Health and Science News for Parents
May
20

Another study supports the public health community’s blind spot on cosleeping and bedsharing

written by Tara Haelle

Another cosleeping/bedsharing* study came out today, and I expect to see this one getting lots of press, as it well should. It pulls together data from five previous studies, making it the largest study to date on this issue. It clearly lays out the risks for SIDS for babies who share a bed with parents, and it purports to adequately take other risk factors into account in its analysis.

And it falls short — for the very same reasons that I’ve seen previous studies on SIDS risk and bedsharing fall short: it doesn’t take into account enough of the other possible risk factors for SIDS during bedsharing. Therefore, the study will likely, as others have, cause more harm than good in the form of guilt-ridden parents who are at their wit’s end and have no place to turn for practical, realistic advice. It may even – although I cannot provide evidence for this – continue to be a part of the problem in NOT reducing SIDS deaths due to bedsharing.

As the cosleeping debate rages on, the public health community has neglected its duty in providing guidelines on best practices for parents who will cosleep/bedshare, regardless of what the “official” recommendations are. Photo courtesy of Microsoft stock images.

First, what did the study find? It found that a breastfed baby of nonsmoking parents was at five times higher risk for SIDS if sharing a bed with parents than if sleeping in his or her own crib/bassinet/cot — but wait.** That “five times” number is actually an adjusted ratio of risk. The real risk is 2.7 times, which is almost meaningless unless you know the absolute risks. (For an excellent analysis of the statistical limitations in this study see this UNICEF commentary on it.) So let’s look at the raw numbers instead: Among the 1,472 babies who died of SIDS, 22.2% were bedsharing with parents; of the 4,679 control babies who did not die of SIDS, 9.6% were sharing a bed with parents the day of the study interview. In absolute risk terms without percentages, 8 of every 100,000 room-sharing babies in their own beds will die of SIDS while 23 of every 100,000 bedsharing babies will die of SIDS. Sounds a little scary, right? Let’s take a closer look at the way the study was done, the confounders they included in their analysis and what the authors are neglecting to address at all.

In any study, confounders are the other factors that might influence the result of an association between two things, usually an exposure and an outcome. Typical confounders include age, sex race/ethnicity, socioeconomic status, education level, occupation, etc. Depending on the study, other factors can be important confounders: in most studies about prenatal issues, for example, the woman’s reproductive history (previous pregnancies, miscarriages, abortions, etc.) and “parity,” or history of childbirth, are potentially important confounding factors. A study that does not adequately account for confounders runs the risk of having bias that influences the findings.

This study, published today in BMJ Open (you can read the full paper yourself), re-analyzes the raw data from five previous case-control studies while accounting for several really important confounders. In a case-control study, researchers identify a group of cases (here, the babies who died of SIDS) and compare them to a control group of babies/families with similar characteristics to find out what could account for differences in outcomes (one group died from SIDS; one did not).

The confounders they took into account are really, really important – many of the same ones that I’ve previously not seen adequately accounted for in previous studies. They include whether the parents smoke (a high risk factor for SIDS in any sleeping arrangement) and whether the baby was breastfed. They also took into account mother’s age, the baby’s birth weight, the position the baby was last left in and other important factors, but they only had the data on the mother’s alcohol and illegal drug usage for two of the five studies — a pretty significant limitation to the overall analysis. They also analyzed the deaths associated with sleeping on couches separately so that those numbers did not bias the results of BEDsharing (as opposed to accidentally falling asleep with a baby on the sofa).

It’s also important to keep in mind that the study is retrospective: the authors gathered data after the SIDS deaths. A prospective study follows participants forward and tends to be less susceptible to recall bias and other forms of bias. Further, suffocation deaths are counted as SIDS deaths because the UK Office of National Statistics “found that many of their characteristics were very similar.” I find this conflation disingenuous and unhelpful, but that’s not the biggest weakness of this study. The biggest problem is that authors left out three of the most important confounders. In fact, from what I can tell in the study, they never even considered them, never even asked parents about them. They are: Did you intend to share a bed with your baby (as opposed to accidentally falling asleep with the baby in the bed)? Do you know ways to reduce the risk of SIDS for a bedsharing baby? Did you use any practices to reduce the risk of SIDS while sharing a bed with your baby?

