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Critical New Infant Sleep Guidelines Frown Heavily on Co-Sleeping

By Meredith Carroll |

Mother and child

According to the AAP, co-sleeping is one of the leading causes of sleep-related deaths in infants

About 2,500 babies die annually from sudden infant death syndrome (SIDS). Now the American Academy of Pediatrics is speaking out with updated information about how sleep-related fatalities can be reduced.

New recommendations state that no bumper pads should ever be used in cribs, not just “puffy” bumpers that were previously frowned upon. The AAP also suggests pacifiers be offered to infants, and women breastfeed their babies, according to the Wall Street Journal.

But what’s bound to spark some debate is the suggestion that while babies should sleep in the same room as parents so they may be monitored closely, they should not sleep in the same bed.

Co-sleeping increases the risk of suffocation, according to the AAP.

The American Academy of Pediatrics issued updated recommendations aimed at reducing all sleep-related deaths in infants.

SIDS deaths as a result of babies sleeping on their stomachs have decreased since 1992, at which time the AAP recommended babies sleep on their backs. But deaths from causes like suffocation and entrapment as a result of co-sleeping and crib bumpers have been on the rise.

Many co-sleeping advocates are passionate about the practice and argue the risk of harm to an infant is reduced by a breastfeeding, sober, non-smoking mother.

Image: Wikimedia Commons

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About Meredith Carroll

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Meredith Carroll

Meredith C. Carroll is an award-winning columnist and writer based in Aspen, Colorado. She can be found regularly on the Op-Ed page of The Denver Post. From 2005-2012 her other column, "Meredith Pro Tem" ran in several newspapers, as well as occasionally on The Huffington Post since 2009. Read more about her (or don’t, whatever) at her website. Read bio and latest posts → Read Meredith's latest posts →

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39 thoughts on “Critical New Infant Sleep Guidelines Frown Heavily on Co-Sleeping

  1. Ridiculous. Yet again, instead of taking the opportunity to inform parents about safe co-sleeping vs un-safe co-sleeping and how to know if it’s right for their family (i.e. provably not if you’re on medication or smoke or drink), the AAP chooses to demonize a practice cherished and safely practiced by millions of family globally. Check out the research of Notre Dame’s mother-baby sleep lab for a more balanced view of the “risks” of co-sleeping, and check out the Natural Parents’ Network and Dr. Sears websites sleep sections for more info on safe co-sleeping (co-sleeping certainly can be dangerous under the wrong conditions, but it shouldn’t be if you’re informed!)

    Geesh. How did humanity survive all those thousands of years before the AAP began telling us all our natural parenting instincts are wrong?!? Thank goodness they’re here to save us from ourselves now!

  2. Leanne says:

    Let’s be clear: babies who bed share and die do so from suffocation from bedding and overlying, which in turn is generally caused by parents who smoke, take meds, take drugs and who drink and also bed share. Bed sharing is NOT correlated with SIDS. Sleeping in a crib in a different room from their parents and formula use are correlated with SIDS. Teach parents how to bed share safely and ban the things that cause SIDS.

  3. SafeAPmom says:

    There are over 20 peer reviewed scientific studies that show bedsharing to increase the risk of death for infants, particularly those under 4 months of age. Bedsharing *IS* very much correlated with SIDS and infant suffocation. Adult beds were never made nor intended to accommodate infants and adult bedding such as pillows, comforters, blankets, pillow top mattresses, etc. have all been implicated in infant death.

    As far as the good ole days and long ago humanity? The infant mortality rate was over 50%. If you want your baby to die, just follow their lead.

  4. Andrea says:

    It is virtually unheard of NOT to co-sleep in Japan, which has one of the lowest rates of SIDS in the world. The problem is with North American beds. Co-sleeping on a futon on the floor with minimal bedding is THE safest way for any infant to sleep. So instead of laying out a whack of cash on a crib and bassinet and bumpers and baby bedding, put your mattress in the storage room and buy a futon. After all the kids are transitioned to their own beds, the futon can be recycled and the big mattress can come back out of storage.

  5. daria says:

    roomsharing (a form of co-sleeping) saves lives and is not associated with sids. it also encourages more long-lasting breastfeeding, which also saves lives.

  6. Sara Tamburrino says:

    My infant son, Carl died in 1992. He was in bed with me, was sleeping on my shoulder and his face got turned down into my nightgown and he suffocatsed. I was not drinking of doing drugs. I never have. For over 5 years I have worked for our statewide SIDS organization and as a part of the job I do, I work with families whose babies die of SIDS/SUDI, including accidental suffocation. Over 50% of these babies are in the adult bed with their parent(s). Yes, some of these parents are under the influence of drugs and alcohol, but not all of them are. These babies suffocate on the blankets, pillows, etc., or are rolled onto by the parent. Can you imagine realizing that you are responsible for the death of your baby. This is not something that you ever want to have to go through. The safest way for a baby to sleep is in a crib as close to the parent’s bed as possible. Please I ask each of you to consider doing this. I don’t want to have to call any of you to tell you how sorry I am that your baby has died.

