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Monday
Jun012009

8.8 deaths per 100,000 population

8.8 deaths per 100,000


In 2003, in Canada 8.8 people per 100,000 population were killed in fatal car accidents.


8.8 deaths per 100,000


In 2008, in Ontario 8.8 babies per 100,000 live births died while sharing an adult bed or mattress with an adult.



The Ontario coroner says it is dangerous for babies to share a bed with their parents because of 8.8 deaths per 100,000 live births. That must mean it is dangerous to travel by car, because there were 8.8 deaths per 100,000 people. The Ontario coroner should be advising all Ontarians to avoid car travel. Travel by foot is much safer. We should ban cars.


How would that recommendation go over?


Not well.


Cars are convenient. People like cars. Peoples lives would be changed significantly and we would have to drastically change our habits to give up cars.


Bed sharing is convenient. Parents and babies like co-sleeping. Parents would be more tired, breastfeeding rates would be reduced, and parents would be less responsive to their infants at night if they had to give up bed sharing.


Bed sharing is a reality. Parents do it. Banning it or discouraging it is as ridiculous as trying to ban or discourage car travel.


If people stopped traveling by car except when it was really necessary, there would probably be more accidents and more deaths because the roads would be full of inexperienced drivers. And when parents are generally discouraged from sleeping with their babies and then bring them into bed when really desperate, there are more accidents, more deaths.


The Ontario coroner should stop telling people not to bed share and instead tell them how to make bed sharing safer. Public health agencies don't tell people not to travel by car, instead they tell them to use seatbealts, use car seats, drive the speed limit, don't use cell phones while driving, etc. Address the conditions that make bed sharing unsafe. But don't tell people not to do it. Because they will. And they will do it unsafely.


Sources:



« Move over: making room for 1 more in the bed (Part 3 of a series on preparing for baby #2) | Main | To tandem or not to tandem (Part 2 of series on preparing for baby #2) »

Reader Comments (57)

We have co-slept since our 1st was a few months old. She is now 5 and our 2nd is 2. We wouldn't have it any other way. We know we have all slept better over the years. You are right, we need to teach safe bed sharing instead of preaching against it.

June 1, 2009 | Unregistered CommenterDarcel

You ROCK! Again I have to say you blow me away. I have been asking this same question for 11+ years! Why not teach parents how to do it safely instead of saying no??!!
Thank you!
PS - My boys both co-slept beyond infancy and are very happy and secure, independent thinking 11 and 8 year olds respectively. They are not emotionally scarred by the experience (unless teaching them that they can do what feels right for them and gives them the most psychological comfort in the dark of night is scarring).
They are well-adjusted, sweet people with many friends. It didn't stunt their development at all that I can see. And more than that, it worked VERY WELL FOR US!!

June 1, 2009 | Unregistered CommenterSam

Great post. Couldn't agree more.

June 1, 2009 | Unregistered CommenterJana

People always say what I want to say. Oh well, I'll say it anyway. You Rock! This post rocks! What an opportune find that both stats are the same. If you hadn't have snagged it I would have! Excellent find and perfect argument! Anywaone interested in reading more about why it is important to share sleep with your baby - I blogged about it here. http://www.breastfeedingmomsunite.com/2009/05/why-nighttime-breastfeeding-and-bed-sharing-is-so-important/

June 2, 2009 | Unregistered CommenterMelodie

I love the simplicity of this analogy of driving vs. bedsharing safety and morbidity.

Bed sharing is not inherently dangerous. In fact, it is done in most places throughout the world at some point in an infant's life. The key as you have said here, and in your extended post on safety, is that the devil is in the details.

Whether it is a spouse, a baby or pet in the bed there needs to be a baseline awareness of whom is sharing the bed. We have all woken up on "their side of the bed" if our partner is away on trip. When they are home we maintain our boundaries.

As long as there is attention paid to the appropriateness of the bedding, temperature of the room and all parties are sober the natural rhythms of movement and breathing while bedsharing have been shown to be protective for the newborns.

You have made a powerful argument here for the need of an attitude adjustment in public health policy toward bed sharing. When it's going to be done, it should be done safely.