The last two, to my knowledge, have never been asked in a study about cosleeping/bedsharing. Why not? Perhaps they are nonsensical questions to researchers who, along with the public health community at large, have such a blind spot related to bedsharing that they refuse to acknowledge that there is ANY way to reduce SIDS risk in a baby who sleeps with their parents. The belief seems to be that if they repeat it often enough – ”Don’t share a bed with your baby” – and emphasize the risk of SIDS enough, then parents will magically start following their advice. They won’t.

Does this sound familiar? The idea that just repeating “don’t do it” will somehow make people stop doing it? Teen abstinence comes to mind: if we just tell teens not to have sex at all instead of teaching them safe ways to avoid pregnancy and sexually transmitted infections, then teen pregnancy and STI rates among teens will plummet, right?

Except that strategy hasn’t worked very well, as the public health community knows. They get sex education right. They have found that abstinence-only education does not have different long-term outcomes than more comprehensive sex ed and that comprehensive programs teaching safe sex and abstinence together are effective. In fact, abstinence-only education might even increase sexual activity, not to mention unprotected sex.

And that is why I have serious problems with this study and similar ones. The researchers are contributing valuable information to the research literature, and they claim to provide information “to enable an informed choice to be made by parents as to whether the risks associated with bed sharing outweigh the postulated benefits.” But parents cannot make an informed choice if the researchers are refusing to study or even acknowledge bedsharing practices that can reduce the risk of SIDS.

By denying parents information on best practices about ways they can reduce risks while bedsharing in addition to encouraging them not to bedshare, the public health community potentially shares responsibility for the continued SIDS cases in bedsharing. Their short-sighted, dogmatic, counterproductive, bang-their-heads-against-the-wall-expecting-different-results thinking might actually contribute to SIDS deaths among bedsharing babies. The study authors wrote, “Our analysis estimates that 88% of bed sharing deaths are attributable to bed sharing, that is, would not have occurred had the baby not been bed sharing.” My question is, how many of those deaths are attributable to parents’ not being adequately informed about the best ways to reduce the risk of SIDS if they were choosing to sleep with their baby?

Parents need sleep. There are some babies who absolutely, positively will not sleep on their own, period. My son was one of them. From day one in the hospital, he WOULD. NOT. SLEEP. by himself. I had two options: my son could sleep with me (which I had sworn I wouldn’t do before he was born), or I could go sleep-deprived for weeks on end. The latter was untenable — and much less safe. If I had continued to rock my newborn to sleep, lay him down in the bassinet and then walk away for the ten minutes it took before he woke up crying, hour after hour after hour, night after night, then I would have been a nervous wreck and a worthless parent. I would have placed my son at greater risk during the day for carelessness resulting from sleep deprivation. I wouldn’t have been able to drive – except that some days I had to, which would have been unsafe. I get dizzy with sleep deprivation; could I have dropped him? Sleeping with my son enabled me to get sleep and was tremendously more efficient for breastfeeding through the night.

I realize I may be promoting a paleofantasy fallacy, but I do think it’s safe to say that mothers, like other mammals, have been sleeping with their babies for thousands of years. I doubt Ms. Cavewoman placed her baby on a bed of leaves in a separate corner away from her at night, and much of the non-Western world sleeps with their babies. (In fact, even “sleep training” is a pretty modern and Western practice because most of the world, for most of human existence, has not had to return to work after six weeks of unpaid leave to conform to a biologically artificial 9-5 schedule.)

Parents need solutions, not shaming. These kinds of studies pile on the guilt for a mother who desperately needs sleep and whose only option might be to sleep with her child, but the public health community refuses to do evidence-based studies into best practices to give her practical advice she can actually use. And I’m leaving aside the fact that millions of mothers want to sleep with their babies, regardless of whether they feel they have to or not, which is a completely valid choice. There are definitely benefits to cosleeping/bedsharing, and there are excellent resources where parents can get information on safe cosleeping/bedsharing guidelines.

