• Recommendation on kids sleeping in bed with parents stirs debate

June 29, 2006

It’s now up to parents to weigh the risks of letting their children sleep in bed with them, following a new recommendation in Massachusetts, according to physicians from Hasbro Children’s Hospital in Providence, RI.

Last week, the chief medical examiner in Massachusetts recommended that parents stop allowing infants to sleep in bed with them because 31 infants died in the state last year while sharing a bed with a parent or sibling. The recommendation is confusing to parents and has stirred up debate in the pediatric community, physicians say.

“This puts parents in a difficult situation, and it puts pediatricians in a difficult situation. What do they advise parents to do?” asks Judith Owens, MD, director of the pediatric sleep disorders clinic at Hasbro Children’s Hospital and an associate professor of pediatrics at Brown Medical School.

Last week, Owens co-led a discussion group on the topic of “co-sleeping,” including recommendations from the American Academy of Pediatrics, at the Association of Professional Sleep Societies annual meeting in Salt Lake City.

“The implication is if you allow your child to sleep in bed with you, you’re putting them at risk of dying. That’s a pretty Draconian message,” Owens says.

Certain groups of infants have always been at high risk, she says—particularly those with mothers who smoke, are obese, use sedatives or sleep on a couch or chair.

The most recent recommendations from the American Academy of Pediatrics from November 2005 do not address specific groups but generally stress that, in the first six months of life, infants should be put to sleep on their backs, preferably in their parent’s room, but not in their parent’s bed. The guidelines also stress avoidance of soft pillows, bedding and other soft objects in a baby’s bed while promoting the use of pacifiers.

“It’s a very hard thing to tell parents not to let their children sleep in bed with them,” says Pamela High, MD, director of developmental and behavioral pediatrics at Hasbro Children’s Hospital and a clinical professor of pediatrics at Brown Medical School. “In the middle of the night, when an infant is sick or can’t get to sleep, parents are desperate.”

It is safer for a child to sleep in bed with a parent for short periods of time. So while pediatricians advise parents not to let their infants sleep in bed with them, parents are left to weigh the risks, High says.

“We’re not talking about a huge number of infants dying since the current rate of sudden infant death syndrome in the United States is about 1 in 2,000 infants. But if your infant dies, it’s devastating,” High says.

Studies show that infants who share a bed with their parents are at increased risk of sudden infant death syndrome (SIDS). Yet in most countries outside the United States, it is common practice for babies to sleep with their parents, Owens says, and those countries have lower rates of SIDS. Even in the United States, certain ethnic groups have a practice of letting children sleep in their bed. Also, co-sleeping is associated with more success in breastfeeding.

With the new recommendation, parents may be reluctant to let pediatricians know their babies sleep in bed with them.

“The concern is that parents will now go underground about this,” Owens says. “Sleeping with your infant has often been something parents were reluctant to discuss with their health care provider. Now this may be even more the case, and that’s really problematic.”