A single mom was moving into her own place with her 3 children. They spent all day moving and unpacking, and at the end of the day she only had 1 bed put together. She tucked herself and the 3 children into the bed and they all zonked out. She woke early in the morning to find that her youngest... a baby just a few months old... was dead. I can't even type this without getting nauseous. This is a real story of a real family I cared for as a young nurse in the the Emergency Department in Pennsylvania.
That morning, after driving home from night shift, I cried and promised myself that one day when I got married and had kids, I would under no circumstance sleep with my kids in my bed. And I didn't. Intentionally. There were nights I dozed off while holding my daughter those first couple weeks because she cried anytime I laid her down overnight. And I have pictures of myself asleep on the couch with my son when he was about 1 month old.
What We Know: Bedsharing Happens, Whether Planned or Not
According to a study published in the Maternal Child Health journal in 2007, 77% of families bedshare "sometimes or always". During the first few months of life, when babies eat frequently, and moms are super tired, many mothers feel that bedsharing is a practical way to do things. A study published in 2010 showed that 40-50% of moms (depending on ethnicity) bedshare because they think it is the best thing to do, 44-53% bedshare because "its the only thing that works", and 4-12% bedshare because their doctor told them to.
This story is long, so let me get to the point. I once agreed with the hard stance of... "don't bedshare ever under any circumstance." However, I wasn't totally informed at this time. And the more families I work with who struggle with sleep challenges, the more I realize that bedsharing is something that happens, whether planned or not.
A Message that Doesn't Work: Don't Bedshare Ever
A message we know doesn't work - Don't bedshare ever, under any circumstance, to reduce the risk of SIDS.
77% of families bedshare with their babies, yet only 21-39% of mothers think that bedsharing is a good idea (Ball, 2007). Ok, so bedsharing isn't always planned (insert exhaustion/convenience in the middle of the night). We know this.
A Message That Is Actually Helpful: Don't Bedshare If You are Unable to Meet The Following Criteria
A message that is actually helpful - Don't bedshare if you are UNABLE to meet all 7 of the following criteria, to reduce the risk of SIDS.
1. No Smoking - This includes prenatal, second hand, and third hand smoke exposure. Prenatal smoking (during pregnancy) is the biggest risk factor for SIDS! (Vennemann (2012)
2. Breastfeeding - Breastfeeding babies prefer to be at breast level, while formula fed babies (who have no attachment to the breast) tend to wander and push north towards the pillow. Pillow = SIDS risk (McKenna, et al 2007). Additionally, breastfeeding mothers have a synchrony with their baby (mom and baby are aware of each other throughout the night) that we do not see with formula feeding mothers. (McKenna and Mosko, 1994).
3. Sober - No sleep aids, alcohol, or drugs (Drago and Danneberg,1999)
4. Back is Best - Baby sleeping on her belly while bedsharing increases the risk of SIDS 2x. (Dwyer, 2009)
5. Healthy Baby - Babies who are born premature or who have other underlying health conditions are thought to possibly have difficulty rousing from deep sleep, leading to an increased risk of SIDS (Randall, 2013)
6. Lightly Dressed - Babies who are swaddled (while bedsharing!) and sleeping in heated rooms are at an increased risk of SIDS (Ponsonby, 1993)
7. Safe Bed - A safe bed prevents accidental suffocation /strangulation which is different than SIDS, but still a serious concern. NO fluffy bedding, cracks/crevices for baby to fall into (beds, sofas), cords (cell phone chargers!), non-sober adult, sharp edges (chairs/sofas), blanket on baby’s head.
After considering the "perfect storm" that leads to SIDS (Filano and Kinney, 1994) and many other studies, the risk of SIDS while bedsharing is essentially non-existent if you can meet ALL 7 of the above criteria.
Also keep in mind, 75% of SIDS cases occurs during 0-5 months of age, only 2% of SIDS cases occur between 9-12 months.
Lahr, M. B., et al. (2007) Maternal -infant bedsharing: Risk Factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction. Maternal Child Health Journal, 11, 277-286.
McKenna, J. J., & Volpe L. E. (2007). Sleeping with baby: An internet-based sampling of parental experiences, choices, perceptions, and interpretations in a Western Industrialized context. Infant and Child Development, 16, 359-386.
Filiano J.J., & Kinney H. C. (1994). A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model. Biol Neonate, 65 (3-4), 194-197.
Vennemann MM, et al. Bed sharing and the risk of sudden infant death syndrome: can we resolve the debate? J Pediatr. 2012 Jan;160(1):44-8.e2. doi: 10.1016/j.jpeds.2011.06.052. Epub 2011 Aug 24. PMID: 21868032.
McKenna JJ, Mosko SS. Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine. Acta Paediatr Suppl. 1994 Jun;397:94-102. doi: 10.1111/j.1651-2227.1994.tb13271.x. PMID: 7981481.
Dwyer T, Ponsonby AL. Sudden infant death syndrome and prone sleeping position. Ann Epidemiol. 2009 Apr;19(4):245-9. doi: 10.1016/j.annepidem.2009.01.024. PMID: 19344862.
Marinelli KA, Ball HL, McKenna JJ, Blair PS. An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse. J Hum Lact. 2019 Aug;35(3):510-520. doi: 10.1177/0890334419851797. Epub 2019 Jun 11. PMID: 31184521.
Randall BB, Paterson DS, Haas EA, Broadbelt KG, Duncan JR, Mena OJ, Krous HF, Trachtenberg FL, Kinney HC. Potential asphyxia and brainstem abnormalities in sudden and unexpected death in infants. Pediatrics. 2013 Dec;132(6):e1616-25. doi: 10.1542/peds.2013-0700. Epub 2013 Nov 11. PMID: 24218471; PMCID: PMC3838527.
Ponsonby AL, Dwyer T, Gibbons LE, Cochrane JA, Wang YG. Factors potentiating the risk of sudden infant death syndrome associated with the prone position. N Engl J Med. 1993 Aug 5;329(6):377-82. doi: 10.1056/NEJM199308053290601. PMID: 8326970.
Drago DA, Dannenberg AL. Infant mechanical suffocation deaths in the United States, 1980-1997. Pediatrics. 1999 May;103(5):e59. doi: 10.1542/peds.103.5.e59. PMID: 10224203.
Kendall-Tackett, K. A., et al. (2010). Mother-infant sleep location and nighttime feeding behavior; US data from the Survey of Mother's Sleep and Fatigue. Clinical Lactation, 1(1), 27-30.
Katie Ramirez, RN, BSN, CLC
Born Happy, Owner and Coach
Katie Ramirez is a Registered Nurse, Certified Lactation Counselor, and Coach for parents of babies, toddlers, and preschoolers. She has spent more than a decade serving patients at major university hospitals such as Vanderbilt University and Penn State University Medical Centers. Katie now spends her time supporting and empowering parents of babies, toddlers, and preschoolers as founder and coach for Born Happy.
Katie is the proud mother of two beautiful children, Roberto (age 7), and Veronica (age 5). She has a passion for health, wellness, and happy children, and believes that, with the necessary knowledge and support, all parents can live happy.
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