Commentary by Terri LaPoint
Health Impact News
As long as parents have been having children, babies and parents have been sleeping together.
“Co-sleeping,” as it is called now, has been a normal part of life across the majority of the world’s cultures, throughout all of human history. It is only in modern times that babies have been expected to sleep in a crib, separated from the warmth and comfort of their mothers’ breasts.
Now, the practice is frowned upon by some doctors and experts, and it is even being used as justification for Child Protective Services (CPS) to take babies away from their parents.
The American Academy of Pediatrics (AAP) strongly warns against co-sleeping, and some have termed it “child abuse,” connecting it to SIDS and even perversion and sexual abuse.
These assertions fly in the face of the attachment parenting model as well as the practices of millions of parents world-wide. Proponents of co-sleeping cite many valid health and emotional benefits of co-sleeping.
Yet the mere mention of co-sleeping can trigger explosive debates in media, social media, and the public policy arena, with passionate opinions on both sides of the debate.
How do we separate fact from myth? More importantly, how do we protect children? Are they truly at a greater risk of dying by sleeping in their parents’ bed? At what point does the risk of them being seized by CPS and taken away from their parents outweigh the benefits of co-sleeping?
Michaeleen Doucleff of NPR recently addressed many of these issues in a well-documented article entitled, “Is Sleeping With Your Baby As Dangerous As Doctors Say?”
She points out that the studies used to show the danger to babies from co-sleeping are misleading, because they lump all co-sleepers together. They fail to differentiate between parents who are drunk or high on drugs and normal, low-risk parents who sleep with their babies.
Information that should be used for recommending safer practices are instead being used to demonize good, loving parents.
Most advocates of co-sleeping stress the importance of safe habits. If a parent is using illicit drugs, taking prescription medications that cause heavy sleeping, or is drinking, then the baby certainly needs to be placed in a crib to sleep. Few would argue with this logic.
Yet, the unsafe practices of a few have translated into policies that threaten to deprive the majority of the choice to nurture their babies through the night through co-sleeping.
Sharing Photos of Baby Sleeping in Your Bed May Result in CPS Kidnapping Your Child
It has come to the point where parents who co-sleep can no longer risk posting their photos of mommy or daddy sleeping with their baby on social media. There have been cases where innocent, sweet photos, like those that many of us have in our photo albums from an earlier time in history, have been reported to Child Protective Services, and the parents receive an unwelcome knock on the door.
Photos of new mothers sleeping with their newborn in the hospital bed have been used as grounds for accusing parents of being neglectful or abusive.
Imagine being a proud grandma posting on Facebook a precious picture of the new little one sleeping cradled by your daughter’s arms in the hospital bed, and then having that photo be used in court as evidence against your daughter, while your grandbaby is placed with strangers in foster care.
Caution should always be exercised when posting photos of children to social media.
Likewise, parents who tell their pediatrician that they co-sleep have been known to be reported to CPS. It doesn’t always happen, but it is occurring with increasing frequency.
The AAP policies have convinced some doctors that the risks of co-sleeping outweigh the risk to the baby of the trauma of being separated from the mother.
But the actual statistics tell a different story.
Excerpts from “Is Sleeping With Your Baby As Dangerous As Doctors Say?“:
Six months ago, Melissa Nichols brought her baby girl, Arlo, home from the hospital. And she immediately had a secret.
“I just felt guilty and like I didn’t want to tell anyone,” says Nichols, who lives in San Francisco. “It feels like you’re a bad mom. The mom guilt starts early, I guess.”
Across town, first-time mom Candyce Hubbell has the same secret — and she hides it from her pediatrician. “I don’t really want to be lectured,” she says. “I know what her stance will be on it.“
The way these moms talk about their secret, you might think they’re putting their babies in extreme danger. Perhaps drinking and driving with the baby in the car? Or smoking around the baby?
But no. What they’re hiding is this: They hold the baby at night while they sleep together in the bed.
AAP – Avoid Co-sleeping at All Times
But the practice goes against medical advice in the U.S. The American Academy of Pediatrics is opposed to bed-sharing: It “should be avoided at all times” with a “[full-]term normal-weight infant younger than 4 months,” the AAP writes in its 2016 recommendations for pediatricians. The organization says the practice puts babies at risk for sleep-related deaths, including sudden infant death syndrome, accidental suffocation and accidental strangulation. About 3,700 babies die each year in the U.S. from sleep-related causes.
AAP cites seven studies to support its recommendation against bed-sharing.
But a close look at these studies — and an independent analysis from statisticians — reveals a different picture. And some researchers say it might be time for the U.S. to reassess its recommendation and its strategy to stop SIDS.
The Studies are Flawed
“Of course, the parental bed can be dangerous,” says Peter Blair, a medical statistician at the University of Bristol who has studied SIDS epidemiology for 25 years. “The Western bed was not designed with the infant in mind.” [He was referring to the “modern bed, with a 6-inch pad on top of a mattress and giant goose-down pillows.]
