Monday, August 1, 2011

On Co-sleeping, Bed-sharing, and Infant Death

We need some education. That's right, education. It hits the news all the time when a baby passes away in the night. SIDS is mentioned, sleeping in an adult bed is mentioned, etc. It all gets garbled and confused and we are hit with absolutes about sleeping babies. Don't sleep with the baby, never put the baby in an adult bed, etc, etc, etc.

Ok, well, here's the thing, these news reports or stories do a little bit of reporting on the incident and then jumble up all kinds of facts and if you aren't clear on the details, they'd have you believe that SIDS is caused by a family bed. All these things are mentioned in these reports but typically, they forget to differentiate. I want to lay the record straight. No matter how you choose to arrange bed time for you and the baby is your decision, but understand the differences in what they are talking about.

Let's talk SIDS. SIDS stands for Sudden Infant Death Syndrome. What makes it scary is that no one knows the cause. Babies simply pass away in their sleep. Many news reports that talk about babies dying in their sleep mention SIDS, but then go on to talk about how the baby suffocated while sleeping with his or her mother. Well, that cause of death was not SIDS, it was suffocation. Why was SIDS even brought up? Who knows, but they bring it up anyway. If a child truly died of SIDS, it almost assuredly was not sleeping with it's parent(s) - that's not a guarantee, it's just not likely. There are many things that can be done that are suggested to decrease the risk of SIDS such as having a fan on, giving the baby a pacifier when going to sleep, having the baby sleep in the same room with the parents, breastfeeding, lay the baby on his or her back to sleep, etc. Other safe sleeping practices have nothing to do with SIDS and more to do with preventing suffocation such as making sure the crib sheet is tightly fitted to the mattress, keep blankets and stuffed animals out of the crib, etc.

And speaking of suffocation, that is most commonly the cause of death when a death is reported when the baby was sleeping with the parent. You hear many things like the baby rolled into the soft mattress or that the baby suffocated in the pillows. Alternately, you hear the tale of the baby being suffocated while the parent and baby were napping on the couch. Well, yeah, of course that is what you hear - those are all considered unsafe sleeping practices even among the people that encourage sleeping with the baby. Now, I'm not trying to make light of the situation, obviously it's a tragedy and no one wishes that upon any parent. The problem is that most of the news reports make too many generalizations and tend to confuse people and then just make people believe that if your baby sleeps with you, you will suffocate it. Co-sleeping becomes a dirty word. Which is odd considering it's actually encouraged by the AAP.

What? It's encouraged? I must be crazy to say that. Nope, I'm not. The reason it doesn't sound right is because there is a distinction between co-sleeping and bed-sharing that people don't always recognize. Co-sleeping means parents sleeping with the baby in the same room - not necessarily in the same bed. The AAP recommends that babies sleep in the parent's room on a separate surface. The "in the same room" part helps reduce the risk of SIDS since it is believed that the parents breathing patterns help to regulate the breathing of a sleeping baby. The "on a separate surface" part is to reduce the risk of suffocation. Most people that are afraid to sleep in the same bed with a baby are afraid to do so because of suffocation. Many people that do sleep with the baby in the same bed (or unfortunately couch) do not understand the safety measures that need to be taken before setting up this sort of arrangement. So, despite what the news says, co-sleeping is good and encouraged.

Bed-sharing however, is typically looked down upon or at the very least, discouraged. Bed-sharing is a type of co-sleeping, but co-sleeping does not necessarily mean bed-sharing. Bed-sharing has a long history, most notably in tribal communities where mother and baby sleep side by side - not necessarily on a bed though, typically on the ground. Studies have actually been done with mothers and babies sleeping side by side where if there is a change in the baby's breathing, the mother will, in her sleep, nestle the baby closer to her. It is believed that is action will kick-start the baby's regular breathing pattern because they are once again closer to their mother who has a regular breathing pattern. It's just my two cents, but physiologically speaking, presence of carbon dioxide in the lungs is what makes us breathe, not lack of oxygen, so it would make sense that the mother exhaling carbon dioxide near the baby's face would cause inhalation - that's just my personal conclusion - that this has something to do with reduction of SIDS risk along with close proximity of the mom helping to regulate heart rate and breathing. In any case, bed-sharing isn't inherently dangerous, but the blanket discouragement of it is due to lack of appropriate safety measures in place. Safe bed-sharing means that the baby is not near pillows or blankets, the bed is a firm surface (sorry to those of you who like your pillow-top mattresses), the baby sleeps next to the mother only - not another adult (or especially another child) because only the mother is biologically "programmed" to have an altered sleep pattern/habit because of a present baby, neither parent should be under the influence of drugs or alcohol, the parents should not be over-tired, etc. Another point that is not often discussed: breastfeeding is a pre-requisite. Yes, that's right, if you don't breastfeed, the baby shouldn't be sleeping in the bed with you. One reason that was suggested by one expert was because positionally, a breastfeeding baby is safer since they typically sleep lower next to the mother where her arm will typically block upward movement of the baby towards the pillow.

Either way, no matter what you choose for your family, make sure you are educated. SIDS is not suffocation. SIDS is deemed the cause of death when they have eliminated all other causes. Co-sleeping does not always mean bed-sharing - though the news reports would have you believe so. The media jumbles it all up and confuses and scares us (unless you pay close attention to the subtleties of their reporting). This is why we need to be educated.

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