. However, it is essential to define the denominator. The same argument can be made about sleep position. 997 of each 1000 babies who sleep on their stomachs will NOT die of SIDS. However, when you consider the number of births in the U.S., prevention of those 2-to-3/1000 deaths by babies sleeping on their backs has resulted in over 15,000 fewer deaths since introduction of the "Back to Sleep" recommendation."