Cosleeping

Copy Pasted Safe Co-sleeping information from multiple sources. References and sources included.


Basic safety stuff:
What constitutes a "safe sleep environment" irrespective of where the infant sleeps?

Safe infant sleep begins with a healthy gestation, specifically without the fetus being exposed to maternal smoke.

Breastfeeding significantly helps to protect infants from death including deaths from SIDS/SUDI and from seconday disease and/or congenital conditions.

Post-natally safe infant sleep begins especially with the presence of an informed, breastfeeding, committed mother, or an informed and committed father.

Infants should sleep on their backs, on firm surfaces, on clean surfaces, in the absence of smoke, under light (comfortable) blanketing, and their heads should never be covered.

The bed should not have any stuffed animals or pillows around the infant and never should an infant be placed to sleep on top of a pillow.

Sheepskins or other fluffy material and especially bean bag mattresses should never be used. Water beds can be dangerous, too, and always the mattresses should tightly intersect the bed-frame Infants should never sleep on couches or sofas, with or without adults wherein they can slip down (face first) into the crevice or get wedged against the back of a couch.



Bottle-feeding babies should always sleep alongside the mother on a separate surface rather than in the bed.
If bed-sharing, ideally, both parents should agree and feel comfortable with the decision. Each bed-sharer should agree that he or she is equally responsible for the infant and acknowledge that the infant is present. My feeling is that both parents should think of themselves as primary caregivers.
Infants a year or less should not sleep with other children siblings -- but always with a person who can take responsibility for the infant being there;
Persons on sedatives, medications or drugs, or is intoxicated - -or excessively unable to arouse should not cosleep on the same surface with the infant.
Excessively long hair on the mother should be tied up to prevent infant entanglement around the infant's neck -- (yes, it has really happened!)
Extremely obese persons, who may not feel where exactly or how close their infant is, may wish to have the infant sleep alongside but on a different surface.
It is important to realize that the physical and social conditions under which infant-parent cosleeping occur, in all it's diverse forms, can and will determine the risks or benefits of this behavior. What goes on in bed is what matters.



For safe co-sleeping:
We recommend using a bassinet that attaches safely and securely to parents’ bed, which allows both mother and baby to have their own sleeping space, while baby still enjoys sleeping close to mommy for easier feeding and comforting.

If bed-sharing, practice these safe precautions:
Place babies to sleep on their backs.
Be sure there are no crevices between the mattress and guardrail or headboard that allows baby’s head to sink into.
Do not allow anyone but mother to sleep next to the baby, since only mothers have that protective awareness of baby. Place baby between mother and a guardrail, not between mother and father. Father should sleep on the other side of mother.
Don’t fall asleep with baby on a cushy surface, such as a beanbag, couch, or wavy waterbed.
Don’t bed-share if you smoke or are under the influence of drugs, alcohol, or medications that affect your sleep.



No matter where you have your baby sleep, be sure you provide a safe sleeping environment. If you decide to share sleep with your baby, and this arrangement is working for your family, observe these precautions:

DOS:

Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby's limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.
Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby's presence even while sleeping, that it's extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby's presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby's presence.
Place baby to sleep on his back.
Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of "baby furniture." If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.
Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.



When you shouldn’t co-sleep
To reduce the risk of cot death, the Department of Health recommends you should not share a bed with your baby if:
You or your partner smoke: Nobody knows exactly why, but when smokers sleep with their babies, the risk of cot death is higher.

You or your partner have been drinking alcohol, or have taken medication or drugs: These substances can impair your memory and make you forget that your baby is in your bed. They can also make you to sleep so soundly that you may not realise it if you roll over on your baby.

You feel very tired: Extreme fatigue or a sleep disorder, such as sleep apnoea, may make you sleep so deeply that you're at risk of not awakening if you roll onto your baby.

Your baby was premature: The risks are increased if your baby is premature or of low birth weight.



