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Cosleeping and baby safety

Cosleeping or sleep sharing is when parents sleep in close proximity to their baby, generally in the same room. Bed sharing is a specific form of cosleeping: baby sleeps with at least one parent on the same surface. A practice as old as humanity itself, cosleeping is still widespread among two thirds of the population on the planet, in industrialized and non-industrialized countries across Asia, Africa, South and Central America. Here, after many years of babies sleeping alone in a room separate from their parents, cosleeping is making a comeback. How can we ensure it is practiced safely?

Sudden infant death syndrome (SIDS) and unexpected crib death (for example by suffocation) are the main cause of death in babies aged 1 month to 1 year. They were reduced by half in the nineties following an awareness campaign recommending that babies be laid down to sleep on their backs, on firm, flat surfaces, with no soft pillows or blankets, and for mothers not to smoke during pregnancy. When all these precautions are taken, the odds of SIDS decrease by another 50% among babies who sleep near their parents, when compared with those that sleep alone in their room. Since 2004, the Canadian Paediatric Society has recommended parent-baby cosleeping for the first six months of life (see http://www.cps.ca/english/statements/cp/cp04-02.htm) Cosleeping on separate surfaces is recommended, but not bed sharing, which involves certain risks that we must be aware of.

Cosleeping on separate surfaces satisfies many parents, since it allows them to check on baby’s breathing and meet their nightly needs without waking up too much themselves. It is extremely comforting for babies to hear their parents breathing, smell them, know that they are nearby if they need them. In general, this form of cosleeping is practiced with a bassinet or crib near or against the parents’ bed. There are also special little beds that hang on the edge of the parents’ bed or others that are set in bed, between mother and father.

While bassinets and cribs are generally built to established safety standards, adult beds are not. So when bed sharing, care must be taken to reproduce all baby safety conditions in the adult bed. First, ensure that baby cannot fall out of bed. The simplest solution is to get rid of the bed structure and to place the mattress on the ground, a good distance from the wall. This prevents the risk of serious falls. Most fatal accidents in parental beds occur when babies get caught between the mattress and the bed frame, headboard or footboard, or between the mattress and a wall or piece of furniture against which the bed was placed and which shifted slightly.

Always avoid sleeping with babies on a couch, padded armchair or waterbed, since it makes SIDS or accidental death by asphyxia is 25 times as likely. Not only is the surface too soft, but there are several areas on a couch or armchair for babies to get caught and asphyxiate: between cushions, or between a cushion and the back or armrest. 

In the parents’ bed, babies must also be kept away from blankets, bedspreads, soft pillows, etc. If parents use blankets, it is better to have several thin ones, made of porous material such as cotton, and to avoid thick blankets and duvets. Babies can sleep, always on their back, in a warm sleep sack or footed pajamas, with no blankets. Before the age of one year, babies should not sleep next to older children, or near pets. If an older child sleeps in the family bed, either place the baby in their crib near the family bed, or ensure that mother’s (or father’s) body serves as a barrier between the older child and the baby at all times.

When parents smoke (please, never in the baby’s room), cosleeping on separate surfaces is recommended. Mothers who smoked during pregnancy should not sleep with their babies, even if they breastfeed. The combination of maternal smoking during pregnancy and bed sharing is a risk factor for SIDS, while cosleeping on separate surfaces is protective.

It is also recommended that obese parents not share their bed with babies. The weight of their body on the mattress could create a gap in which babies could get caught, creating a risk of crushing.

It is very important to place babies in their crib rather than the parents’ bed if either parent is under the influence of alcohol or any other substance that can affect alertness. The same goes for extremely tired or sick parents. Quite often in cases of infant death by crushing or accidental asphyxia, the parent involved was in no condition to care for a baby.

Despite all these warnings that may lead you to believe bed sharing is dangerous for young babies, this isn’t the case when parents take basic precautions. Certain experts even hypothesize that a non-smoking mother who breastfeeds and shares her bed with her baby actually represents a protective factor against SIDS. Scientific literature contains no known cases of such mothers who had crushed their baby during bed sharing unless other factors were involved: alcohol, drugs (including certain cold or allergy medications that cause drowsiness), or excessive fatigue. Ligue La Leche encourages mothers to breastfeed while lying in bed, even if they sometimes fall asleep with their baby held against them. This nocturnal mother-baby proximity is known to promote the establishment and duration of breastfeeding. It now also appears to be shown that breastfeeding is a protective factor against SIDS.

It should be added that cosleeping must be a family decision. It is only a good choice if the entire family sleeps better and if everyone’s emotional and physical needs are met. Certain parents have valid reasons for choosing to have babies sleep in their own room. In this case, rapid response to nocturnal cries and close cuddling during the day will help meet babies’ need for contact.  

Claudette Nantel,

Psychotherapist, pre- and perinatal psychology specialist

claudettenantel@sympatico.ca

This article is presented by Maman Kangourou (www.mamankangourou.com)

 

Additional resources

In French:

http://cododo.free.fr/ A francophone site on cosleeping, written by Nathalie Roques, and full of information, suggestions, and accounts of the author’s personal experience. A must read.

http://www.aspq.org/view_bulletins.php?id=53&article=265 An article by Association pour la santé publique du Québec in favour of cosleeping.

http://www.babyfriendly.org.uk/pdfs/french/sharingbedleaflet_french.pdfPartager un lit avec votre bébé : un guide pour les mères qui allaitent.” Also available in English at http://www.babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf “Sharing a bed with your baby: A guide for breastfeeding mothers” UNICEF (United Kingdom) leaflet that summarizes precautions you should take to share a bed safely with a baby.

http://www.votre-enfant.com/wiki/La_mort_subite_du_nourrisson_%28MSN%29 A 2006 article published in Le Figaro that describes the issues with cosleeping and sharing a bed, the risks of SIDS, etc.

In English:

http://www.nd.edu/~jmckenn1/lab/index.html An anglophone site on cosleeping, by Dr. James McKenna, American anthropologist and world authority on cosleeping.  A highly interesting article by Dr. McKenna, “Why We Never Ask ‘Is it Safe for Infants to Sleep Alone?’: Historical Origins of Scientific Bias In the Bed-sharing SIDS ‘Debate’", can also be found at http://www.naturalchild.org/james_mckenna/why_we_never_ask.html

McKenna, James J. Sleeping with your baby: a parent’s guide to cosleeping.  Whether you do it occasionally or every night, do it safely. 2007. Washington, DC: Platypus Media, LLC.  An excellent little book, written by the eminent American specialist on cosleeping, to inform parents on the elements of risk they need to be aware of to make the most of their cosleeping experience with baby. Available online (under $20) or on www.chapters.indigo.ca or www.amazon.ca

In 2003, the excellent American magazine Nurturing (often found in Quebec in natural food stores) published a special issue on cosleeping. Its articles are still relevant today and available in a booklet entitled “Sleeping with your baby: the world’s top scientists speak out” at www.nurturing.com/shop or 1-888.810.4150.

From the same source, the January-February 2009 issue of Nurturing is available. It contains a great overview and update on the most recent scientific data on cosleeping, in “The science of sharing sleep”, by L. Gettler and J. McKenna.