  7. Meredith Carroll says:

    @Sara — Thanks for sharing, and so deeply sorry for your tragic loss.

    @Daria — Results of another study out today talks about the importance of babies sleeping near their parents. http://www.foxnews.com/health/2011/10/19/newborns-need-to-be-near-their-mothers-at-night/

  8. Elizabeth says:

    I co sleep with my 3 month old son. My husband and I have a king sized bed, and my son slept in his crib, right beside me for his first 2 weeks of life. He only start sleeping with me when I accidentally fell asleep breastfeeding him one night in the side lying position. @Meredith- I’ve read SO many studies done in other countries about how co sleeping can actually HELP infants, IF it is done properly. Dr Sears actually has at least 2 articles on it that I’ve read. I understand that there is some risk with it, but I also was not going to listen to my 2 week old son scream himself to sleep because he would not stay asleep when he was placed in the crib. EVERYTHING in life comes with risks. I do not regret co sleeping with my son, and he now naps in his cribs, and will soon be making the full transition to his crib now that he is sleeping through the night.
    @Crunchy- I’ve often wondered the same thing. Thank the Lord for the AAP to tell me how everything I do is wrong.
    @Leanne- I don’t think going from one extreme to another is safe either. Some women never get their milk in. (I know 3 people personally that have had multiple children and never got milk in.) They NEED to formula feed. I think a happy middle would be the best option. :)

  9. Meredith Carroll says:

    @Elizabeth — I have a 7-week-old baby and understand what you’re saying about a crying baby wanting to be in bed with you instead of in the crib.

  10. stephaniemz says:

    Since statistically, babies die most frequently from car accidents, I hope that we see some posts about the dangers of driving in cars. That being said, everything comes with a risk. And statistics mean very little to the mother who did everything “right” and still loses a child.

  11. daria says:

    thanks for the link, meredith. more evidence that babies want to be close to their parents. i’d love to see some safe co-sleeping recommendations rather than a generalized avoid it approach. nearly all mothers end up co-sleeping at some point, even if during a nap, so why not spread helpful guidelines aap?

  12. Alison says:

    I can’t imagine putting my baby in a crib in another room to sleep. Sleeping with her is one of the greatest pleasures of parenting for me. My baby, now 16 months, sleeps in our king sized mattress on the floor with us. We were very careful to keep covers from obstructing her breathing and I am keenly aware of where and how she is positioned all night (I generally spoon her except while she nurses). The studies I have read seem to show that nursing mothers who aren’t using substances have extremely low chances of SIDS striking. I also find it interesting that the SIDS incidence in countries like India and Japan, where infants routinely sleep with parents is much lower than the US, where babies routinely sleep separately in cribs.

    I don’t really care about anyone else’s sleeping arrangements and don’t make negative comments about them, but I find it somewhat ironic when I am criticized for making what I think (after doing my own research) is a safer choice.

  13. http://shouldbethebeginning.com says:

    SIDS, by nature, is UNEXPLAINED infant death, even after autopsy. Suffocation is an identifiable, discoverable, explainable death. Suffocation is not SIDS; there seems to be a significant amount of confusion on this point. If a baby suffocates on bedding (theirs, or their parent’s), is rolled onto by a sleeping adult, or gets their nose/mouth planted in a pillow top mattress and can’t roll themselves over, all of these things–while unbelievably tragic–are suffocation, not SIDS. Co-sleeping might carry risk for some of these reasons, but it does not increase the risk of SIDS; in fact, many co-sleeping studies have found that it actually reduces the risk of SIDS (unexplained infant death), when done properly. If you want to debate the risks of suffocation in various sleep scenarios, I think that’s a very legitimate discussion point. But let’s not call it SIDS, because that is inaccurate at best and fear-mongering at worst.

  14. http://shouldbethebeginning.com says:

    Oh, and Meredith, I actually think you do an exceptional job of distinguishing SIDS/suffocation death in the article. My comment was more to the debate that has followed in the comments, the distinction seems to have gotten very muddied.

  15. SafeAPmom says:

    Just some points for clarification -

    - Anyone who throws Japan up to you as an example is either a) grossly misinformed about international research or b) intentionally trying to mislead. The truth about Japan and trying to compare the death rates of other countries involves what they *don’t* tell you. Japan has traditionally defined SIDS very differently from the US. In 1995, researchers found that “Suffocation as cause of death is rarely recorded in western countries. The situation in Asia is essentially different. Taiwan and Japan both record suffocation rates that are higher than SIDS rates and together these two causes of death sum up to values similar to those for SIDS in western countries.” Japan views death as more of a private, family matter and autopsies are only performed on a fraction of those babies who die – thus there is much less to report. According to the the International Journal of Forensic Science (Sept 2002) “It is a well-recognized fact among professionals that the diagnosis of sudden infant death syndrome (SIDS) involves difficult elements; a SIDS diagnosis is not uniform throughout Japan; and such a diagnosis is not made based on any internationally recognized definition.”