June 2, 2009 | Unregistered CommenterMáire Clements

[...] But I think there's a real flaw in the logic of her most recent post criticizing the Ontario coroner for advising parents against letting their children sleep with them. [...]

Tried to be as polite as I could, but I had some serious problems with this post, which I've detailed over on my blog:

http://communities.canada.com/vancouversun/blogs/parenting/archive/2009/06/01/co-sleeping-dangerous.aspx

June 2, 2009 | Unregistered CommenterChad Skelton

But by this argument, we also shouldn't tell people to breastfeed. After all, some people are going to formula-feed regardless, and if we focus entirely on telling people to breastfeed and how to do that, then the people who do formula-feed will have no idea how to do it safely (they won't know how important it is to mix the milk accurately, to sterilise everything, to hold and interact with your baby as much as possible while feeding...).

I think there has to be a balance. Yes, there should be information out there on how to make co-sleeping and formula-feeding as safe as possible for those who are going to do those things anyway. But we do also need to inform parents that the research shows lower risk with breastfeeding compared to formula-feeding and lower risk with sleeping in a cot next to the parent's bed compared to bedsharing. And I think it better to talk about 'safer co-sleeping' rather than 'safe co-sleeping', because I think the latter phrase is misleading - research does show that even co-sleeping under low-risk conditions does seem to carry some increased risk for very young babies compared to crib sleeping under low-risk conditions. (Sorry, Maire and others - I know that isn't a popular finding, but it's still what the research shows.)

June 2, 2009 | Unregistered CommenterSarah V.

Seperate sleep arrangements, hospital managed birth, formula feeding and independence training all developed only a few generations ago in the western world. All of those things were implemented without any scientific study or attention to how they affected the mother-baby pair. Now, as we are beginning to question the validity of these practices, the defenders are coming out of the woodwork to demand that we provide them with scientific proof that a return to a more traditional approach is valid. I'm also interested in the fact that those who defend the status-quo are more often male or career oriented feminists trying to carve their niche in the male world. (Think Hannah Rosin)

June 2, 2009 | Unregistered CommenterShotgun Mary

Figures on co-sleeping deaths are always very difficult to interpret. How many deaths occur because of the sleeping arrangement? How many would still have occurred if the child was in a cot? That is why I am wary of research like that quoted above by Sarah V. Academics can pretty much make the stats say whatever they want.

There is a lot of evidence to show that co-sleeping prevents SIDS if it is done safely. So I agree with you phdinparenting - I really wish all new parents were educated in how to co-sleep safely.

Babies prefer it. It is how things have been for thousands of years in the vast majority of civilisations. It is loving and kind. This argument may be too soft and unscientific for some, but it is enough for me.

June 2, 2009 | Unregistered CommenterCave Mother

@ Chad:

Thank you for your polite response despite your strong objections to my post. I'll try to be as polite in my reply.

1) Yes, there are deaths associated with co-sleeping. The fact is, many of those happened in unsafe co-sleeping environments. However, the coroner does not differentiate between a death that occurred in a water bed with drunk, smoking parents, 10 pillows and a heavy duvet and deaths versus a death that occurred in an adult bed with a tight fitting sheet, appropriate bed rail, mother that is not intoxicated, and so on. However, the coroner does differentiate between a death that occurs in a so-called "safe" crib environment (it gets called SIDS in that case) and a death that occurs in an unsafe crib environment (one with bumper pads, baby sleeping on stomach, with stuffed animals, etc.). There were 5 deaths from SIDS in Ontario in 2006. How does that compare to the number of deaths that occurred in safest possible co-sleeping environment? I don't know. Because the coroner won't tell us. What it comes down to is that no sleep environment is perfectly safe, but there are plenty of things parents can do to make either a crib or an adult bed as safe as possible.

2) I don't think the incidence of co-sleeping is as low as you think. Most parents that I know co-sleep at least part of the time. Unfortunately, deaths from co-sleeping often occur when parents are NOT co-sleepers, but decide to bring their baby to bed out of complete exhaustion because the baby just won't sleep in the crib. If public health officials taught parents about how to create a safer co-sleeping environment, rather than just saying that it is outright dangerous, then maybe some of those deaths could be prevented.