To be sure, I am not suggesting there is no increased risk of SIDS among parents whose babies sleep with them. I don’t believe adequate studies have been done to truly find out by taking into account ALL the necessary confounders, but I would not be flabbergasted to find there is an increased risk. However, we take risks all the time, every day. The point of public health is to teach the public how to reduce those risks as much as is possible. Even if we take this study’s findings at face value, 15 additional babies out of every 100,000 will die of SIDS because of bedsharing. Frankly, that is not a high risk, and my risk of endangering my baby through sleep deprivation is likely higher. The risks of dying in a car accident hover somewhere around 1 in 17,000 – without considering drowsiness or distraction by cell phones, etc. If not sharing a bed at all significantly reduces a child’s risk of SIDS and a parent can do that and chooses to do that, that’s great. For the rest of us, the public health community is neglecting its duty in teaching safe, effective ways to cosleep/bedshare while reducing the risk of SIDS or suffocation.

*Cosleeping is sometimes taken to mean sleeping in the same room but in separate beds and is other time taken to mean sharing a bed. To reduce confusion, I will use “bedsharing” throughout this post to refer to the kind of cosleeping where a baby sleeps in the parents’ bed.
**Edited to add the info about the risk and the link to the excellent analysis of the statistics in the paper.

29 Responses to “Another study supports the public health community’s blind spot on cosleeping and bedsharing”

  1. lora

    What has always concerned me about bedharing (and I did it, thought when my children were very small they were sidecarred) was the small amount of conflicting and vague information rgearding blankets, conforters, and pillows. Come on–everyone uses pillows and blankets and we all know it. Yet “official”-type cosleeping materials say “no blankets or pillows near the baby’s face.” What does this even mean? Is baby supposed to be way down on the bed outside of the blankets? I’ve never known anyone who coslept this way, especially in winter. Or does near just mean “not OVER baby’s face”? I mean, obviously…but the thing is, how near is NEAR? Little tiny babes can’t move that stuff off, which is what bothered me and which is why my little tinies were in the cosleepers. Bigger babies are a different matter. Also, no one I know who cosleeps pays much attention to “no older children in the bed with the baby.” Most people, once they cosleep, they cosleep for years.

    • Tara Haelle

      Hi Iora, that’s actually part of my point. The guidelines are not clear because the public health community refuses to put forward clear guidelines, preferring instead to say parents should not cosleep at all, period, end of story. If they would study practices in high-quality, well-designed quantitative and qualitative studies, we might actually have some good evidence to go on. Regarding your specific question, though, I actually DID cosleep that way: I used a pillow, but my son was down closer to my waist, far from the pillow (about a foot, at least), and I did not use a blanket or sheet except wrapped tightly around my legs only, again far from him. He was on a firm mattress with a single sheet cover, no blankets or sheets or pillows within a foot of him.

      • Jo

        Same here, Tara. I use one pillow and the baby sleeps at chest level (i.e. head near my boob for easy access). In the winter, we close our bedroom door to keep the heat in and I dress warmly from the waist up (nursing tank under for boob access/long-sleeved shirt over for warmth). My husband likes blankets still, so he sleeps on the other side of the King with his own blanket.

        We also co-slept with our first until I became pregnant with the second and then immediately worked toward getting her in her own bed. It was surprisingly easy. When #2 was a newborn, we rarely let Big Sis back into the big bed with us. On the handful of occasions she joined us, she slept on the other side of my husband, meaning he was between the two girls. If she had trouble sleeping alone, my husband would generally go to her bed instead. Now that everyone is older, we occasionally get all four crashed together, but it gets crowded fast ;)

      • lora

        See, to be honest, I could never have slept that way! (blanket wrapped tightly around legs only) It just sounds terrifically uncomfortable, and cold! I mean, but I do think it’s probably the safest way However, my strong suspicion is that only about 10% of cosleepers, if that, are as careful as you are. I want to say this, though: I don’t think pro-cosleeping people are innocent here either. I don’t think they really mention the idea that unsafe blanket/pillow/cover stuff could be causing issues. It’s always said or implied that this was drunk people on sofas.

        • Jo

          However, my strong suspicion is that only about 10% of cosleepers, if that, are as careful as you are.

          I don’t know where you get that assumption because I know a lot of intentionally cosleeping families and most who choose this route choose to do it safely. Does that mean all who cosleep do it safely because those are the anecdotes I have? No. But my personal assumptions here are equally as valid as yours. And they’re both pretty much useless because they’re not backed by actual data.

