In a recent visit to Australia, US Anthropologist Professor James McKenna claimed that under the right circumstances, breastfed babies could safely sleep in the same bed as their mothers. This was a perfectly natural scenario, he said, adding it promoted breastfeeding and bonding.
Perhaps most disturbing was McKenna’s claim that co-sleeping was not a risk factor for sudden infant death syndrome (SIDS).
SIDS is the sudden and unexpected death of an infant under one year of age, usually while sleeping, for which no cause can be found. A number of risk factors increase the chance of an infant dying. They include being placed to sleep on their tummy, allowing them to get their face covered by bedding and exposing them to cigarette smoke.
The Reducing the Risks for SIDS public awareness campaign, which alerted parents to these risks and explained how parents could protect their infants, successfully reduced the incidence of SIDS in Australia by more than 80% over the past 20 years.
So what should we make of McKenna’s claims? Let’s look at the evidence.
It is true that around the world the majority of babies will sleep in the same bed with their mothers. However, in western cultures the sleeping arrangements are generally very different from those in the developing world. We usually sleep in a soft bed which is raised from the floor and have pillows and soft bedding such as doonas. And there are often two adults in the bed with the infant. All of these factors pose a suffocation risk to an infant, in addition to the risk of a parent suffocating their child inadvertently.
There is now strong scientific evidence from large epidemiological studies in a number of countries that co-sleeping or bed-sharing increases the risk of SIDS. More than one in two babies who die suddenly and unexpectedly are found sharing a bed.
These alarming statistics have recently alerted the coroners in both South Australia and Victoria to issue press releases warning parents of this risk. The Melbourne Coroner John Olle found that 33 out of 72 SIDS deaths in three years occurred when infants were co-sleeping. Most of these deaths were among babies less than six months of age.
Co-sleeping is most dangerous if the mother smokes, but the risk is also increased if just the father smokes. It is also very dangerous if the parents have been exposed to alcohol or drugs, as they’re less able to be roused.
There is now growing evidence that even when none of these “risk factors” are present there is still an increased risk of SIDS and this is particularly problematic for infants under three months of age. In a recent, yet-to-be-published study which combines data from five previous studies in the United Kingdom, New Zealand and Germany and a large multicentre European study, data show that even if the baby is breastfed and the parents do not smoke there is still an increased risk.
But babies who are taken into bed for feeding and then placed back in their own cot are not at any increased risk.
The safest place for a baby to sleep is on their back, in their own cot or bassinette in the parent’s room. The cot should be made so the baby’s feet meet the foot of the bed (known as “feet to foot”, which prevents the baby from wriggling under the covers) and should also be free of any bedding such as doonas, pillows or bumper pads and soft toys that could cover the baby’s face.
It is critical that parents, carers and health professionals are aware of the risks of co-sleeping and take steps to avoid it. Breastfeeding is protective for SIDS, but it can be done without the need to share a bed.
Join the conversation
Comments (13)
Byron Smith
(PhD candidate in Christian Ethics at University of Edinburgh)
The headline is too strong for the evidence referenced by the article. Furthermore, the article does not present the full perspective of the evidence it discusses. I will refer primarily to the meta-study to which the article links three times. The full text is available here (for those with institutional access, I presume): http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1754.2011.02215.x/full.
According to this meta-study, compared to other risk factors (parents who smoke, are drunk, overweight…
show full comment
Alan Todd
(logged in via Facebook)
Thanks Byron for bringing a bit of scale and perspective into this one. As often happens, the drive for simplistic "health messaging" ignores the broader consequences of following certain practices. Co-sleeping has many benefits, for mothers, infants and their wider families, some of which were identified in the meta analysis you quoted. It would be a pity if this was ignored in pursuit of the holy grail of eliminating all risk of one particular outcome. Risk should be understood in terms of statistical probability, which in the case of co-sleeping and SIDS is next to negligible. (I would be interested too to explore confounding factors in the studies showing a link). It is unfortunate however that the language of risk translates in the popular mind to fear. We now have mothers too afraid to sleep with their children because they both greatly overestimate the likelihood of SIDS, and believe that by not co-sleeping they greatly reduce this already overestimated risk.