DO NOT drink alcohol, do drugs or take medication: It is very important to ensure that nothing is impairing your ability to sense your baby's presence in bed. This means abstaining from alcohol before going to bed, not doing drugs and not taking medication.
DO NOT smoke: Smoking poses a significant risk for babies (in terms of SIDS and increased chance of asthma and other conditions) and parents should not smoke in the room that the baby is sleeping in and ideally not at all in the home.
DO NOT let a baby sleep next to an older child, pet, or adult that is not likely to sense the baby's presence: The person most in tune with the baby is a breastfeeding mother. Formula feeding mothers and fathers are less likely to sense their child's presence and should be more cautious about their co-sleeping arrangements. It is not safe to have a baby sleep with older children or pets as they can easily compromise the baby's safety.
DO NOT use heavy adult bedding: Blankets, duvets, pillows and other adult bedding pose a suffocation risk to your baby. Ideally, all adult bedding should be removed from the bed during the early months and only introduced with extreme caution as the baby gets older. Remember that for crib sleeping, it is recommended that babies be put to bed with nothing more than a light baby blanket, so it is safest not to exceed that in your bed either. Both the parents and baby should be dressed warmly enough (but not too warm!) that they do not require additional heavy blankets to keep them warm. A lot of parents that feel they cannot go without any blanket choose to use a sheet or light blanket and only pull it up to their waist and then have baby sleep up higher away from the blanket (of course you need to consider when doing this whether you are the type of sleeper that would subconsciously pull that blanket up to your chin in your sleep).
DO NOT let baby sleep on surfaces such as soft mattresses and waterbeds: Soft mattresses, squishy pillow top mattresses, memory foam, and waterbeds can all result in the baby sinking into the sleep surface and potentially obstructing the baby's ability to breathe. As a result, it is not safe to have an infant sleep on these surfaces.
DO NOT let baby sleep anywhere that has crevices or spaces where the baby can get stuck: Adult beds are designed for adults and not for babies. This is too bad, considering that upwards of 70% of parents bring their baby to bed with them at some point. As a result, it is important to be cautious of any crevices or other spaces where the baby could get stuck. Ensure that the bed is flush with the wall (if pushed up against the wall) and ensure that there are no spaces between the mattress and headboard where the baby could get caught.
DO NOT co-sleep on surfaces other than beds/mattresses: Sleeping on a couch or recliner is not safe. It is too easy for the baby to fall off or get stuck or smothered.
DO NOT leave your baby alone on an adult bed unless the bed and room are completely safe: Some parents will choose to use a crib or bassinet when they are not sleeping with their baby (e.g. for naps, early in the evening, etc.). Some parents choose not to have a crib or other separate sleep surface and therefore need to ensure that the bed and room are completely safe, i.e. the baby cannot fall to the floor, cannot get into anything that is dangerous if exploring the room, etc. We also found using a baby monitor turned up very high and checking on the baby if we heard any noise at all provided additional security.
BE CAUTIOUS about your impact on your baby: I explained above that breastfeeding mothers are very unlikely to overlay or otherwise hurt their baby. However, certain behaviours or characteristics of the mother can make this risk greater. People who are extremely overweight should ensure that they do not create a dip in the mattress that could create an unsafe crevice that the baby could roll into. Excessively long-hair should be tied back to prevent entanglement around the baby's neck. Parents should ensure that they do not wear clothing or jewelry that could cause the baby to suffocate or get entangled. Parents should not wear perfumes or other scented products to bed, as this can impact baby's ability to breathe clearly.
BE CAUTIOUS about your extreme exhaustion: Parents of newborns can often be extremely exhausted. If you are overly tired, you may wish to be more cautious than usual as your extreme exhaustion may result in you being less easily woken or more likely to roll over the baby or pull covers up over the baby's head. It may be best to have your baby sleep on a separate surface in those instances, but still close by.
DO NOT co-sleep if you and your spouse are not both committed to doing it and doing it safely: In order for co-sleeping to work and to be safe, both parents need to be committed to making it work.



Have the infant sleep between the breastfeeding mother and a wall/bedrail: The breastfeeding mother is the one most able to sense and respond to the infant. As a result, the safest place for the infant is between the breastfeeding mother and either a wall, bedrail, or other product designed to ensure that the infant doesn't fall out of bed.
Dress warmly, but not too warm: When sleeping with my children as babies, I always wore a long-sleeved shirt so that I didn't feel the need for a blanket to keep my upper body warm. I would dress my baby in pyjamas and a sleep sack if required, depending on the temperature.
Consider putting the mattress on the floor: Putting the mattress on the floor is the safest way to co-sleep. This ensures that the infant doesn't sustain a fall from an adult bed and also takes away the worry about unsafe headboards and other bed parts. However, you still need to ensure that the mattress is placed flush against the wall and that there is no way for the infant to be trapped between the mattress and the wall.
Preventing falls: There are a number of safety products that can be used to prevent falls if you choose not to put the mattress on the floor. This can include traditional bed rails as well as newer products. With any product designed to prevent falls, it is important to ensure that there aren't gaps where the infant could get caught or fall and also ensure that they come high enough above the mattress that your infant can't be pushed easily over the top of it. Some examples of products I like include the Safety 1st Secure Top Bedrail and the Snug Tuck Pillow, both of which sit on top of the mattress. Another option is the Humanity Family Bed, which lays on top of a regular bed.



Here is some more info about it:
by Tami E. Breazeale
Excerpted from "Attachment Parenting: A Practical Approach for the Reduction of Attachment Disorders and the Promotion of Emotionally Secure Children", Master's thesis, Bethel College, February, 2001.

