Co-sleeping

Co-sleeping is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used. Bed-sharing, a practice in which babies and young children sleep in the same bed with one or both parents, is a subset of co-sleeping. Co-bedding refers to infants (typically twins or higher-order multiples) sharing the same bed. There are conflicting views on bed-sharing safety and health compared to using a separate infant bed. The conflicts surrounding infant sleep are exacerbated by the misuse of the term co-sleeping interchangeably with bed-sharing.

The American Academy of Pediatrics does encourage room-sharing (sleeping in the same room but on separate surfaces) in its policy statement regarding SIDS prevention, but it recommends against bed-sharing with infants.^{[1] [2]}

Introduction

Bed-sharing is standard practice in many parts of the world outside of North America, Europe and Australia, and even in the latter areas a significant minority of children have shared a bed with their parents at some point in childhood. One 2006 study of children age 3–10 in India reported 93% of children bed-sharing.^[3]

Bed-sharing was widely practiced in all areas up until the 19th century, until the advent of giving the child his or her own room and the crib. In many parts of the world, bed-sharing simply has the practical benefit of keeping the child warm at night. Bed-sharing has been relatively recently re-introduced into Western culture by practitioners of attachment parenting. A 2006 study of children in Kentucky in the United States reported 15% of infants and toddlers 2 weeks to 2 years engage in bed-sharing.^[4]

Proponents hold that bed-sharing saves babies' lives (especially in conjunction with nursing),^[5][6] promotes bonding, enables the parents to get more sleep and facilitates breastfeeding. Older babies can breastfeed during the night without waking their mother.

Opponents claim that co-sleeping is stressful for the child when they are not co-sleeping.^[7] They also cite concerns that a parent may smother the child^[8] or promote an unhealthy dependence of the child on the parent(s). In addition, they contend that this practice may interfere with the parents' own relationship, by reducing both communication and sexual intercourse at bedtime, and argue that modern-day bedding is not safe for co-bedding.

Safety and health

Health care professionals disagree about bed-sharing techniques, effectiveness and ethics.^[9] The U.S. Consumer Product Safety Commission warns against practicing it with babies because of risk of suffocation or strangulation,^[8] but many pediatricians, breast-feeding advocates, and others have criticized this recommendation.^[10]

Advantages

One study reported mothers getting more sleep by co-sleeping and breastfeeding than by other arrangements.^[11]

It has been argued that co-sleeping evolved over five million years, that it alters the infant's sleep experience and the number of maternal inspections of the infant, and that it provides a beginning point for considering possibly unconventional ways of helping reduce the risk of sudden infant death syndrome (SIDS).^[12][13][6]

Stress hormones are lower in mothers and babies who co-sleep, specifically the balance of the stress hormone cortisol, the control of which is essential for a baby's healthy growth.^{[14][15][16][17]}

In studies with animals, infants who stayed close to their mothers had higher levels of growth hormones and enzymes necessary for brain and heart growth.^[18][19]

The physiology of co-sleeping babies is more stable, including more stable temperatures, more regular heart rhythms, and fewer long pauses in breathing than babies who sleep alone.^[20][21]

Co-sleeping may promote long-term emotional health. In long-term follow-up studies of infants who slept with their parents and those who slept alone, the children who co-slept were happier, less anxious, had higher self-esteem, were less likely to be afraid of sleep, had fewer behavioral problems, tended to be more comfortable with intimacy, and were generally more independent as adults.^{[22][23][24][25]} However, a recent study (see below under precautions) found different results if co-sleeping was initiated only after nighttime awakenings. Co-sleeping from birth or soon afterwards is the norm except in some Western cultures.

Precautions

Bed-sharing is known to be dangerous for any child when a parent smokes, or has a history of skin infections, but there are other risk factors as well.^[9] Some common advice given is to keep a baby on its back, not its stomach, that a child should never sleep with a parent who smokes, is taking drugs (including alcohol) that impede alertness, or is obese.^[26] It is also recommended that the bed should be firm, and should not be a waterbed or couch; and that heavy quilts, comforters, and pillows should not be used. Young children should never sleep next to babies under nine months of age.^[27] It is often recommended that a baby should never be left unattended in an adult bed even if the bed surface itself is no more dangerous than a crib surface. There is also the risk of the baby falling to a hard floor, or getting wedged between the bed and the wall or headboard. Parents who roll over during their sleep could inadvertently crush and/or suffocate their child, especially if they are heavy sleepers, over-tired or over-exhausted and/or obese. Co-sleeping advocates also recommend that the baby should only sleep next to the mother, on the outside of the bed with mattress on the floor (without a box-spring).

