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Safe Sleep FAQ

Will cosleeping get in the way of my child’s ability to be independent?


Ultimately, absolutely not, but it may delay your baby’s willingness to be alone when she sleeps. Sometimes parents are under the mistaken impression that if they don’t train their babies to sleep by them- selves, somehow some developmental or social skill later in life will be kept from them, or they worry that their babies will never exhibit good sleep patterns as adults. In reality, there has never been a scientific study anywhere that has shown any benefit whatsoever to sleeping through the night at young ages, or even sleeping through the night as adults. Independence and autonomy have nothing to do with self-soothing or forcing babies to learn how to sleep by themselves. Studies have shown recently that children who routinely sleep with their parents actually become more independent socially and psychologically, and are able to be alone better. The idea that you shouldn’t pick up a baby or touch a baby during the night, which is believed by many who promote solitary sleep, is completely antithetical to a hundred years of biological information on what constitutes good development: the development of empathy, the development of autonomy, the ability to be alone when you need to be alone, and the ability to interrelate and to become inter- dependent with others. As you begin to know your child better and identify your priorities as a parent, you will guide your child toward these goals. When compared to solitary sleeping children, children who have coslept tend to make friends easily, are more innovative, better able to control their tempers, and are better problem-solvers. Earlier we talked about parenting trade-offs, and this is an important and useful concept here. For example, should you choose to routinely cosleep all night every night with your child, you should be prepared for the possibility that, when you are ready to wean your child from your bed, they may not be on the same timetable as you. One study found that, compared with solitary sleepers from birth, infants who cosleep from birth either learn or accept sleeping alone about a year later than infants who have no choice but to sleep alone. So the trade off may be this: the emergence of independent solitary sleeping in children may be delayed with routine cosleeping, but eventually separate sleep will not be a problem for your child, and the good news is that as parents you derived great feelings and memories from cosleeping. Along with those experiences, your child may have developed a more permanent capacity for self-sufficiency, resilience, comfort with affection, and the ability to be alone when necessary.




Will we be able to get a good night’s rest if we bring our baby into our bed?


The answer to this question depends in part on exactly how parents define a “good night’s sleep,” and whether bedsharing is a choice made by the parents or a situation they feel was imposed on them by their child’s inability to sleep alone. But remember that the reason that many families unexpectedly decide to bedshare is that it permits the family to get more sleep. It is more accurate to say that some parents, while still happy with their decision to bedshare for emotional reasons, are not able to get as much uninterrupted sleep. For many families it remains worth it to bedshare with older children, even if on some nights Dad or Mom makes a hasty retreat to an empty bed somewhere else in the house for some extra rest they feel they need—a system I refer to as “musical beds.” Sometimes one parent takes the call from a child sleeping in another room and enters the child’s bed, stays for while, then slips back into their own bed. Moms and Dads often take turns—or maybe just Dad does the nighttime responding (as I did). For families that like this method, it can work very well. (Upon reflection, I can honestly say I think back with gratitude for those times when my son called me into his bed to snuggle upon waking and feeling a bit insecure.) Again, each family should work to find what arrangements work best for them. Contrary to popular belief, and according to the mothers themselves, the choice to bedshare with infants tends to promote a longer, more restful night’s sleep for both babies and parents alike, and this is especially true if the mother is breastfeeding. A baby sleeping in a separate room, in order to elicit a feeding from the mother, needs to cry. This generally makes the baby less calm and more excited, even before the breastfeeding begins. While bedsharing mothers may have many more arousals, they perceive that their sleep is better when they are sleeping with their babies. And, of course, if you do experience difficulty sleeping with your child in your bed, you can still experience many of the benefits of cosleeping by having your baby sleep on a separate surface in the same room.




My pediatrician says I will create a “bad habit” that will be hard to break if I bedshare. Is this true?


