Nursing News:
Cosleeping continues to be hotly debated subject

Although the image of a baby and parent dozing off together is not an uncommon one, the practice of cosleeping is controversial in the United States. Cosleeping, or sharing a bed with an infant, claims the lives of 64 children under age 2 each year, according to the U.S. Consumer Product Safety Commission. This organization cautions parents against sharing beds with their babies, but supporters of cosleeping believe that a parent's bed is just where an infant belongs. But is it safe?

What Is Cosleeping?

Cosleeping is the act of having your infant in your bed with you during sleep. There are many reasons why parents choose to cosleep. Some find that it makes nighttime breast-feeding more convenient, or that it's easier to soothe an infant back to sleep in the middle of the night. William Sears, MD, a cosleeping proponent, says that it also helps babies fall asleep more easily, especially during their first few months, as well as stay asleep longer. In addition, Dr. Sears says that cosleeping makes it easier for a nursing mother to get her sleep cycle in sync with her baby's. Cosleeping mothers often awaken just before their babies start to cry for a feeding and can nurse them back to sleep before they both fully awaken.

Some parents who are separated from their babies during the day believe that cosleeping helps them regain the closeness with their infant that they missed during the day. What are the downsides of cosleeping? Having a baby in bed sometimes prevents both parents from getting a good night's sleep. And infants who cosleep typically become dependent upon being in a parent's bed in order to sleep, says Mary McCord, MD, MPH, an associate clinical professor of pediatrics and public health at Columbia University.

"They become habituated to it, and emotionally, they come to want it," Dr. McCord says. "There isn't anything wrong with this, but the parents have to accept that their sleep is more likely to be disrupted." Eventually, the cosleeping routine will be broken at some point, either naturally because the child wants it or by the parents' choice.

Is Cosleeping Safe?

Despite the potential benefits of cosleeping, the CPSC warns parents not to put their infants in adult beds, stating that the practice puts young children at risk of suffocation and strangulation. The CPSC found that at least 515 infant deaths occurring during January 1990 to December 1997 were linked to sleeping in adult beds. Most of the deaths involved babies who were under 3 months old. "Our recommendation is that the safest place to put an infant to sleep is in a crib that meets current standards and has no soft bedding," says Ken Giles, a CPSC spokesperson. "We recommend against having an infant sleeping in an adult bed because there are a number of hazards, many of which can lead to death."

The CPSC identifies four primary hazards:

• suffocation caused by an adult rolling on top of or next to a baby

• suffocation when an infant gets trapped or wedged between a mattress and nightstand, wall, or other rigid object

• suffocation resulting from a baby being face down on a waterbed, a regular mattress, or on soft bedding such as pillows, blankets, or quilts

• strangulation in a headboard or foot board that allows part of a child's body to pass through an area while trapping the head

Of the 515 deaths, the CPSC reports that 121 were due to an adult or sibling rolling on top of a baby, whereas the other 394 resulted from entrapment of a child's head.

But despite the statistics, some people dispute the commission's findings. Dr. Sears says that cosleeping is not inherently dangerous and that the commission went too far in recommending that parents never sleep with children under age 2. According to him, parents will not roll over onto a baby because they are conscious of the baby's presence even during sleep. However, Dr. Sears recommends that a baby not be put to bed between two parents, but rather between a parent and a wall or guardrail. He also says that parents should not cosleep if they are under the influence of alcohol or any drug because it could diminish awareness of the baby.

The American Academy of Pediatrics (AAP) is in agreement with the CPSC about cosleeping. Although the AAP notes that cosleeping is a widespread practice in many cultures, it highlights the fact that families in other countries almost never sleep in beds with soft mattresses and bulky covers that could smother a child. As a result, the risks are lower in these countries compared to the United States.