A recent report explored the relationship between ad hoc parental behaviors similar to traditional co-sleeping methodology, though the study's subjects typically utilized cribs and other paraphernalia counter to co-sleeping models. While babies who had been exposed to behaviors reminiscent of co-sleeping had significant problems with sleep later in life, the study concluded that the parental behaviors were a reaction to already-present sleep difficulties. Most relationships between parental behavior and sleeping trouble were not statistically significant when controlled for those preexisting conditions. Further, typical co-sleeping parental behavior, like maternal presence at onset of sleep, were found to be protective factors against sleep problems.^[28]

Products for infants

There are several products that can be used to facilitate safe co-sleeping with an infant:

• special-purpose bedside bassinets, which attach directly to the side of an adult bed and are open to the parent's side, but have barriers on the three other three sides.^[29]
• bed top co-sleeping products designed to prevent the baby from rolling off the adult bed and to absorb breastmilk and other nighttime leaks.
• side rails to prevent the child from rolling off the adult bed.
• co-sleeping infant enclosures which are placed directly in the adult bed.

Prevalence

A study of a small population in Northeast England showed a variety of nighttime parenting strategies and that 65% of the sample had bedshared, 95% of them having done so with both parents. The study reported that some of the parents found bedsharing effective, yet were covert in their practices, fearing disapproval of health professionals and relatives.^[30] A National Center for Health Statistics survey from 1991 to 1999 found that 25% of American families always, or almost always, slept with their baby in bed, 42% slept with their baby "sometimes," and 32% never co-slept with their baby.^[31]