This ubiquitous warning is based on subjective, perceived values, not science. One family’s “bad habit” is another family’s most treasured time together. And for most (though maybe not all), bedsharing feels pretty darn good, and for all the right reasons. Like adults, infants and children will be reluctant to give up something that feels right to them. That said, any human habit can be broken and the way new sleeping arrangements are introduced depends on who the parents and children are and the special characteristics of the family. There is absolutely nothing wrong with deciding that you are ready to have your child sleep in his or her own room, but the trick is to trust your own knowledge of your child in deciding how best to do this. Methods tried by some parents include making bedtime full of stories and rituals unique to your child or offering a sleeping companion doll or favorite object, easing the child from the bed by having the child sleep on the floor or a mat next to the bed or on a cot or bed in the room but not in the bed, or merely stressing the excitement of a new room or having special privileges for an older child. Changing routines is a necessary part of growing up, and the transition away from cosleeping can be a positive experience for your child.




What about naptimes?


Most babies do not mind sleeping alone during naps during the day—it is the darkness of nighttime that is intimidating. But it is ideal to not isolate babies even for naps. Try to let your baby nap in a bassinet or crib wherever there are people around, if this is possible. Don’t worry about your baby not being able to fall asleep, because most babies can sleep in the middle of a rock concert when they are tired. The old idea of “Shhhh! ...the baby is sleeping,” only conditions a baby to sleep lightly and to stir at each extraneous noise. Babies feel secure hearing the voices of their brothers or sisters and parents while sleeping. The level of normal noises in a household assures a level of arousal in your baby that’s probably just about right for the safest possible sleep. And remember to purchase an extra set of baby monitors and put the speaker next to your baby!




If I have twins or multiples, should we cosleep?


As with any aspect of caring for twins, there are added challenges to bedsharing, especially without the proactive involvement of your partner or spouse. My general recommendation is to place at least one twin back in the crib or bassinet after feeding and sleeping with one twin or multiple at a time, to place both or all infants back in the same crib or bassinet to cobed with each other (see the next chapter), or to place two or more bassinets next to each other. If you do not have the kind of spouse or partner that sees him or her- self as an active partner in the care of your twins, it is best not to fall asleep with the twins in the bed. Moreover, if regularly bedsharing with your twins, it is essential to have a king-size bed and a partner who is more than a passive participant, and who has agreed to work with you to take responsibility for knowing exactly where each twin is at all times. If the second adult does not agree to take responsibility for at least one twin, but you want to continue to bedshare, then do not leave one twin between yourself and your partner, but rather have both twins in front of you so that you can curve your body around them and shield them from your bed-mate. Keeping yourself and your twins at some distances from each other will be important too, only because it is easier for one twin to want to snuggle as close to you, and in the process, as close (perhaps too close) to his sibling as he can get. Use only the lightest of blankets to ensure free air passage for both twins. Being mindful of the fact that hungry infants are quite capable of mistaking a sibling’s nose for a breast is worth preparing for, because as strange or as funny as it may seem, one twin sucking on the nose of the other can quickly dehydrate the other. Yes, it has happened. I recommend that if there is a partner in the bed who has no interest in monitoring or taking responsibility for one or both twins, after each breastfeed (and if not breastfeeding at all), it is best to place the infants back in a bassinet or crib to cobed. (Karen Gromada has written a wonderful book on parenting multiples.).




What is cobedding? Does it serve the same purpose as bedsharing?


