Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding

doi:10.1016/j.prrv.2005.03.006

Paediatric Respiratory Reviews

Volume 6, Issue 2, June 2005, Pages 134-152

https://doi.org/10.1016/j.prrv.2005.03.006 Get rights and content

Summary

There has been much controversy over whether infants should co-sleep or bedshare with an adult caregiver and over whether such practises increase the risk of SIDS or fatal accident. However, despite opposition from medical authorities or the police, many western parents are increasingly adopting night-time infant caregiving patterns that include some co-sleeping, especially by those mothers who choose to breast feed. This review will show that the relationships between infant sleep patterns, infant sleeping arrangements and development both in the short and long term, whether having positive or negative outcomes, is anything but simple and the traditional habit of labelling one sleeping arrangement as being superior to another without an awareness of family, social and ethnic context is not only wrong but possibly harmful. We will show that there are many good reasons to insist that the definitions of different types of co-sleeping and bedsharing be recognised and distinguished. We will examine the conceptual issues related to the biological functions of mother–infant co-sleeping, bedsharing and what relationship each has to SIDS. At very least, we hope that the studies and data described in this paper, which show that co-sleeping at least in the form of roomsharing especially with an actively breast feeding mother saves lives, is a powerful reason why the simplistic, scientifically inaccurate and misleading statement ‘never sleep with your baby’ needs to be rescinded, wherever and whenever it is published.

Section snippets

INTRODUCTION

While recent cultural implements such as cribs, mattresses and bedding did not evolve to protect and feed infants throughout the night, protective maternal behaviours including bodily contact between the mother and infant during co-sleeping most certainly did.2, 3 Despite opposition from western medical authorities or police officials, many western parents are increasingly adopting night-time infant caregiving patterns that include some co-sleeping behaviour, especially amongst mothers who

HOW SOCIAL FOLK MYTHS ABOUT THE ‘NORMALCY’ OF SOLITARY INFANT SLEEP ACHIEVED SCIENTIFIC VALIDATION

When infant sleep studies were first undertaken using polysomnography the bottle fed, solitary sleeping infant became the gold standard method used to produce data on ‘normal’ infant sleep physiology. Neither ethological sleep studies of non-human primates nor cross-cultural or ethnographic data on more universal patterns were used as comparators. Instead, western social ‘folk’ assumptions about what constituted healthy infant sleep were made, often based on moral justifications reflecting

The Supine Co-sleeping Infant Probably Emerged to Facilitate Breast Feeding at Night

‘For species such as primates, the mother is the environment’ Sarah Blaffer Hrdy… Mother Nature: A History of Mothers, Infants and Natural Selection (1999)³³

If anthropological evidence on infant sleep and development were integrated and used as a starting point to inform infant sleep research, there is no doubt that the question we would be asking is not if it is safe for an infant to sleep next to its breast feeding mother, but rather, is it safe not to!

Born with only 25% of its adult brain

TOWARD CLARIFYING DEFINITIONS AND DISCOURSE ON MOTHER–INFANT CO-SLEEPING: CO-SLEEPING VERSUS BEDSHARING VERSUS DANGEROUS CONDITIONS

Mother–infant co-sleeping represents the preferred and obligatory sleeping arrangement for most contemporary people. In many instances there is no other choice for families and, still, even in industrialised western countries without the intense breast feeding and physical monitoring that accompanies co-sleeping, the survival of an infant is threatened. For example, Chen and Rogan⁶⁸ found that, even in the USA where infectious diseases do not seriously threaten the lives of infants,

CO-SLEEPING: A MANY DIVERSE THING

‘I slept in the same bed with my granddaddy…and then in the same bed with my four cousins, I never slept alone ‘til I got married’ Bobby Bowden, Head University Football Coach, Florida State University

‘Cosleeping? When both my wonderful children are sleeping at the same time’. Robert Hahn, Ph.D., Center For Disease Control, Atlanta, Georgia

Mother–infant co-sleeping takes different forms worldwide.67, 69, 70, 71, 72 No singular outcome can be associated with it, unless ‘factors’ associated with

FROM THE PERSPECTIVE OF THE BREAST FEEDING MOTHER–INFANT DYAD: WHAT DOES IT MEAN TO ‘BEDSHARE?’