Solitary infant sleeping is a principally western practice which is quite young in terms of human history. The practice of training children to sleep alone through the night is approximately two centuries old. Prior to the late 1700s cosleeping was the norm in all societies (Davies, 1995). Today in many cultures the practice of cosleeping continues, with babies seen as natural extensions of their mothers for the first one or two years of life, spending both waking and sleeping hours by her side. Cosleeping is taken for granted in such cultures as best for both babies and mothers, and the western pattern of placing small infants alone in rooms of their own is seen as aberrant (Thevenin, 1987). Comprehensive studies of western nonreactive cosleeping, defined as family cosleeping from birth as a custom, rather than as the result of childhood sleep disturbances, are not yet available. However medical and anthropological evidence suggests the western movement to solitary infant sleeping in the past two centuries may have consequences in the areas of attachment security and physical safety.
Attachment and sleeping environment

Early work by John Bowlby noted that the mother and baby pair who were continuously together would have a secure attachment relationship (Bowlby, 1953 cited in Davies, 1995). It is believed that the emotional security of the baby benefits from skin-to-skin contact during the night (Davies, 1995). In a study of early childhood cosleeping by Hayes, Roberts, and Stowe (1996) it was found that infants and children who were solitary sleepers had a much stronger attachment to a security object and were more likely to be disturbed by that object's absence than cosleepers. In a 1992 study of soft object and pacifier attachments in children (Lehman, Denham, Moser, & Reeves) 40% of children with dual soft object and pacifier attachments, and 80% of children with attachments to pacifiers alone were rated as having an insecure attachment relationship with their mothers by 19 months. Attachment benefits of cosleeping are not limited to mother and child; fathers also report enjoying additional time to bond with the baby as a direct result of sharing a sleeping area (Davies, 1995; Seabrook, 1999; Thevenin, 1987). Fathers who share the family bed are likely to experience less disturbed sleep, because babies do not have to awake fully and cry to get their needs met.

Anthropological evidence

Anthropological evidence of cosleeping societies is abundant. In reviews of literature on cosleeping societies Thevenin (1987) and Lozoff and Brittenham (1979) noted classic studies which included nearly 200 cultures, all of which practiced mother-infant cosleeping even if in some cultures the sleeping location of the father was separate. Examples of cultures included in the studies were the Japanese, the Korean, the Phillipino, the Eskimo Indian, the !Kung San of Africa, and the natives of Okinowa (Lozoff & Brittenham, 1979; Thevenin, 1987). The description of the Okinowan Indian culture included observations both of parent-child cosleeping until the age of six and unrestricted breastfeeding, as well as of characteristics of adult behavior that are very consistent with secure attachment histories (Thevenin, 1987). Cosleeping is the cultural norm for approximately 90% of the world's population (Young, 199  .

An interesting contrast to the abundant anthropological evidence of cosleeping is the Israeli kibbutz practice of communal nurseries. In Israeli traditional kibbutz communities, infants are raised sleeping in communal nurseries starting at age six weeks. In a study of the influence on such a sleeping arrangement on infant-mother attachment Sagi, van Ijzendoorn, Aviezer, Donnell, and Mayseless (1994) found the rate of secure attachment was diminished significantly by infants sleeping in kibbutz infant houses instead of in their parents' homes. In their study of 48 healthy infants, all infants spent nine hours a day, six days a week in small groups with a professional caregiver. All infants also went home for four hours during dinner time, from approximately 4 to 8 P.M. The infants in the kibbutzim with home-based sleeping would then spend the overnight hours in the care of their parents while the communal sleeping kibbutzim babies were returned to the infant houses to be put to sleep and watched overnight by two women who were monitoring several children's houses from a central location and were responsible for upwards of 50 children between the ages of 6 weeks and 12 years. These "watchwomen" were kibbutz community members who served in this capacity for one week every six months on a rotating basis and were thus never consistently familiar to the infants. Background data with regards to quality of day care experiences, mothers' biographical characteristics, mothers' job satisfaction levels, and infants characteristics were considered essentially the same in both groups. The sole difference tested was the kibbutz sleeping arrangements. Within the kibbutz home-based infants, 80% were classified as having secure attachment relationships with their mothers, while among the communally-sleeping infants, only 48% demonstrated secure attachment relationship with their mothers. Although this has no direct relationship to cosleeping per se, it is likely that the primary reason the home-based babies had a higher rate of security was because of the consistency of their caregiver, who was by definition more able to respond to them quickly than the watchwomen.

