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On July 14, 2014, Pediatrics, the official journal of the American Academy of Pediatrics, released a study entitled "Sleep Environment Risks for Younger and Older Infants." The study evaluated 8,207 sleep-related infant deaths from 24 states from 2004-2012, attempting to determine if the risk factors for younger infants (0-3 months) were different than those of older infants (4-12 months). Their findings? Just under 70 percent of the younger infants who died in a sleep environment were bedsharing at the time of death.
Now, the AAP and others are latching on to this study claiming it provides irrefutable evidence bedsharing with an infant is deadly. But as with every study of this kind, the information you get is only as good as the information you have — and this study is sorely lacking several key pieces of information to effectively evaluate precisely how "dangerous" bedsharing actually is.
Bedsharing ≠ co-sleeping
First, let's be clear on a few definitions routinely used when discussing infant sleeping: co-sleeping — the practice of sharing a sleeping space (usually a room) with your child, and bedsharing, the practice, of, well, sharing your bed with your child. While the two are often used as synonyms, they aren't interchangeable. This study discusses both, but is particularly hostile against bedsharing practices.
Intentional vs. unintentional
Second, let's clarify the two types of bedsharers, because the risk factors are drastically different for both. You have the intentional bedsharer, who makes a conscious, informed decision to share their sleeping space with their child. These people educate themselves on safe bedsharing and make their sleeping space safe for their little one. Then, there is the unintentional bedsharer, who ends up with their child in their sleeping space for one reason or another. In this second group, the child ends up sleeping in an area that was not intended or prepared for them to sleep in.
This study evaluated infants who died while sleeping, and evaluated the conditions of their sleeping space to see if any commonalities occurred. What it did not account for though — and this is extraordinarily important — is if the infants who died while sleeping were intentionally bedsharing or unintentionally bedsharing. This is extremely important to know, because without it the information is useless in the bedsharing debate.
Risk factors not a factor in this study
The main risk factors for bedsharing are known to be parental smoking (during pregnancy or antenatal), use of any alcohol, use of any prescription, non-prescription or illegal drugs and non-breastfeeding. Also, having an improper sleep area increases risk. Universally, the type of sleep area infants need is agreed upon, bedsharing or not: They need to sleep on firm mattresses with no pillows, toys or soft bedding. Infants need at most a small, light blanket or sleep sack. The room should be kept at an optimal temperature around 70 degrees, minimizing the need for covers. Infants should be placed to sleep on their back, and should be in an area free from cigarette smoke.
Aside from the sleep area, none of these other bedsharing risk factors were accounted for in this study — which is huge. Why? Because intentional, informed, educated bedsharers are highly unlikely to use alcohol or drugs, smoke around their child or place them on a pillow. Most people who make a conscious decision to share their sleep space with their child do it in a way that makes it safe, and the ones who don't make it safe aren't considered to be informed bedsharers.
More younger babies in bed overall
Also, this study doesn't account for the fact that younger infants are far more likely to be brought into their parents' bed — unintentionally or not — period. Younger infants eat more often and need more nighttime parental comfort. As they get older their dependence diminishes, requiring fewer nighttime needs. The first few months parents tend to be extremely sleep-deprived, which often results in them bringing their baby to bed with them out of a simple desire to sleep. Younger infants are more likely to die while bedsharing, because younger infants are more likely to bedshare.
Tracy Cassels from Evolutionary Parenting did some fantastic number crunching, and came up with an increased risk factor of 2.5 percent when accounting for the higher likelihood of younger infants to be bedsharing at all and says, "I can tell you from a lot of stats experience, that kind of increase isn't going to result in significant differences above and beyond chance."
Abstinence doesn't always work
While one of the authors of the study, Dr. Rachel Moon, M.D., claims this study shows bedsharing for younger infants to be "extremely risky," the data really doesn't show that finding at all. What this study will do, however, is discourage a proper talk about safe bedsharing, which is what parents really need. Tracy makes a great analogy on this front, likening it to sex education: "If you only preach abstinence, then those who will do otherwise (for many reasons) will not have the information to keep themselves and others safe. But if you speak of the benefits of abstinence and acknowledge it won't work for everyone and then teach safe sex on top of it, well, you're making sure more people are safe."
Considering the known benefits of safe bedsharing, information needs to be presented the same way. Perhaps parents would be better served if the AAP came out with recommendations on safe bedsharing, rather than routinely publishing studies missing crucial information, and presenting them as conclusive fact.