From a scientific point of view, this is an area that is little investigated. The term for cosleeping twins is “cobedding.” Cobedding is another form of cosleeping, and is very different from what the majority of this book has been concerned with. Cobedding takes the form of two bodies of equal size and weight in the same crib. How cobedding functions, and its role in infant development and safety, is very different from other forms of cosleeping. Since twins and multiples in general (for reasons still unknown) are associated with a higher risk for SIDS, questions pertaining to what kind of sleep environment might best protect them or put them at increased risk is especially critical. Questions pertaining to cobedding emerge against the larger background of trying to understand why premature births occur, as many twins are born premature. Prematurity is the leading cause of hospitalization during the neonatal period, and is responsible for up to 75% of neonatal illness and deaths, so this is an area in need of much further exploration. The challenge of all newborns in making their way from the womb to the worldly environment is to re-establish some kind of “biorhythmic balance” by stabilizing the functions of sleep-wake cycles, eating pat- terns, blood chemistry levels, and respiratory and heart rates. Two teams of researchers have argued that the mutual sensory exchanges that are facilitated by cobedding may enhance the ability of any one twin to accomplish this task specifically by improving breathing, using energy more efficiently and, in general, reducing the twins’ stress levels. It is known, for example, that the stress response which leads to increased cortisol production can negatively impact growth and development and generally alter thermal regulation, sleep duration, breathing and heart rate in potentially negative ways. These researchers found that, similar to what is observed to occur in the womb, cobedded twins move close together, touch and suck on each other, hold each other, and hug one another. Studies done by Dr. Helen Ball show that twins smile at each other and are often awake at the same time, supporting several anecdotal reports by parents of twins that their own infants prefer to be together, and that their babies settle better together and sleep more soundly when cobedded. Given the challenges of caring for two babies, as Dr. Ball points out from her studies, it is not surprising that parents will come to practice any behavioral care pattern which tends to maximize their own sleep and ease the burden of caring for and feeding two babies simultaneously. Nowadays when you hear a recommendation against cobedding, it often illustrates cultural biases against cosleeping in general where medical authorities assume—without any data—that if some instances of bedsharing between an adult and a baby are dangerous, then certainly two infants of equal body size must likewise pose a mutual threat. When and where there is a gap in our knowledge, or little information is available, recommendations (whether medical or not) quickly rely on generalizations, stereotypes, and anecdotal information, which is then passed on as if proven scientifically to be true. In this case, studies of bedsharing involving adults and infants are being applied to the question of whether or not it is safe or beneficial for twins to share a crib. Some hospital nursery wards are already assuming that the AAP’s recommendation against bedsharing applies to twins when, in fact, no twin studies were considered as the basis for those SIDS guidelines and no evidence-based considerations have, thus far, been used to justify hospital policies that argue against cobedding. As the following drawing shows, there are many different ways that parents of twins arrange a cobedding sleep environment for their infants:




Is there anything different about cosleeping with an adopted baby?


Depending on their ages and experiences, adopted infants and children may have heightened needs for affection and contact, but, if older, they may not be used to intimacy. Watch care- fully how your child reacts to you and respond accordingly. It is also helpful, where possible, to know your child’s history of experiences and assess what special needs or processes may be required to integrate the child into your family and to establish secure, safe and trustworthy new relationships. If you have adopted an infant and not a child, of course, there is no difference. Regardless of cultural origin, place of birth, or ethnicity, all babies have the same needs. Since attachment between any of us can be greatly enhanced by contact, cosleeping behavior can greatly facilitate the developing bond between your adopted child and yourself. It may be the case that adoption agencies require infants or children to have their own rooms. But you will be joining millions of parents whose nighttime care and associations with their children are hardly defined nor limited by the number of bedrooms they have, or where a crib may be located.




What should a cosleeping family know about traveling together?


During the first few years of life, you will find your infant or child will feel especially reassured sleeping in your company when away from home. Many parents permit cosleeping while traveling who do not ordinarily practice it. There does seem to be an elevated risk of SIDS for babies who experi- ence a previously unknown sleep environment. That is, babies between 2 and 4 months of age who are left to sleep alone while traveling and who ordinarily do not sleep alone have an increased risk (however slight) of dying from SIDS. And the reverse seems also to be true. A baby who does not ordinarily bedshare but who does while sleeping away from its home is at an increased risk of SIDS because she is in a new sleep environment. The bottom line: perhaps it is best while traveling to mimic as closely as possible what you ordinarily do at home. If you bedshare, bedshare; if you sleep apart, sleep apart. Keep in mind that if you are bedsharing while traveling, you need to ensure that the bedsharing setup is safe for your baby (see Part II: How to Cosleep). When you are traveling or on vacation, risk factors that may endanger your baby are still present. Risks may, in fact, be increased, so it will pay to be extra careful as to where and how your baby is sleeping while traveling.