    - Shouldbethebeginning you’ve been misinformed. There is absolutely no difference between SIDS and suffocation on autopsy. None. In the absence of a detectable level of force there is absolutely no way to tell the difference between SIDS and suffocation upon postmortem exam. SIDS and suffocation also share the same risk factors. The best a forensic pathologist can do is to use information gathered in a thorough death scene investigation to determine the ultimate cause of death. There is also no doubt that the scientific evidence definitely shows bedsharing to increase the risk of death for an infant. A bedsharing baby is 20 to 40 more times likely to die.

    - no one is suggesting that anyone put their baby to bed in another room. Where in the world dod that come from? In fact, SIDS organizations and the AAP have been very clear on this for years – the best place for a baby to sleep is alongside the mother in its own, protected space.

    - statistically, a baby (2 wks to one year) is much more likely to die a sleep related death than they are to die in an auto accident. Sleep related deaths are the number one killer of babies born healthy.

  16. daria says:

    @safeap mom, you are misinformed. Healthy, breastfed babies in safe co-sleeping environments promote healthy sleep for mom and infant, and are not at risk for SIDS. 36% of SIDS deaths are in homes where babies are in separate room, while rates for bedsharers were less than half that. Most of the peer reviewed studies are seriously flawed. There are are also variations in types of co-sleeping (including the very dangerous sofa sleeping) that become comingled together in determining these blanket regulations.

  17. SafeAPmom says:

    Daria, please provide citations for your claims from peer reviewed research published in scientific journals. Thanks.

  18. Linda, t.o.o. says:

    Eh. It’s pretty easy to co-sleep safely.

  19. goddess says:

    Funny how some of the same pepole who are slamming the medical experts reports on this are the same ones shoving the reports on breast feeding wholesale down mothers’ throats. LOL! Pick and choose!

  20. Sanriobaby =^.^= says:

    Personally, I wouldn’t co-sleep w/my child, simply due to the fear that I or my hubby might roll over our baby, but I understand why so many parents choose to do so. It’s one thing to co-sleep w/a baby, but it’s another thing to co-sleep w/an infant. Maybe there needs to be more wide spread education to give parents proper guidelines on how to co-sleep safely.

  21. Linda, t.o.o. says:

    “Funny how some of the same pepole who are slamming the medical experts reports on this are the same ones shoving the reports on breast feeding wholesale down mothers’ throats. LOL! Pick and choose!” Not really. When prepared co-sleeping (intentional cosleeping with all normal, recommended safety precautions followed combined with breastfeeding) is compared with crib sleeping, the co-sleeping death rate is lower. Theses blanket public health recommendations assume that all co-sleeping parents have risk factors (obesity, drug or alcohol use, unsafe bedding, formula feeding) that simply don’t apply. This reminds me of the recent backlash against slings because parents weren’t bothering to learn how to use them properly. Let’s face it, for a small infant, literally anything can be a suffocation risk.

  22. daria says:

    certainly. check out anything from (as another commenter mentioned above) the notre dame sleep lab. james mckenna.

  23. http://shouldbethebeginning.com says:

    @safeapmom, it seems that you are determined to retain your beliefs, regardless of the research, so perhaps it’s not worth mentioning. However, since others are reading your comments, I think it is worth noting that there is a balance of research that does not support the blanket claims you are making, nor the generic recommendations made by the AAP.

    The McKenna/McDade 2005 research overwhelmingly disagrees with the American oversimplification of sleep practices, and condemns route recommendations as non-scientific in nature and predicated on an outdated bias against co-sleeping of all stripes, even though empirical research does not support this. “…when critical data about infant bedsharing deaths are missing, health authorities act as if associated details pertaining to why the infants died are unnecessary. Instead, both researchers and health authorities (knowingly or not) fall back on at least 100 years of negative assumptions and anti-co-sleeping rhetoric strengthened by a general societal ignorance sustained by never having been exposed to any science or set of arguments that shows a different perspective.”

