Friday, August 04, 2006

Are You Afraid To Co-Sleep?

If you're not afraid to cosleep, you should be.  At least according to the state of Indiana's latest public service announcement warning parents of the danger of suffocating their infants.  The latest ad is part of a series of PSA's trying to educate parents to potential dangers and can be viewed here. (Warning, clip is truly frightening.  It's as if a parent were using his video camera and is very realistic.  Even knowing that it's not true, I felt sick after watching it.  Discretion advised!)

Indiana is concerned about a growing number of children who have died because of unsafe sleeping practices.  But their own statistics don't prove the inherent risks of cosleeping. 

 In Marion County in 2001, there were 15 infant deaths due to suffocation while sleeping. Of those, 13 deaths were associated with unsafe sleeping conditions. Two of the 13 babies were suffocated when someone sleeping with them rolled on top of the infant.

From 1995 to 2000, 69 infants died in unsafe sleeping circumstances in Marion County. These circumstances include an infant who suffocated when his head became wedged between cushions of a couch; an infant that died when a 3-year-old sibling rolled on top of him in an adult bed; an infant who suffocated when his twin rolled on top of him; an infant who died sleeping on a pillow in his parent's bed; and a child who suffocated with his face in his crib pillow.


What their statistics prove is that parents need to be aware of how to sleep their babies safely.  Only two of the deaths reported were from parental smothering, and in neither of those cases do we know if there were other risk factors involved such as alcohol consumption, drugs, or illness. 

Babies can die anywhere, when their sleep area is unsafe.    There are risk reducers no matter where a child sleeps.  When a hundred babies a year were dying in the 1980s in cribs (not including the thousands per year who died from SIDS in their cribs), crib manufacturers worked to make their product safer, and spread the word to parents about safe crib sleeping.   Their advice included fitted matresses, close crib rails, removal of pillows and stuffed animals, etc. 

Cosleeping is no different.  There are ways to make cosleeping safe for your baby.  From API:

  • Baby should sleep next to mother, rather than between mother and father.
  • Take precautions to prevent baby from rolling out of bed. Use a mesh guardrail and be sure the guardrail is flush against the mattress and fill in any crevice with a rolled-up baby blanket or towel.
  • Use a large bed with a mattress that fits snugly against the rail or is flush up against a wall. Don't use fluffy bedding or cover baby with comforters, etc.
  • Do not sleep with your baby if you are under the influence of alcohol, drugs, or sleep-inducing over-the-counter medications or if you are overly exhausted from sleep deprivation
  • Do not allow baby-sitters or older siblings to sleep with baby.
  • Don't fall asleep with baby on a couch, bean bag chair or waterbed.
  • Do not let baby sleep unattended on an adult bed.
  • Don't overly bundle baby, because they get additional warmth from the mother's body. Overheating can be dangerous to infants.
  • Instead of using scare tactics, designed to be alarmist and extreme, the state of Indiana should be encouraging parents to sleep safely with their children when they so desire. 

    There are many benifits to co-sleeping, after all:

    1. Babies sleep better. Sleepsharing babies usually go to sleep and stay asleep better. Being parented to sleep at the breast of mother or in the arms of father creates a healthy go-to-sleep attitude. Baby learns that going to sleep is a pleasant state to enter (one of our goals of nighttime parenting).

    Babies stay asleep better. Put yourself in the sleep pattern of baby. As baby passes from deep sleep into light sleep, he enters a vulnerable period for nightwaking, a transition state that may occur as often as every hour and from which it is difficult for baby to resettle on his own into a deep sleep. You are a familiar attachment person whom baby can touch, smell, and hear. Your presence conveys an "It's OK to go back to sleep" message. Feeling no worry, baby peacefully drifts through this vulnerable period of nightwaking and reenters deep sleep. If baby does awaken, she is sometimes able to resettle herself because you are right there. A familiar touch, perhaps a few minutes' feed, and you comfort baby back into deep sleep without either member of the sleep-sharing pair fully awakening.

