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. Co-sleeping individuals sleep in sensory proximity to one another, where the individual senses the presence of others.[1] This sensory proximity can either be triggered by touch, smell, taste, or noise. Therefore, the individuals can be a few centimeters away or on the other side of the room and still have an effect on the other.[1] It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used.

A family together in a bed

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.[2] There are conflicting views on bed-sharing safety and health compared to using a separate infant bed.

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.[3][4]

Recent legal rulings suggest that bed-sharing has been attributed as a factor of unintentional infant suffocation. For instance, parents under the influence of drugs or alcohol and whose children died while bed-sharing have been charged and, at times, prosecuted with manslaughter[5] in several US states (including Minnesota,[6] Michigan,[7] Georgia,[8] Pennsylvania,[9] Texas,[10] Wisconsin[11] and Utah[5]).

Introduction

A child lies in the arms of his father.

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[12] while 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.[13]

Bed-sharing was widely practiced in all areas up to 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. Proponents hold that bed-sharing saves babies' lives (especially in conjunction with nursing), [14][15] promotes bonding, enables the parents to get more sleep and facilitates breastfeeding. Older babies can breastfeed during the night without waking their mother. Opponents argue that co-sleeping is stressful for the child when they are not co-sleeping.[16] They also cite concerns that a parent may smother the child[17] 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.

Because children become accustomed to behaviors learned in early experiences, bed-sharing in infancy will also increase the likelihood of these children to crawl into their parent's bed in ages past infancy.[18]

Safety and health

Health care professionals disagree about bed-sharing techniques, effectiveness and ethics.[19] The U.S. Consumer Product Safety Commission[17] and the American Academy of Pediatrics[3][4] strongly discourage bed-sharing because of the risk of suffocation or strangulation, but some pediatricians and breast-feeding advocates have opposed this position.[20]

Advantages

One study reported mothers getting more sleep and breast-feeding by co-sleeping than other arrangements.[21] Parents also experience less exhaustion with such ease in feeding and comforting their child by simply reaching over to the child. As a result, co-sleeping also increases the responsiveness of parents to their child's needs.[18]

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).[14][15][22]

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.[23][24][25] 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.[26][27] Also, 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.[28][29]

Besides physical developmental advantages, co-sleeping may also 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.[30][31][32][33]

Opposing arguments and precautions

Some parents pose threats to infants due to their behaviors and conditions, such as smoking or drinking heavily, taking drugs, a history of skin infections, obesity, or any other specific risk-increasing traits.[19][34] In addition, there are certain dangerous behaviors that increase SIDS and should be avoided whether placing a baby in a crib or co-sleeping: infants should always sleep on their backs on a firm surface (not waterbeds, pillows, recliners, or couches), mattresses should intersect the bedframe tightly, there should be no stuffed animals or soft toys near the baby, blankets should be light, a baby's head should never be covered, and other SIDS risk factors should be avoided.[35]

Co-sleeping deaths in Texas reached at least 182 in the 2013-2014 fiscal year, which ends on August 31, compared to 169 in the 2012-2013 period. Nearly all of the infants who died were under the age of one year. John Lennan, a spokesman for Webb County child protective services in Laredo, said that each family's situation is examined individually to offer recommendations for a safe environment for the children. The key to such sleeping arrangements is to make sure that the infant has room to breathe while sleeping, he added.[36]

Co-sleeping also increases the risks of suffocation and strangulation. The soft quality of the mattresses, comforters, and pillows may suffocate the infants.[18] Some experts, then, recommend 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. Another common advice given to prevent suffocation is to keep a baby on its back, not its stomach.[34] 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.[34] There is also the risk of the baby falling to a hard floor, or getting wedged between the bed and the wall or headboard. A proposed solution to these problems is the bedside bassinet, in which, rather than bed-sharing, the baby's bed is placed next to the parent's bed.[18]

The presence of the child in the parent's bedroom also raises the concern of a lack of privacy between the parents and the child. The lack of privacy may result in increased tension and reduced intimacy between a couple.[18]

Another precaution recommended by experts is that young children should never sleep next to babies under nine months of age.[37]

A 2008 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.[38]

Association with sudden infant death syndrome (SIDS)

Co-sleeping can often be regarded as an unnecessary practice that can be associated with issues such as sudden infant death syndrome (SIDS).[39][40] However, research shows that opinions vary in the association between SIDS and co-sleeping.[1][41] The most controversial issue regarding SIDS is whether bed sharing is a main cause, and whether it should be avoided or encouraged.[1]

Research indicates that co-sleeping, particularly bed sharing should be avoided as it increases the risk of SIDS.[39][40] Controversially, research shows that if co-sleeping practices are done in an appropriate and safe manner it can be very beneficial and reduce risk of SIDS occurring.[1][41] The Pacific Islands Families study, conducted in New Zealand, showed that the adoption of safe bed-sharing and room-sharing practices were saving infant lives and that there was no infant that died from SIDS.[41]

Products for infants

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

• special-purpose bedside bassinets, sidecar sleepers and bedside sleepers, which attach directly to the side of an adult bed and are open to the parent's side, but have barriers on the other three sides.[42]
• 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.
• specially designed separate sleeping bags for parents and infants which prevent covers being inadvertently pulled over the baby's head.
• wahakura : A simple woven basket that allows babies to safely sleep in the same bed as parents.[43]

Prevalence

A study of a small population in Northeast England showed a variety of nighttime parenting strategies and that 65% of the sample had bed-shared, 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.[44] 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 bed-shared with their baby.[45]

Socioeconomic factors

Initial assumptions on co-sleeping may place it in a context of income and socioeconomic status. Generally, families of low socioeconomic status will be unable to afford a separate room for a child while those of high socioeconomic status can more easily afford a home with a sufficient number of rooms.[18] However, statistical data shows the prevalence of co-sleeping in wealthy Japanese families and the ability of poor Western families to still find a separate space for their child, suggests that the acceptance of co-sleeping is a result of culture.[46]

Cultural factors

Several studies show that the prevalence of co-sleeping is a result of cultural preference. In a study of 19 nations, a trend emerged, depicting a widely accepted practice of co-sleeping in Asian, African, and Latin American countries, while European and North American countries rarely practiced it.[47] This trend resulted mostly from the respective fears of parents: Asian, African, and Latin American parents worried about the separation between the parents and the child, while European and North American parents feared a lack of privacy for both the parents and the child.[18]

See also

• Infant bed
• Overlying

References

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Further reading

• Moreno MA, Rivara FP. Bed Sharing: A Controversial but Common Practice. JAMA Pediatrics. 2013;167:1088.
• 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 Pediatrics and Adolescent Medicine Available at: http://archpedi.ama-assn.org/cgi/content/short/162/4/360