Sunday, March 2, 2008

Where is the safest place for a baby to sleep?

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."

Here's why:

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."

-NewsAnchorMom Jen


Maria said...

"Insufficient evidence to endorse"... key words.

No matter who you interview or what you report, this is a topic where neither side is going to budge... much like the cry-it-out versus no-cry sleep options for babies/toddlers.

Tom321 said...

Great blog. I'm always surprised when I read about SIDS though the things that I think are sort of important but never reported:

(1) Dr. John Kattwinkel's daughter died at 3 days of age in 1966. Could he in anyway (even slightly) be biased towards preventing SIDS at all costs due to his personal tragedy.
(2) There are lots of negative effects associated with the back (supine) sleep position which seem to never be reported.
(3) The SIDS statistics themselves are very misleading and not as convincing when one looks closely at them.

Here's some information I've found which corresponds to the above:
(1) "Why should she be a beautiful, healthy-looking girl and be dead two days later?"
Dr. John Kattwinkel on the death of his 3 day old baby daughter in 1966 - Dartmouth Alumni Magazine
"The Academy was looking for someone who didn't have an agenda. So they chose me."
Dr. John Kattwinkel on being chosen to head the 1992 American Academy on Pediatrics Task Force on SIDS Prevention
(2) The BTS Program causes the following in infants who sleep supine compared to infants who sleep in the prone position:
- Social skills delays at 6 months (Dewey, Fleming, et al, 1998)
- Motor skills delays at 6 months (Dewey, Fleming, et al, 1998)
- Supine Sleep causes increased rates of gastroesophageal reflux (GER) (Corvaglia, 2007)
- Below norm AIMS scores (Majnemer, Barr, 2005)
- Milestone delays (Davis, Moon, et al., 1998)
- Increased duration of sleep apnea episodes during REM sleep at both 2.5 months and 5 months (Skadberg, Markestad, 1997)
- 6% decrease in sleep duration (Kahn, Grosswasser, et al.,1993)
- 1 in 300 infants had plagiocephaly in 1974 (Graham, Gomez, et al., 2005)
- 1 in 60 infants had plagiocephaly in 1996 (Graham, Gomez, et al., 2005)
(3) "Federal records show a dramatic decline in reported cases of SIDS, dropping from 4,895 cases in 1992 to only 2,247 in 2004, the most recent year for which complete data is available. The records reviewed by Scripps showed that cases of SIDS virtually disappeared in some states and cities over the last several years, but closer examination of the data makes it evident that thousands of those lives have not been ‘saved,’ but rather lost under another name. Coroners and medical examiners said SIDS was responsible for nearly 80 percent of all sudden infant deaths 15 years ago and only 55 percent in 2004. What increased during this time were diagnoses that CDC statisticians labeled as "threats to breathing" and ‘other ill-defined causes of mortality.’"
Bowman and Hargrove, Scripps Howard News Service

I apologize for writing a bit too much but I am really passionate about this subject and the need for the negative effects of the "Back to Sleep" campaign to be examined more closely. Best regards,


Shannon said...


I have to agree with the previous posters... it's all about who you choose to interview. I'm sure Dr. Sears would have granted the interview, and likely presented different information. But who's to say who's more reliable? It's easy to see why it's so confusing to so many parents.

I think your interviewee dodged the last question though, and I'm disappointed by that response. The figures I used may not have been exact, but they're pretty close. And the follow-up would be to ask where those 3/1000 babies die... in a crib or in bed with their parents?

To add to Tom's post, here' something else I don't understand about SIDS research. Statistically speaking, we know that breastfeeding greatly reduces the risk of SIDS. Again, I can't find the exact number but a Lactation Consultant has told me it's something like for every 80 babies who dies of SIDS, 2-3 were breastfed. Noone's saying it's a guarantee, but certainly that would make it as important as putting baby on its back. But you almost never see that reported by the "back to sleep/baby in crib" camp. Why is that? said...

I will look into interviewing Dr. Sears. I interviewed the AAP to find out why the recommendations were made in the first place. I thought that would give us some perspective.

Marcia said...

Here's a link to Dr. Sear's co-sleeping article.

Knight in Dragonland said...

Here's what I can tell you from my personal experience as a pediatrician ... I've seen five kids die from asphyxiation due to co-sleeping, but I have yet to see a case of crib death.