Physical safety

In May 1999, the Consumer Product Safety Commission [CPSC] released a warning against cosleeping or putting babies to sleep on adult beds that was based on a study of death reports of children under the age of two who had died from 1980 to 1997. Among the 2,178 deaths by unintentional strangulation in the Commission's study were 180 young children who had died from being overlain on a sofa or bed. In another analysis of CPSC data it was found that of 515 deaths in an adult bed, 121 of these were the result of overlying and 394 children died as a result of entrapment in the structure of the bed (Heinig, 2000). The CPSC statistics resulted in a media frenzy discouraging cosleeping which, instead of educating the public on how to share sleep safely, chose to alarm parents. Neither media announcement mentioned the 2,700 infants that died in the final year of that study of Sudden Infant Death Syndrome [SIDS], formerly called "crib death"; the vast majority of those infants died alone in their cribs (Seabrook, 1999). Meanwhile, it is interesting to note that the CPSC media announcements did not release data regarding risk factors other than sleeping location, such as whether the overlying adult was under the influence of alcohol or drugs or whether the sleeping surface was appropriate; 79 of the 515 deaths occurred on waterbeds (Seabrook, 1999). Parents must observe safety guidelines for cosleeping, just as they would for picking out a crib.

Safety while cosleeping is of utmost importance. Parents should take very seriously the importance of providing their babies with a safe sleeping environment. There are many guidelines, most of which are common sense (Sears, 1995b; Thevenin, 1987). To start with, the bed must be arranged in such a way as to eliminate the possibility of the child falling out. This can be done using a mesh guardrail, a special cosleeper crib (with three sides), or by pushing the bed flush against the wall, making sure there are no crevices which could entrap the baby. Next, in the early months, parents must be sure to place the baby next to the mother rather than between the parents as fathers are not usually as aware of their infants as the mothers are at first. Cosleepers should use a large bed or a sidecar arrangement, with a three-sided crib clamped flush to the mother's side of the bed and the mattresses set to the same level. They should avoid using heavy comforters or pillows near the infant. Babies should not be overdressed as the warmth of the mother will be shared with the child. Infants who cosleep are usually breastfed throughout the night; this is to be encouraged. Waterbeds, sofas, and other soft surfaces should not be the location for cosleeping (Heinig, 2000; Sears, 1995b; Thevenin, 1987). Most importantly, parents should not cosleep if they are seriously sleep-deprived or under the influence of drugs or alcohol. Parents who are smokers should not cosleep as secondary smoke greatly increases the risk of death from SIDS (McKenna et al., 1993; Sears, 1995b).

Sudden Infant Death Syndrome

Research on cosleeping and SIDS has resulted in remarkable new body of knowledge which many view as affirming the decision of parents to opt for the family bed. Virtually all SIDS-related infant sleep research prior to the 1980s was conducted on isolated infants in sleep laboratories. In contrast to these studies, James McKenna, a medical anthropologist, has conducted several research studies of mother-infant cosleeping. McKenna postulated that infant sleep physiology evolved in the context of cosleeping and that infant sleep cannot be fully understood without studying the infant in its normative cosleeping environment (McKenna et al., 1993).

Within Dr. McKenna's research, cosleeping is defined as the child sleeping close enough to another to "access, respond to or exchange sensory stimuli such as sound, movement, touch, vision, gas, olfactory stimuli, CO2, and/or temperature" (McKenna et al., 1993, p. 264). McKenna believes that cosleeping also alters other risk factors of SIDS, such as dangerous bedding, environmental temperature, and infant sleeping position. Using established polysomnographic recording guidelines, McKenna recorded the sleep, breathing, and arousal patterns of mothers and their two to four month old infants cosleeping in a laboratory and also recorded the same information for infants and mothers sleeping alone in adjacent rooms for two nights and then sleeping together for a third night (McKenna et al., 1994). Preliminary findings of cosleeping research indicated that cosleeping mothers and infants had a significantly higher levels of partner-influenced arousal overlap and synchronous sleep patterns. Since there is a suspected relationship between arousal deficits in infants and some deaths from SIDS (McKenna et al., 1993; Sears, 1995b), McKenna's hypothesis that the influence of cosleeping on the infant's respiratory patterns, central nervous system, and cardiovascular systems may have a protective effect seems quite valid.

Intriguingly, in a 1994 study in the United Kingdom of physiological development, infant sleeping, and SIDS risk in Asian infants, Petersen and Wailoo found that although the Asian babies had several increased physiological risk factors for SIDS, the SIDS rate is much lower in this population. The authors note that perhaps this is due to the increased stimulation the infants receive as a result of Asian infant care practices. These practices include cosleeping, carrying, and other activities which involve the child more in household life (Petersen & Wailoo, 1994). SIDS rates in Asian countries, where cosleeping is often the norm, are significantly lower than those in western society (Thevenin, 1987).