    Many babies need help going back to sleep because of a developmental quirk called object or person permanence. When something or someone is out of sight, it is out of mind. Most babies less than a year old do not have the ability to think of mother as existing somewhere else. When babies awaken alone in a crib, they become frightened and often unable to resettle back into deep sleep. Because of this separation anxiety, they learn that sleep is a fearful state to remain in (not one of our goals of nighttime parenting).

    2. Mothers sleep better. Many mothers and infants are able to achieve nighttime harmony: babies and mothers get their sleep cycles in sync with one another.

    Contrast sleepsharing with the crib and nursery scene. The separate sleeper awakens – alone and behind bars. He is out of touch. He first squirms and whimpers. Still out of touch. Separation anxiety sets in, baby becomes scared, and the cry escalates into an all-out wail or plea for help. This piercing cry awakens even the most long distance mother, who jumps up (sometimes out of the state of deep sleep, which is what leads to most nighttime exhaustion), and staggers reluctantly down the hall. By the time mother reaches the baby, baby is wide awake and upset, mother is wide awake and upset, and the comforting that follows becomes a reluctant duty rather than an automatic nurturant response. It takes longer to resettle an upset solo sleeper than it does a half-asleep baby who is sleeping within arm's reach of mother. Once baby does fall asleep, mother is still wide-awake and too upset to resettle easily. If, however, the baby is sleeping next to mother and they have their sleep cycles in sync, most mothers and babies can quickly resettle without either member of the sleepsharing pair fully awakening. Being awakened suddenly and completely from a state of deep sleep to attend to a hungry or frightened baby is what leads to sleep-deprived parents and fearful babies.

    3. Breastfeeding is easier. Most veteran breastfeeding mothers have, for survival, learned that sharing sleep makes breastfeeding easier. Breastfeeding mothers find it easier than bottlefeeding mothers to get their sleep cycles in sync with their babies. They often wake up just before the babies awaken for a feeding. By being there and anticipating the feeding, mother can breastfeed baby back to a deep sleep before baby (and often mother) fully awakens.

    A mother who had achieved nighttime-nursing harmony with her baby shared the following story with us:
    "About thirty seconds before my baby wakes up for a feeding, my sleep seems to lighten and I almost wake up. By being able to anticipate his feeding, I usually can start breastfeeding him just as he begins to squirm and reach for the nipple. Getting him to suck immediately keeps him from fully waking up, and then we both drift back into a deep sleep right after feeding."

    Mothers who experience daytime breastfeeding difficulties report that breastfeeding becomes easier when they sleep next to their babies at night and lie down with baby and nap nurse during the day. We believe baby senses that mother is more relaxed, and her milk-producing hormones work better when she is relaxed or sleeping.

    4. It's contemporary parenting. Sleepsharing is even more relevant in today's busy lifestyles. As more and more mothers, out of necessity, are separated from their baby during the day, sleeping with their baby at night allows them to reconnect and make up for missed touch time during the day. As a nighttime perk, the relaxing hormones that are produced in response to baby nursing relax a mother and help her wind down from the tension of a busy day's work. (See

    5. Babies thrive better. Over the past thirty years of observing sleepsharing families in our pediatric practice, we have noticed one medical benefit that stands out; these babies thrive . "Thriving" means not only getting bigger, but also growing to your full potential, emotionally, physically, and intellectually. Perhaps it's the extra touch that stimulates development, or perhaps the extra feedings (yes, sleepsharing infants breastfeed more often than solo sleepers).

    6. Parents and infants become more connected. Remember that becoming connected is the basis of parenting, and one of your early goals of parenting. In our office, we keep a file entitled "Kids Who Turned Out Well, What Their Parents Did." We have noticed that infants who sleep with their parents (some or all of the time during those early formative years) not only thrive better, but infants and parents are more connected.

    7. Reduces the risk of SIDS. New research is showing what parents the world over have long suspected: infants who sleep safely nestled next to parents are less likely to succumb to the tragedy of SIDS. Yet, because SIDS is so rare (.5 to 1 case per 1,000 infants), this worry should not be a reason to sleep with your baby. 

    (shamelessly ripped from Dr. Sears website)

    So, feel free to sleep with your baby, despite what the state of Indiana thinks.  But do so safely so that you and your baby will reap the benefits! 

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