Posted: May 28, 2013 8:00 AM
When it comes to babies and sleep... well, the only constant is that we all need it. How we manage to get it looks completely different from one family to the next. Enter the issues of bedsharing, SIDS and infant sleep safety. The issues are complex to say the least. But are we doing a disservice to those babies who bedshare by not offering safety advice to their parents other than "it's not safe, so don't do it?"

Summary of the AAP recommendations for safe infant sleep:

  • Back to sleep.
  • Sleep in same room as parents but on separate sleeping surface such as crib, bedside co-sleeper or bassinet.
  • No loose bedding, pillows or stuffed animals.
  • No crib bumpers.
  • No maternal smoking or exposure to second-hand smoke.
  • Use pacifier at nap and bedtime.
  • Avoid overheating and use overhead fan if possible.
  • Do not bedshare.

Which brings me to the next relevant question…

Is bedsharing dangerous?

The short answer is that it certainly can be. There are so many factors at play and study after study has deemed it inherently risky and puts babies who bedshare at a higher risk for SIDS. The most recent study has concluded that the risk of SIDS for bedsharing infants increases fivefold.

But... these studies and thus our recommendations do fall a bit short: They simply do not capture the whole picture. One baby bedsharing with a smoking mother who uses a heavy comforter at night and with two other siblings in tow is certainly not the same as the breastfeeding bedsharing baby of a non-smoking mother who sleeps on a firm mattress devoid of loose bedding, heavy blankets, etc.

It doesn't take into account the SIDS or suffocation deaths (because they are not distinguished here) of infants that have resulted from unintentional bedsharing.

It doesn't take into account the SIDS or suffocation deaths (because they are not distinguished here) of infants that have resulted from unintentional bedsharing. Meaning, an exhausted parent who brings her baby into bed out of sheer exhaustion and/or desperation without making that bed safe for her baby.

Or, the mother who falls asleep on the couch with her baby in her arms because she was just too terrified of bedsharing and simply didn't know what else to do for her crying baby who simply needed to be in direct contact with her.

I worry about those babies. The ones who end up in adult beds, without forethought and without any safety measures in place. And the reality is that simply saying bedsharing is not safe, don't do it, is not enough. We cannot simply send those families on their way knowing full well that they will be in their parents' bed that night.

What we need are universal safe sleep precautions for all babies. Perhaps, something like this:

  • Best place for the baby is in same room as parents but on a separate sleeping area such as a crib or bedside co-sleeper.
  • But if you do bedshare, plan for it and make the environment as safe as possible.
  • Bedsharing musts: firm, bare mattress with only mother and child. No heavy comforters or loose bedding.
  • Do not bedshare if you smoke, have been drinking alcohol or use sedating medications.
  • Avoid unintentional bedsharing by having a sleep plan and preparing a safe sleep environment for baby. Don't bring baby into your bed when you're exhausted and “just need a few minutes of sleep.”
  • No loose bedding, pillows, stuffed animals or crib bumpers.
  • Always place your baby on his/her back to sleep.
  • Breastfeed if you can.
  • Hold off on bedsharing until at least 4 months of age when risk of SIDS dramatically decreases.

When it comes to infant sleep safety, I don't think it's unreasonable to concede that bedsharing is absolutely dangerous for some families but can be safe and beneficial for others. We need to put it all into context. The only constant when it comes to sleep and babies is that we all need it.

Dr. Mom's bottom Line^ Follow the AAP safe sleep recommendations if you can. It's still the gold standard when it comes to infant sleep safety. However, if you do choose to bedshare (whether born out of need or not), make sure to take the time to prepare a safe sleeping environment for your baby. All babies need protection against SIDS and accidental suffocation, not just the ones sleeping in cribs.

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