Attitudes toward cosleeping

Cosleeping from birth is recommended by La Leche League International, the world's leading breastfeeding organization (LLLI, 1997), as well as by many professional lactation consultants (Heinig, 2000). The benefits of cosleeping to the nursing couple include increased access to nursing with less disturbance of sleep for both mother and infant. According to sleep lab studies, cosleeping mothers actually nurse their infants more frequently throughout the night, but upon awaking for the morning have little recollection of those interactions. Despite frequent arousals during the cosleeping studies, the mothers reported that they got more sleep cosleeping than they did sleeping apart from their babies (McKenna et al., 1994). An additional benefit of cosleeping and unrestricted night nursing is natural child spacing, as the return to fertility for a nursing woman whose child nurses exclusively and cosleeps, can often be delayed up to a year after the birth. Cosleeping is also reported to lead to a reduction in night fears and to the fulfillment of the maternal protective instinct (Medoff & Schaefer, 1993). Many cosleeping advocates also believe that cosleeping, as a component of natural, or attachment, parenting ultimately leads to more confident and independent children (Sears, 1995a; Thevenin, 1987).

Pediatric experts in decades past have described children sleeping in the "parental bed" as having serious negative consequences on both parents and children. Child care authors and experts such as Dr. Spock, Dr. Brazelton, and Dr. Ferber admonished parents who coslept that they would be creating negative habits or sleep disorders in their children, and fostering unhealthy childhood dependency, and that cosleeping would be harmful to the parents' marriages (Ball, Hooker, & Kelly, 1999). A misunderstanding of the nonreactive custom of cosleeping from birth compared to the reactive use of cosleeping to solve problems with older children seem to be at the root of these anti-cosleeping positions. Studies of reactive cosleeping (Lozoff, Wolf, & Davis, 1984; Rath & Okum, 1995) have found correlations between cosleeping and childhood sleep disorders and family stress, however cultural differences in Black family cosleeping and that of whites and Hispanics were significant. In the 1984 study by Lozoff, Wolf, and Davis, a representative sample of 150 mothers of six-month-old to four-year-old children were interviewed. The rate of reported sleep problems for white cosleeping children was three times that of the solitary sleepers, but the opposite was true for Black cosleepers, who had a lower rate of sleep problems than Black solitary sleepers. Cosleeping was "routine and recent" in 70% of the Black families and 35% of the white families. The results of such studies have failed to show a causal relationship between cosleeping and sleep disorders (Medoff & Schaefer, 1993). Also, the fact that the cosleeping white and Hispanic children were older than the cosleeping Black children in the Lozoff, Wolf, Davis (1984) study, suggests that there is a cultural difference in the use of cosleeping; namely the Black families were more likely to engage in nonreactive cosleeping than the white and Hispanic populations. Although significant, peer-reviewed, studies of nonreactive cosleeping are not yet available, anthropological evidence (Lozoff & Brittenham, 1979; Thevenin, 1987) and research by both Dr. McKenna (1994) and Dr. Sears (1995b) appears to support the validity of cosleeping as a worthwhile custom, especially if the mother and child are breastfeeding.

In an article in the popular magazine The New Yorker, John Seabrook (1999) describes his journey with his wife and newborn son, into the experience of cosleeping. His wife, who coslept with her own parents and who is nursing their son, intuitively desires to cosleep. The author, however, feels more comfortable following the anti-cosleeping experts. After months of sleep deprivation and many tries at teaching the baby to sleep alone, the father relents. He has, in the course of this time, visited the infamous Dr. Richard Ferber, whose sleep-training method is a Pavlovian, incremental, cry-it-out system that promises the reward of solitary all-night sleep from babies once they are "ferberized." In the course of the interview, the author asks Dr. Ferber about cosleeping, and Dr. Ferber, who criticizes cosleeping in his widely popular 1985 book, Solve Your Child's Sleep Problems, recants, instead saying that "there's plenty of examples of cosleeping where it works out just fine" (Seabrook, 1999, p. 64). After this the father begins to recognize that the primary reasons most experts give for their anti-cosleeping stances is parental convenience and a vague idea about the importance of infant independence. Mr. Seabrook learns to respect the sleep patterns of his young child and he adapts, allowing the cosleeping relationship to blossom into a bonding experience which the whole family can enjoy.

Ball, Hooker, and Kelly (1999) conducted a study in the United Kingdom to determine a baseline of nonreactive cosleeping among British parents. It was believed that although cosleeping is not part of the mainstream of parenting ideology in Britain or America, and although the literature in the field is a mess of reactive and cross-cultural juxtapositions, this study would open the door to a valid discussion of the attitudes and practices of nighttime parenting. The study was conducted by enlisting expectant parents in an economically depressed community in Northern England. Parents were interviewed about expectations of infant care practices prior to the birth and then about actual infant care practices when the baby was expected to be two to four months old. Forty families completed both interviews. Both new and experienced parents were interviewed. None of the new parents anticipated cosleeping with the child although 70% of them actually did end up cosleeping with their infants at least occasionally. Mothers being interviewed following the births frequently cited the ease of breastfeeding while lying down in bed and the ease of caring for the child while cosleeping. Not surprisingly the experienced parents were more realistic in their expectations, with 35% anticipating cosleeping and 59% actually participating in cosleeping. The vast majority of the first-time mothers who coslept and all of the experienced mothers who coslept, were also breastfeeding their infants. The study revealed that despite preconceptions of cosleeping as a dangerous and rare practice, these mainstream British parents consider it an effective infant care technique and commonly engage in it.

