Infant Sleep Methods Series : Part 1, Infant Sleep Safety

SLEEP! is one of the top questions I'm asked about in my practice! (Istock:dlinca)

SLEEP! is one of the top questions I’m asked about in my practice! (Istock:dlinca)

You are a new parent!  Your baby doesn’t seem to have the same sleep needs as you. Little did you know that in America, because of our hectic lifestyle, there’s a huge industry built around infant sleep. In traditional cultures, people don’t fuss so much about infant sleep, family life has a slower, natural rhythm.

You were used to doing pretty much what you wanted, working, staying up late. Maybe you have a nice career that you’ve nurtured over the years. You took certain steps, and the career path responded, expanding accordingly.

 But your baby is not responding in this structured manner. It’s just not what you thought it would be. You feel exhausted, confused, happy and angry all at once. You wonder if you are a bad parent. Why won’t he sleep? Why do my partner and I bicker? What you’d really like is for someone to come over and hold the baby while you take a shower, or to bring over a casserole for dinner.

Everyone in the world seems to be zooming in on you and giving advice. While they **are** well-meaning, the advice comes in dribs and drabs, and is contradictory, and maybe it just doesn’t feel quite right for you.

People are commenting, “Oh, my baby slept through the night the first week she was home!” Do they all do that, you wonder? You’re just not sure. There are so many books out there about infant sleep. So many opinions! So you can have an overview of what’s out there, for the next few weeks, I’m writing a blog series on the leading infant sleep methods. Then, you can pick and choose which you’d like to incorporate into your parenting style.

My first blog post in this series is about infant sleep safety. Infant sleep safety is a large topic. Crib-sleeping, co-sleeping, and bed-sharing all have safety issues associated with them.

Sudden Infant Death Syndrome (SIDS)

Learn the precautions against Sudden Infant Death Syndrome (SIDS). The good news is that SIDS is at an all-time low. American SIDS Institute says its occurrence has dropped significantly since 1983. The NationalInstitute of Health says SIDS has dropped 50% since since 1992, when the parents were first told to put babies to sleep on their back. SIDS is most likely to occur between ages 2 -4 months, 90% occurs before six months and January is a peak month.

Research from the American Academy of Pediatrics (AAP) lists the risk factors for SIDS as smoking, sleep position, illicit drug use, alcohol use, prematurity, overheating, teenage motherhood, being male, being a multiple, poor prenatal care, soft bedding, poverty, sleeping on a couch or recliner with a caregiver, co-sleeping with a parent, and spacing of less than one year between pregnancies.

Infant sleep safety includes:

  • Put the baby to sleep on his back

  • Do NOT smoke in the house or car or near the baby

  • Do NOT over-heat the baby with clothing or room heat

  • Do NOT use soft bedding in the crib

  • USE a tightly-fitting sheet in the crib

  • Do NOT use comforters or large, thick blankets with an infant

  • Do NOT put anything else in the crib

  • Do room-share. That is, keep the baby’s crib in the bedroom until the baby is six months old. The AAP believes that infants are safest when near their mother.

  • The AAP says that babies should NOT sleep in the same bed as their parents

  • The Academy of Breastfeeding Medicine  has found that exclusive breastfeeding is a protective factor for SIDS

  • The AAP has found competing evidence that breastfeeding is protective of SIDS, but not enough to recommend it

  • Using a pacifier may be protective of SIDS

Bed-Sharing vs. Co-Sleeping


The issue of bed-sharing has become controversial. Bed-sharing is practiced worldwide and as the United States becomes a breastfeeding culture, bed-sharing is more widespread. As noted above, the AAP conducted research around SIDS. The AAP concludes that co-sleeping is a risky behavior and recommends room sharing instead of co-sleeping on a population-wide level.

However, the Academy of Breastfeeding Medical Professionals has made a distinction between bed-sharing and co-sleeping. The ABMP analyzed the AAP study and found a significant lack of scientific rigor in distinguishing infant cause of death.

The ABMP has made a distinction between bed-sharing as a safe behavior and co-sleeping as a risky behavior.

The ABMP defines bed-sharing as a safe practice between a breastfeeding mother-infant dyad, as distinct from co-sleeping which is a risky behavior.

 James McKenna, PhD, is a researcher in the field of co-sleeping and the mother-infant dyad across the world. Dr. McKenna believes the AAP’s unqualified recommendation against co-sleeping aimed at a population-wide level, is not scientifically valid. Dr. McKenna feels that co-sleeping is a normative human behavior, objects the AAP has medicalized this normal human behavior, and believes the AAP has disregarded research regarding the benefits of human touch in their conclusions.