          I, personally, know a lot of families who put their babies in cribs and ignore a lot of safety recommendations because they find them inconvenient or don’t know any better. Young babies with crib bumpers and blankets and loveys. Families who put babies to sleep on their bellies overnight because they sleep better that way. Families who keep baby’s room too warm or too cold.

          And babies die of SIDS in cribs all. the. time. Yet no one is saying that crib sleeping is unequivocally dangerous or somehow blaming their parents for the deaths (“my strong suspicion is that only about 10% of cosleepers, if that, are as careful as you are… I don’t think pro-cosleeping people are innocent here either.”)

          “I don’t think they really mention the idea that unsafe blanket/pillow/cover stuff could be causing issues. It’s always said or implied that this was drunk people on sofas.”

          It is said or implied because many of the deaths included in “cosleeping” statistics *are* accidental smotherings on couches or next to intoxicated parents. It’s said because those are reported, documented facts. Not just propaganda.

          When it comes down to it, babies die in all sleeping environments. And they do so unexpectedly and without a known cause. (Babies who are suffocated did not die from SIDS. They died from suffocation.) Many families will use cribs. Many will share their bed. What we need to do is make sure that ALL babies are sleeping safely, wherever that may be, and we can’t ensure that if we stick our fingers in our ears and yell “DON’T DON’T DON’T!” in regards to bed sharing. That’s not helping anybody.

          • lora

            On the other hand, speaking of sticking fingers in ears, I think the cosleeping community needs to look at this study and talk about how the risk of death seems to be higher in the first 3 months. This is important information. There doesn’t seem to be much reason to be freaked out about older babies.

            Look, I coslept and I’d do it again, but I think both sides have their issues here with not being fully honest. The health/medical community wants to play up the risks because of paranoia and, I think, fear of cosleeping going even more mainstream and being unsafely adopted. The cosleeping community–not necessarily talking about the official, sanctioned line but the AP world–likes to tell us that cosleeping is safe as mother’s milk. I think the truth is somewhere in the middle. The study says, “Importantly, the combined data have enabled the demonstration of increased relative risk associated with bed sharing when the baby is breastfed and neither parent smokes and no other risk factors are present (see figure 2 and table 2). The average risk is in the first 3 months and is 5.1 (2.3 to 11.4) times greater than if the baby is put to sleep supine on a cot in the parents’ room (table 3). This increased risk is unlikely to be due to chance.” Do we think ALL of this 5X greater risk is due to unreported suffocation due to poor cosleeping practices? I don’t know. Probably some of it is. ALL of it?

          • Tara Haelle

            It’s worth noting that the 5x risk is referring to an adjusted risk specifically for babies under 3 months. The ACTUAL risk is 2.7 times. They adjust that number to scale down for the age. You can read more on the way the statistics were handled at this UNICEF commentary (which I’ve since added to my post above): http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/UNICEF-UK-Baby-Friendly-Initiative-statement-on-new-bed-sharing-research/

            In terms of raw data, we’re talking about 8 kids out of 100,000 in cribs vs. 23 kids cosleeping out of 100,000. That’s actually a 2.9x risk in raw numbers, but look at the number. TWENTY-THREE kids out of 100,000. These are not huge numbers. I have a much greater risk of my child dying in a car crash caused by me because I’m driving while sleepy because I’m sleep-deprived if I’m not cosleeping. It sounds all scary to say “It’s a risk FIVE TIMES greater!” but it’s important to stop and see where that 5 comes from and what it really means. It’s means 15 additional babies, over the 8 who are already going to die, will also die of SIDS while cosleeping — although it’s possible mothers who used alcohol or drugs are included in that risk because only two studies even collected that information.

    • Tara Haelle

      Jo, we’re hoping/planning to have a second, and I don’t know how that will work. He’s been going to bed in his own bed and room for a year (he’s almost 3), but he almost always comes in at some point during the night or early morning. I always slept with him, as an infant, on the outside of me, with my husband on my other side, so that he was never between us. Perhaps we would switch things around: my son could sleep w my husband and I’d sleep in my son’s bed with the new (hypothetical) baby. Not sure.