Will my child be different, in any negative sense, if I choose to cosleep or bedshare?


NO! Sleeping arrangements never, by themselves, create any specific kind of relationship that has not already been shaped by what occurs during the day. Sleeping arrangements only reflect the nature of the relationship a parent and child already share before they come to bed. In other words, sleeping arrangements generally reflect and sometimes strengthen, contribute to, or exaggerate the nature of the relationship that already exists, whether good or bad. Sleeping arrangements do not create a relationship: if the nature of a relationship is very, very good during the day, cosleeping simply makes whatever is already good just as good or even better at night. In contrast, if a parent is depressed or is resentful of the infant during the day, these same dynamics will impact the child negatively during the night if the parents choose to cosleep. That said, cosleeping can be a wonderful way for content and affectionate parents to continue to deepen the bond with their child during the night.




How long should I cosleep with my child?


However long you want to! In fact, how long an infant or child sleeps in proximity to her parents has never been a concern throughout all of the evolution of our species. As long as cosleeping is enjoyed by everyone involved and the relationship it reflects is healthy during the day, cosleeping in some form or another never has to stop...but, of course, it will. There is no specific cut-off after which suddenly, or even gradually, the family cosleeping arrangement becomes harmful, unless some- one in the arrangement is no longer pleased or at some point the situation has became socially, psychologically or physically unhealthy or undesired by a participating member of the family. Cosleeping (whether bedsharing or roomsharing) could never be best if all participants do not feel comfortable with the practice, and this is always the best time to stop. If anyone involved does not wish to cosleep, then cosleeping should never be forced. I am reminded of the number of times my South American under- graduate students sheepishly come up to me after my lectures on cosleeping to whisper their stories that they could never tell to their peers for fear of ridicule. More often than not, they wish to tell me they STILL cosleep with their parents when they return home for the holidays! One of my young friends described how all of the kids jump into their parents’ bed for conversation, storytelling, eating, watching TV, and for the simple enjoyment of sleeping together and being with each other in their parents’ bed.




Should we cosleep if my partner is not the baby’s father?


There is one study that has shown an increased risk of an infant dying when bedsharing with an unrelated adult male or other adult. However, the group that was studied for the most part had more than one risk factor present when these babies died. My guess is that if an unrelated sleeping partner is committed to an infant, assumes responsibility for her, considers the bedsharing infant his or her responsibility in the same ways the mother doethen the bedsharing should be as safe as it would be if the biological father or an adoptive parent were bedsharing. But the point is worth repeating. Unrelated adults may not care to be responsible for the infant in the same way as a biological or adoptive parent might be, or may choose to disregard their own responsibility for the infant’s safety. In any situation in which this is true, I would recommend against bed- sharing. Instead, place the baby next to the bed on a different surface.




What long-term effects will my baby experience if we cosleep?


It has never been proven, nor shown, nor is it even probable, that sleeping with your baby has any kind of negative long-term effects when the relationships between those involved are healthy. Instead, experts are finding that cosleeping can help develop positive qualities, such as more comfort with physical affection, more confidence in one’s own sexual gender identity, a more positive and optimistic attitude about life, or more innovativeness as a toddler and an increased ability to be alone. One major epidemiological study showed cosleeping school-age children as being under-represented in psychiatric populations. And, while I do not know if you might regard this as a blessing or a curse, a survey of college-age subjects found that males who coslept with their parents between birth and five years of age had significantly higher self-esteem, experienced less guilt and anxiety, and even reported greater frequency of sex! Cosleeping is part of a loving, supportive environment that parents produce for their children, and this, in turn, will give them the confidence to grow into social, happy, loving adults.




Is it possible to reduce night feedings in a cosleeping situation?