 In his research, he says there are distinctions between unsafe co-sleeping and bed-sharing, which is safe co-sleeping. He feels that bed-sharing is a complex behavior, and is not a good fit for all persons. However, Dr. McKenna thinks the US is a breast-feeding culture and bed-sharing is beneficial for the breastfeeding mother-infant dyad, as long as it is done responsibly.

McKenna says, like the AAP, unsafe co-sleeping occurs on a recliner, couch, with overheating and soft blankets, in bed with with adults who smoke, drink alcohol, or take drugs (illicit or medication that causes drowsiness), bottle-feed and that other children should not be
permitted to sleep with an infant. Ideal co-sleeping conditions are between a mother-infant dyad who are breastfeeding.

McKenna believes that the physiological attunement which occurs between the breastfeeding mother-infant dyad helps infant development, and the positive benefits of touch facilitate infant growth and development.

Dr William Sears offers some more information. He also believes that AAP did not do a legitimate job of distinguishing between co-sleeping and bed-sharing. He adds that the benefits of bed-sharing protect against SIDS, as the physiology of the nearby parent help regulate the physiology of the infant.

He recommends another alternative to the infant sleeping in the bed would be a safe arms-reach arrangement whereby the infant sleeps in her own bassinet but close to the mother in bed.

 Crib Safety

Crib and bassinet safety is important. The Consumer Product Safety Commission (CPSC) says there have been 18 recalls of cribs totaling nine million units.

The CPSC recommends:

  • Use a bassinet for a baby six months or younger (recall list here)

  • Drop-side cribs are NOT safe

  • The crib should be less than ten years old

  • Check that your crib has not been recalled on the CPSC website

  • Cribs with a gap  larger than two fingers between the mattress and slats are unsafe. Check
    this regularly, as hardware can loosen with use.

  • Slats should be less than 2 1/8” inches wide

So, there you have it, the complex world of modern American infant sleep safety!

Kind of makes you wish you were a !Kung mother, where things aren’t so complicated by time schedules and such! LOL!

So, let me know where you weigh in on such things, if you have anything to comment or add!

Happy Conscious Parenting !

Infant Sleep Part Two – Mrs. Elizabeth Pantley

Infant Sleep Part Three – Dr. Marc Weissbluth

Infant Sleep Part Four – Dr. Harvey Karp

Infant Sleep Part Five – Dr. Sears

References

American Academy of Pediatrics. (2005). Task Force on SIDS Policy Statement.
aappolicy.aappublications.org/cgi/reprint/pediatrics;116/5/1245.pdf

American Academy of Breastfeeding Medicine (2008). Guideline on Co-sleeping & Breastfeeding. http://www.bfmed.org/Media/Files/Protocols/Protocol_6.pdf

Consumer Product Safety Commission (2011).
http://www.cpsc.gov/onsafety/2010/06/watch-and-share-check-your-crib-for-safety/

McKenna, W. (2011). Co-sleeping and Bed-sharing Behaviors.
www.nd.edu/~jmckenn1/lab/interview.html

Sears, William (2011). Sleeping Safely with Your Baby. www.askdrsears.com/html/10/t102200.asp

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2 Responses to “Infant Sleep Methods Series : Part 1, Infant Sleep Safety”

  • diem:

    i am vietnamese and in my culture bed sharing is the norm. i was a single mother with my first child and i was bed sharing with her with no problems..i dont move around much when sleeping and i wake easily and am not a deep sleeper..i also didnt share a blanket with my baby. the room was always in comfortable temperature to where my baby was in the right clothes and i used a throw blanket to keep me warm and all pillows were out of the way and i did this from birth to when she was older.. our matress was on the floor so she couldnt fall off the bed and the bed was really big for the two of us. i also had a bassinet close by in case i felt she needed to sleep in it that night..we had such peaceful nights and no fussiness and baby slept well and woke up happy. before she fell asleep i would lay in bed with my baby girl and watch tv or talk on the phone or listen to music this was very helpful since she would fall asleep during the noise (not too loud though) and would never get startled. what works for me is the tv on sleep mode or the cd that played music would end so it wasnt playing all night to where i wouldnt hear her wake or cry.

    • Hi Diem – It must be strange for you to read all the fuss about infant sleep methods that people in the United States make!
      The fuss is so funny as co-sleeping is the norm in the majority of cultures around the world, and I think is the most relevant point made so far!
      It is normal to co-sleep with an infant. It’s just everything gets so complicated here in the US, as we have so many childcare camps and also the potential for lawsuits. And yes, there are people who use substances, sleep on couches and then there is the potential for rolling on the baby is those cases. But it sounds like you used common sense and you are a good mother and kept care of yourself and your baby well.
      Thanks for stopping by!

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