Nicholas Aberle
(logged in via Facebook)
Why do these articles keep saying co-sleeping babies die "suddenly and unexpectedly" - isn't the clear insinuation that they are suffocating? So if our babies are going to sleep in our beds, we should just get a harder mattress and not use a doona? And don't be drunk or covered in cigarette smoke.
Also, have the people doing these studies ever had to deal with an incessantly crying baby at 2am?
Peter Fox
(logged in via email @gmail.com)
Susan, in the quoted BMJ article, co-sleeping occurred at more than double the rate than the control group. I don't think this is anti-co-sleeping bias, just researchers reporting their scientific findings. They openly comment on some of the shortcomings of the methodology, but certainly the study poses some interesting questions.
"Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%)"
Susan McCosker
Former school teacher (logged in via email @yahoo.com.au)
Thanks for the reply. That makes it a lot clearer.
Jennifer Power
(Research Fellow at The Bouverie Centre (Victoria's Family Institute) at La Trobe University)
Is there an age where the risks associated with co-sleeping reduce? eg. If baby sleeps in a bassinet when they are very small then co-sleeps from 6 months onward are the risks mitigated? I am asking partly out of personal interest and partly because research such as this is always presented in such black and white terms. It's terrifying enough as a new parent and most advice is presented in terms that suggest it could be devestating for your baby if you don't follow it to the letter: breastfeeding…
show full comment
Matt Stevens
Senior Research Fellow/Statistician (logged in via email @gmail.com)
Excellent comments people and a poorly reported article as the one above has been shown up for what it is - scaremongering without a balanced argument on pros and cons.
Jennifer James
(Dr at RMIT University)
I fully agree with Byron here. In addition: The reality for many women is that they fall asleep unintentionally while breastfeeding and because they haven't intended to co-sleep have not prepared a suitable surface for their baby. The article also does not recognise the significant amount of research that James has conducted over the years looking at co bedding/ sleeping. The fear that comes from these sorts of headlines is counterproductive.. we need rational and calm discussion that recognises the reality for many women... balancing the need for sleep with doing the best for their baby.
Claire Law
(logged in via Facebook)
There is a well researched blog article from a neuroanthropological perspective about co-sleeping from a few years ago which may be some relief to mothers that use co-sleeping some/all of the time and in a safer manner:
http://neuroanthropology.net/2008/12/21/cosleeping-and-biological-imperatives-why-human-babies-do-not-and-should-not-sleep-alone/
Susan McCosker
Former school teacher (logged in via email @yahoo.com.au)
I would like some clarification.
"33 of 72 babies who died of SIDS were found to co-sleeping and therefore co-sleeping is dangerous" is the recommendation that I've heard numerous times recently. Logic would tell me that 39 babies who died of SIDS weren't co-sleeping, and therefore co-sleeping is safer, unless the parents smoke or other risk factors are present.
There seems to me to be either an anti-co-sleeping bias at play here, or there is information missing (such as the number sharing a room but not a bed and the number in a separate room).
Paul Richards
(logged in via LinkedIn)
Rosemary - what is wrong with putting children is a sling above the bed?
Except smoking of course, which we abhor.
We have three healthy grown children now, one twenty one this year, one eighteen this year and one seventeen December. My worries now are thousand kilos or more of rubber, steel, plastic glass and explosive fuel.
Mary Krone
(logged in via Twitter)
This is terrifying to me. I slept with both my babies to the horror of my grandmother who was afraid of SIDS. I thought it was fine and loved being with them. To think that I put my babies at higher risk (even though they are now in their mid twenties) gives me a long, cold shiver.
My daughter did not sleep with her son and observed all the SIDS advice. Still, he died of SIDS. One can't always prevent it but all the more reason to ensure that risks are not increased. The sudden death of a beautiful, healthy little baby is almost too hard to bear.
Arthur James Egleton Robey
Industrial Electrician (logged in via email @gmail.com)
I have raised two batches of children that I fathered.
With the first batch I insisted on having my wife to myself and the infants had a room of their own. This lead to classic new baby stress which I believe is born by my now adult children.
I had the second batch (1 child) to a Eastern European. By now I was a much more relaxed father and he slept in the nuptial bed. I managed to give him a secure infanthood, after which he experienced the severe trauma of a family breakup. He has managed to surpass his father in his career.
Humans are mammals. They need the smell and touch of the mother as infants.
They can survive without physical contact but there are consequences. Oh yes, there are.