      Iora, it was very comfortable for me, but maybe I’m weird. The sheets weren’t for warmth but for comfort. That said, to be fair, I had my son in June in Texas. Staying warm wasn’t a concern. Regarding safety of other cosleepers, your 10% figure could be correct. I don’t know, and there’s probably no way of knowing, but I would argue that it’s small precisely BECAUSE the public health community refuses to speak openly about the safest possible ways to cosleep. I have heard plenty of cosleeping moms talk about how it’s only unsafe if you’re a smoker, drinking *or* using blankets/pillows/sheets. We’re probably talking to different folks :)

    • Guest

      We didn’t plan to cosleep, but like the author, we had one of those children who absolutely, positively would not sleep. At one week of age, he was awake for TEN HOURS IN A ROW. In the early weeks, his TOTAL sleep, including naps, fell short of double digits. Cosleeping was the only thing that worked.

      Fortunately, before he was born, we read extensively about cosleeping so we’d know how to do it safely if need be. We did NOT use pillows, we slept on a firm mattress. We put the mattress on the floor so there was no headboard for baby to get injured on. We did not use comforters, wore tight-fitting close to bed, and short-sheeted our bed. That is, the thin blankets and the sheet only came to our waists! We also slept with our heads around baby’s legs, so if we were to roll over in the night (which we never did), our heads would land on his legs rather than his lungs.

      Oh, and we locked the cats out of the bedroom.

      We still cosleep with our son, who just turned three. We still all enjoy it. We have a baby on the way, and if I manage not to miscarry this one, we will move the 3-year-old either to his own bed in our room or onto a bed in our room with dad or into a separate room with dad. No way in hell the preschooler is going to be in the same bed as a new born. No way.

      • Tara Haelle

        Thanks for sharing your story. It’s great that you had been able to do that extensive research before your baby arrived. I wish more pediatricians would realize that children like yours DO exist — they’re not all programmed to sleep X numbers of hours of day on their own — and that parents like you who may not have had that information need it and deserve it. We continued co-sleeping with our son until he was 2 and moved him to his own bed shortly after that. However, he still comes and joins us in the middle of the night or in the morning, and he’s now 3. We’re hoping for another soon as well, and we figured I would just sleep in another room with the door locked so our toddler could go sleep with daddy in the morning :)

  2. As a pediatrician and first time mom, boy did I struggle with this issue for my son’s first few months of life. He was one of those babies: needed to be in my arms or right up next to me to sleep. I, of course was terrified to even think of bringing him into our bed. My instincts were telling me one thing ( do it) and my pediatrician science minded half was saying no way, the safety evidence is stacked against you.

    So I spent the first 6 months of his life on fragmented sleep, ended up in some VERY unsafe sleep positions b/c of my fear of bed sharing, like falling asleep on the couch with him in my arms.

    Finally, when I was brave ( and desperate) enough, I knew things needed to change. Granted, he was 6 months old so the overall risk of SIDS had dramatically decreased. I decided we needed to change our sleep arrangements and create as safe a bed sharing environment that I could. I put a firm queen mattress on the floor up against the wall. No comforters. Just a pillow for me, he nowhere near it, and a thin blanket around my legs. He slept between mr and the wall. And oh my god, it was the best thing we ever did.

    But it took us a long time to get there.

    Here is the big issue with SiDS and bed sharing and studies; and you elucidate it so clearly. There are simply too many confounding factors. It’s easy to come up with safe sleeping guidelines for cribs, it’s much more of a controlled environment. But, from both personal and professional experience, it doesn’t mean we shouldn’t try and advocate for safer bedsharing guidelines. We must in my opinion. I don’t think we’ll ever get the studies we’re hoping for ( again I think we should try but SO many factors involved).

    I would have preferred my baby sleep in a bedside bassinet or crib next to our bed, but apparently he didn’t get the safety memo. I hope that most parents heed those safety warnings. But for families struggling with sleep or who are committed to bed sharing, I think we have an obligation to advise them on how to make it as safe as possible. What scares me, is most parents aren’t willing to completely overhaul their sleeping environment if they choose to bed share. But if the do, it’s absolutely what needs to be done. You can’t simply bring a baby into your adult bed. That’s not safe. So Yes, we need to do better. We need universal safe sleep guidelines for ALL babies not just the ones sleeping in cribs or bassinets.

