Co-sleeping: from Queen B, our Building Cathedrals Medical Mom

Thanks to Queen B, our dear sister and doctor mom, for the following information (and I tossed in an image for your enjoyment):

What a billboard to drive by!  If nothing else good can be said about it, it has sparked a great conversation about an important subject, namely co-sleeping.  It would be interesting to know who sponsored the billboard, because as with many things in life, context is everything.

Juris Mater’s question about the safety of co-sleeping, prompted by the billboard, is an important one.  As mothers, we should all be informed and educated on the topic of co-sleeping so that we can make safe, satisfying decisions about our family sleeping arrangements.  Co-sleeping is a controversial topic for cultural, philosophical and medical reasons.  From a medical standpoint, some studies have highlighted potential short-term health benefits (including facilitation of breast feeding and maternal-child bonding) of mothers sleeping in beds with their infants.  The primary medical concern is, of course, that bed-sharing may be hazardous under certain circumstances, resulting in a sudden, unexpected infant death.

As we consider the concerns about bed-sharing, it is important to be aware of a few distinctions.

First, many lay people, and perhaps even some clinicians, may confuse this issue by lumping the terms “Sudden Infant Death Syndrome” (SIDS) and “sudden unexpected infant death” (SUID).  The currently accepted definition of SIDS is “the sudden death of an infant under 1 year of age, which remained unexplained after a thorough investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.”  Thus, if suffocation or asphyxia is a determined cause of death for an infant, that is not technically a case of SIDS.  SIDS is rare during the first month of life, peaks between 2-4 months of age and decreases dramatically after that.  The cause of SIDS remains unknown, however the American Academy of Pediatrics (AAP) acknowledges several scientifically identified independent risk factors.  It is worth mentioning that bed-sharing has not been consistently shown as an independent risk factor for SIDS.  Infants may die of SIDS whether in a crib or in a bed.  However, even if bed-sharing doesn’t carry a higher risk of SIDS, bed-sharing can be a risk factor for sudden unexpected infant death (including suffocation or asphyxia) under certain conditions.

The recommendations from the AAP regarding bed-sharing (co-sleeping) are all about risk reduction, not condemnation.  In other words, if you choose to sleep with your infant, whatever your reasons, do it as safely as possible:  make sure the infant is sleeping on their back on a very flat, firm surface on the bed (couch co-sleeping carries a much higher risk), free from wrinkled sheets, pillows, sheets, bedding and a safe distance from other bed-sharing family members.  Side-sleeping is not considered as safe as back sleep, so if you are side-nursing at night in bed, ensure that your infant returns to the back-sleeping position after nursing.  Avoid co-sleeping after the use of any alcohol or other impairing substance, when you or other bed sharers are overtired, and in all situations that might involve smoking family members.  Be especially vigilant with infants under 12 weeks of age, and continue safe co-sleeping practices until at least one year of age.

On a personal note, I have been wrestling with the benefits and concerns over co-sleeping myself, as my third child was born 2 months ago.  I can relate to the breastfeeding and bonding benefits of sleeping with my baby in my bed, and I have noticed that we both seem to sleep and cope better if we spend at least part of the night in bed together.  However, a few weeks ago I awoke suddenly with my son beside me, his face far closer to my pillow and blanket than I consider safe. I couldn’t remember bringing him into bed with me, and I wasn’t sure if he was breathing.    I must have reached down and lifted him into bed in an overtired state of sleep.  Praise the Lord, he was sleeping soundly, but the hair still raises on my arms as I write about it.  It drove home for me the important reality that in bed at night it only takes one terrible mistake to end a life.  Just as we employ extreme vigilance with our children at pools, in the car, near the street, etc, we need to be vigilant about safety in sleep.

I have very little admiration for the approach of the billboard or those who condemn co-sleeping all together.  But should someone in the medical profession (doctor, nurse, etc) make you bristle with their negative opinion of co-sleeping, consider extending them the charity of the benefit of the doubt.  For an invested, caring clinician, as for any of us, a preventable death is truly devastating to behold, especially when it is that of a helpless infant or child.  Encountering a SIDS or SUID case may color a person’s opinion of certain sleeping practices for life, whether scientifically validated or not.

For more up to date information on the pediatric consensus statements regarding SIDS, infant sleeping environments, and an excellent list of references for reading, see the following document from the American Academy of Pediatrics: http://aappolicy.aappublications.org/cgi/reprint/pediatrics;116/5/1245.pdf