3) You asked "if the evidence of the health risks of formula feeding is so strong and irrefutable that it warrants strongly advising women against it, shouldn't the evidence on the risks of co-sleeping warrant at least the same level of concern". Good question. I have a few thoughts in reply.

Here is what the Ontario coroner said about sleep:

Unsafe sleeping environments - Infants should sleep alone, on their backs and on a surface specifically designed for infant sleep. The Paediatric Death Review Committee stresses the importance of not bed-sharing, particularly with infants under the age of 12 months. Examples of unsafe sleeping environments include: adult beds,couches, armchairs and infant swings. The sleeping environment should not contain bumper pads, toys, pillows or covers designed for adults.

I have never heard a public health authority say anything like:

Unsafe feeding practices - Infants should be breastfed, exclusively, and not given anything but breastmilk for the first 6 months of their life. The [insert name of health authority] stresses the importance of not formula feeding, particularly for infants under the age of 12 months. Examples of unsafe feeding practices include: infant formula, soft drinks and peanuts. Feeding practices should never involve the use of bottles, cups, or feeding mechanisms designed for adults.

Public health authorities do say that breastmilk is safest and they do tell parents how formula feed properly if that is what they choose. The booklet that I got from the provincial government has plenty of information on how to feed formula if that is what you choose to do. The package of formula also contains information on how to use it properly.

The risks of unsafe co-sleeping practices do warrant a level of concern. In fact, they warrant a strong level of concern. In the same way that we need to ensure that parents are not feeding their children formula that is watered down or made with dirty water, we need to ensure that parents that are co-sleeping are not drunk and using adult bedding.

I wrote a long response to the Ontario coroner's report last year and am still so exhausted from that, that I chose a shorter snappier post this year. However, to understand the problems in the way that statistics on co-sleeping deaths are reported, I would recommend reading last year's post: http://www.phdinparenting.com/2008/06/05/faulty-logic-from-the-ontario-coroner-regarding-bed-sharing/" rel="nofollow">Faulty logic from the Ontario coroner on bed sharing

Note: I'm cross-posting this reply on your blog.

June 2, 2009 | Unregistered Commenterphdinparenting

"Examples of unsafe sleeping environments include: adult beds,couches, armchairs and infant swings."

This is interesting. I have known several families who choose to have baby sleep in swing, instead of cosleeping, when baby wouldn't sleep in a crib.

June 2, 2009 | Unregistered Commenterradmama

Great post! I totally agree: education is the key. Give parents, especially rookie, exhausted, overwhelmed parents the information on how to do it safely if they so choose. I co-slept with DS5 who bf'd non-stop. More sleep for both of us and mama buffet for him. DD2 on the other hand wanted nothing to do with me and we moved her into a crib where she was totally happy (sad mama, but happy babe) She pushed away from me and wanted "her space" so that was a better, safer option. But I was informed. Our bed was baby friendly and her crib was baby friendly.

I really wish this wasn't such a big deal.

June 2, 2009 | Unregistered Commenterlunzy

@ Sarah V - I think I addressed a lot of your points in my reply to Chad, but just wanted to agree that we can talk about safer co-sleeping and about safer crib sleeping. Neither one is completely safe. Both of them can be made safer through specific practices.

June 2, 2009 | Unregistered Commenterphdinparenting

Thank you for pointing this out. I have co-slept with all 6 of my children and they are all still alive.... wow... what a concept...

I totally agree that maybe they should put more information about these deaths that did occur. I mean you hear if the person was drunk or under the influence or had health problems when it concerns a car crash so why wouldn't they give those details for co-sleeping deaths. They won't give those details because it is not in their best interest to tell. I mean if people learned all of the benefits about co-sleeping (not just the ease of nursing your little one when they are right beside you) like regulating of the infant's breathing, body temperature regulation and less stress on the infant. They won't talk about stuff like that because they can't make money off of it. Why have an infant who is healthy and doesn't need all of those expensive bedding sets, cribs, machines to monitor breathing, baby monitors, etc.....

For people to comment negatively about co-sleeping, have you ever done it? If so was it an inconvenience because you couldn't go to bed drunk or high? People who comment about stuff that they have no expertise at really makes me laugh. It is like reading parenting books written by a childless person....

