Article: Should the AAP Sleep Alone? (Co-Sleeping)

[mabillon]

(my note: I thought couldn't agree more with this article.  When Leigh was just a couple weeks old, I was so afraid of co-sleeping that I fell asleep on the couch with her several times before realizing that was WAY more dangerous and finally researching a safe way to bedshare.)

Should the AAP Sleep Alone?

www.huffingtonpost.com/melissa-bartick/should-the-aap-sleep-alon_b_5135712.html?fb_action_ids=10152087052082157&fb_action_types=og.likes

Some public health messages everyone can agree with: Never drink and drive. Always put your infant in a car seat. Other public health messages seem to ask us to do the impossible: Teenagers must never have sex. Mothers must never share a bed with their infants.



Advice around the U.S. urges parents never to bed share, reinforced by the official stance of the American Academy of Pediatrics. Scary ads abound. One ad shows a queen-sized bed with a headstone in place of headboard reading "For too many babies last year, this was their final resting place." Another shows a baby in an adult bed with a meat cleaver, stating "Your baby sleeping with you can be just as dangerous," and another ad says "Your baby belongs in a crib, not a casket."



The fact is, across the United States and the world, across all social strata and all ethnic groups, most mothers sleep with their infants at least some of the time, despite all advice to the contrary, and this is particularly true for breastfeeding mothers. 1-4 Unfortunately, we also know that parents who try to avoid bed sharing with their infants are far more likely to feed their babies at night on chairs and couches in futile attempts to stay awake, which actually markedly increases their infants' risk of suffocation. 5 According to a 2010 study of nearly 5,000 U.S. mothers, "in a possible attempt to avoid bed sharing, 55 percent of mothers feed their babies at night on chairs, recliners or sofas. Forty-four percent (25 percent of the sample) admit that they [are] falling asleep with their babies in these locations." 6 This is truly disturbing.



The advice to never sleep with your baby has backfired in the worst possible way. Rather than preventing deaths, this advice is probably even increasing deaths. In another study, parents of two SIDS infants who coslept on a sofa did so because they had been advised against bringing their infants into bed but had not realized the dangers of sleeping on a sofa. 5 In fact, deaths from SIDS in parental beds has halved in the UK from 1984-2004, but there has been a rise of deaths from cosleeping on sofas. 7?



In the U.S., bedsharing cannot often be discussed in pediatricians' offices: without their professional organization to back them up, U.S. pediatricians may feel uncomfortable mentioning the topic without liability fears, and parents may fear criticism if they ask about it. It is swept underground. Like most mammals, human mothers and infants are drawn to sleep next to one another, and infants and mothers sleep in synchrony when they sleep together. 8,9 No amount of scary ads is likely to change what is almost certainly a deeply ingrained biological imperative. 1 The lack of opportunity to discuss the issue with clinicians squanders an opportunity for education and balanced discussion.



In contrast, medical authorities in Canada, Great Britain and Australia have different messages than the American Academy of Pediatrics. They all acknowledge that most mothers do share a bed with their infant at least some of the time. If one chooses to bedshare, they educate the public on risks and on ways to markedly decrease the risk of infant death. Bedsharing should be avoided if a parent has used alcohol or sedating medication, if the mother is a smoker, if the baby is formula fed, if the bedding underneath is soft like a sheepskin or waterbed. No matter where a baby sleeps, he should not be in a room alone or placed on his stomach. Most of all, never sleep with an infant on a couch or recliner, the most dangerous place of all.



Some medical authorities acknowledge that there are even benefits to sharing a bed with an infant, such as ease of breastfeeding, increase in the number of nighttime breastfeedings and increased maternal rest. Regardless, authorities other countries uniformly state parents should be told of the risks and benefits and be able to make their own informed decisions.



How unsafe is bedsharing anyway? Like many things in science and medicine, the answer is neither simple nor clear cut. The studies on "bedsharing" have often lumped beds and couches together when looking at infant deaths, making it impossible to distinguish the true risk. Often studies did not separate out whether the infants were breastfed or not, although breastfeeding cuts the risk of SIDS by nearly 75 percent. 10 The one recent study that attempted to look at SIDS and bedsharing without other risk factors found an increased risk with bedsharing, but it turned out that information one of the biggest risk factors, consumption of drugs and alcohol, was not fully collected, and the risk of smoking was not fully adjusted for, per a statement from UNICEF UK.



In addition, research shows that bedsharing facilitates breastfeeding and is associated with longer breastfeeding duration. 11-13 Breastfeeding mothers who try not to bedshare either end up giving up breastfeeding or bed share anyway. 13 The nutritional content of human milk necessitates frequent feeding both day and night and frequent close contact.



What is certainly clear and uncontroversial is that many other factors are much bigger risk factors for death than bed sharing itself. One of those risk factors, sleeping on the stomach, was the subject of the highly successful "Back to Sleep" marketing campaign. But one of the biggest risk factors, formula feeding, is not discussed at all in social marketing campaigns to prevent infant deaths. Instead we have scary ads about bedsharing. From all available social marketing evidence, it looks like it is easier to convince women to stick with breastfeeding than it is to convince them not to sleep with their babies. The lowest hanging social marketing fruit: Ads educating people about the dangers sofas and recliners would go a long way to decreasing risk of death, provided that women also got the message that a bed is a safer place to feed their baby than the couch or recliner.