    In research published in Pediatrics, Chen demonstrates that there has been absolutely no published evidence of increased risk to a baby sharing a bed where the mattress is firm and bedding is positioned so as to not cover the baby’s face with parents who are not under the influence of medication or alcohol. Bedsharing is a very nuanced practice; not all forms are created equal, and there are a combination of multiple risk factors wherein risk of SIDS and/or death by accidental overlay or suffocation is more prevalent than in other circumstances, such as infants sleeping alone in a crib. The Notre Dame research, which can be found in entirety here, http://www.prrjournal.com/article/S1526-0542%2805%2900023-0/fulltext, explains very clearly why blanket referrals to “co-sleeping” and even “bed sharing” as a uniform practice are misleading, and recommendations to cease these practices is not in keeping with the best outcomes for infants, nor are such recommendations generally being heeded by the public, even as SIDS rates continue to decline.

    With proper education and mitigation of other risk factors (medication, drug or alcohol use, laying infants in on their stomachs, or on surfaces like couches or waterbeds), bedsharing between breastfeeding mother and infants has actually been proven to be one of the safest ways to sleep with the best possible long-term outcomes for mother and children (studies have been done of adults who co-slept or bed-shared as infants and children, who have displayed more positive outcomes in terms of self-esteem and healthy relationships than their isolation-sleeping peers). Your overly simplistic take on bed-sharing, while perhaps well-intentioned, is not comprehensive enough in scope to be particularly useful to this conversation (much like the AAP recommendations themselves).

    A longitudinal study over 10 years of co-sleeping and bed-sharing families, also published in Pediatrics, sums it up nicely: “We believe it is inappropriate to fundamentally condemn the practice of bed-sharing by professional advise. In parental counseling, the individual child’s needs, the family context, and cultural background need to be taken into account.”

  24. http://shouldbethebeginning.com says:

    Oh, and @safeapmom, this is from the actual policy brief released by the AAP on the latest SIDS recommendations:
    “Therefore, when considering the recommendations
    in this report, it is fundamentally misguided to
    focus on a single risk factor or to attempt to quantify
    risk for an individual infant.”
    I think telling @Crunchy Con Mom “If you want your baby to die, just follow their lead.” would fall fall under the fundamentally misguided part of the brief.

  25. Denise says:

    I don’t plan on co-sleeping because I don’t want to take the risk that my husband or I would be responsible for our baby suffocating (and I believe children will grow up emotionally healthy whether they co-sleep or not – parenting isn’t just about proximity) However, what about meeting in the middle on the issue? Everyone agrees here that the baby should be in the same room with their parents when they sleep. The problem is whether or not to have them in the bed with you. Why not put the baby in a moses basket and put the basket in between mom and dad (assuming you have a large enough bed to accommodate the basket) this way the baby is in its own protected space (you cant roll on it and it wont suffocate on bedding) yet still in close proximity to the parents. Has there ever been any studies done on this alternative? I have never even heard of anyone doing this but it is something I have thought about when reading debates such as this and I have been looking into what kind of bassinet I want to get for my baby and see that a moses basket might be a good option for the first couple of months. Any thoughts?

  26. Meredith Carroll says:

    @Denise — Neither of my daughters ever took to the Moses basket. And even if they did, they wouldn’t have gotten the same thing out of it —- even if we did put it in our bed (which we would not have; the basket is too big —- and that’s because they want to be held. My infant daughter sleeps right now in a bassinet pulled up exactly next to me in bed so I can put my hand in there as necessary (usually to stick a pacifier in her mouth about 100 times each night) —- but maybe that’s close to what you’re trying to say?

  27. SafeAPmom says:

    @Shouldbe, Au contraire :-) Perhaps there’s a wee bit of projection going on? :-) Bedsharing is one of the most wonderful bonding activities of parenting – just not with young infants. Having such a blind allegiance to a parenting practice is a lunacy I refuse to participate in when the evidence clearly demonstrates that is not only dangerous but unnecessary. McKenna’s research clearly shows a baby can reap the same benefits alongside in their own, protected space, so it’s no wonder those with knowledge of the research question the motives of those who continue to rabidly defend bedsharing in light of safe alternatives that promote both breastfeeding, bonding and close proximity. Further, much of what you’ve written I’ve heard over and over and over again. It’s the McKenna talking points; nicely spun, carefully worded and a beautifully crafted house of cards. I am a fervent supporter of breastfeeding and attachment parenting principles but I also have a brain. I refuse to be a parrot marching in blind lockstep when the scientific evidence continues to grow and too many babies continue to die.

    The so-called McKenna/Mc Dade research you refer to wasn’t research at all – it was a review paper. I assume the Chen research you refer to is Breastfeeding and the Risk of Postneonatal Death in the United States? If so, that’s kind of like saying they didn’t find bedsharing deaths in a study of outer space. Chen wouldn’t find something he was never looking for.

    I think there’s been a new study or two not included here, but even with conservative estimates, the compilation of the evidence is beyond compelling.

    1. “Co-sleeping should be avoided in infants who are less than 20 weeks of age.”

    McGarvey C, McDonnell M, Chong A, O’Regan M, Matthews T. National Sudden Infant Death Register, The Children’s Hospital, Temple Street, Dublin 1, Republic of Ireland Factors relating to the infant’s last sleep environment in sudden infant death syndrome in the Republic of Ireland. Arch Dis Child. 2003 Dec;88(12):1058-64. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14670769

    2. “Sharing a sleep surface was associated with SIDS .. The association remained if mother did not smoke or the infant was breastfed … Bedsharing is associated with an increased risk of SIDS for infants less than 11 weeks of age.”

    Tappin D, Ecob R, Brooke H. Paediatric Epidemiology and Community Health (PEACH) Unit, Department of Child Health, University of Glasgow, Yorkhill, Scotland, UK Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study. J Pediatr. 2005 Jul;147(1):32-7.

    3. “For mothers who did not smoke during pregnancy, OR for bed-sharing was very small… and only significant during the first 8 weeks of life.” [One way to phrase this in a one sentence headline is: Co-sleeping with children under 2 months old was a significant risk factor for SIDS.]

    R G Carpenter, L M Irgens, P S Blair, P D England, P Fleming, J Huber, G Jorch, P Schreuder Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 2004; 363: 185-91 http://www.thelancet.com

    4. “Epidemiologic evidence shows that there is little or no increased risk for SIDS among infants of nonsmoking mothers but increased risk among infants of smoking mothers and younger infants [less than 8-11 weeks of age] of nonsmoking mothers. It seems prudent to discourage bedsharing among all infants less than 3 months old. Young infants brought to bed to be breastfed should be returned to a crib when finished…[P]utting an infant of a nonsmoking mother to sleep in an adult bed should be delayed until 3 months of age.”

    Lahr MB, Rosenberg KD, Lapidus JA. Bedsharing and maternal smoking in a population-based survey of new mothers. Pediatrics. 2005 Oct; 116(4):e530-42.

    5. “Infants aged less than 12 weeks born of non‐smokers are at increased risk of SIDS with bed sharing compared with infants of non‐smoking mothers not bed sharing.”

    E A Mitchell Department of Paediatrics, University of Auckland, Private Bag 92019, Auckland, New Zealand. Recommendations for sudden infant death syndrome prevention: a discussion document. Arch Dis Child. 2007 February; 92(2): 155–159.

    6. “Bed-sharing is a serious risk factor for sudden infant death for all babies of less than 4 months of age.”

    Ruys JH, de Jonge GA, Brand R, Engelberts AC, Semmekrot BA., Leiden University Medical Center, Reviuslaan 38, 2343 JR Oegstgeest, The Netherlands. Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr. 2007 Oct;96(10):1399-403.

    7. “Bed sharing (especially for infants younger than 13 weeks… increased the risk for sudden infant death syndrome.”

    Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA; GeSID Study Group. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics. 2009 Apr;123(4):1162-70.

    8. “By demonstrating that among an urban population at high risk for SIDS, bedsharing is strongly associated with a younger age at death, independent of any other factors.”

    Cindie Carroll-Pankhurst and Edward A. Mortimer Jr Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at Death PEDIATRICS Vol. 107 No. 3 March 2001, pp. 530-536

    9. “[Y]ounger infants are at highest risk when faced with the environmental challenges of bedsharing….There was no evidence of diagnostic shift and the prevalence of bedsharing did not change over the decade. Conclusions: Bedsharing was associated with a high proportion of SUDI cases, especially in the youngest infants.”

    Lynne Hutchison B, Rea C, Stewart AW, Koelmeyer TD, Tipene-Leach DC, Mitchell EA. Sudden unexpected infant death in Auckland: a retrospective case review. Acta Paediatr. 2011 Aug;100(8):1108-12. doi: 10.1111/j.1651-2227.2011.02221.x. Epub 2011 Mar 22.

    10. “During 2000-2002, 1,064 infants died from [Accidental Suffocation and Strangulation in Bed], resulting in an ASSB mortality rate of 9.2 per 100,000 live births. Most ASSB deaths (71%) occurred before an infant reached 4 months old.”

    Carlberg MM, Shapiro-Mendoza CK, Goodman M. Matern Maternal and Infant Characteristics Associated With Accidental Suffocation and Strangulation in Bed in US Infants. Child Health J. 2011 Jul 17. [Epub ahead of print] PMID: 21769585 [PubMed - as supplied by publisher]

    11. “Reported deaths of infants who suffocated on sleep surfaces other than those designed for infants are increasing. The most conservative estimate showed that the risk of suffocation increased by 20-fold when infants were placed to sleep in adult beds rather than in cribs. The public should be clearly informed of the attendant risks.”

    N. J. Scheers, PhD, George W. Rutherford, MS and James S. Kemp, MD Where Should Infants Sleep? A Comparison of Risk for Suffocation of Infants Sleeping in Cribs, Adult Beds, and Other Sleeping Locations PEDIATRICS Vol. 112 No. 4 October 2003, pp. 883-889

    http://pediatrics.aappublications.org/content/112/4/883.long

    12. “Infant mortality rates attributable to accidental suffocation and strangulation in bed have quadrupled since 1984.”