I am proud to have my children know that they are important to me and that I didn’t think that they should be left alone in a room all by themselves..... How can people even think that is healthy for an infant...

I love this article. Thank you for trying to make people aware. Sometimes it is hard to get your point across to bricks though.

Also since breastfeeding was brought up... I am a firm believer in extended breastfeeding and think that formula should be banned.... Formula has killed many infants all over the world and has caused many health problems. Not to mention now it is okay for there to be melamine in formula... I mean why would someone want to give their infant what they were supposed to get.... human milk. Whether it is from the mother or donated from another woman.... but ewww what an ick factor right... no let's give the infant something that comes from an animal that isn't the same species... btw are people even aware what most of the cows eat in the mega dairies where the milk comes from for formula.... probably not...

We live on a farm and I can tell you that my animals that I have had to bottle feed have never been as healthy as ones that lived on their mother’s milk.

June 2, 2009 | Unregistered CommenterMomma of 6

Most people I know co-sleep without calling it co-sleeping. Usually when they are too tired to get up with their baby. The admission is often followed by some acknowledgement that they are going advice. "I know I shouldn't" or "shh" or "I feel naughty"- All comments I've heard from mothers just trying to get a good nights sleep. It is such a natural and sensible way for everyone to get the sleep they need. You are so right, we don't need more people telling mothers not to do it, we need people learning how to do it safely.

June 2, 2009 | Unregistered CommenterJulie Cottle

I had the good fortune of finding an amazing pediatrician for my first daughter. She was the one who helped me learn to breastfeed and helped me not to worry. She had practiced on four continents and said North Americans were the only ones to routine put their babies in a cage in another room. She RECOMMENDED co-sleeping. Another care provider recommended bed sharing.

We did half and half with my first child who was very wiggly and I bedshared from day one with my younger, now 17 months.

I guess we all need to talk about bedsharing. In my case, bedsharing at least part of the night is the norm with my friends.

Great use of stats to give the issue a dose of reality.

June 2, 2009 | Unregistered CommenterJill--Unnecesarean

I am in strong support of safe bedsharing! I learned at a conference that bedsharing is a form of co-sleeping. Co-sleeping is an important part of early infancy nurturing and care .... esp breastfeeding even if bedsharing is not for you.... Both Annie, Melodie and Maire bring up important points of safety. I especially like the points of Shotgun Mary- that we now have to "prove" the validity of such a practice since the opposite approaches were placed into general practice without studies. Good point!
In China and many other places, UNICEF workers would be horrified to hear the young Chinese mother had no bassinet or crib... her sleeping provisions for the baby were to have the baby sleep with her! Her reason??? "He too little to sleep all alone!" Imagine that. wonder what statistics are in countries like that!

June 2, 2009 | Unregistered CommenterBirth_Lactation

Forgot to say kudos for your response to the Vancouver Sun post and @Chad

June 2, 2009 | Unregistered CommenterBirth_Lactation

[...] This post was Twitted by phdinparenting - Real-url.org [...]

As an unplanned co-sleeper, I think it's been the best solution for my son and I. He was preemie 8.5 wks on monitor and meds and the only way I could BF and not get up every ten seconds was to have him in a sleeper next to me.

June 2, 2009 | Unregistered CommenterLildevilMama

Wonderful post! Thank you for sharing this. When my daughter was in the NICU at Mt. Sinai for the first two months of her life, the nurses and doctors taught all of us that sleeping with our babies in our beds with us was a big No-No. I totally see the reasons for which co-sleeping can be dangerous, but wondered why in some countries the numbers for death from SIDS were far less than the numbers in North America. There was one nurse who came up to me and gave me her theory. She said that she thinks that in Asian countries (like the one she is from), co-sleeping is part of the culture, the lifestyle...and also from lack of beds and space for multiple children to sleep in. Babies sleep with their parents or siblings. I won't get into her theory here because I'm sure it will spark tremendous debate.

Just thought I'd mention the give away I'm having on my blog.

http://lifeonmanitoulin.blogspot.com/2009/06/this-can-save-your-childs-life.html

June 2, 2009 | Unregistered CommenterC

Brilliant, as always. Love your response to Chad as well. That's something I really appreciate about your blog - if someone asks a question of brings up and issue in the comments, I can count on you replying to it thoroughly and respectfully, usually within a few hours!

