Co Sleeping

The Babble Staff

American parents tend to want to sleep alone in their bed, placing their baby in a separate crib. The AAP cautions against co-sleeping on the grounds that parents might accidentally smother their infant. Until recently, co-sleeping was regarded by most as a vaguely suspect practice best left to hippies. But public opinion is changing. Several mainstream child-care experts, including Dr. Sears and Dr. Greene, now advocate some form of co-sleeping, and suggest it might prevent SIDS, provided proper measures are taken. Former sleep hard-liner Dr. Ferber has softened his approach and concedes that "children can sleep well during a wide range of circumstances." Still, Ferber does remind his readers that, while kids might sleep well in such an arrangement, their parents might not. He also describes a nightmare scenario: "twelve-year-olds who feel abnormal and unable to attend sleepovers due to needing to sleep in their parents' bed." Dr. Cohen counters that in his experience children who have co-slept during their first couple of years tend to come out as well-adjusted as those who slept in bassinets.

Wherever all family members get the best night's sleep is the right arrangement for your individual family.

Co-sleeping adds a nighttime touch that helps busy daytime parents reconnect with their infant at night. Since nighttime is scary time for little people, sleeping within close touching and nursing distance minimizes nighttime separation anxiety and helps baby learn that sleep is a pleasant state to enter and a fearless state to remain in.

Why sleep sharing works: babies go to sleep better, babies stay asleep better, mothers stay asleep better, breastfeeding is easier, sleep sharing fits in with a busy lifestyle, etc.

Parents who choose to sleep with their babies (a wonderful choice for many families) should be taught how to do it safely. Anything that makes parents more difficult to wake up or anything that hinders babies' ability to breathe should be avoided.

Babies are safer sleeping next to someone who is aware of their presence and easily awoken. Usually, this is the mother. Fathers, siblings, and babysitters do not tend to wake up as easily when needed, though there are exceptions.

Whoever you are, don't sleep with a baby if you are taking something (alcohol, antihistamines, or other drugs) that makes you less aware of the baby when you sleep. The same holds true if you are so sleep-deprived that you would have difficulty waking up if the baby were in need.

Teaching babies to sleep in their own cribs is a good option for some families; sleeping with their babies is a good option for others. Many babies sleep in a crib most of the night, and then join the parents after the last feeding for some snuggle and sleep time together before starting the day.

The U.S. Consumer Products Safety Commission and the JPMA have launched a new national safety campaign urging parents not to ever bring babies to sleep with them, but to always put them to sleep in cribs that meet current safety standards. (Note: the JPMA is the Juvenile Products Manufacturer Association — the association for crib manufacturers).

Which is really safer? The only way to know is to learn how many kids sleep where, and for how long — statistics we just don't have yet. But we do know a lot about the kids who die.

A recent review of all the SIDS cases in Alaska over a period of six years was published in the October 2001 issue of Pediatrics. It was consistent with previous studies. Far more important than where a child slept was the sleeping position and the parents use of tobacco, alcohol, antihistamines, or other drugs. During 6 years, 130 children died of SIDS. Only 2 children died face up in a crib; only one died face up in bed with a non-drug-using parent on a non-water mattress. Fully 98 percent of cases were associated with other risk factors.

Based on my personal observations as a doctor, it doesn't make a difference. In the long run, the little guys who shared their parents' beds for the first few years are just as intelligent and emotionally well-developed as those who slept in bassinets. Another bit of common sense applies here: What you do when your kids are awake matters much more than what you do when they're asleep.

In terms of safety, sharing a bed is controversial. Some inconclusive research says you run a small risk of smothering "Lucy" by rolling over onto her. That said, mammals have slept with their progeny since the dawn of evolution. I find it hard to imagine that something as instinctive as sleeping together could frequently lead to tragedy. As a father, I remember being keenly aware of that little presence when our kids slept with us in the early months.

My feeling is that co-sleeping is perfectly safe, barring such extenuating circumstances as alcohol, drugs, extremely heavy sleep, or anything else that would impair your ability to sense a newborn.

You are free to choose the way that best suits you and your philosophy of parenting. . . If you chose co-sleeping, you must plan when and how to stop. Far too many families start co-sleeping early, assuming it will stop on its own at some point, and then find themselves years later with a five-, seven-, ten-, or twelve-year-old that they "can't get out of" their bed. The parents are unhappy and the child is embarrassed, feeling "different" and unable to host or attend sleepovers.

Co-sleeping with an infant in the kinds of bedding typically used in Western societies (soft mattresses, fluffy pillows, and plush comforters — as opposed to mats on the ground and thin pillows and blankets) does increase the risk of SIDS and suffocation slightly (available studies do not always make a clear distinction between the two.) An overweight parent or one impaired by alcohol or other drugs or medication impose additional risks.

Some people claim that co-sleeping actually protects against SIDS, possibly because babies (and parents) experience more arousals during the night when they co-sleep than when they sleep alone. However scientific evidence regarding the safety of co-sleeping is mainly to the contrary [. . .].

If you choose to co-sleep, you can take steps to minimize or eliminate most of the risk factors.

The safest way to assure that these precautions are always met while still keeping your infant close by, according to the American Academy of Pediatrics in their 2005 guidelines is to keep your infant in your room but in a separate crib [. . .].

If your child is to share your bed after the early months, be aware that young children are frequently very restless sleepers. [. . .] They sleep well but the parents may not.

When parents and children share a bed, it is more difficult to set limits or change habitual sleep patterns.

Recommendations about when the co-sleeping should stop are varied. Some people suggest ending it by the time the child is six months old, before separation anxiety becomes and issue. [. . .] Few child care specialists recommend co-sleeping much past the age of three.

Children can sleep in a room by themselves from the time they are born as long as the parents are near enough to hear them when they cry. An inexpensive intercom can help. If your child starts out sleeping in your room, two to three months is a good age to move her out: when she's sleeping through the night and doesn't need so much care. By six months, a child who regularly sleeps in her parents' room may become dependent on this arrangement and be unwilling to sleep anywhere else. It then often becomes harder to make the change to sleeping in a separate room, although it's never impossible.