The Do's and Don'ts of Co-Sleeping
By Tracy Cassels, from Evolutionary Parenting
It's come to my attention that there are places in the US that are ramping up their fight against co-sleeping. In some areas of the country, there seem to have been a rash of infant deaths that have been attributed to co-sleeping and so those in charge have decided to campaign against the practice. For example, in Cincinnati, the police are taking up the cause in hopes of educating parents about the dangers of sleeping with your child. In Jefferson County, IL, five babies have died in the past year due to co-sleeping and their mothers are joining forces with "healthcare providers" to speak out against sleeping with your child. Now, no one wants to see babies die, least of all me. It's probably the most heart-wrenching experience, especially if it happens in your arms or because of something you've done. BUT, and this is a huge but, banning co-sleeping is NOT the answer. In fact, at the same time that these articles came out, Dr. James McKenna from the University of Notre Dame, a preeminent sleep researcher who has studied infant sleep for over 30 years, spoke out in favor of co-sleeping. His and others' research that has found that at the very least, co-sleeping in the form of having your baby next to the bed reduces the risk of SIDS by about 50%. While accurate numbers for bedsharing are harder to obtain because few studies covary for the risk factors, places like Japan boast some of the highest rates of bedsharing in developed nations (close to 40%) and some of the lowest rates of SIDS in the world; thus, bedsharing can not only be safe, but you and your baby can reap immense benefits from it.
It is worth noting that Dr. McKenna is not some crackpot, but a well-respected, highly intelligent researcher whose work has been published in top journals like Sleep and Pediatrics. He is also not some crazed co-sleeping advocate. His articles suggest a balanced examination of the issues pertaining to infant sleep which includes being considerate of cultural issues and the problems surrounding the definitions of co-sleeping, while also noting the evolutionary purpose of co-sleeping for infant sleep patterns. And in all of his work, he consistently finds large benefits to having infants and mothers sleeping together or, at the very least, having infants and mothers in the same room. For example, one of McKenna's studies found that infants who co-sleep show greater arousal patterns during sleep than solitary sleepers, predominantly due to mom's presence and breastfeeding while sleeping. Why is this important? Well, the failure to arouse during sleep is hypothesized to be a part of the etiology of SIDS, and so babies who fail to arouse are at a greater risk of dying from SIDS. It seems that mom's arousal affects baby's, lending protective support against SIDS. As put so beautifully in one of his articles:
"If anthropological evidence on infant sleep and development were integrated and used as a starting point to inform infant sleep research, there is no doubt that the question we would be asking is not if it is safe for an infant to sleep next to its breast feeding mother, but rather, is it safe not to!"
So we have research touting the benefits of co-sleeping and how it protects infants on one hand and certain mothers and health care "authorities" saying it's dangerous and women shouldn't do it on the other. How do we reconcile this? Well, it seems that the health care authorities would prefer to throw the baby out with the bathwater instead of trying to educate people about the do's and don'ts of co-sleeping. We've evolved to co-sleep and thus it is an expected part of an infant's life and development, but our environment has undergone some rather dramatic changes over the past couple hundred years or so and we need to account for that.
Here you will find a summary of some of the things that you should and should not be doing in order to safely co-sleep with your child.
Now, the fact remains that many people will do some of these things some of the time and be fine (though some, like being intoxicated, should never be done). For example, some fathers will sleep with their infants and by and large everyone will live. It's important to remember that these are factors that are associated with a higher risk of infant death, but they do not guarantee it. When you think about how we evolved as a species and the drastic changes we've made to our society in the last couple hundred years, it's no wonder these particular factors are the ones that raise the risk. We didn't used to abuse drugs and alcohol (though they have obviously been around for ages), we didn't have waterbeds or sofas or duvets. And the 'family bed' has always been on a large enough surface that other siblings didn't run the risk of rolling over a baby. But times have changed and so we need to make sure we work to keep everyone safe. If you cannot do that, the next best thing is to buy a Co-Sleeper which attaches to your bed and allows you to be close and touching your baby, but without having the baby right in your bed.
Despite the fear that has been created by health professionals surrounding co-sleeping, it remains something we were evolutionarily built to do. Infants thrive when sleeping close to their mothers, and mothers benefit as well by being able to breastfeed without much disruption which leads to better sleep which reduces the risk of post-partum and contributes to overall well-being. It's a win-win. But it needs to be done safely and our society has made significant changes to our general lifestyles that do put infants at risk. However, instead of throwing the proverbial baby out with the bathwater, we need to focus on teaching people how to safely co-sleep with their infants. By doing that, everyone will benefit.
 McKenna JJ & McDade T. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Pediatric Respiratory Reviews (2005); 6: 134-152.
 McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VL, & Glotzbach SF. Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome. Sleep (1993); 16: 263-282.
 McKenna JJ & Mosko S. Evolution and infant sleep: an experimental study of infant-parent co-sleeping and its implications for SIDS. Acta Paediatrica (1993); 82: 31-36.
 Mosko S, Richard C, McKenna JJ, & Drummond S. Infant sleep architecture during bedsharing and possible implications for SIDS. Sleep (1996); 19: 677-684.
 Mosko S, Richard C, & McKenna JJ. Infant arousals during mother-infant bed sharing: Implications for infant sleep and sudden infant death syndrome research. Pediatrics (1997); 5: 841-849.
 Blair PS, Fleming PJ, Smith IJ et al. Babies sleeping with parents: case control study of factors influencing the risk of the sudden infant death syndrome. CESDI SUDI research group. British Medical Journal (1999); 319: 1457-1462.
 Carpenter RG, Irgens LM, Blair PS et al. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet (2004); 363: 185-191.
 Drago DA, Dannenberg AL. Infant mechanical suffocation deaths in the United States, 1980-1997. Pediatrics (1999); 103: e59.
 Fleming P, Blair P, Bacon C et al. Environment of infants during sleep and the risk of the sudden infant death syndrome: results of 1993-1995 case control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. British Medical Journal 1996; 313: 191-195.