Monday, October 24, 2016

Why we cosleep with our infant and you (perhaps) should too

The feeling of a soft little one gradually melting into my arms is lovely, and I wouldn't soon give up rocking my baby to sleep. That said, shifting from foot to foot in the dark several hundred times night after night can get repetitive. So tonight, as I was rocking little Peregrine, I set myself an intellectual challenge. I was going to simultaneously count how many times I shifted from foot to foot and plan out this blog post. It turned out that after only 564 rocks he woke up and demanded to be nursed, but I will write what I planned anyway.

Peregrine is now almost two months old, and we've slept with him in our bed with us from the very beginning, as we did with both his older sisters. I can hear the million voices crying out in horror, but hold on and let me explain why. The benefits, I hope are obvious (snuggles, not needing to wake up to nurse the baby, baby sleeping better, family bonding, etc.) but most people (in the US anyway) don't sleep in the same bed as their baby, don't feel allowed to, because the public health advice is that it can cause the infant to strangle or suffocate.
Zero day old Peregrine cosleeping (don't tell the nurses)
Our three children were born in Germany, Denmark and Wisconsin, respectively, and we have learned to be quite skeptical of official advice and cultural mandates that vary wildly from place to place. Advice regarding infant suffocation risk certainly depends on where one lives. When we told our Japanese friends how strongly Americans are cautioned against cosleeping, they were surprised and amused. In Japan, apparently, the official advice and common practice is for the baby to sleep between the mother and father, like Lancelot's sword (misplaced cultural reference, I know.) Our German friend warned us strongly against letting our cat near our baby, as a smothering would surely ensue.
Tigerlily and Flopper, dressed for Halloween
As an American scientist with a professional interest in early mortality, and with kids, I of course looked up the science upon which the American advice is based. The most common reference regarding the risks of cosleeping is:
Blair et al. (1999). Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. British Medical Journal. 319, 1457-1462.
There are more recent papers on this conducted in several countries, and as far as I can see none of them have basically contradicted Blair et al.'s clearly stated "Key messsages" (sic):

Key messsages

  • Cosleeping with an infant on a sofa was associated with a particularly high risk of sudden infant death syndrome
  • Sharing a room with the parents was associated with a lower risk
  • There was no increased risk associated with bed sharing when the infant was placed back in his or her cot
  • Among parents who do not smoke or infants older than 14 weeks there was no association between infants being found in the parental bed and an increased risk of sudden infant death syndrome
  • The risk linked with bed sharing among younger infants seems to be associated with recent parental consumption of alcohol, overcrowded housing conditions, extreme parental tiredness, and the infant being under a duvet
Now, my wife and I do not smoke, do not drink, are not sleeping on a sofa, do not put the baby under a duvet, do not have overcrowded housing conditions and are merely very, rather than extremely, tired. As this 2016 study makes clear, cosleeping is often associated with overcrowding because people in poverty don't have the money for an extra room or an extra bed. Poverty increases the risk of almost all causes of death, especially infant deaths, and much of the risk from cosleeping may actually be risk from poverty. Our baby is under 14 weeks, but according to Blair et al.'s findings, without these other risk factors (particularly smoking), there is no increased risk associated with cosleeping, even for neonates.

Not child endangerment (with Tigerlily)
Other studies have added parental obesity and extreme youth as risk factors. I am certainly overweight by the standard definition, but not obese. We are not particularly young parents. But still, if there is any risk at all of rolling over onto the baby, wouldn't it be safer to have him in a crib in another room? Emphatically, disastrously, not. Blair et al. write, "There was an increased risk for ... infants who slept in a separate room from their parents." Their estimate, that having the baby sleep in another room increases risk by about ten times, has been revised by more recent research to increasing risk by about half. Long story short, having the baby in a separate room is dangerous, while having him in our bed with us presents no documented risk compared to a good modern crib.

This presents two obvious questions: How should parents who aren't trained in interpreting regression tables make this decision? And, why is the official US advice (which resembles that in several other countries) what it is?
My interpretation, based on Blair et al., and the studies that have followed from their work: Always sleep in the same room as the baby. (Shockingly, this has only now become the advice from the American Academy of Pediatrics)  Never sleep on the couch with the baby (they tend to roll into the cracks, and this is truly dangerous). Don't cosleep with a baby under 14 weeks old if you are a smoker, are under the influence, are obese, are overcrowded (which is associated with poverty and all its ills), or are otherwise difficult to wake. If those risk factors don't apply to you, there are hundreds of hours of baby snuggling available to you, and you can decide to take them or leave the baby in a proper crib in your room. Quitting smoking is astoundingly good for your children's survival, even if you don't smoke inside the home.

Now why is the official advice a simple, "Never cosleep," or starker versions thereof? Because official advice has to be short and simple to be effective. My paragraph of advice, above, is 150 words. "Never cosleep" is two. "Don't live in poverty," would be great, if people were given the opportunity of escaping. People are, on the whole, really bad at following complex advice, and really good at finding reasons why things don't apply to them. Have my wife and I really never used a duvet with a baby? Questionable. Am I really overweight rather than obese? I haven't weighed myself in over a year. How tired is "extremely?" Have I ever fallen asleep on the couch with a baby? Certainly. You see, it gets messy, and it is easier for officialdom to just say, "No."
Baby Kestrel sleeping on the couch with Big Sister. Closely supervised.
So my message to you, should you be in the position of choosing where to sleep your baby is to make an informed decision. Good slogans are rarely good advice, and extensive snuggles are one of the things babies need most.
This baby (Kestrel) is not asleep. A desk drawer is not a proper crib.

1 comment:

GML said...

Very sensible advice, even if not slogan-length. GML