‘Breast feeders are three times more likely to bed share and appear to differ from non-breast feeding bedsharers in several characteristics. These data do not link bedsharing to risk of SIDS.’ McKenna et al.⁷⁶

In the largest in-house laboratory study yet undertaken, differences in the sleep behaviour and physiology of 70 breast feeding mothers and infants were quantified. This study involved over 105 separate nights in the laboratory, 155 8-hour infra-red video recordings and 210 separate mother

INFANT BREATHING AND HEART RATE PATTERNS IN THE BEDSHARING AND SOLITARY SLEEP ENVIRONMENTS

The bedsharing environment is also associated with more central apnoeas, fewer obstructive apnoeas and more periodic breathing in infants than the solitary environment (although the clinical significance of these differences cannot be assessed.⁷⁸ Thus, during bedsharing, irrespective of the routine sleeping arrangement at home, the infant experiences a higher frequency of central apnoeas during stages 1 and 2 and during rapid eye movement (REM) sleep. Among routinely solitary sleeping infants,

SIDS BEDSHARING EPIDEMIOLOGY AND CATASTROPHIC ‘OVERLAYS’

‘The findings suggest that it is not bedsharing per se that is hazardous but the particular circumstances in which bedsharing occurs.’

‘There is no published evidence of any increased risk to a baby from sharing a bed with a firm mattress with parents who do not smoke and have not consumed alcohol or other drugs providing the bedding is arranged so that it cannot slip over the baby's head, and the baby is not sleeping on a pillow, or under an adult duvet.’⁶⁸

‘Sixteen percent of SIDS were

BOTTLE FEEDING–BEDSHARING MOTHER–INFANT DYADS AND BREAST FEEDING–BEDSHARING MOTHER–INFANT DYADS ARE NOT THE SAME!

‘Bad science sets out to make a point, looks neither to the left nor to the right but only straight ahead for evidence that supports the point it sets out to make. When it finds evidence it likes, it gathers it tenderly and subjects it to little or no testing’. Mark Vonnegut, The Boston Globe, October 1999.

Breast feeding and co-sleeping, including breast feeding in the context of bedsharing, are often mutually reinforcing and constitute an integrated system. That is, the choice to breast feed

SUMMARY

‘We believe it is inappropriate to fundamentally condemn the practice of bedsharing by professional advise. In parental counselling, the individual child's needs, the family context, and cultural background need to be taken into account’ Jenni et al. (2005)⁸⁹

The rejection by the media of Commissioner Ann Brown's recommendation against ‘sleeping with baby’ in the USA and the public controversy generated by papers by Nakamura et al.,²⁹ Drago and Dannenberg²⁴ and, more recently, by Scheers et al.,

CONCLUSIONS

‘Pediatricians need to recognize the cultural environments in which children live and how cultural beliefs and values interact with the needs of the individual child and with the biological characteristics of his or her sleep patterns’ Jenni and O’Connor.⁹¹

Discussions about infant and childhood sleeping arrangements will benefit by moving away from the notion that a single recommendation is appropriate. In a recently published supplement to Pediatrics⁹² on ‘Cultural Issues and Children's Sleep:

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REVIEWWhy babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding

Summary

Section snippets

INTRODUCTION

HOW SOCIAL FOLK MYTHS ABOUT THE ‘NORMALCY’ OF SOLITARY INFANT SLEEP ACHIEVED SCIENTIFIC VALIDATION

The Supine Co-sleeping Infant Probably Emerged to Facilitate Breast Feeding at Night

TOWARD CLARIFYING DEFINITIONS AND DISCOURSE ON MOTHER–INFANT CO-SLEEPING: CO-SLEEPING VERSUS BEDSHARING VERSUS DANGEROUS CONDITIONS

CO-SLEEPING: A MANY DIVERSE THING

FROM THE PERSPECTIVE OF THE BREAST FEEDING MOTHER–INFANT DYAD: WHAT DOES IT MEAN TO ‘BEDSHARE?’