    Carrie K. Shapiro-Mendoza, PhD, MPHa, Melissa Kimball, MPHa, Kay M. Tomashek, MD, MPHa, Robert N. Anderson, PhDb, Sarah Blanding, MPHa Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland. US Infant Mortality Trends Attributable to Accidental Suffocation and Strangulation in Bed From 1984 Through 2004: Are Rates Increasing? Pediatrics Vol. 123 No. 2 February 1, 2009 pp. 533 -539 (doi: 10.1542/peds.2007-3746)

    http://pediatrics.aappublications.org/content/123/2/533.abstract

    13. “The Office of the Chief Medical Examiner (OCME) has recorded a significant increase of accidental asphyxia deaths in infancy associated with cosleeping in the state of Maryland in 2003. A total of 102 infants died suddenly and unexpectedly during 2003… Ten of the 46 cosleeping infant deaths (20%) were determined to be the result of accidental asphyxia, and 28 cosleeping infant deaths (59%) were classified as “undetermined” because the possibility of asphyxia due to overlay while cosleeping could not be ruled out.”

    Li L, Zhang Y, Zielke RH, Ping Y, Fowler DR. Observations on increased accidental asphyxia deaths in infancy while cosleeping in the state of Maryland. Am J Forensic Med Pathol. 2009 Dec;30(4):318-21. PMID: 19901821 [PubMed - indexed for MEDLINE]

    14. “Bed sharing showed an increased risk of dying accidentally, when compared with infants sleeping in designated infant containers.”

    Beal SM, Byard RW Sudden infant death syndrome in South Australia 1968-97. Part 3: is bed sharing safe for infants? J Paediatr Child Health 2000 Dec 36:552-4http://reviews.bmn.com/medline/search/record?uid=MDLN.21012639&refer=scirus

    15. “Several factors related to the sleep environment during last sleep were associated with higher risk of SIDS: … bed sharing overall, bed sharing with parent(s) alone, and bed sharing in other combinations.”

    Fern R. Hauck, Stanislaw M. Herman, Mark Donovan, Solomon Iyasu, Cathryn Merrick Moore, Edmund Donoghue, Robert H. Kirschner, and Marian Willinger Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study Pediatrics 2003; 111: 1207-1214 http://pediatrics.aappublications.org/cgi/content/abstract/111/5/S1/1207

    16. “[C]osleeping or placing an infant in an adult bed is a potentially dangerous practice. The frequency of cosleeping among cases diagnosed as SIDS in our study suggests that some of these deaths may actually be caused by mechanical asphyxia due to unintentional suffocation by the cosleeping adult and/or compressible bedding materials.”

    Person TL, Lavezzi WA, Wolf BC. State University of New York at Plattsburgh. Cosleeping and sudden unexpected death in infancy. Arch Pathol Lab Med. 2002 Mar;126(3):343-5.

    17. “[A]sphyxia plays a greater role in many sudden infant deaths than has been historically attributed to it.”

    Pasquale-Styles MA, Tackitt PL, Schmidt CJ Infant death scene investigation and the assessment of potential risk factors for asphyxia: a review of 209 sudden unexpected infant deaths. . J Forensic Sci. 2007 Jul;52(4):924-9. Epub 2007 Jun 6.

    18. “Bed-sharing was involved in most of the unintentional suffocation deaths (90.9%) and the SIDS deaths (70.0%). All unintentional suffocation deaths (100%) and the majority of SIDS deaths (77.5%) took place in a non-crib sleeping environment….The study demonstrates how CDR provides enhanced documentation of risk factors to help steer prevention efforts regarding SUID deaths in a community and reaffirms infants in an unsafe sleep environment have an increased risk of death.”

    Brixey SN, Kopp BC, Schlotthauer AE, Collier A, Corden TE. Department of Pediatrics, Policy Core, Injury Research Center, Medical College of Wisconsin, Downtown Health Center Pediatric Clinic, Milwaukee, Wisconsin, USA. Use of child death review to inform sudden unexplained infant deaths occurring in a large urban setting. Inj Prev. 2011 Feb;17 Suppl 1:i23-7.

    19. “Bed-sharing appears to increase the proportion of unexplained deaths, regardless of the position of the infant.”

