Health & Fitness
Sleeping Like a Baby (Safer Sleep for Infants) -- Part Two: Safer Bedsharing
Lists links and guidelines for safer co-sleeping (bedsharing) with infants.
I have been a parent for just over six years now. Within a two year period, we had not one but two cribs recalled.
The wait for our replacement crib the first time was over six weeks because the store had so few cribs in-stock that were not part of the recall. We already bedshared most of the time, anyway so for us this was not such a huge deal.
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For many parents, six weeks without a crib was a real burden. And it was very scary to know a product I purchased for my child had lead to injuries and even fatalities to other infants. Add to this sort of experience the products like crib bumpers, which are suspected to have contributed to multiple infant deaths and “sleep positioners” which were sold as devices intended to prevent SIDS/SUDI (Sudden Infant Death Syndrome/Sudden Unexpected Death of an Infant), which have caused numerous deaths.
There is plenty reason for parents to think, “there has to be a better way.” So some of us come to bedsharing as an alternative. Many more of us come to bedsharing as a commonsense method of breastfeeding and getting good rest. You could call it rest-feeding. So there is a convenience factor as well. Then there are those of us who bedshare for economic reasons, or living space reasons, cultural reasons and the list goes on.
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The thing of it is, information on Safer Bedsharing Guidelines not often readily accessible in places like Pediatrican offices, mainstream parenting magazines, baby care books and certainly not in most hospitals.
I am not a medical expert, nor am I a medical practitioner of any type. The information I am providing here is for informational and educational purposes because, as a doula, perinatal fitness instructor and childbirth educator, I have heard of and seen a great variety of sleep situations in homes. There are many parents who, for social, cultural, economic, or other reasons do and will continue to share sleep space with an infant. When this is done intentionally and with informed forethought, it is often a very rewarding experience for all involved. However, as we tragically saw in late December in Meriden, bedsharing can result in the horrifying loss of a child's life. This is why I believe it is critical to get out the information that does exist on how to make bedsharing, when it does occur, safer for infants.
There are those who say that this is proof that babies should always be placed alone in their cribs with nothing else around them (see my previous post ). However, on the flip side, there are many benefits to safe bedsharing. I am not in any way suggesting that any family should bedshare, but, if you are going to do it, please take precautions to keep baby safe.
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Co-sleeping is a term that is laden with multiple meanings. It is NOT safe for an adult to fall asleep, or even rest when drowsy, in a recliner, on a couch, in a rocker or on any soft or fluffy surface. It is never safe to share sleep surfaces with an infant if you are under the influence of drugs or have been drinking alcohol.
Bedsharing may be a better word to use meaning specifically, an adult choosing to sleeping on the same surface as their infant. Remember that there are no safety regulations for adult beds. Furthermore, it is imperative that if you are sharing an adult bed with an infant that the bed be very firm (in other words HARD). This means NEVER BEDSHARE on an air mattress (inflatable or Sleep Number types), nor on a memory foam mattress. More details below on making an adult bed safer.
Room Sharing means the infant is on his/her own surface (ie crib or Arms Reach Co-Sleeper product), but is sleeping in the same room as the adult care giver. Currently, the American Academy of Pediatrics suggests Room Sharing for young infants.
Making Bedsharing Safer
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Adult(s) in the bed must be:
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The infant's parent(s) (sitters and other care providers may not be as attuned to baby's sleep patterns and needs). Monitor baby to avoid overheating.
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A breastfeeding family. (See the links to Dr. McKenna's work for more on this)
Non-smokers (this is a HUGE factor)
Not extremely obese.
Sober and not under the influence of any drugs, alcohol or medications that may cause drowsiness, or be severely sleep deprived, or in any other way feel that their ability to be awakened could be diminished. Heavy sleepers may be better off with a side-car sleeper. Drugs and alcohol have been linked to many Connecticut bedsharing deaths.
An infant should never be left unattended in an adult bed. Ever.
BEDSHARING means sleeping on an adult bed. NOT a couch, NOT a recliner. Babies in Connecticut have died, trapped in couches and recliners. Don't risk it.
The mattress must be firm. NO Waterbeds, NO Soft Mattresses, NO Airbeds (Memory foam and Sleep Number Beds were referred to as “death traps” by Dr. Rachel Moon, an infant sleep safety authority).
Parents and their infant should dress in seasonally-appropriate pajamas (WITHOUT strings or ties, which are strangulation hazards to baby). Such seasonally-appropriate clothing removes the need for blankets or top sheets, which could lead to a infant entanglement. (Yes, I realize this sounds radical, but trust me, you don't want your baby stuck in a blanket.)
The safest place for the adult mattress is directly on the floor. Several sources suggest pushing the mattress snug against the wall. Better still, place in the center of the room, on the floor, eliminating entrapment risks and minimizing fall risks to the infant. (Again, I know this sounds like a huge chore. We took our own mattress frame apart and stored it for about four and a half years between the two kids. And when the youngest was sleeping across the hall around 18 months old, the bed went back up. It is unconventional, but again, no one takes risks with their baby if they know it is a serious risk.)
Baby should still be placed on her/his back to sleep, and all toys and everything soft should be removed from the sleep surface.
Parental long hair is a strangulation risk, and should be tied up to prevent this issue.
Baby should be full-term and not a preemie.
Sibling bedsharing is not recommended until the younger child is at least a year old, as children do not have the same awareness as parents do.
As Dr. James McKenna states, “It may be important to consider or reflect on whether you would think that you suffocated your baby if, under the most unlikely scenario, your baby died from SIDS while in your bed. Just as babies can die from SIDS in a risk free solitary sleep environment, it remains possible for a baby to die in a risk-free co-sleeping/bed sharing environment. Just make sure, as much as this is possible, that you would not assume that , if the baby died, that either you or your spouse would think that bed-sharing contributed to the death, or that one of your really suffocated (by accident) the infant. It is worth thinking about.”
Additional Resources and Links:
http://www.cpsc.gov/CPSCPUB/PREREL/prhtml08/08312org.html
http://nd.edu/~jmckenn1/lab/guide.html
http://www.calgaryhealthregion.ca/clin/cme/cpg/InfantSleepGuidelines_BedSharing.pdf
http://www.kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/10/8851.pdf