INFANT BREATHING AND HEART RATE PATTERNS IN THE BEDSHARING AND SOLITARY SLEEP ENVIRONMENTS

SIDS BEDSHARING EPIDEMIOLOGY AND CATASTROPHIC ‘OVERLAYS’

BOTTLE FEEDING–BEDSHARING MOTHER–INFANT DYADS AND BREAST FEEDING–BEDSHARING MOTHER–INFANT DYADS ARE NOT THE SAME!

SUMMARY

CONCLUSIONS

Journal of Pediatrics

Lancet

Journal of Nurse-Midwifery

Journal of the American Academy of Child and Adolescent Psychiatry

Pediatrics

Early Human Development

Association between sudden infant death syndrome and prone sleeping position, bed sharing, and sleeping outside an infant crib in Alaska

Pediatrics

Evolution of human behavior development

Infant–parent co-sleeping in evolutionary perspective: implications for understanding infant sleep development and the Sudden Infant Death Syndrome (SIDS)

Sleep

Where will baby sleep? Attitudes and practices of new and experienced parents regarding cosleeping with their newborns

American Anthropologist

Frequency of bed sharing and its relationship to breast feeding

Developmental and Behavioral Pediatrics

National Infant Sleep Position Study. Trends in infant bed sharing in the United States, 1993–2000: The National Infant Sleep Position Study

Archives of Pediatrics and Adolescent Medicine

Population-based study of bedsharing and breastfeeding

Pediatric Research

The prevalence and characteristics associated with parent-infant bed-sharing in England

Archives of Disease in Childhood

Bed sharing patterns in a cohort of Australian infants during the first six months after birth

Journal of Pediatrics and Child Health

Mutual behavioral and physiological influences among solitary and co-sleeping mother-infant pairs; Implications for SIDS

Early Human Development

Breastfeeding, bedsharing, and infant sleep

Birth

Mother-infant cosleeping: toward a new scientific beginning

Reasons to bedshare: why parents sleep with their infants

Journal of Reproductive and Infant Psychology

Interaction between feeding method and co-sleeping on maternal-newborn sleep

Journal of Obstetric, Gynecologic, and Neonatal Nursing

Bed sharing promotes breastfeeding

Pediatrics

Infant arousals during mother-infant bed sharing: implications for infant sleep and sudden infant death syndrome research

Pediatrics

Maternal sleep and arousals during bedsharing with infants

Sleep

Babies sleeping with parents:case-control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group

British Medical Journal

Cosleeping increases the risks of the sudden infant death syndrome but sleeping in the parent's bedroom lowers it

Infant mechanical suffocation deaths in the United States, 1980–1997

Pediatrics

Environment of infants during sleep and the risk of the sudden infant death syndrome: results of 1993–1995 case control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers

British Medical Journal

Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study

Pediatrics

Sudden infant death syndrome, bed-sharing, parental weight, and age at death

Pediatrics

Unsafe sleep practices and an analysis of bed sharing 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

Review of hazards associated with children placed in adult beds

Archives of Pediatric and Adolescent Medicine

Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations

Pediatrics

An anthropological perspective on the sudden infant death syndrome (SIDS): the role of parental breathing cues and speech breathing adaptations

Medical Anthropology

Solve Your Child's Sleep Problems

Mother Nature: A History of Mothers, Infants and Natural Selection

Sleeping position, orientation, and proximity in bedsharing infants and mothers

Sleep

More awakenings and heart rate variability during sleep in preterm infants

Pediatrics

The Handbook of Emotion

Higher rectal temperatures in co-sleeping infants

Archives of Disease in Childhood

REVIEW
Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding