A "dirty little secret" among new parents is that more of them than one might think choose to "co-sleep," which is loosely defined as sleeping with one's infant very near by—even in the same bed.
As a mother who chose to co-sleep, I have heard every argument possible from the Grandmother Squad for getting him out of my bed and into a crib—“You’ll smother him,” “You’ll confuse him sexually,” “He’ll never leave.” What they don’t know is how rewarding co-sleeping is. The reward is tempered with worry in the early months, but so is leaving a child to sleep in another room, or living in a continuous state of sleep-deprivation.
If I had the energy, I would advise the Grandmother Squad, the Mommy Police and the Consumer Product Safety Commission that co-sleeping with an infant should be considered if it can be attempted according to safety guidelines; it may actually guard against SIDS, promote breastfeeding and provide vital tactile stimulation. But there are a few aspects of the dilemma that need to be teased apart, first.
Real or manufactured controversy?
Back in 1999, an alarming study about a possible correlation between SIDS and co-sleeping enjoyed wide circulation. It was put out by the Consumer Product Safety Commission (CPSC), and both its construction and its potential advantage to crib manufacturers raised some suspicion. The study was even repudiated by the CSPC vice president, Mary Sheila Gall. Among other things, the study failed to differentiate between SIDS deaths, possibly due to intrinsic CNS factors, and “overlaying,” as infant suffocation by a larger person’s body is called. It did not control for other risk factors such as familial lifestyle choices. James McKenna, an anthropologist and maternal/infant sleep researcher at Notre Dame University, remarked that “It is a safety issue, but not the only safety issue. . . . Most babies die in cribs, so do you conclude that cribs are dangerous and babies should sleep with parents?” (1)
Recognizing risk factors that could contribute to SIDS or overlaying, McKenna, Sears and others have laid down a set of safety guidelines that should minimize the dangers of sleeping with an infant, summarized below:
Guidelines for safer co-sleeping
- Parents who smoke, drink, sleep unusually deeply, have a very high BMI or who feed formula should let the baby sleep in a bedside bassinet or three-sided co-sleeping crib, because smoking and formula feeding increase the risk for SIDS, and alcohol use decreases parental nighttime awareness. Morbid obesity also decreases awareness of the infant and increases the likelihood of smothering.
- No lambskins, waterbeds, pillows, stuffed toys or fluffy bedding. These are smothering risks for young, relatively immobile infants (and so are crib bumpers).
- Don’t overdress or swaddle a co-sleeping child; unlike crib sleepers, they don’t need the extra warmth, and warmth is implicated in SIDS.
- No letting toddlers, older siblings, or anyone who is not a parent sleep with a little baby; they aren’t aware enough of the baby’s position or activity during sleep.
- Avoid a bed with siderails, head- or footboards or pushed against the wall such that a baby could get stuck and smother.
- Avoid falling asleep on the davenport with the baby, or letting the baby sleep alone, there, because of the cushions and the smothering risk.
Sometimes sleep deprivation in the mother of a non co-sleeper poses a hazard, too. I used a bassinet at first, and was exhausted to the point of psychosis. The first week home, I would sit up in bed in the middle of the night and nurse my newborn, holding him in my lap on a pillow. I lost count of the times I would fall forward, dozing, and seal his mouth and nose with a breast. His panicked gasping would awaken me. At other times he would roll off my lap and I would flop backwards, only to awaken later in a start, finding him just about anywhere on the bed. In a similar situation, my cousin once dozed off and dropped her newborn on the floor. Because of those and other factors, she decided to co-sleep on purpose, with safety precautions, and so did I. The bed got stripped of pillows and heavy bedding, and I dressed my son in thin onesies. We slept facing each other, and I remember waking a few times a night, long enough to change a diaper or offer the other breast, but getting a lot more quality sleep.
As for quality sleep, there was a 2002 study done on 101 infants by Hunsley and Thoman presenting evidence that co-sleeping causes disordered sleep architecture, as evidenced by lighter sleep than chronic non co-sleepers when they co-sleep, and deeper sleep than chronic non co-sleepers when they sleep apart from the parent. The authors find that pattern consistent with stress in the infant, and say that such sleep fragmentation has negative effects on development in general and cognition in particular. (2) First of all, while statisticians smile on sample sizes greater than 30, 101 is not all that big a sample. Second, and more pointedly, I have to wonder why, if co-sleeping is so detrimental to baby humans, that it is the overwhelming favorite arrangement of parents world wide? (3) The crib culture in the United States is by no means normative elsewhere.