In the early 2000s, several studies found that bed-sharing substantially raised a baby’s risk of SIDS. By 2011, pediatricians started giving parents a strong, universal message about bed-sharing: “Don’t do it,” Blair says. “But it doesn’t seem to have worked.”
For starters, some health agencies took the message to an extreme, Blair says. In Milwaukee, parents saw an ad in which the mom is portrayed as a meat cleaver. In another ad there, the headboard of the parental bed is portrayed as a tombstone and etched onto it are the words: “For too many babies last year, this was their final resting place.”
“These ads are saying, ‘Not only shouldn’t you sleep with your baby, but it’s almost against the law, and parents should be arrested,’ ” Blair says. “It’s quite unacceptable really. And it’s not really the evidence.”
The early studies came with a major caveat, Blair says. They lumped together all types of bed-sharing, including when babies were put in very dangerous circumstances, such as sleeping next to a parent who was drinking, doing drugs or smoking. [Emphasis added by HIN]. The studies also included babies who slept with a parent on a sofa, not a bed.
In these cases, the evidence is strong and clear. Parents who drink or do drugs shouldn’t be sleeping with their babies because they could roll over onto their child. Babies who are born premature or whose parents smoke shouldn’t sleep in the parents’ bed because of potential respiratory problems. Suffocation can also happen when babies sleep on sofas because babies can be trapped between a parent and the cushions.
“These situations don’t happen often, but when they do, they are often lethal,” Blair says. “There have been many studies showing this.”
In one of these studies, Blair and his colleagues found a baby was 18 times more likely to die of SIDS when sleeping next to a parent who had been drinking. In another study, they found a similar risk for babies sleeping on sofas.
But what about families who don’t drink or smoke? Whose babies aren’t premature or underweight?
“The question really was: In the absence of these hazards, is there an increased risk in bed-sharing?” Blair says.
Better Studies Show Much Lower Risk
So far, only two studies have looked at this question. And doctors and families need to be careful with how they interpret these studies, says Robert Platt, a biostatistician at McGill University, who analyzed the studies for the AAP.
“The evidence is quite thin or weak,” he says. In both studies, the number of SIDS cases is small. One study included 400 total SIDS cases and only 24 cases in which that baby had shared the bed in the absence of parental hazards. In the other study, there were just 12 of these cases out 1,472 SIDS deaths. In the latter study, some information about the parent’s drinking habits was missing and had to be estimated.
Nevertheless, the two studies came to similar conclusions. For babies older than 3 months of age, there was no detectable increased risk of SIDS among families that practiced bed-sharing, in the absence of other hazards.
And for babies younger than 3 months?
“I would probably say there may be an increased [risk] for this group,” Platt says. “And if there is an increased risk, it’s probably not of comparable magnitude to some of these other risk factors,” such as smoking and drinking alcohol.
Note: None of this takes into account the increased risk of SIDS from vaccines and other causes. It seems easier for the medical establishment to blame the nurturing practice of parents co-sleeping than to look in the mirror at the real causes.
Time-Honored Tradition of Co-Sleeping
When I became a mother, I believed the parenting philosophy that AAP demands.
However, my first-born was not content sleeping in her crib. Neither of us got much sleep, as I tried to do what the “experts” said, forcing her to sleep in the crib.
She cried, and my heart broke. She just wanted to be close to me. She craved that skin-to-skin contact and the ready availability of my milk.
I would “give in” and let her sleep in our bed, beating myself up every minute that I did. I found that what I had been taught was at direct odds with my every maternal instinct.
But both she and I slept better. We were completely in sync with each other – I often woke up moments before she awakened in search of my milk.
Then, I read two books that forever changed my thinking. I realized than that I wasn’t the one out of step.
The Family Bed by Tine Thevenin made it clear that it was this modern philosophy of detachment that is out of step with almost all of human history and world cultures.
In The Continuum Concept by Jean Liedloff, I learned that there are entire civilizations in this world where babies don’t generally cry. (Website here.)
These are usually “primitive” cultures where babies are carried all the time, they co-sleep, and they have free access to breastfeed whenever they want. In turn, the babies are secure and bonded to their parents, and they rarely cry.
I later learned about “Kangaroo care,” where babies are held skin-to-skin, and it literally saves babies’ lives.
It helps to regulate breathing, heart rate, and temperature, and boosts the babies’ immunity.
In some NICUs, it is standard practice for at-risk newborns. Co-sleeping facilitates skin-to-skin contact and its many health benefits.
The NPR article cites many recognized benefits of co-sleeping.
Instinct and tradition, but is it safe?
There is no question that many moms have an instinct to sleep with their babies. And many babies have strong opinions about wanting to sleep with their moms. Demanding to be held is a newborn’s forte.
