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.

On Weaning

When it came to weaning my oldest, I wanted to take the easy approach - I wanted him to self-wean. I had heard horror stories about how difficult it was to initiate it as a mom. I also would have been comfortable nursing until the age of two which is recommended by the World Health Organization, but much longer than that, I wasn't too keen on. At 15 months, my little one showed no sign of slowing, which was fine, but I wondered if he would call it quits on his own (which I preferred) or if I'd have to step in once he got a little older.

My "easy" approach, and what I really hoped for, was to get pregnant, have my supply drop, and then have him wean because of a lack of supply. Well, it kinda happened that way. But, as my sister once told me, we make plans and God laughs. I really believe this is true sometimes.

I did get pregnant. My little one was about 12 months old when I got pregnant. As I said, at 15 months he was showing no sign of slowing, so the reduction in milk supply seemed to not be an issue. Until it was. Around 16 months, he started to be really bothered by it. We had weeks, I'd say 2-3 at least where he'd ask to nurse so I'd oblige. I followed the recommendations for easier weaning that said, "Don't offer, don't refuse" - a supposedly gentler way to ease them through the process of self-weaning. But that time period was pure torture. He'd ask, and I'd nurse him, but after several moments of not getting much of anything, he'd sit up and show me the signs for "milk," "more," and "please." I'd change sides so he could nurse on the other side. Again, after a few moments, he'd sit up and request, "more milk please" signing frantically. We went back and forth several times, each time, he'd get more and more frustrated. Fussing and crying was added into the mix of frantic sign language. Eventually, he'd climb down off of my lap and stand in front of me, tears streaming down his cheeks, crying and signing incessantly. It broke my heart. I was helpless. And this happened several times a day for weeks. Every time I'd sit down, no matter where, he'd beg me to nurse. Every time, I was completely lost. There was no way I could help my little boy. I felt like a terrible mother. His world was falling apart, and it was my fault. What had I done to him? Occasionally, I'd try to offer him a sippy cup with milk. He had started drinking cow milk by this age, but when he wanted to nurse, he refused the sippy cup and swatted it out of my hand. I cried along with him many of those times because I had no clue what to do about it. There was no way I could ease his pain.

It did get better though. Eventually, he would take the sippy cup here and there. Then, he'd take it more frequently. We were able to reach a time when he'd nurse even with little supply for short sessions and then go about his business. Our main nursing sessions became when he went to bed for a nap or for the night. He started sleeping through the night more frequently by this point too. Some nights he'd wake up and scream and cry and I'd nurse him back down. Other times, he'd awaken, but go back to sleep on his own. This was around 17 months of age.

After a while though, the lack of milk available made him nurse for even shorter periods of time. It wasn't long enough to settle him down for sleeping. I'd always offer milk in a sippy cup before bed, but turned instead to standing and swaying to settle him down for naps and bed time. We've been doing this for a couple of weeks now.

Looking back, I really don't want to experience those early times of reduced supply ever again. It was horrible, heart-breaking, and made me question my mothering ability. After he came to terms with it, weaning was a dream and couldn't have gone smoother. I had no angst about him not continuing for longer (after all, I really had no intentions to tandem nurse. Kudos to those who do it, but it's not for me). I was at peace with letting him grow up and ease away from it. I miss the cuddle time with him immensely, but the nursing itself, I'm not mourning the loss of. It happened like I wanted, but not how I expected. I really thought it'd be easier, but I didn't anticipate his reaction. I only hope that other moms that experience forced weaning due to pregnancy acknowledge that this can happen - it may not, but it is a possibility. I don't think anything can really prepare you for it, but there you go - the info is out there.

On Baby Sleep

Baby sleep is one confounding subject. There are all kinds of articles on it that will tell you how much sleep they are supposed to get, what ages you'd expect to have your baby take two naps a day and when they'll transition to one nap, how to get them to bed at night, etc. If there is one consistent thing I've found with all of the articles I've read, it's that not a single one seems to apply to my baby. I'll explain.