    Thogmartin JR, Siebert CF Jr, Pellan WA. Palm Beach County Medical Examiner Office, West Palm Beach, Florida Sleep position and bed-sharing in sudden infant deaths: an examination of autopsy findings. J Pediatr. 2001 Feb;138(2):212-7. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WKR-45SR7D1-1H&_cover date=02%2F28%2F2001&_alid=128612081&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=6913&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1a30538b9ea46661bbf85336bdc6f88d

    20. “Bed sharing was associated with 2 times greater risk of SIDS compared with not bed sharing. .. bed sharing was still associated with an increased risk of SIDS, even when the infant was not using a pillow or sleeping on a firm surface…Bed sharing is a common practice among black infants. It is associated with a clear and strong increased risk of SIDS…This practice likely contributes to the excess incidence of SIDS among blacks.”.

    Fu LY, Moon RY, Hauck FR. Bed sharing among black infants and sudden infant death syndrome: interactions with other known risk factors. Acad Pediatr. 2010 Nov-Dec;10(6):376-82.

    21. “Babies were found on a sleep surface that was not designed for infants (adult bed, sofa, or chair) in more than 75% of the deaths. Bedding covered the baby’s head or face in nearly 30% of the cases. A shared sleep surface was the site of death in almost half the cases.”

    Kemp, J. S., Unger, B., Wilkins, D., Psara, R. M., Ledbetter, T. L., Graham, A.{p. M. A., Case, M., Thach, B. T. Unsafe Sleep Practices and an Analysis of Bedsharing Among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths. Pediatrics Vol. 106 No. 3 September 1, 2000 pp. e41

    http://pediatrics.aappublications.org/content/106/3/e41.full

    22. “In addition, the co-sleeping habit, which was not uncommon in Japan, seems to contribute to certain deaths of infants whose causes of death were controversial. In the investigation of SIDS, therefore, the sleeping environments, such as bedclothes and the co-sleeping habit, as well as the sleeping position should be taken into consideration as risk factors.”

    Mukai T, Tamaki N, Sato Y, Ohno Y, Miyazaki T, Nagamori H, Hara S, Endo T. Department of Forensic Medicine, Tokyo Medical University, 160-8402, Tokyo, Japan Sleeping environments as risk factors of sudden infant death syndrome in Japan. Leg Med (Tokyo). 1999 Sep;1(1):18-24.

    23. “Asian v. Western Countries – These comparisons are grossly misleading and often used by those who may lack detailed knowledge on SIDS research. Unfortunately, the ways infant deaths are investigated and diagnosed vary from country to country and even state to state in the US. For example, up until 1995, Japan held two definitions of SIDS. Researchers that compared Asian and western countries found that ‘Suffocation’ as cause of death is rarely recorded in western countries. The situation in Asia is essentially different. Taiwan and Japan both record suffocation rates that are higher than SIDS rates, and together these two causes of death sum up to values similar to those for SIDS in western countries. Additional research in Japan has found bed sharing to be a risk factor for SIDS.”

    Cindie Carroll-Pankhurst* and Edward A. Mortimer Jr.) Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at Death. PEDIATRICS Vol. 107 No. 3 March 2001, pp. 530-536 http://pediatrics.aappublications.org/cgi/content/abstract/107/3/530?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=co-sleeping&searchid=1068846875876_9946&stored_search=&FIRSTINDEX=0&sortspec=date&resourcetype=1&journalcode=pediatrics

    24. “Almost all SIDS deaths in Alaska occurred in association with prone sleeping, bed sharing, or sleeping outside a crib.”

    Gessner BD, Ives GC, Perham-Hester KA. Association between sudden infant death syndrome and prone sleep position, bed sharing, and sleeping outside an infant crib in Alaska. Pediatrics Vol. 108 No. 4 October 1, 2001 pp. 923 -927 (doi: 10.1542/peds.108.4.923)

    http://pediatrics.aappublications.org/content/108/4/923.abstract

    25. “It might be prudent to inform parents that co-sleeping is a risk factor for SIDS and that it should therefore be avoided.” [Note: this study focuses on deaths over 100 years ago.]

    Williams FL, Lang GA, Mage DT. Sudden unexpected infant deaths in Dundee, 1882-1891: overlying or SIDS? Scott Med J. 2001 Apr;46(2):43-7.

    26. “Bed sharing is a risk factor for SIDS and is especially enhanced in smoking parents and in very young infants.”

    Mechtild M. Vennemann MD, MPHa, Hans-Werner HenseMDb, Thomas Bajanowski MD, PhDc, P.S. Blair PhDd, Christina Complojera, Rachel Y. Moon. Bed Sharing and the Risk of Sudden Infant Death Syndrome: Can We Resolve the Debate? The Journal of Pediatrics doi:10.1016/j.jpeds.2011.06.052 28 June 2011

    http://www.sciencedirect.com/science/article/pii/S0022347611006809

  28. daria says:

    Interesting because blind adherents to AP seem a little off to me…. Anyway, interesting that you dismiss out of hand research and researchers you don’t like. A review article criticizes and examines the limitations of already published peer reviewed studies. Because, see, peer reviewed publication does not equal impeccable research. Feel free to list tons of articles though, and feel free to assume correlation is causation, and feel free to sidestep that it is possible to create a safe cosleeping environment ( a number of studies you refer to support
    this) and feel free to chastise self righteously. Meanwhile, we’ll all be raising our kids how we see fit, and you’ll be doing the same.