    Thanks for putting into words what I have struggled with for years now.

    • Tara Haelle

      Melissa, thank you so much for sharing your story. It actually is pretty meaningful to me to hear a pediatrician who struggled similarly. I was DEAD SET against cosleeping before I had my son — I had seen all the literature on the risks and the supposed “evidence” about how it was SOOOO much more dangerous than a crib. We had a bassinet specially made by a family friend and were planning to have it in the corner of our room. Alas, our son had other plans. The only big difference between your story and mine was that I gave in a lot sooner. I wrote a novel-length, teary-eyed email to about 12 mom friends in desperation because I did NOT want to cosleep and didn’t know what to do. That was when I found out ALL except two of them had coslept! It was like this dirty little secret no one had talked about. Even my mother told me she had coslept with me. (Before I had my son, I was completely unaware of how many coslept or that there was a whole discussion/controversy. I had never heard the term attachment parent until my son was a few months old, and I was already carrying him in a sling because it just worked for me.)

      So, I then made the conscious decision to cosleep for my own sanity and did lots of research to find the best ways to minimize risk. But it would have saved me a lot of tears, anguish and SLEEP if my pediatrician had talked to me about it in some way other than if cosleeping was the dawn of the Apocalypse (he was a great pediatrician otherwise!)

      I really appreciate hearing how you came to your own decision. I’m a huge proponent of encouraging people to listen to and trust their doctors (especially with vaccines!), and the only two places I differ significantly from the AAP are in this cosleeping debate and in swimming lessons for babies/toddlers (a whole other post coming in June :)

      • I really wish I had come to the decision sooner too. Would have saved us all a lot of lost sleep, worry, and heartache. I really hate that it has become this “dirty little secret” so I appreciate you talking about it openly too. I have come to really appreciate your writing and analysis of pediatric studies. Looking forward to your swimming lessons post! Yes, I encourage families to trust their doctors and now we must do our part too and stop turning a “blind eye” to what millions of families are already doing and will continue to do. :-)

  3. lora

    I suspect that part of the problem is that the medical community is very worried that parents will get complacent and/or not take the guidelines seriously, if there were to be issues. Because people don’t sleep that way, especially in winter. For many families, especially poorer ones with winter newborns, it would actually be an economic burden to keep the house warm enough to sleep comfortably with only a thin blanket wrapped around your legs. I know it would be hard for us to do this (I sleep cold, and in winter I have two puffy comforters on the bed and am in multiple layers, including fleece and wool socks). I do think it’s tricky. Of course, we still do need to know how much of a part covers/pillows really play.

    • Tara Haelle

      That is possible, but that’s not a good reason not to provide the guidelines. Even though I know you’re not making the argument, that argument is similar to “A lot of teens won’t wear the condoms if we teach them to, so we should just teach abstinence only.” That analogy is perfect in every way to comparing the way we teach teens about sex and the message we send parents about infant sleeping. The former doesn’t work, and the latter isn’t working. If a pediatrician takes their job seriously (as just about all do) and they engage with the parents in an honest, direct conversation, they can impress upon them “Sleeping in a crib is safer, statistically, by a small amount, but if you are going to cosleep, you need to be aware of the additional risks of X and Y and Z. Here is how you can reduce the risk of suffocation or SIDS, and here is what can happen if you don’t.”

  4. lora

    Also, naps are tricky.I used to get stressed about this when I had an older cosleeper. I didn’t like leaving him on my bed alone (worried about him rolling off).

  5. I was terrified of SIDS. Which was why I wanted my babies in and near my bed. I do get frustrated when people equate suffocation with SIDS.
    “SIDS is the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history.” -sids.org
    We don’t know what causes SIDS. We can prevent suffocation, but we can’t really prevent a baby from just suddenly dying for no reason. We do know that being in close proximity to mother helps a baby to regulate his breathing and heart rate, among other physiological benefits (Kangaroo Care.) Wouldn’t you think that could be a protective factor against SIDS? I sure did.

    I absolutely agree that we need to educate parents about safety and bed-sharing. It has inherent risks. Let’s remove those risks so baby and mother can enjoy the benefits.