How much babies sleep. I've read several articles that say even though it seems counter intuitive, the more a baby sleeps, the more they will sleep. Ok, what? Basically, they tell you that consistent naps and early bed times ensure longer naps and longer night time sleep. While you may think that the earlier they go to bed, the earlier they awaken, this is not true. They theoretically will sleep longer if you put them to be earlier.

Many people will recommend you let the baby cry it out. As in, you put them to bed awake and if they are crying, let them cry to exhaustion until they finally go to sleep. This is actually not a recommended solution, even though many pediatricians still tell parents to do it. The problem with crying it out (and we're not talking a 5 minute spurt, we're talking 20-30 minutes or longer) is that as a baby cries are unanswered, the more they become stressed out, the more thy are learning that their needs will not be met. They are learning, however unconscious, that people can not be trusted and this will not only lead to an anxious child, but also one that has problems developing relationships with people. Cry it out can be done following the Ferber Method which involves several steps of reassuring the child that their cries are not unanswered and helping them to soothe themselves, knowing that their parents are close by if they are needed. I have a whole post on cry it out, if you want to check that out.

I have many friends that talk about their babies naps and how they can't do certain activities or have to postpone to a later time because that is the baby's nap time. I hear of moms whose babies have slept through the night from the time they put them to bed until they get up in the morning since an early age. I've read that a consistent sleep schedule is best for getting your child to nap and sleep.

And then there is my child.

Now, granted, it's not for lack of trying. Pretty early on, when my little one started staying awake longer, he developed his own sleep schedule. Since I've adopted a more attachment-parenting parenting style, I did not insist on a particular schedule and followed my munchkin's cues to identify when sleep times were. So, pretty early on, this was established by him. He'd wake up around 6:30 or 7 in the morning, get cranky and tired for a nap around 11:30 or 12, get cranky for a second nap around 2, and then he'd go to sleep at night starting at about 10:30p and slowly moving up to around 8:30p. At around 1 year of age, he started skipping the morning nap crankiness and would get tired around 1pm. So, he went from two naps to one. All of this seems perfectly normal.

So where is the problem? Well, it's that he doesn't always sleep. I've tried to put him down to naps before he is cranky (as the articles suggest) around the times he'd normally get tired, but he'd do nothing but sit up and scream. I refuse to let him cry it out, and even trying the Ferber method, his crying doesn't subside upon seeing me as it is supposed to. We have a regular bed time routine too (also as books and articles suggest) but that doesn't mean he always goes down on time. Even if I start the routine at the same time every night. It doesn't matter. He also still wakes up at night (at 13 mo.) which some people seem to think this should be done by much earlier. It is rough. I don't get a ton of sleep, but, at the same time, it is kind of my choice. I don't use cry it out. I haven't tried methods lined out in "The No-Cry Sleep Solution" which I've heard works well. I haven't seriously sought out assistance in getting my baby to sleep more.

But at the same time, I am not stressing out over it, does it bother me? Sure, but I'd rather let my baby sleep when he needs it. I figure it's less stress on him (and me) if I don't try to force him. When he is cranky and fighting sleep and really needs a nap, I take a nap with him. That solves that problem. The bottom line is, it works for us. Don't let people tell you that you need to change what you are doing unless it is causing problems, stressing you out, or putting your child's safety at risk. So what if my baby doesn't take two naps a day and sleep 12 hours at night? I'm not alone and my baby is happy. He is not over-tired and sleep deprived as many of the articles would have you believe. When he doesn't take regular naps he catches cat naps here and there to get the sleep he needs and then goes back to playing and exploring - his favorite activities.

On Cry-It-Out (CIO)

Cry it out is a common topic you hear in discussion with moms pretty frequently. It raises quite a bit of controversy too. For some, it is the only way to get some peace and quiet, for others it is neglect to let your child do it.

Growing up, I had always been indoctrinated with the concept that with kids, you can't just go to them every time they scream and cry. It will merely teach them that this type of behavior is acceptable, and even if you show displeasure, it still has the desired affect of giving the child attention. And this is true, to an extent. I will explain:

It is pretty much a well known fact that kids will try to get the attention of their parents. Kids don't always care if it is good or bad attention. They'll take it any way they can get it. Attention seeking behavior, in my opinion can be either on purpose or subconscious, but I think we all will do it, even as adults. Training a kid sometimes is like training a dog (you'd say the opposite if you had kids first, I had a dog first so for me, this is the order I choose). Positive reinforcement yields positive behaviors. Punishment is not always effective because it is often carried out inconsistently (enter shows like Super Nanny and Nanny 911). Attention is intangible and so when poor behavior attracts it, it is the same as giving a mouse a cookie, so to speak.