It is a difficult and unique process to wean a baby who has slept next to you from birth. The decision to wean is important, and should only be made if you feel it is necessary. Some babies might have difficulty adjusting to less breastfeeding. One strategy for less night breastfeeding is to breastfeed your baby more during the day. Placing a barrier between your breast and the baby, or sleeping facing in opposite directions can sometimes reduce the infant’s detection of milk nearby and eliminate some feeds, as can simply placing the baby in a crib in your room, or next to you in a bassinet. If your baby is crying to be fed, Dad can walk with the baby to help her learn a new association. Dad’s role in weaning a baby from night feedings can be very rewarding for fathers, leading to a new aspect of the attachment relationship with the baby. Trusting and using your own judgment and experience with your baby is important— and every baby will give you different insights as to what might work best for them and only them. Like the decision to cosleep or bedshare, the decision to wean has to be made carefully and with full attention to the needs of each individual family.




Should I bedshare with my premature or underweight baby?


In almost all of the epidemiological studies of which I am aware, infants who are small for gestational age or premature are disproportionately represented as SIDS victims and as victims of sudden unexpected infant death in bedsharing situations. While the reasons for this are not yet known, and could possibly include in-utero developmental events or assaults to the fetal nervous system (some of which are induced by maternal smoking, which can cause intra-uterine growth retardation), it is probably safer not to bedshare with your underweight or premature infant. Routine bedsharing does not seem to be found to contribute to the survival of these more fragile infants, so it is best avoided. Place your premature or underweight baby right next to your bed on a different surface, but not in bed with you. Skin-to-skin contact while awake, however, is extremely protective, and sensory exchanges with an adult are known to be clinically beneficial to developmentally disadvantaged infants. The more holding, carrying and breastmilk made available for these special babies, and the more physical interactions you have with them, the better.





A charming baby dozes during each of her family's outings.

 

Wakened by the sounds and smells of the places where they go, Baby opens her eyes and sees a lively detail—a flower, a hoof, a rubber duck—in this beautifully photographed series of books. Help Baby solve the mysteries of this guessing game book filled with beautiful photographs. 

Resources for Safe Infant Sleep

Sleeping with your baby has been the norm for almost all cultures through almost all ages. Despite this, few issues in modern parenting generate as much disagreement as whether or not parents and babies should sleep in the same bed. Authorities warn that child should never sleep in an adult bed. Parents who cherish the closeness, warmth and security of cosleeping find their hearts at odds with their brains.

This page provides information about cosleeping, sleep training, crib safety, and overall sleep safety presented in an unbiased and family-friendly way. On this page, you will find resources to supplement your knowledge of safe infant sleeping and to assist in the facilitation of any discussions amongst groups of new parents, parents-to-be, and with your parenting partner. These resources have been carefully compiled to provide you with the most current research and accurate information, so you can make the best decisions regarding safe infant sleeping.

 

Below you will find:

These questions are excerpted from Sleeping With Your Baby: A Parent's Guide to Cosleeping, written by director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame and leading expert in the field Dr. Jim McKenna.

This book, containing all the information parents need to know about cosleeping, is available in many languages, as well as in an abridged pamphlet in both English and Spanish. 

Dr. McKenna's newest book, Safe Infant Sleep: Expert Answers to Your Cosleeping Questions (2020), is also available in English and coming soon in Spanish!

Click the screen to download Dia's presentation on the benefits of cosleeping

The Safe Sleep Checklist includes a variety of checklists from expert doctors and professional medical organizations to ensure a safe sleeping environment for an infant.

 

Some lists address sleep training, cosleeping, and bedsharing, specifically, while others cover general safe sleeping requirements. Following the steps in the checklists will help ensure that an infant has a healthy sleeping environment.

 
 
 

Fox 6 investigative report: Fatal Mistake

Watch this investigative report and see what all these SIDS babies had in common in Milwaukee. 

It's a must-see for maternal/child health professionals and parents alike.

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