There is good reason for this mutual pull toward each other, says James McKenna, an anthropologist at Notre Dame who has been studying infant sleep for 40 years.
“Human babies are contact seekers. What they need the most is their mother’s and father’s bodies,” McKenna says. “This is what’s good for their physiology. This is what their survival depends on.
What’s more, the practice of bed-sharing is as old as our species itself. Homo sapien moms and their newborns have been sleeping together for more than 200,000 years, says anthropologist Mel Konner at Emory University.
Modern hunter-gatherer cultures provide our best insight into the behaviors of our early ancestors, and bed-sharing is universal across these groups, he says.
The practice continues to be widespread around the world. Bed-sharing is a tradition in at least 40 percent of all documented cultures, Konner says, citing evidence from Yale University’s Human Relations Area Files. Some cultures even think it’s cruel to separate a mom and baby at night. In one study, Mayan moms in Guatemala responded with shock — and pity — when they heard that some American babies sleep away from their mom.
“But there’s someone else with them there, isn’t there?” one mom asked.
Staring at the breast
Back in the early 1990s, Notre Dame’s McKenna decided to do what seemed almost impossible: Figure out just what happens at night when a mom sleeps with a baby.
McKenna and his colleagues transformed his laboratory into an apartment, recruited dozens of moms and babies, and analyzed their bodies while they slept. “We measured heart rate, breathing patterns, chest movement, body temperatures, brain waves — even the carbon dioxide levels between the moms’ and babies’ faces.” They even had infrared cameras to watch how the babies moved around at night.
What McKenna found was remarkable. When the mom is breastfeeding, she essentially creates a little shell around the baby.
“The mother naturally arches her body around her baby,” McKenna says. “She pulls up her knees just enough to touch the baby’s feet.”
Inside this shell, the baby hears the mom’s heartbeat and, in turn, changes her own heart rate. “It usually slows down,” McKenna says. The baby also hears the mom’s breathing, which has a rhythm similar to the sounds the baby heard in the womb.
“It contains that ‘swoosh, swoosh’ sound,” McKenna says, “which in turns sounds like, ‘hush, hush little baby.’ … It’s no wonder nearly every culture uses a swooshing sound to soothe a crying baby.”
The baby also feels the mom’s warm breath, which creates little clouds of carbon dioxide around the baby’s face. That may sound scary, but the gas stimulates the baby’s breathing, according to McKenna. It pokes the baby and says, “Hey, take a deep breath.”
And then there is the baby’s and mom’s movement. McKenna found that throughout the night, breastfed babies in the study don’t move all over the bed, willy-nilly. Instead newborns stay laser-focused on one location: “The babies are basically staring at their mother’s breast almost all night,” he says.
Even babies in cribs, when they’re placed close to their moms, have a similar attraction to their mother: They turn their faces to their mom for the majority of the night.
This tells him, McKenna says, that “babies have evolved to experience this closeness, night after night after night.”
UK Changed Approach with Good Results
According to NPR, the University of Bristol’s Peter Blair says that the United Kingdom has changed their approach from that of forbidding bed-sharing to discussions of safer ways to co-sleep, and the approach has changed outcomes.
“We recognize and acknowledge that bed-sharing happens. We don’t promote it, but neither do we judge people about it,” Blair says. “By doing that, you can open up a conversation with the parents about the really dangerous circumstances when you shouldn’t do it.”
Over the past few decades, the U.K. has also seen a large drop in SIDS. Since 2003, total SIDS deaths has fallen by 40 percent, from about 350 deaths per year to about 200 deaths per year, the nonprofit Lullaby Trust reports. At the same time, the SIDS rate in U.S. has nearly plateaued at about 90 deaths per 100,000, the Centers for Disease Control and Prevention reports.
Blair thinks it could be time for U.S. pediatricians to reconsider their approach to advice about bed-sharing.
“When you come out with a simple message, ‘Don’t bed-share,’ then the conversation stops there because you’re not supposed to be doing it,” he says.
AAP Isn’t Budging
The AAP is standing by its universal recommendation against bed-sharing, says Dr. Lori Feldman-Winter, a pediatrician at Cooper University Health Care and a member of the AAP’s Task Force on SIDS.
American pediatricians generally follow the recommendations of the AAP, and they sometimes report parents for co-sleeping.
Until this policy ends, any parent who tells their doctor or a social worker that they co-sleep is at risk. If their child goes into the foster care system for whatever reason, they are at least 6 times more likely to be abused, raped, molested, or killed.
Parents must be aware of the risks that they are taking.
Just as sleeping with a baby when drunk or high is dangerous, or sleeping with a baby on soft, fluffy, down-filled mattresses or covers is not safe, telling the pediatrician that you co-sleep or posting photos on social media showing co-sleeping is also risky.
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