Many new parents use sidecars that attach to the sides of adult beds, keeping the infant within easy reach for breastfeeding but still in a separate space. For reasons that are unclear, any findings of safety for in-home use of these popular devices has never been published, and even the AAP does not advocate for their testing. The AAP policy statement only says their use is "not recommended." They were tested in hospitals and found to be safe and effective for increasing breastfeeding in the postnatal ward.14 Rather than spending money on scary ads, we should prioritize testing these devices for the home and regulate them for appropriate safety standards like cribs.



If advice not to bedshare may inadvertently end up decreasing breastfeeding duration, that would affect many diseases in addition Sudden Infant Death Syndrome and infant suffocation.



Breastfeeding duration impacts obesity, a host of infections of infancy, and breastfeeding duration affects a host of maternal diseases as well. Suboptimal breastfeeding duration in the U.S. results in nearly 5,000 excess cases of breast cancer per year, nearly 14,000 excess heart attacks per year, and over 50,000 excess cases of high blood pressure per year.15 Thus, any recommendations that may negatively impact breastfeeding must take into account all the health implications of breastfeeding, not just a single disease.



Telling mothers never to share a bed with their infants is a message doomed to fail, and has likely contributed to at least some infant deaths on sofas. Instead of showing scary ads of infants in beds with headstones and cleavers, we should be focusing educational efforts sleeping on couches and recliners, smoking, and in the presence of alcohol, drugs, and formula feeding. And of course, we should be supporting mothers to breastfeed.

[breezy8407]

wait...I skimmed some, but why is formula feeding mentioned? is it bottle propping? My sleep deprived brain isn't comprehending.

[EnchantedSoul]

Parents Magazine had a small blip about making sure you NEVER sleep with your infant. I've never been compelled to write into a magazine before, but I really wanted to tell them to offer safe ways to co sleep instead of shaming those who choose to do it. Alas, I couldn't figure out how to do it from the digital version.

Thanks for sharing.

[sunshineluv]

This was an interesting read to me. I completely agree that the recommendation to never sleep with your infant is making us doomed for failure. With Henry I slept with him in a recliner and on the couch, thinking it was safer. He needed to be held to sleep for a while. Annabelle is just an easier baby, so she has only been in the bed with DH or I a handful of times. I do wish we had more statistics separating the number of true SIDS cases vs infant suffocation. And for the bed sharing deaths, I always want to know what percentage were the parents under the influence of medication or alcohol. In my mind, the risk of suffocation from bed sharing when not under the influence isn't very big, but I would love to know the real stats.

I don't get this comment, breastfeeding cuts the risk of SIDS by nearly 75 percent, I wonder where that's that comes from? I have never heard that at all.

[dixeedeluxe]

Apr 17, 2014 7:42:56 GMT -5 breezy8407 said:

wait...I skimmed some, but why is formula feeding mentioned? is it bottle propping? My sleep deprived brain isn't comprehending.

As always, it seems that they've taken the socioeconomic factors out of their "research" and shoved it into their article out of context.

[dixeedeluxe]

The author seems to be very educated. And I see the connection that if women were given the OK to cosleep, then they may be more likely breastfeed as they can do it in bed while nodding off.

But this is a really poor way to lead off the article if you want any non breastfeeder to pay attention.


In contrast, medical authorities in Canada, Great Britain and Australia have different messages than the American Academy of Pediatrics. They all acknowledge that most mothers do share a bed with their infant at least some of the time. If one chooses to bedshare, they educate the public on risks and on ways to markedly decrease the risk of infant death. Bedsharing should be avoided if a parent has used alcohol or sedating medication, if the mother is a smoker, if the baby is formula fed, if the bedding underneath is soft like a sheepskin or waterbed. No matter where a baby sleeps, he should not be in a room alone or placed on his stomach. Most of all, never sleep with an infant on a couch or recliner, the most dangerous place of all.



Read more: pandce.proboards.com/thread/314656/article-aap-sleep-sleeping#ixzz2z9JKuGmt

[lolaburns]

I get really annoyed when suffocation deaths are called SIDS deaths. Suffocation deaths are not SIDS.

There are safe ways to bed share and cosleep. They should be practiced to prevent suffocation. I don't like when either side up plays or down plays the risks.

[dixeedeluxe]

Well, that explains it.

Melissa Bartick, MD, MSc is an internist and an Assistant Professor in Medicine at Harvard Medical School and Cambridge Health Alliance and engages in breastfeeding research. She has served as the chair of the Massachusetts Breastfeeding Coalition since 2002 and has served on the Board of Directors of the United States Breastfeeding Committee since 2009. She also serves as the chair of the Breastfeeding Forum of the American Public Health Association (APHA). She works as a hospitalist and is the mother of two children. .

