Friday, October 01, 2010

the safety of sharing a bed with a baby

Newspaper and other public media outlets are declaring that "Sharing bed raises infant death risks"

I have, for many years, encouraged mothers to consider co-sleeping. I was part of a group who prepared a co-sleeping brochure "Is your baby sleeping safely?" [2004 BFHI Australia]

Sue Cox explores the complex issue of safe co-sleeping and breastfeeding [see full article], with reference to James McKenna who has written and spoken extensively on the matter:
Professor McKenna defined co-sleeping as not about sharing a physical area, ie a bed, but having the baby within arm's length. He continued on by saying that breastfeeding and co-sleeping are the same adaptive complex designed by natural selection to maximise infant survival and parental reproductive success; there is no documented scientific study to show deleterious consequences of co-sleeping in safe environments; we have come to think of the abnormal as normal; and we are mistaking parental best interests for the infant's best interest. He suggested that current Western beliefs are based on Western European cultural history in which infanticide by 'overlying' existed and was so commonplace that same-bed co-sleeping was outlawed. This cultural history also favoured the notion of romantic love, patriarchal household authority and sanctity of parental privacy.

The claim that bedsharing raises infant death risks originates from the South Australian Coroner's review of the deaths of five babies, aged 3 weeks to 10 months. [full report]

The forensic pathologist has been reported to say that "Western culture had turned co-sleeping into something dangerous. ... in some cultures babies traditionally slept with their parents, but usually on firm bedding or on the floor without the weight of heavy covering."

Rather than a *blanket* outlawing of all co-sleeping, parents need to know where the danger lies. The same principles apply whether the mother is co-sleeping with her baby or placing her baby in another location such as a cot.

Avoid unsafe physical situations:
One of the five babies who died was suffocated when she became entrapped in the cushions at the back of a couch after falling asleep with her father.
Any parent knows about the exhaustion that we all face with the changes in the early days of parenting. It is not safe for anyone to lie on a couch with a baby. It is not safe for a baby to be sleeping in any environment where she can become trapped under or between cushions, pillows or other bedding. It is not safe for a baby to go to sleep lying on a parent who is also falling asleep, or even to let a baby sleep with other children.

Avoid unsafe temperature rise
A baby who is over-dressed, or over heated is placed at danger. Never use an electric blanket or other bed heaters with a baby. When sleeping with a baby, use cotton sheets and wool blankets, which allow air flow and moisture balance, rather than synthetic blankets and quilts/doonas. It is not safe to have pets in a room with a baby.

Avoid unsafe parental situations
Parents who have taken substances that may suppress their ability to respond (eg alcohol, cold medication, sleeping pills), or parents who smoke, should not co-sleep with their babies.

A breastfeeding mother who sleeps with her baby is intentionally responsive to the baby, and will usually form a C-shape with her own body around her child. In this way she will be responsive and alerted by any unusual movement by the child.

Sleep studies have shown mothers and babies interacting significantly while both appear to be sleeping. Mothers who follow intuitive patterns of mothering are able to learn safe sleeping with their infant, as well as being able to put their baby down in a safe place such as a cot for sleep.

Reference [quoted in Sue Cox's article linked above]:
McKenna JJ 1998 Breastfeeding and Mother-Infant Co-sleeping as an Adaptive System: Historical and Biocultural Perspectives. "Breastfeeding The Best Investment," CAPERS August Seminar, Melbourne, Australia.


Ann said...

Hi Joy,

The Coroner's findings are here:

Joy Johnston said...

Thankyou, Ann, for the link.

Having now read the full report from the Coroner, I am satisfied that my comments in the blog are reasonable. The circumstances surrounding the tragedy of unexpected death of a baby must be investigated and reported on.
The interpretation taken from these five deaths, that sleeping with another person is intrinsically unsafe, is steeped in cultural bias. Another person looking at these deaths may have noted the effect of drugs and alcohol and perhaps social factors in several of the cases, and made warnings about accidental suffocation.

Joy Johnston said...


The (US) FDA and the Consumer Product Safety Commission (CPSC) have issued a joint warning against the use of sleep-positioning devices designed for babies (in cots).
The devices have caused 12 infant deaths over the past 13 years.
“Our goal is to make sure parents and caregivers are aware of the risks and to warn them to immediately stop using these devices,” said FDA principal deputy commissioner Joshua Sharfstein in a statement to reporters.
The devices, which have been on the market since the 1980s, have risers on their sides to hold a baby in place during sleep. Some also include wedges to raise the baby’s head. Several of the devices were cleared by the FDA as a means of alleviating symptoms caused by gastroesophageal reflux disease (GERD) and for preventing flat-head syndrome, a deformity caused by pressure on one side of a baby’s head.
However, the FDA, which has jurisdiction over the products because of the medical claims made by the manufacturers, has now determined that the risk of death far outweighs any potential benefits provided by the sleep positioners.
[source: Medscape ]