Co-sleeping
Co-sleeping refers to the practice of parents sleeping in close proximity to their child, which can take the form of bed-sharing (sharing the same sleeping surface) or room-sharing (sleeping in the same room but on separate surfaces). This practice is seen by some as a way to enhance the parent-child bond and facilitate breastfeeding. However, it is also associated with significant safety concerns, particularly the risks of sudden infant death syndrome (SIDS) and other sleep-related fatalities. The American Academy of Pediatrics recommends room-sharing as a safer alternative to bed-sharing, highlighting that many parents engage in co-sleeping, especially during the first year of their child's life.
Cultural differences influence co-sleeping practices; while it is common in many cultures worldwide, Western societies have shifted towards promoting independent sleep for children. Despite this, studies indicate that a significant number of parents, particularly in certain demographic groups, continue to bed-share. Concerns arise around unsafe co-sleeping practices, which can occur under risky conditions, such as when parents are impaired or co-sleep on soft surfaces. Advocates for safe co-sleeping suggest strategies to mitigate risks, emphasizing the importance of awareness and vigilance. Overall, co-sleeping remains a complex and multifaceted practice that reflects varied cultural beliefs and parenting styles.
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Subject Terms
Co-sleeping
Co-sleeping is the practice of a parent or parents sleeping in close proximity of a child. This includes sharing the same sleeping surface, known as bed-sharing, and slumbering in the same quarters, called room-sharing. Co-sleeping has been credited for strengthening the bond between parent and child, but it has also been blamed for creating an unsafe sleeping environment for the child.
The American Academy of Pediatrics (AAP) recommends room-sharing over bed-sharing as a safe practice for infants. Bed-sharing increases the risks of sudden infant death syndrome (SIDS), suffocation, and other sleep-related deaths. The AAP reported in October of 2016 that about 3,500 infants in the United States die annually due to sleep-related deaths. According to several studies, a majority of parents have practiced some form of co-sleeping during the first year of their child's life.
Media campaigns and educational programs aim to inform new parents of the dangers of co-sleeping, particularly bed-sharing, while promoting healthy parenting practices such as breastfeeding and limiting exposure to tobacco, drugs, and alcohol.
Background
The major forms of co-sleeping are bed-sharing and room-sharing. Bed-sharing involves a child sleeping on the same surface as a parent for part or all of the night. Room-sharing is when the infant is sleeping in the same room as the parent but on a separate surface, such as a crib, bassinet, or other sleeping unit. In the United States, most co-sleeping infants are six months old or younger.
Many families worldwide practice some form of co-sleeping. It has been a part of the family dynamic and societies for generations. During the nineteenth century, many Western families began to designate individual living spaces inside their residences and separating children from their parents to sleep.
In Western societies in the middle of the twentieth century, pediatricians regarded co-sleeping as suppressive to a child's independence and disruptive of their sleep health. Noted pediatricians such as Benjamin Spock theorized that children could be traumatized if they witnessed parents engaged in sexual intercourse and co-sleeping could make children overly dependent on parents.
The theoretical psychological implications of co-sleeping were eventually overshadowed by evidence of the physical dangers. Studies found that SIDS and other sleep-related deaths were associated with co-sleeping, specifically bed-sharing. As NBC News reported, a 2014 analysis of infant deaths from twenty-four states between 2004 and 2012 found that about 74 percent of infants younger than four months died in a bed-sharing setting; the rate was nearly 59 percent among babies between four months and one year of age. In the late 2000s and early 2010s, media and education campaigns in the United States emphasized the dangers of bed-sharing and the necessity of having babies sleep alone on a surface. As more mothers chose to breastfeed their babies, experts noted an increase in the number of families that chose co-sleeping arrangements.
Parents in rural environments and developing countries are more likely to co-sleep with their children and for longer periods of time than in industrial settings and Western societies. One exception is Japan, where children as old as ten years may share beds with their mothers or both parents. Anthropologists link Japan's interdependent culture to this longer parent-child link. Japan also has a lower infant mortality rate—2.8 deaths per 1,000 live births compared to 6.2 in the United States, according to human development researchers Robert A. and Sarah LeVine —and fewer SIDS-related deaths.
Overview
Some parents turn to co-sleeping as a way to foster breastfeeding, to encourage skin-on-skin contact with the infant, or to soothe a fussy baby. According 1997 and 2004 studies cited by T. Gettler and James J. McKenna, only a few first-time, pre-term mothers planned to bed-share with their infants. However, after giving birth, nearly five times as many mothers admitted to occasionally bed-sharing. A 2013 study cited by Yi Huang et al. found that 60 percent of mothers surveyed practiced bed-sharing for breastfeeding purposes and bed-sharing mothers were more likely to breastfeed their infants longer than those who did not bed-share. Other studies have shown that bed-sharing and room-sharing mothers breastfeed more frequently and wake more often at night, but they get as much sleep as non-co-sleeping mothers. A sleeping environment in which the mother and child are in close proximity can promote positive bio-behavioral experiences for both. These include the infant's breathing patterns, heart rate, and sensory exchanges and a regular breastfeeding practice for mothers.