    • Tara Haelle

      Exactly. Hopefully the medical and public health community will eventually discover the way they’re fighting this battle just isn’t working.

  6. lora

    “It’s worth noting that the 5x risk is referring to an adjusted risk specifically for babies under 3 months. The ACTUAL risk is 2.7 times.” Agreed, and I think the “cosleeping risk” argument should be more couched in terms of very small babies. So the medical community needs to be honest about that part. However, re 2.7–that’s the actual risk for babies with no other risks. If mom and dad are smokers (and lots of people smoke) or mom bottle feeds (and lots of moms do), etc etc, risk goes up a LOT. There was a freaky hypothetical stat in there about a 12% (12/100 babies with these risks could be expected to die of SIDS) risk for a theoretical infant. We need to keep in mind that bedsharing is common across all kinds of lines. Re the absolute risk–I don’t know. I think these are kind of whopper numbers. If using a pacifier, or introing solids too early, or something non-APish, was shown to up babies’ risks of dying 5 times, I think the AP community would be pretty up in arms. I don’t know the stats on how much nursing reduces infant mortality in developed countries, but is it 5X? Maybe it’s greater…anyway, I’ve personally found that convincing. A preventable baby death is a preventable baby death. As for driving when fatigued, you could make the argument the other way as well–I know a lot of AP moms who were pretty damn exhausted by AP sleep practices…

    • Tara Haelle

      Iora, I get the impression that you’re frustrated with the idea of AP practices in general, perhaps a little hostile toward them. I can understand frustration or hostility toward individuals who dogmatically espouse a whole parenting philosophy and sanctimoniously judge others who do not follow it. However, there are many, many, many parents who do a little of this and a little of that. I did a lot of AP practices before I’d even heard the term AP because I was out of the loop. I only did them because they made my job as a mom EASIER. I coslept with my son because I got much more sleep that way. I wore him everywhere because it was convenient, easy and less tiring. I breastfed him on demand I truly found that easier than trying to pump milk or worry about formula or anything like that. To each her own. I didn’t care if other mothers did or didn’t do those things because their needs were different. You may not realize it, but your words carry an underlying judgment about AP practices that ignores what motives parents might have for those practices.

      I don’t think AP parents or any others would necessarily be up in arms about any risk increasing 5 times if they knew the absolute risks. If you have 0.01% chance of getting a mosquito bite that will give you dengue fever in Florida, and wearing short sleeves increases that likelihood to 0.05%, I highly doubt any parent will cancel their trip to Disneyworld or insist their kid’s skin is covered head to toe in August. Now, if your risk of a car accident while alert is 1 in 17,000 in a lifetime (as it is), and driving drowsy increases that risk to 1 in 3,400 (which is a fivefold increase), then I would hope that parents would think twice about driving while drowsy.

      And yes, certainly any public health message should be cognizant of all the stripes of people in the population. That’s exactly why I’m saying that doctors need to be MORE honest and transparent about each of the risks and what they mean. If a smoking, drinking mom’s decision to cosleep means her child’s risk is 12 in 100, then heck yes, the doctor should spell that out. That’s not a reason not to provide complete, accurate, transparent information on the best ways overall to reduce risk of cosleeping. One of those ways: don’t smoke. Another: don’t drink. Another: firm mattress. Another: no blankets. And so on.

  7. [...] In fact, no study will probably ever do that. (You can read some critiques of the Carpenter study here and [...]

  8. Elizabeth

    Here, let me address your concerns in exactly the same way that attachment parents have addressed me as a formula-feeding mom:

    1. “The study will likely, as others have, cause more harm than good in the form of guilt-ridden parents who are at their wit’s end and have no place to turn for practical, realistic advice.”
    Someone else can’t make you feel guilty, only you can make yourself guilty. When you know better, you do better! Maybe you should feel guilty.

    2. “Parents need sleep. There are some babies who absolutely, positively will not sleep on their own, period.”
    Putting your sleep before your baby’s health is selfish. If you wanted full nights of sleep and no crying, you shouldn’t have had a baby. I’m sorry your child is such an inconvenience for you.

