Family bed advocates, critics state their cases.

Byline: THE HEALTH FILES By Tim Christie The Register-Guard

The question is simple: Should parents sleep with their babies?

The answer is anything but simple and has sparked a furious debate in medical and parenting circles that shows no signs of waning.

Advocates of co-sleeping - also known as bed sharing or the family bed - say mothers have been sleeping with their babies since caveman times. They point to studies that show infants who sleep with their mothers breast-feed more often, sleep less deeply, and respond to their mother's arousals, and that mothers more easily detect and respond to a baby in crisis.

Critics say bed sharing poses an unnecessary risk to infants. They point to studies that suggest an increased risk of Sudden Infant Death Syndrome among babies who sleep with their mothers - a risk that's intensified when parents smoke, drink or use drugs. SIDS is the label given to any infant death that remains a mystery even after investigation.

Even the American Academy of Pediatrics, while noting that bed sharing "may be hazardous under certain conditions," is ultimately agnostic on the question. In a footnote of its 2000 policy statement on how and where infants sleep, the doctors charged with reviewing the issue said there was insufficient data "to conclude that bed sharing under carefully controlled conditions is clearly hazardous or clearly safe."

Wading into this contentious, unsettled area of medical science is the Lane County child fatality review team, which last month called a news conference in Eugene to recommend that parents not share their bed with infants.

Team members became concerned when they found that seven of nine infant deaths investigated by the medical examiner's office last year had co-sleeping as a risk factor. All of the deaths also had other risk factors, such as parents who smoked, drank or took drugs.

Team members include a public health nurse, a medical examiner, a representative of the medical examiner's office and a physician, Dr. Scott Halpert. Halpert, a Eugene pediatrician and family physician and medical director of the Lane County Child Advocacy Center, said at the time that the team was sticking its neck out by making such a recommendation.

The team's advice was countered by other pediatricians who support co-sleeping for certain families, and it sparked outrage from members of La Leche League, who view bed sharing as an effective way to encourage breast-feeding of young mothers' babies.

"Parents have slept with children since the beginning of time," said Judy Mieger of Cottage Grove, a longtime La Leche League leader. "It's crucial that the average family know that co-sleeping is being practiced safely around the world."

Mieger cites the research of James McKenna, a biological anthropologist and director of the Mother-Baby Sleep Laboratory at the University of Notre Dame. McKenna and his colleagues have studied mothers and infants as they slept together and apart, recording infants' heart rates, brain waves, breathing, body temperature and nursing.

They found that mothers and babies who sleep together are highly responsive to each other's movements, wake more frequently and spend more time in lighter stages of sleep than they do while sleeping alone. Bed-sharing infants nurse almost twice as often and three times as long each round, than when sleeping alone.

In addition to more nighttime nourishment, sleeping with mother provides the infant with a steady stream of sensations of the mother's presence, including touch, smell, movement and warmth, McKenna found.

Simply put, McKenna believes infants were designed to sleep next to their mothers for nighttime breast-feeding, and it's the way most of the world sleeps, including Japan, which has the lowest SIDS rates.

In an interview, McKenna said the debate over co-sleeping is more than a question of medical science.

"It has remained an ideological and cultural issue for Americans," he said. "I think in part any kind of child care in our society has assumed moral meaning."

America's social and cultural history favors individualism and autonomy, and parents want their babies to be autonomous by sleeping in their own beds, he said. Infant deaths that occur when a baby is in bed with her parents draws far more scrutiny than those that occur when the baby is alone in a crib, he said.

"Deaths of babies in cribs are tragedies and problems to be solved," he said, "whereas babies dying in any kind of social co-sleeping environment becomes an indictment of any and all forms of co-sleeping."

Part of the problem results from different types of behavior that fall under the broad heading of co-sleeping, he said.

"A nonsmoking, breast-feeding mother who knows the risk factors is different than a poor, 16-year-old first-time mom who smokes and sleeps with baby on the couch," he said.

Sleeping on couches and recliners is "incredibly dangerous," he said, because it's easy for the mother to smother the infant or for the infant to fall into the soft cushions and suffocate.

But critics of bed-sharing point to research that indicates an increased risk of SIDS when mothers sleep with their babies.

Halpert cited a study published in December in the British journal Archives of Disease in Childhood which examined SIDS cases in Ireland. The researchers concluded co-sleeping "significantly increased the risk of SIDS," and recommended that co-sleeping be avoided with infants who are younger than 20 weeks of age or whose mothers smoked during pregnancy.

Another study published last month in the British journal The Lancet examined SIDS cases in 20 regions across Europe. The researchers found a "very small" risk of SIDS among babies who shared a bed with non-smoking parents.

That study prompted the Foundation for the Study of Infant Deaths, a British group, to change its advice on bed-sharing. The safest place for a baby to sleep, the group said, is in its own crib in the parents' bedroom.

Critics say neither study differentiated between babies who slept in bed with their parents and those who co-slept on couches or other inappropriate surfaces.

Dr. John Kattwinkel, a Virginia pediatrician, chairs the American Academy of Pediatrics' task force on infant positioning and SIDS. He said there may never be satisfactory scientific evidence on the issue of bed-sharing.

"The most controversial issues are because there's no convincing studies," he said.

It's possible that the benefits of co-sleeping outweigh its risks if parents take all the recommended steps to create a safe sleeping environment, he said.

Kattwinkel and McKenna said studies have shown that the risk of SIDS is reduced if babies sleep in the same room as their mothers during the first year.

For parents concerned about the risk of sharing their bed with their baby, the best compromise may be a device that straps onto the side of an adult bed, he said. That allows the mother to breast-feed her child in the middle of the night, then return the infant to its own safe sleeping environment.

"Those are the kinds of compromises that make the most sense," Kattwinkel said.

Tim Christie can be reached at 338-2572 or tchristie @guardnet.com.

GOOD NIGHT

La Leche League International, which supports parents sleeping with their babies, recommends these books on the practice:

"Sweet Dreams: A Pediatrician's Secrets for Your Child's Good Night's Sleep," by Paul Fleiss

"Good Nights: The Happy Parent's Guide to the Family Bed," by Dr. Jay Gordon and Maria Goodavage

"The Family Bed: An Age Old Concept in Child Rearing," by Tine Thevenin

"Nighttime Parenting," by Dr. William Sears 

For more information on La Leche League, call 942-9398, 741-0187 or 345-5235.

SLEEPING SAFE

The American Academy of Pediatrics says parents who choose to sleep with infants should know the risks and take these steps to create a safe sleeping environment:

Put babies to sleep on their backs, the lowest risk position, or in the alternative, on their sides. Don't put babies to sleep on their stomachs.

Put babies to sleep on flat, firm sleeping surfaces - no water beds, pillows or sofas.

Avoid soft materials in the sleeping area, such as pillows, quilts, sheepskins and stuffed toys.

Avoid overheating by making sure the bedroom temperature is cool.

Make sure there are no cracks between the mattress and the footboard or headboard, where babies can become trapped.

Don't let older children sleep in beds with infants.

Parents who smoke, drink or take drugs should not sleep with infants.