There is however, an age/developmental issue that people don't talk about. Probably because it is virtually impossible to pin point. What do I mean by that? Well, babies have no concept of what attention means. They simply have needs and as a baby, needs need to be met. Their only choice when it comes to communication is crying. They are telling their parents what they need. Yes, sometimes that includes attention and snuggling, but that is not always a bad thing. I've read in several places that in a baby that is left to cry (and I mean for an extended period of time), cortisol levels rise in the brain and can cause permanent psychological or physiological changes - such as an insecure person that lacks the ability to trust others. A baby whose needs are met when called for are more secure through their life.

So, what about all the questions of attention seeking behaviors and inability to be alone or self soothe? Well, that is where cry it out (CIO) come in as well as simple individual development.

I'll start with Cry It Out (CIO). When I was younger and of babysitting age, I believed that letting a cranky, fussing kid alone to figure out that their attention seeking behavior was not effective was the thing to do. Eventually, they'd realize it wasn't working and go to sleep on their own. I was told this by many a people and it seemed to make sense. This is not CIO, however, this is what most people think it is and they continue to do this. Now, there is a place and time, but this is not how it's done.

The official method of Cry It Out (CIO) means that the parent is actually teaching the baby to self soothe. When the baby is put down and starts crying, the parent goes through several steps that involve checking on the baby, letting the baby see them and feel secure that the parent  is close by but the baby is not picked up. The parent will then through multiple checks every so often while the baby is fussing check on the baby and ensure to be seen. The checks will lessen in frequency and the distance to the baby in the bed/crib will lengthen. Eventually, the child, knowing that mom or dad (or whoever) will come when called is secure and comfortable and will eventually fall asleep. This is the correct way to do CIO (more detailed information can be found online or in books. I am not an official teacher of this). The child is not simply left to cry to exhaustion.

So, even the official Cry It Out (CIO) method involves tending to the needs of the child, despite what many people believe. What about teaching the child to not fuss and scream just for the attention? Well, when CIO is practiced correctly, it does teach them this. If you don't know how to do CIO or you want to do your own method, the answer is easier, but more vague. Trust your instincts. You know your child better than anyone. You know if he or she is crying because he or she is hungry, needs a diaper change, or is tired. Maybe not at first, but you will come to realize that you actually have figured it out. Until then, be assured that you can't spoil a newborn. Being there to meet his or her every need is necessary with a newborn and this will help you to learn the source of the crying. The day will come when the baby is just tired and you will need to just let him or her cry for a short period of time, whether you use CIO or not. You will know when that is, because you have figured out, although in a very abstract manner, what your baby is telling you. Crying is necessary for communication and babies cry for a reason. Responding to that is not spoiling the child and teaching them to seek attention - it is meeting their needs and helping to ensure a secure, trusting future. Once again, it is all about trusting your instincts.

As far as my personal experience and my baby goes, I don't really use the official Cry It Out method because I haven't learned the specifics. I pretty much respond when he is crying. Sometimes he is just fussy and tired. I've been known to let him fuss for a little bit when putting him down. If at any point, it escalates to a screaming fit or goes on for more than 10-15 minutes, I usually will see to him and address what he needs. Sometimes he's just not ready to go down, sometimes he's hungry, sometimes it's a diaper issue. He doesn't always fuss when I put him down either. Sometimes he will go to sleep quietly and calmly. Sometimes he's already nursed to sleep when he is put down. Other times, he'll fuss for a little bit and then go to sleep on his own. My baby is able to self soothe back to sleep after awakening, so there are times when I can hear him moving around after he has gone down and if I leave him be after a couple of minutes, he'll go back to sleep. Other times when he awakens at night, he starts bawling - that is when I know he needs something. This is what has worked for us and I wish you all the luck with your little one.