  29. SafeAPmom says:

    Daria, I don’t dismiss any research. I read it all. I used to support bedsharing and still do with older children – just not with young infants. The science changed my mind because like it or not, it runs about 10 – 12 to 1 against bedsharing. In addition to all the studies demonstrating its risks, there is not ONE STUDY that demonstrates bedsharing to be the safer option. Not one. One would think that if it were as benign as you claim, there would be one somewhere. Hmm. Oh and nice try with the correlation/causation thing ;) If I didn’t know better I’d swear you were a tobacco company and we were talking about lung cancer. :-) However, anyone who knows anything about scientific research knows that there is no such thing as an absolute *proof* in science and that intelligent people can draw conclusions based on a compilation of the evidence.

    No side stepping here. :-) There are many ways to create a safe, co-sleeping environment but it is impossible to create a safe bedsharing one. Certainly, there are safer ways do do anything risky – heck, there are safer ways to do crack but responsible and rational people don’t go around promoting an activity that is inherently dangerous. Bedsharing is inherently dangerous to young infants.

  30. Maggie says:

    When my mother’s children were small, the pediatrician said it was mandatory to always put the baby to sleep on her stomach, so that if she spits up in the night she won’t aspirate. When my children were small, the only safe position was on his side. Now it’s on his back.

    In the meantime, the last two babies I grandmothered both had strong preferences about the position in which they could sleep, and neither one of them conformed to the pediatrician’s wishes.

    From my perspective it still seems like ‘experts’ have strong ‘feelings’ which they then try to dress up with logic and ‘studies.’ Studies that find correlation without looking at the details are worse than useless.

    The only SIDS death I ever knew personally was in an approved bassinet, a baby sleeping on a fairly firm surface with no bumpers or pillows anywhere near. The hypothesis at autopsy was that either the child was just starting an upper respiratory infection or … well, we don’t know why.

    Maybe we should just acknowledge that our experts don’t know everything, and stop punishing parents by blaming their behavior or skills when disaster strikes.

  31. Linda, t.o.o. says:

    “There are many ways to create a safe, co-sleeping environment but it is impossible to create a safe bedsharing one.” You can say this as many times as you want. That doesn’t make it true. You pick and choose research and quotes to demonstrate what you already believe.

  32. Meagan says:

    I think there probably are safe ways to co-sleep, but I’m finding this comment stream a little sickening. Sara, your story makes my stomach clench, I am so sorry, and I don’t understand how 30 comments can simply ignore it to continue this “what do they know anyway?”At tirade.

    I DO think some safe co-sleeping guidelines would be literally life saving because I suspect many parents end up co-sleeping at some point, from exhaustion, which is far from optimal. I’ve been in the position of choosing between the fear of dropping my baby while nursing upright or co-sleeping. Guidelines would help.

  33. SafeAPmom says:

    Dr. Sears is not a SIDS expert. He has never conducted, written or published and SIDS, SUID or sleep related studies.

  34. Dee Bee says:

    I think that it’s never healthy to go to extremes. It’s obvious that we STILL don’t know whether co-sleeping is BAD or GOOD, so the responsible thing to do is to be CAREFUL. I chose to use a bed-side co-sleeper (Arm’s Reach) so that I could have my baby in the room and at arm’s reach, but not in the bed with me. I chose that because I personally don’t trust my sleeping self (or my partner’s) to know in my sleep that I’m not going to roll over a baby; and like Sara’s very sad case, sometimes you can be the utmost careful and still an accident can happen.

    I also think that it’s indeed very different to co-sleep in the same bed with a BABY vs. an INFANT. I felt comfortable sleeping in the same bed with my son only after he was 9 months old (and could sit up, hold his head up, push with some strength, etc.). And I agree that it’s a wonderful feeling, but I can’t really do it all night because he kicks a lot. ;-)

    Also, Dr. Sears has been criticized for being a little too radical in his beliefs. I still used his Pregnancy and Baby books, but with a grain of salt. Again, because I am mistrustful of any radicalism/extremism.

    Why don’t we all just calm down?

  35. daria says:

    Dear safeap mom, your link cites McKenna under references. You may also consider enrolling in an introductory statistics and research methodology class. Like Dr Sears, you are also not a SIDS expert. I never bedshared with my kids as newborns btw, but found your first post so horrible that I felt compelled to keep writing. No parent deserves to lose a child for any reason, and your implication otherwise is reprehensible.

  36. baby and new infant says:

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    http://www.youandyourfamily.com

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