References
Ball, H. L., Hooker, E., & Kelly, P. J. (1999). "Where will the baby sleep? Attitudes and practices of new and experienced parents regarding cosleeping with their newborn infants." American Anthropologist, 101, 143-151.
Davies, L. (1995). "Babies co-sleeping with parents." Midwives: Official Journal of the Royal College of Midwives, 108, 384-386.
Hayes, M. J., Roberts, S. M., & Stowe, R. (1996). "Early childhood co-sleeping: Parent-child and parent-infant nighttime interactions." Infant Mental Health Journal, 17, 348-357.
Heinig, M. J. (2000). "Bed sharing and infant mortality: Guilt by association?" Journal of Human Lactation, 16, 189-191.
La Leche League International, Inc. (1997). The Womanly Art of Breastfeeding. (6th rev. ed.) Schaumberg, IL: Author.
Lehman, E. B., Denham, S. A., Moser, M. H., & Reeves, S. L. (1992). "Soft object and pacifier attachments in young children: The role of security of attachment to the mother." Journal of Child Psychology and Psychiatry and Allied Disciplines, 33, 1205-1216.
Lozoff, B., & Brittenham, G. (1979). "Infant care: cache or carry." Journal of Pediatrics, 95, 478-483.
Lozoff, B., Wolf, A. W., & Davis, N. S. (1984) "Cosleeping in urban families with young children in the United States." Pediatrics, 74, 171-182.
McKenna, J., Mosko, S., Richard, C., Drummond, S., Hunt, L., Cetel, M. B., & Arpaia, J. (1994). "Experimental studies of infant-parent co-sleeping: Mutual physiological and behavioral influences and their relevance to SIDS (sudden infant death syndrome)." Early Human Development, 38, 187-201.
McKenna, J., Thoman, E. B., Anders, T. F., Sadeh, A., Schectman, V. L., & Glotzbach, S. F. (1993). "Infant-parent co-sleeping in an evolutionary perspective: Implications for understanding infant sleep development and the sudden infant death syndrome." Sleep, 16, 263-282.
Medoff, D., & Schaefer, C. E. (1993). "Children sharing the parental bed: A review of the advantages and disadvantages of cosleeping." Psychology: A Journal of Human Behavior, 30 (1), 1-9.
Petersen, S. A., & Wailoo, M. P. (1994) "Interactions between infant care practices and physiological development in Asian infants." Early Human Development, 38, 181-186.
Rath, F. H., Jr., & Okum, M. E. (1995). "Parents and children sleeping together: Cosleeping prevalence and concerns." American Journal of Orthopsychiatry, 65, 411-418.
Sagi, A., van Ijzendoorn, M. H., Aviezer, O., Donnell, F., & Mayseless, O. (1994). "Sleeping out of home in a kibbutz communal arrangement: It makes a difference for infant-mother attachment." Child Development, 65, 992-1004.
Seabrook, J. (1999). "Annals of parenthood: Sleeping with the baby." New Yorker, 75 (33), 56-65.
Sears, W. (1995a). "Attachment parenting: A style that works." The NAMTA Journal, 20 (2), 41-49.
Sears, W. (1995b). SIDS: A parent's guide to understanding and preventing Sudden Infant Death Syndrome. Boston: Little, Brown, and Company.
Thevenin, T. (1987). The family bed: An age old concept in child rearing. Wayne, NJ: Avery Publishing Group, Inc.
Young, J. (199  . "Babies and bedsharing.... Cosleeping". Midwifery Digest, 8, 364-369.


By Tina Kimmel
Published in Mothering, Issue 114
The Consumer Product Safety Commission (CPSC) and the Juvenile Product Manufacturers Association (JPMA, the crib manufacturers' lobby) recently launched a campaign to discourage parents from placing infants in adult beds or sleeping with them, based on data showing that infants have a very small risk of dying in adult beds.1,2 The CPSC implies that infants in adult beds are at greater risk than infants in cribs, but as we know, and as they know, babies also die in cribs.