[Deleted]

Apr 17, 2014 7:28:52 GMT -5 mabillon said:

(my note: I thought couldn't agree more with this article.  When Leigh was just a couple weeks old, I was so afraid of co-sleeping that I fell asleep on the couch with her several times before realizing that was WAY more dangerous and finally researching a safe way to bedshare.)

I did the same thing with my oldest. I've bed-shared with both of my kids and baby girl still sleeps with me.

[kkfeb04]

I think it was a good article until it got to the breastfeeding part. Benefits of breastfeeding aren't needed in an article stating why cosleeping isn't the big bad wolf.

Signed the former cosleeping breastfeeder.

[dixeedeluxe]

I slept on the recliner MANY nights with my refluxing babies. I mean, that's real life. I really feel like researchers often ignore real life. I do think their intentions are good.

[mabillon]

Apr 17, 2014 8:17:26 GMT -5 dixeedeluxe said:

The author seems to be very educated. And I see the connection that if women were given the OK to cosleep, then they may be more likely breastfeed as they can do it in bed while nodding off.

But this is a really poor way to lead off the article if you want any non breastfeeder to pay attention.


In contrast, medical authorities in Canada, Great Britain and Australia have different messages than the American Academy of Pediatrics. They all acknowledge that most mothers do share a bed with their infant at least some of the time. If one chooses to bedshare, they educate the public on risks and on ways to markedly decrease the risk of infant death. Bedsharing should be avoided if a parent has used alcohol or sedating medication, if the mother is a smoker, if the baby is formula fed, if the bedding underneath is soft like a sheepskin or waterbed. No matter where a baby sleeps, he should not be in a room alone or placed on his stomach. Most of all, never sleep with an infant on a couch or recliner, the most dangerous place of all.



Read more: pandce.proboards.com/thread/314656/article-aap-sleep-sleeping#ixzz2z9JKuGmt

To be fair, that was the author summarizing the thoughts of other medical authorities.

To be even more fair, I agree that this quote much later didn't add value to the article and is inflammatory: "But one of the biggest risk factors, formula feeding, is not discussed at all in social marketing campaigns to prevent infant deaths.
"

All that said, there is scientific research to indicate co-sleeping is safer when you're breastfeeding.  I'm not breastfeeding anymore (but still co-sleep) and I have noticed that I do sleep more deeply these days (not even in comparison to infant days but literally just a couple months ago).  No joke, I didn't wake up a couple weekends ago until she was half off the bed (she went down by my feet to get off) - her rolling over used to be enough to wake me.  Obviously though, I've accounted for it in the way I place my baby, the things I keep in my bed, gates in bedroom doorways, even when I tie my hair back at night.  These are all things that formula-feeding moms could do too and there was a missed opportunity for education there.  But this was the HuffPo and they are not exactely known for in-depth educationy articles either...

ETA: I need to correct myself, I believe the research isn't about co-sleeping in general but bed-sharing, specifically. There's a big difference! I am guilty of using the terms interchangably though when I'm really referring to bed-sharing.

[breezy8407]

Apr 17, 2014 9:02:47 GMT -5 @tambcat said:

Some of the formula discussion bugs me, of course, like the irrelevant mention of how decreasing breastfeeding "would affect many diseases." I get that it is a risk factor for SIDS, although I will say that I was less sleep deprived because I was bottle feeding (breastmilk, not FF yet in the earlier days) and could split the nights with H, which probably made my couch/chair sleeping a little less unsafe. There are also other risk factors for SIDS that never get discussed because they aren't really something a mom can help, like having a baby in the winter months.

Having H be able to feed at night was a lifesaver. We both got 3-4 hour stretches of sleep because of it. 

[breezy8407]

And yes like most things, why can't we just educate people instead of fear-mongering?

It's even mentioned in the opening paragraph...like sex education. So then people just end up doin it wrong. heh.

[dixeedeluxe]

"It's OK to bedshare as long as you breastfeed. If you formula feed, this article is not for you because formula feeding is likely to kill your baby anyway."

[lolaburns]

Apr 17, 2014 8:43:05 GMT -5 @pcloadletter said:

lolaburns that drives me crazy as well. I lost a lot of respect for the article when it said never bedshare if you ff. I can understand not feeding the baby in bed because of propping, but ff moms aren't any less sleep deprived.

I didn't get this aspect of it either.

[dixeedeluxe]

You guys know I have gigantic boobs. And I know I'm not the only one. I'm really confused as to how a bottle has any more of a risk of suffocation than my gigantic soft pendulous boobs.

[ktstorm]

My H caught me sleeping after nursing B early on because I was so tired. I was in a rocking chair with B on the Boppy. I'm pretty sure I could have done that if I had been giving him bottle too.

[laurack]

The SIDS/Suffocation blurred lines also annoy me.

The way I see it is, SIDS is: your baby stops breathing for no apparent reason. Not smothered, airway not restricted by something etc.

If your baby smothered because of teddy bears in the crib or something, I don't think that is SIDS?

when they report on SIDS numbers, do they include suffocation? Because it seems that would skew things a lot.