    3. “I would have placed my son at greater risk during the day for carelessness resulting from sleep deprivation. I wouldn’t have been able to drive – except that some days I had to, which would have been unsafe. I get dizzy with sleep deprivation; could I have dropped him?”
    Sorry you weren’t able to tough it out like I did.

    4. “Parents need solutions, not shaming. These kinds of studies pile on the guilt for a mother who desperately needs sleep.”
    Your need to be free of shame does not overwhelm the public’s need to know what is best for their babies.

    5. ” I would not be flabbergasted to find there is an increased risk. However, we take risks all the time, every day. … Frankly, that is not a high risk.” That’s nice you feel comfortable risking your baby’s safety to any extent, but a good mom always wants the best for her child.

    (I absolutely don’t buy into any of these rebuttals and I don’t think you do either. I’m just being snarky after taking this crap from attachment parents for the past 6 months.)

    • Tara Haelle

      Elizabeth, I won’t go through and do counter-arguments for each of these because I realize you’re being facetious and trying to make a point. Your point is valid in that no one should be judged for parenting practices that do not harm their children. However, I would caution that “attachment parents” should not be lumped together as all being sanctimonious and judgmental. I happen to practice many of the behaviors of an attachment parent, though I’m not sure I would label myself “an attachment parent.” Yet I do not judge my mom friends for their practices that don’t coincide with mine, and I have many breastfeeding, baby-carrying mom friends who don’t judge their friends’ decision to formula feed or use cry-it-out sleep training methods.

      Certainly, you do not deserve to be judged when you are providing your child with high-quality nourishment, which is what we’re supposed to do. I just hope the judgment you’ve suffered from others doesn’t jade you to the point that you become judgmental yourself of parents who choose different practices. (I still breastfeed my son – who turns 3 in a week – at night, and I’ve had mom friends judge me for that. It works both ways.)

      And all that said, you may enjoy the Sanctimommy Facebook page that does exactly what you did above. It’s a favorite page of mine: https://www.facebook.com/pages/Sanctimommy/523533471000365?ref=ts&fref=ts

  9. [...] whether or not the baby was subjected to a high degree of interventions, parent intention, etc.).  Others can do that much better than I, but mostly I don’t even really care to dignify this idiotic study with even the pretence of [...]

  10. [...] fact, I’ve come to agree with Tara Haelle’s post (http://www.redwineandapplesauce.com/2013/05/20/another-study-supports-the-public-health-communitys-b…) on the subject that suggests that the anti-cosleeping campaign is much like abstinence-only sex [...]

  11. I stumbled upon your website from a friend’s Facebook link – to your vaccine post – and I’ve since been hooked. I particularly enjoyed reading this post as I share many of the feelings you have in regards to bed-sharing. I was adamant about not doing it with my first born. I stuck it out but being the colicky baby that he was (for 4 straight months), I felt like a zombie most of the time. So much so that I can’t really remember “enjoying” those first few months. I think if I had tried to have him sleep with me, things would have been different. I gave birth to my second son 5 months ago and we’ve been bed-sharing almost from the beginning. This time around, I did a lot of research into the matter and in the end, made the decision that co-sleeping was best for us. And of course, we made sure to create the safest sleeping environment possible for him. I appreciate your statistical breakdown which really helps us see the big picture. It’s easy to get caught up in alarming words such as “5 times higher” when really, it needs to be contextualized. I will be a faithful reader of your site from now on! Big thanks from Canada!

    • Tara Haelle

      So glad to read this! Yes, statistical language using “relative risk” (five times higher! oh me!) can be scarier than – and misleading compared to – absolute risk (increase from 0.1% cases to 0.5% cases, for hypothetical example unrelated to this post). I do think there is a slightly higher risk of suffocation (but probably not SIDS), as shown in the data, even when everything is done “right” (despite the fact that we don’t have good data to show this and this is completely my non-medical, non-researcher, layman supposition), but there are risks to being a sleepless zombie for five months too! I’m expecting now and we’ll figure out what to do when my son is born, but I will quite likely co-sleep again.

  12. […] Mentionnons simplement ce texte de la doctorante en psychologue Alice Trépanier, celui de la journaliste scientifique Tara Haelle (en anglais) ou encore celui-ci de la blogueuse scientifique Maman […]

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