What we need to do is calculate the relative riskiness of an infant sleeping in an adult bed versus a crib. We can do that by dividing a measure of danger for each situation by the prevalence, or frequency, of that situation, and then comparing them. (Oddly, the CPSC never presents relative risks.) Using government figures, we can perform a rough calculation to show that infants are more than twice as safe in adult beds as in cribs. This is aside from the many other advantages of cosleeping or bedsharing, such as increased breastfeeding and physiological regulation, the experience of having slept well, parents' feeling of assurance that their child is well and happy, the enhanced security of psychological attachment and family togetherness, and family enjoyment.3

Let's begin by looking closely at the CPSC data. The anti-cosleeping campaign is based on a dataset that contains the 2,178 cases of unintentional mechanical suffocation of US infants under 13 months old for the period 1980 to 1997. CPSC-authored articles about these data reflect only the small portion of deaths that occurred in adult beds.4 However, these data also have been published with summaries of the cause-of-death codes on all 2,178 cases.5

Of these 2,178 infant suffocation deaths, we are certain of only 139 occurring in an adult bed. For 102 of these, we know that a larger person (presumably a sleeping adult) was present, because the cause-of-death code is "overlain in a bed." That does not tell us exactly what caused the death-that is, whether the baby died and then was lain on, or died as a result of being lain on. We can assume that the 37 deaths involving waterbeds occurred in adult beds, since few child waterbeds exist. That gives us a total of 139 infant suffocation deaths known to have occurred in adult beds in these 18 years.

The same data show that 428 infants died due to being in a crib. It is likely that there were preventable risk factors (such as using a crib in need of repair) involved in these crib-related deaths. But that doesn't change our calculations, because the deaths did occur. Similarly, our calculations do not change due to the preventable risk factors (such as intoxication) involved in adult-bed deaths (and other overlying). Note that advocates are raising public awareness to increase the safety of both these sleeping arrangements, with the hope that all these deaths will decrease.

We can't use the other 739 bed- or bedding-related cases in our analysis, because the place of death is not specific enough; these deaths may have occurred in a large adult bed, a single-size adult bed, a child's bed, or a misused crib. Nor can we include the remaining 760 deaths, as we have no idea whether they took place in a sleep situation at all. We also know nothing about the presence or absence of an adult, although a nearby, aware caretaker could have prevented many of these deaths.

So for only 567 (139 plus 42  of the deaths do we know whether they took place in an adult or infant bed. Thus, from 1980 to 1997, 75 percent of the mechanical suffocation deaths of US infants with a known place of occurrence took place in cribs, while 25 percent took place in adult beds.

While it is tempting to make the observation that three times as many babies died in cribs as in adult beds, if three times as many babies were actually sleeping in cribs as in adult beds, the risk would be the same in either place. Based only on this crude death-certificate data, we do not know which is safer. We still need to know how many babies were actually in adult beds or cribs-that is, an estimate of how common cosleeping was.

To estimate cosleeping prevalence, we can turn to the CDC's Pregnancy Risk Assessment Monitoring System PRAMS has been surveying mothers of infants, usually between two and six months of age (but occasionally up to nine months), since 1988. Approximately 1,800 new mothers are sampled each year in each participating state. The sample is rigorously selected to represent essentially every birth in the state, and the response rates are high (70 to 80 percent). Most of the 100 or so PRAMS questions involve prenatal and well-baby care and stressors.

States have the option of adding their own questions and have asked about cosleeping. The basic question asked is, "How often does your new baby sleep in the same bed with you? Always; Sometimes; Never." (Some states add "Almost always."  PRAMS data, therefore, can be used to ascertain cosleeping prevalence in participating states and may be the only data of this kind.

From 1991 through 1999 (the most recent data available) we see that roughly 68 percent (100 percent minus the 23 to 43 percent who "never" coslept) of babies in these states enjoyed cosleeping at least some of the time. Data from the United Kingdom are similar: Helen Ball's Sleep Lab found that around 7 percent always coslept, 40 percent did so for part of the night, and 33 percent never coslept.6

Now let's try to estimate a single cosleeping prevalence rate from these data. Let's say that babies who "sometimes" cosleep do so about half the time. Over all the years of this sample, around 42 percent of babies coslept "sometimes." Let's also say that "always" or "almost always" means 90 percent of the time. Roughly 26 percent of infants coslept "always" or "almost always." Adding "always/almost always" (90 percent of the time x 26 percent of babies) to "sometimes" (50 percent of the time x 42 percent of babies), we get 44 percent of babies ages two to nine months who were cosleeping at any given time, presumably in an adult bed.

Now we can use these figures based on CPSC and PRAMS data to calculate the riskiness of these two sleep arrangements, although it's important to understand the limitations of doing so. For example, these PRAMS data are from only five states (although more will be available in the future), while the CPSC data are from the entire US. The years in which the PRAMS cosleeping data were collected are not the same as those covered by the CPSC dataset, although they overlap. The CPSC covers infants zero to thirteen months, while PRAMS asks about infants two to nine months. The CPSC collects demographic details such as state, income, race, and age of mother (as does PRAMS), as well as time of the death, but they are not easily available to do a more detailed analysis. One or both of these data sources lacks information on impairment of caretaker and other known sleep risk factors, exact sleeping and furniture arrangements during different times in the night, overcrowding and other motivation for cosleeping or crib sleeping, clinical pathology findings, previous health of the infant, etc. Plus, a complete risk analysis should include all causes of infant deaths, including SIDS.