There was just a case of a seven week old asphyxiating while in a prone position here in Pekin. Back to sleep works. If you're awake and watching your infant, by all means place them on their tummy. They need "tummy time" to develop their neck and upper body strength and to prevent positional plagiocephaly (head flattening). When you're putting them to sleep, put them on their back.

Yes, many people will get away with placing their children on their tummy to sleep, just as many people get away with not vaccinating their children ... but you're playing Russian roulette with your child's life by doing so. Yes, the revolver has hundred thousand chambers ... but still. Not worth it, IMO.

By all means, near-sleep. Keep your child in the bedroom with you ... just not in the bed. If you feel you must have the baby in the bed with you, there are special barriers that can be purchased to prevent a parent from inadvertently rolling on top of their child. However, that doesn't solve the problem of bedding. Adult beds are frequently not firm enough and have heavy covers that could still be a suffocation risk.

I'm sorry, but there is no way to adequately remove bias from studies of co-sleeping and the reputed benefits to social/emotional development. Mothers who co-sleep tend to be highly educated and very dedicated & involved parents ... or dirt poor individuals who can't afford a bassinet or crib. There's not much middle ground ... and guess who gets included in the studies? Not many from the second group. Socioeconomic factors and the general level of parental involvement are a far more powerful influence on infant development.

Yes, the risks of death from co-sleeping or tummy sleeping are small. But is it worth risking your child's life for, IMO, rather tenuous benefits? I would say no.

Tom said...

I highly recommend that you try to interview Dr. Ralph Pelligra who is the Chief Medical Officer of NASA and who I quote below. Also, I highly recommend that you try to interview Susan Syron and Phil Stevens who I also quote below. Best of Luck on the reporting.

“There are indications of a rapidly growing population of infants who show developmental abnormalities as a result of prolonged exposure to the supine position.”
Dr. Ralph Pelligra regarding the impact of the Back to Sleep Campaign

“Since the implementation of the "Back to Sleep" campaign, therapists are seeing increasing numbers of kindergarten-aged children who are unable to hold a pencil.”
Susan Syron, Pediatric Physical Therapist

“Infants with deformational plagiocephaly were found to have significantly different psychomotor development indexes and mental developmental indexes when compared with the standardized population.”
Kordestani, et al. in their study “Neurodevelopmental Delays in Children with Deformational Plagiocephaly”

“I do not think it is a medical problem - it is more of a cosmetic one. Mothers may feel it is a syndrome and a problem when it really is nonsense.”
Dr. Peter Fleming, back sleep advocate, on his view of deformational plagiocephaly

“The one we tend to think of has been the rapid increase in the incidence of positional plagiocephaly and positional brachycephaly. However, there have been whispers and rumors of other effects”
Phil Stevens, MEd, CPO regarding side effects of the Back to Sleep Campaign.

“The potential implications of a SIDS risk-reduction strategy that is based on a combination of maintaining a low arousal threshold and reducing quiet (equivalent to or slow-wave sleep) in infants must be considered. Because slow-wave sleep is considered the most restorative form of sleep and is believed to have a significant role in neurocognitive processes and learning, as well as in growth, what might be the neurodevelopmental consequences of chronically reducing deep sleep in the first critical 12 months of life”?
Pelayo, et al. letter to the editor regarding 2006 SIDS Task Force Recommendations

“Back to Sleep campaigns have been in place in many countries since the early 1990s, and there has been no indication that supine sleep has lasting negative effects on infant growth and development”
Dr. John Kattwinkel, in reply to the Pelayo, et al. letter to SIDS Task Force

As it turns out, when the primarily back and side sleeping ALSPAC babies were compared to the primarily stomach sleeping Colorado babies used to develop the DDST the researchers obtained these results: 68% of the ALSPAC infants had abnormal scores at 6 months of age compared to the stomach sleeping DDST Colorado infants and 57% of the ALSPAC infants had abnormal scores at 18 months compared to the original stomach sleeping DDST Colorado infants.
Summary of Alan Emond letter to BMJ in 2005 regarding ALSPAC data and a research project unrelated to Sudden Infant Death Syndrome.

“There is always a well-known solution to every human problem–neat, plausible, and wrong.”
H.L. Mencken

GinaMamaB said...

Here are some wonderful links:

Just some extra info for you researchers out there! :) said...

Cosleeping seems to be a really controversial topic. I will be getting some comments from others. I had no idea it was such a hot topic.

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