As I said, in my experience, I did wake long enough to change the baby or latch him on for a feeding, but I was more rested than I had been with the bassinet. My boy always slept on his side, facing me, as did I, facing him. He never rolled on his stomach (a position correlated with SIDS deaths), and I would be dimly aware when he became warm because he would kick off the loose sheet we used. As an added benefit, my husband slept like a rock, because the baby never had to cry for my attention, waking everyone. It was as if the baby and I were in a fairly restful, somnolent give-and-take throughout the night.
According to the conclusion of one famous study (Mosko, 1997), the choppier sleep of a co-sleeping infant is adaptive, and protects against the deep slumber that some researchers feel may be responsible for SIDS. (4) (Failure of the respiratory drive during stage 4 sleep, some speculate) Moreover, arousal at night may be adaptive in the sense that the infant brain can not go too long without a dosing of lactose. Enter breastfeeding.
Nourish all night
Human milk is digested after fifteen minutes, so a common pattern is for an infant to demand nursing every fifteen minutes or so, at times. They have that "milk-drunk" posture and expression afterwards, for a time, as if some deep craving has been satisfied, but then the cycle begins again; breast-fed babies are frequent feeders. Although this is just my speculation, perhaps SIDS in formula-fed infants is due in part to the change in brain metabolism in an infant who sleeps more deeply and feeds infrequently.
A certain level of arousal is necessary to latch onto a bottle or a breast, and then drink the milk. As I recollect, my son would stir a little in his sleep, or sigh, and I would offer the breast, which he seemed to magically know was there, because he would not even open his eyes as he latched. And he would suck for up to an hour occasionally, in an archipelago of sucking bursts, before trailing off and disengaging. That pattern of his remains with me today, like a delicate tattoo drummed on my skin, years since he weaned. It was another aspect of that night-long conversation.
Who knows? Maybe the more constant influx of lactose to the breast-feeding baby's brain mitigates any damage caused by increased stress. Maybe the different character of a co-sleeping, breast-feeding baby's sleep is somehow more healthful. In any case, co-sleeping promotes milk production and makes breast feeding easier, and breast feeding in turn cuts the risk of SIDS in half for each month it is continued.
Nurture all night
And more sugar for the brain is just one advantage of co-sleeping. So is more “sugar” for mother and infant in the form of physical proximity, a secure attachment and increased touching. We have all heard of the “failure to thrive” infant in an orphanage—a baby who has not had his or her quota of loving skin-on-skin contact and who is not growing well. The opposite may be true of a co-sleeping infant—one who has never been “Ferberized” and left alone to cry, perhaps to the point of vomiting. Absent mistrust of the parent ("Why aren't you answering my cry?"), and with plenty of physical contact throughout the night, the co-sleeping infant might possibly progress more smoothly past the window of vulnerability to SIDS.
I want to stress that while no sleeping arrangement is absolutely safe, there are ways to make sharing a bed with the baby significantly safer, and the practice has several things to recommend it. Not least of all, the baby may get more secure snuggling with the parent, more mother’s milk, and perhaps enough respiratory stimulation to avoid sinking into apnea and possible death from SIDS. Furthermore, common sense seems to say that co-sleeping has always been with us, and is probably an adaptive tradition. Keep an open mind about it.
1. McKenna Interview, quoted in Mothering Family Bed Safety; Stephanie Nakhleh. Issue 132, September/October 2005.Updated by rhubarb at Wed Mar 9, 2011, 02:00:40 PM
2. Hunsley M, Thoman EB. The sleep of co-sleeping infants when they are not co-sleeping: evidence that co-sleeping is stressful. Dev Psychobiol. 2002;40:14–22.
3. McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VL, Glotzbach SF. Infant–parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome. Sleep. 1993;16:263–282.
4.Mosko S, Richard C, McKenna J, Drummond S, Mukai D. Maternal proximity and infant CO2 environment during bedsharing and possible implications for SIDS research. Am J Phys Anthropol. 1997;103:315–328.
Thank you, Rescue Rangers! I am flattered that you chose this diary for the community spotlight. The comments are, of course, terrific, and I must compliment everyone for resisting the urge to flame. Parenting is so very personal.
The manifold topics under the co-sleeping umbrella include breastfeeding, American culture and, to get political, class warfare, when you examine what our current economic system exacts from us as parents.
Any posters out there who co-slept as children? Mine was limited to crawling into bed with Mom and Dad on Sunday mornings. Memorable and fun!