See also

• Infant bed
• Secrets of the Baby Whisperer (book)
• Ferber method

References

Notes

1. ^ "SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment". http://pediatrics.aappublications.org/content/128/5/1030.abstract?sid=ffa523b4-9b5d-492c-a3d1-80de22504e1d. Retrieved 16 November 2011. 
2. ^ Kemp, James S. et al. (2000) Unsafe Sleep Practices and an Analysis of Bedsharing 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 Vol. 106 No. 3 September 2000, p. e41
3. ^ Bharti, B. Patterns and problems of sleep in school going children Indian Pediatr. 2006 Jan; 43(1):35–8
4. ^ Montgomery-Downs, H.E. Sleep habits and risk factors for sleep-disordered breathing in infants and young toddlers in Louisville, Kentucky. Sleep Med. 2006 Apr; 7(3):211–9. Epub 2006 Mar 27.
5. ^ McKenna, J.J. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding, Paediatr Respir Rev. 2005 Jun;6(2):134–52.
6. ^ ^{a b} Sleeping with Baby: ABC TV Catalyst, 21 July 2011
7. ^ Hunsley, M. The sleep of co-sleeping infants when they are not co-sleeping: evidence that co-sleeping is stressful. Dev Psychobiol. 2002 Jan;40(1):14–22.
8. ^ ^{a b} Consumer Product Safety Commission
9. ^ ^{a b} Mace, S. Where should babies sleep? Community Pract. 2006 Jun; 79(6):180–3.
10. ^ MedicineNet.com
11. ^ Quillin, S.I. Interaction between feeding method and co-sleeping on maternal-newborn sleep. J Obstet Gynecol Neonatal Nurs. 2004 Sep–Oct; 33(5):580–8.
12. ^ McKenna, J. Experimental studies of infant-parent co-sleeping: mutual physiological and behavioral influences and their relevance to SIDS (sudden infant death syndrome). Early Hum Dev. 1994 Sep 15; 38(3):187–201.
13. ^ McKenna, J., and T. McDade (2005). "Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bed sharing, and breastfeeding". Paediatric Respiratory Review 6 (2): 134–152. doi:10.1016/j.prrv.2005.03.006. PMID 15911459. http://www.naturalchild.org/james_mckenna/cosleeping.pdf. 
14. ^ Coe, C.L., et al. "Endocrine and immune responses to separation and maternal loss in non-human primates", The Psychology of Attachment and Separation, New York Academic Press, 1985, p. 163–199
15. ^ Hofer, M. "The mother-infant interactionas a regulator of infant physiology and behavior", Sympiosis in Parent-Offspring Interactions, New York: Plenum, 1983
16. ^ Hofer, M.. "Some thoughts on the tranduction of experience from a developmental perspective". Psychosomatic Medicine 44 (19): 1982. 
17. ^ Hofer M., Shair H.. "Control of sleep-wake states in the infant rat, by features of the mother-infant relationship". Developmental Psychobiology 1982: 229–243. 
18. ^ Butler, S.R. et al.; Suskind, M.; Schanberg, S. (1978). "Maternal behavior as a regulator of polyamine biosynthesis in brain and heart of developing rat pups". Science 199 (4327): 445–447. doi:10.1126/science.202031. PMID 202031. 
19. ^ Kuhn, C.M. et al.; Butler; Schanberg, S. (1978). "Selective depression of serum growth hormone during maternal deprivation in rat pups". Science 201 (4360): 1035–1036. doi:10.1126/science.684424. 
20. ^ Field, T. Touch in early development, N.J.: Lawrence Erlbaum and Assoc., 1995
21. ^ Reite, M. and J.P. Capitanio. "On the nature of social separation and social attachment", The psychobiology of attachment and separation, New York: Academic Press, 1985, p. 228–238
22. ^ Crawford, M. "Parenting practices in the Basque Country: Implications of infant and child-hood sleeping location for personality development", Ethos, 1994, 22, 1: 42–82.
23. ^ Forbes, J.F. et al.. "The cosleeping habits of military children". Military medicine 1992: 196–200. 
24. ^ Heron, P. "Non-reactive cosleeping and child behavior: Getting a good night's sleep all night, every night", Master's thesis, Department of Psychology, University of Bristol, 1994
25. ^ Keller, M.A., and W.A. Goldberg (2004). "Co-sleeping: Help or hindrance for young children's independence?". Infant and Child Development 13 (December): 369–388. doi:10.1002/icd.365. 
26. ^ MedicineNet.com IParenting.com.
27. ^ Sears, William MD et al. The Baby Sleep Book, Brown, Little & Company, 2005, p. 131
28. ^ Simard, V., et al. (2008). The Predictive Role of Maladaptive Parental Behaviors, Early Sleep Problems, and Child/Mother Psychological Factors. Archives of Pediatric and Adolescent Medicine
29. ^ E.B. Thoman: Co-sleeping, an ancient practice: issues of the past and present, and possibilities for the future, Sleep Med. Rev. December 2006, 10(6):407-17. Online 16. November 2006. PMID 17112752
30. ^ Hooker, F. Sleeping like a baby: attitudes and experiences of bedsharing in northeast England. Med Anthropol. 2001; 19(3):203–22.
31. ^ Sears, William MD et al. ibid, p. 107

Further reading

• Jackson, Deborah. Three in a Bed: The Benefits of Sharing Your Bed with Your Baby, New York: Bloomsbury, 1999.
• McKenna, James J. Sleeping with Your Baby, Washington, D.C.: Platypus Media, 2007.
• Morelli, G.A.; Rogoff, B.; Oppenheim, D.; Goldsmith, D. (1992). "Cultural variation in infant's sleeping arrangements: Questions of Independence". Developmental Psychology 28 (4): 604–613. doi:10.1037/0012-1649.28.4.604. 
• Thevenin, Tine. The Family Bed, New Jersey: Avery Publishing Group, 1987.
• Simard, V., et al. (2008). The Predictive Role of Maladaptive Parental Behaviors, Early Sleep Problems, and Child/Mother Psychological Factors. Archives of Pediatric and Adolescent Medicine Available at: http://archpedi.ama-assn.org/cgi/content/short/162/4/360

External links

• Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame.
• SafeBedSharing.org Information on how to make the family bed safe, parenting forums and informative links.
• Tribal Baby Practical tips and insights into the practice of sleep sharing.
• The Natural Child Project Articles on co-sleeping.
• Mothering Magazine Regularly updated questions and answers from co-sleeping expert Sarah J. Buckley.
• ABM Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding An in-depth review of the literature on breastfeeding and co-sleeping from the Academy of Breastfeeding Medicine.
• Sharing a bed with your baby Leaflet from UNICEF's Baby Friendly Initiative in the United Kingdom.
• Meret A. Keller, Wendy A. Goldberg: Co-sleeping: Help or hindrance for young children's independence?, in: Infant and Child Development, vol. 13, no. 5, p. 369–388, Wiley InterScience, 2004
• Information about parents' decisions regarding sleep issues with their babies The Bernard L. Pacella, MD Parent Child Center