Nonetheless, these data are important population-based sources of information on sleep risks that we would not have otherwise. So let's go ahead and use them to estimate a risk ratio for cosleeping. We take the 25 percent of the suffocation risk in the CPSC data linked to being in an adult bed and divide it by the 44 percent of babies who were actually in adult beds. Then we divide that fraction by a similar fraction for cribs, i.e., 75 percent divided by 56 percent. (If we multiplied each of these fractions by an overall infant death rate, we would have the actual risk for each group.)

This result shows that it was actually less than half (42 percent) as risky, or more than twice as safe, for an infant to be in an adult bed than in a crib. Based upon these calculations using the CPSC's own data, we can say that crib sleeping had a relative risk of 2.37 compared with sleeping in an adult bed.

Therefore, cosleep with impunity-but, of course, be sure to follow the safe cosleeping guidelines described in this issue of Mothering.


NOTES
1. "CPSC, JPMA Launch Campaign about the Hidden Hazards of Placing Babies in Adult Beds," Consumer Product Safety Commission press release no. 02-153, May 3, 2002.
2. S. Nakamura et al., "Review of Hazards Associated with Children Placed in Adult Beds," Arch. Pediatr. Adolesc. Med. 153, no. 10 (1999): 1019- 1023.
3. Summarized in M. O'Hara et al., "Sleep Location and Suffocation: How Good Is the Evidence?" Pediatrics 105, no. 4 (2000): 915-920.
4. See Note 2.
5. Dorothy A. Drago and Andrew L. Dannenberg, "Infant Mechanical Suffocation Deaths in the United States, 1980-1997," Pediatrics 103, no. 5 (1999): e59.
6. Centers for Disease Control and Prevention, "Pregnancy Risk Assessment Monitoring System," www.cdc.gov/nccdphp/drh/srv_PRAMS.htm [1].
7. "The Sleep Lab Awakening," University of Durham (UK) press release, April 6, 2000.

Tina Kimmel, MSW, MPH, is a PhD student in social welfare at the University of California-Berkeley and is writing her dissertation on "The Effect of Welfare Reform on Breastfeeding Rates: Findings from the Pregnancy Risk Assessment Monitoring System." Previously she worked as a research scientist for California's state health department. She would like to acknowledge the state PRAMS epidemiologists who shared their analyzed data for this article: Rhonda Stephens, MPH (Alabama), Chris Wells, MS (Colorado), Ken Rosenberg, MD, MPH (Oregon), Melissa Baker, MA (West Virginia), and especially Kathy Perham-Hester, MS, MPH (Alaska) for her valuable insights. Tina has two children, Rosie (27) and Jesse (21), and one grandchild, Eli (4)-all born at home and all cosleepers.



Co-sleeping Safety
Excerpts from a LLLI press release from September 30, 1999:

Studies have shown that co-sleeping with a breastfeeding infant promotes bonding, regulates the mother and baby's sleep patterns, plays a role in helping the mother to become more responsive to her baby's cues, and gives both the mother and baby needed rest. The co-sleeping environment also assists mothers in the continuation of breastfeeding on demand, an important step in maintaining mom's milk supply.

Dr. James McKenna, Professor of Anthropology at the University of Notre Dame, a member of LLLI's Health Advisory Council, and an expert on the subject of co-sleeping, believes there to be more danger in leaving an infant alone in a crib than in arranging a safe co-sleeping environment. He states, "We agree... that special precautions need to be taken to minimize catastrophic accidents. However, the need for such precautions is no more an argument against all co-sleeping and, specifically bedsharing, than is the reality of infants accidentally strangling, suffocating, or dying from SIDS alone in cribs, a reason to recommend against all solitary, unsupervised infant sleep." He adds, "While specific structural hazards of an adult bed are important, the fact that they exist means neither that they cannot be eliminated nor that all bedsharing is unsafe."



The sensory-rich sleep environment of bed sharing, which leads to more frequent arousals during deep sleep and more light sleep, from which it is easier for the infant to arouse, appears to confer a survival advantage for children at risk of SIDS (McKenna, 1996; McKenna and Mosko, 1990; McKenna et al., 1993).



While infant suffocation as a result of overlying by the parent in a bed sharing environment is not unheard of, unsafe conditions such as parental intoxication with drugs or alcohol, parental disease, extreme parental fatigue, or marked parental obesity have been found to be present in many of these cases (Bass, Kravath, and Glass, 1986; Gilbert-Barness et al., 1991; see also Carpenter et al., 2004; Gessner, Ives, and Perham-Hester, 2001).