Move Over, Mom and Dad

Last Editorial Review: 1/30/2005

Can Co-sleeping Work For Your Family?

WebMD Feature

Mention "family bed" or "shared sleeping" at any playgroup or cocktail party, and you're likely to spark a flurry of responses, whether it's whispered confessions, raised eyebrows or plain dig-in-your-heels soapbox routines.

You won't get any less of a hodgepodge of opinion from the experts on the practice, also called co-sleeping.

The American Academy of Pediatrics (AAP), the U.S. Consumer Product Safety Commission and many doctors discourage it, mostly due to potential safety hazards, while other child-rearing experts, including pediatric guru William Sears, say the family bed is a healthy, natural setup.

"There are reasons why it's not always going to be the best thing, but it certainly is not inherently bad by any stretch of the imagination, as long as certain basic precautions are taken," says Dr. George Cohen, senior attending pediatrician at Children's National Medical Center in Washington, D.C., and editor-in-chief of the AAP's "Guide to Your Child's Sleep" (Villard, 1999).

The fact is, it's a personal choice that's right for some families and not for others. Sift through the issues and if the "Three's Company" (or Four or Five) approach fits your family, then just be sure to build in some safety measures.

The Family Bed Safety Checklist

Despite the fact that co-sleeping is the norm in almost all cultures around the world, U.S. pediatricians and parents worry most about two things: that a baby will become entrapped in bed or bedding and suffocate, or that an adult will roll over on top of an infant and injure or suffocate the child.

"As comfy and nice and bonding as it might seem, it's very dangerous for the infant," asserts Dr. Douglas Baker, chief of emergency medicine at Yale-New Haven Children's Hospital and member of the AAP's section on pediatric emergency medicine. "We've had three kids in the last three or four months who have been suffocated by co-sleeping."

The U.S. Consumer Product Safety Commission released a controversial study last year, published in the Archives of Pediatrics and Adolescent Medicine, showing an average of 64 deaths per year between 1990 and 1997 among babies under age 2 who slept in adult beds.

But many pediatricians, breast-feeding advocates and others harshly criticized the results, claiming the study was unreliable in large part because it didn't sufficiently consider underlying causes for the deaths or compare like statistics for babies who slept in cribs.

If you do want to share their bed with your children, pediatric experts recommend these safety precautions:

  • Make sure your young baby sleeps on his back on a firm surface and avoid placing him on top of soft, fluffy mattresses, waterbeds or comforters and quilts. One of the major risk factors for sudden infant death syndrome (SIDS) is putting babies to sleep on their stomachs, especially on soft bedding or waterbeds.
  • To avoid the risk of rolling onto your baby, never share a bed with any infant or young child if you're intoxicated or on prescription or over-the-counter medications that could interfere with your ability to awaken easily, such as antidepressants, sleeping pills and some antihistamines. Obesity is another risk factor for rollover accidents. If you are a smoker, you probably shouldn't share a bed with your baby, because infants of smokers are at increased risk of SIDS and childhood respiratory illnesses.
  • Prevent your baby from falling off the bed by placing her between mom and a guardrail, or between both parents. In "The Baby Book" (Little, Brown and Company, 1993), Dr. Sears advises against the latter, saying fathers don't exhibit the same keen awareness of a baby's presence while asleep.
  • Make sure the headboard and footboard don't have openings in which a baby's head or limbs could get caught.

Bedside Breast-feeding

One of the benefits of sleeping with your baby is that it's much easier to handle nighttime feedings if you don't have to drag yourself out of bed to rescue a hungry infant.

"We planned not to sleep with the baby," says Jessica Huff, a mother of two from New York, "but within a week the baby was in the bed -- it was just so much easier." The choice between getting up to sit in a chair and nurse or rolling over to do it was a no-brainer, she says.

Breast-feeding carries all sorts of benefits, of course. Besides the closeness between mother and infant, nursing lowers a baby's risk of bacterial and viral illnesses and may provide longer-term protection against ear infections, diabetes, asthma, allergies and obesity. For moms, it reduces the risk of breast cancer, ovarian cancer, osteoporosis and hip fractures.

"The increased duration and success of breast-feeding is very positive ... and that's one reason I'm in favor of co-sleeping, if a mother really really wants to do it," says Dr. John Kennell, professor of pediatrics at Case Western Reserve University in Cleveland, who pioneered research in bonding.

For nursing mothers who worry about the potential hazards of co-sleeping, putting a crib or bassinet next to your bed offers almost the same convenience and immediacy and may even give nervous parents a better night's sleep.

Together, Again and Again

Many co-sleeping parents describe the closeness they feel to their babies, their rhythmic breathing and warm bodies nestled close. Even elbows or feet in the face, for these parents, pale in comparison to the joy shared sleep brings. The children may even become more secure and self-confident.

However, some studies have shown that adults who share a bed don't sleep as soundly.

"I'm actually supportive of people who want to co-sleep -- I think there's an emotional closeness to it, and it's good for babies," says Dr. Barbara Howard, assistant professor of pediatrics at Johns Hopkins University in Baltimore and the mother of two children and two stepchildren. "But I didn't sleep with my own babies because I needed my sleep too badly."

It's essential that both parents agree on the idea of the family bed; otherwise, resentment could brew. Carefully examine your motives, advises Dr. Howard, to make sure it's not a strategy to avoid intimacy with a spouse.

While some may worry that a child in the adult bed is a surefire recipe for abstinence, some parents who co-sleep say the arrangement simply fosters more romance and creativity.

In a recent Mothering magazine essay, a co-sleeping mother of two from Huntington Beach, Calif., Joylyn Fowler, noted that "If the kids are in the family bed, well, that means they aren't in the living room, bathroom, kitchen, guest bedroom, hallway, on top of the fridge ... you get the idea."

Dr. Howard suggests that parents decide how long they feel comfortable with the arrangement. If they want to limit the family bed to infants only, then 6 months is a good age to make the switch. By 9 months, she says, a child may protest exile from mom and dad's bed.

For those who are committed to shared sleeping for the longer haul, Dr. Sears writes that a good time to gradually encourage children to sleep on their own is at age 2 or 3 years. Start the transition by having them sleep on a mattress or futon at the foot of your bed.

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