New African American mothers have a higher rate of bed-sharing than new white mothers, according to a 2015 study cited by Trina Ward et al. In Georgia, about 81.9 percent of African American mothers in the study reported bed-sharing compared to 58.9 percent of white women. Similar rates were found in Florida (66.9 percent versus 37.5 percent) and Wisconsin (70.6 percent versus 53.4 percent). AAP recommends pre-natal educational programs targeting African Americans and Native Americans to encourage safe infant sleeping practices as these populations are statistically most likely to practice bed-sharing.
Co-sleeping may also contribute to stress among families in the United States. A 2016 study cited by the New York Times indicates that mothers who co-sleep with an infant older than six months can experience cultural criticism, anxiety, and lack of support. Intimacy issues between parents may also arise.
Unsafe co-sleeping and bed-sharing practices can increase the risk of SIDS and other sleep-related deaths. Contributing factors include bed-sharing with a baby younger than four months old, sharing a surface with other children, bed-sharing with an impaired or smoking parent or caregiver, slumbering on a soft surface, and sleeping with an infant on a couch, recliner, or armchair.
In some cases, unsafe co-sleeping can be considered a criminal offense. In December 2016, a Florida woman was charged with aggravated manslaughter after the death of her second child. Her first child, a thirteen-day-old baby, died in 2009 when she fell asleep while breastfeeding. The death, which was caused by asphyxia due to co-sleeping, was ruled accidental. The mother was counseled on safe infant sleeping practices. Her second child, an eighteen-day-old infant, died while propped on a pillow as the mother slept.
While AAP recommends room-sharing and sleeping in separate rooms, bed-sharing advocates outline ways to promote a safe practice because unsafe bed-sharing practices have been associated with SIDS-related deaths. Suggestions include moving the bed to the center of the room, because a bed against a wall may leave a gap in which an infant can become trapped; never using a waterbed, because it is an unstable and soft surface; avoiding alcohol and other substances that can impair the senses and prevent an adult from recognizing when an infant is in distress; and being vigilant and attentive to the infant.
Bibliography
Callahan, Alice. "When Kids Are in the Bed: The Ups and Downs of Co-Sleeping." New York Times, 24 Aug. 2016, well.blogs.nytimes.com/2016/08/24/when-kids-are-in-the-bed-the-ups-and-downs-of-co-sleeping. Accessed 8 Mar. 2017.
Carroll, Linda. "Risky or Loving? Co-sleeping Study Divides Parents and Doctors." Today, 14 July 2014, www.nbcnews.com/news/other/risky-or-loving-co-sleeping-study-divides-parents-doctors-f1D79912957. Accessed 10 Mar. 2017.
"Co-Sleeping Mother Charged in Second Baby's Death." Fox 13, www.fox13news.com/news/local-news/224856142-story. Accessed 10 Mar. 2017.
Gettler, Lee T. and James J. McKenna. "Never Sleep with Baby? Or Keep Me Close But Keep Me Safe: Eliminating Inappropriate 'Safe Infant Sleep' Rhetoric in the United States." Current Pediatric Reviews, vol. 6, no. 1, 2010. University of Notre Dame, cosleeping.nd.edu/assets/32371/gettler‗cpr.pdf. Accessed 10 Mar. 2017.
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Huang, Yi, et al. "Influence of Bedsharing Activity on Breastfeeding Duration Among US Mothers." JAMA Pediatrics, vol. 167, no. 11, Nov. 2013, pp. 1038-1044. jamanetwork.com/journals/jamapediatrics/fullarticle/1740763. Accessed 10 Mar. 2017.
LeVine, Robert A. and Sarah LeVine. Do Parents Matter? Why Japanese Babies Sleep Soundly, Mexican Siblings Don't Fight, and American Families Should Just Relax. PublicAffairs, 2016.
"SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment." Pediatrics, vol. 138, no. 5, Nov 2016, pp. 1-14. pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938. Accessed 7 Mar. 2017.
Ward, Trina C. Salm, et al. "Prevalence and Characteristics of Bed-Sharing Among Black and White Infants in Georgia." Maternal & Child Health Journal, vol. 20, issue 2, Feb. 2016, pp 347-362. Academic Search Main Edition.