June 2, 2009 | Unregistered CommenterLindsay @ Kickypants

I'm not trying to beat a dead horse -- really -- but Annie raised a number of additional points in her reply to my reply. So here's my contribution to Round 2 of the debate:

http://communities.canada.com/vancouversun/blogs/parenting/archive/2009/06/01/co-sleeping-dangerous.aspx

June 2, 2009 | Unregistered CommenterChad Skelton

Sorry, more accurately my response is in the comments section of my original post:

http://communities.canada.com/vancouversun/blogs/parenting/archive/2009/06/01/co-sleeping-dangerous.aspx#comments

June 2, 2009 | Unregistered CommenterChad Skelton

I agree completely. I got incensed with MomLogic sent out a Tweet about how co-sleeping was dangerous/deadly/whatever and immediately discontinued my membership and http://thisisworthwhile.blogspot.com/2009/04/this-is-so-tiring-no-pun-intended.html" rel="nofollow">blogged about it.

It's all scare tactics and rarely, if ever, is there a mention about SAFE BED SHARING. That's the whole point of this. If you do anything in this life recklessly it can prove fatal. It doesn't mean that we should stop doing the activity, just proceed with education and precaution.

As usual - stellar article. *thumbs up* Oh, and I Stumbled this.

We ended up co-sleeping and never regretted it for a moment. It wasn't planned, but I researched safe ways of bedsharing the best I could and never felt that there was any danger for my child. At any rate, there wasn't any sleeping in the crib happening... and I decided sleep was just too important and if the only way that was going to happen was if we all slept together, so be it. I even coslept during a hospital visit, which freaked out the nurses a little but the pediatrician - who was born in a country where bedsharing was common - seemed to be more or less okay with it.

I have to say, though, that I understand in a way why official organizations are still so reluctant to sign off on bedsharing as a 'safe' practice, but it's true that information needs to be readily available for the desperate parents who find themselves in a similar situation to me. Even without official approval I was able to find enough resources to make me feel comfortable with what I was doing, though.

June 2, 2009 | Unregistered CommenterMichelle E.

@ Chad: You said: "If a coroner has clear evidence linking a certain behaviour to child deaths I don't think it's unreasonable for them to recommend against the practice as a whole rather than proposing a flurry of ways to make that unsafe practice safer."

The thing is, the coroner does not have clear evidence linking bed sharing to child deaths. There are about the same number of deaths in cribs/bassinets as in adult beds. However, all deaths in adult beds get automatically classified as "unsafe" and the deaths in cribs get split between "unsafe" and "SIDS". There is a predetermined assumption that an adult bed can never be a safe sleep surface. Not evidence that it is never safe.

There is also evidence that most of the bed sharing deaths involved risk factors that could be reduced through education, like adult bedding, intoxication, baby sleeping on stomach, etc. Sure, there is no guarantee that the "education" will get through to parents, but they have had quite a bit of success in reducing deaths with the "back to sleep" campaign, so why not try a "safer bed sharing" campaign?

You said that "no parents *need* to co-sleep". Then you have obviously never had a baby that won't sleep for longer than 15 minutes on his own in a crib. Otherwise you would realize that there are babies that *need* to co-sleep. In many parts of the world, people consider babies too young to sleep on their own. There is an assumption that no baby should sleep alone.

The real problem, and the real danger, with co-sleeping occurs when parents co-sleep by mistake or out of desperation. If parents are told not to co-sleep, but then fall asleep by mistake while nursing the baby in their bed or on the couch because they are so exhausted from getting up over and over again for a baby that just won't sleep in the crib, that is when deaths occur because those parents have not prepared to co-sleep and are likely bringing the baby into an unsafe sleep environment.

If we instead told parents, there may be times when it is easier to co-sleep. http://www.phdinparenting.com/2009/01/09/cosleeping-benefits/" rel="nofollow">There are even benefits to co-sleeping. But if you do decide to co-sleep, make sure you create the safest bed sharing arrangement possible, then we could reduce the number of deaths.

June 2, 2009 | Unregistered Commenterphdinparenting

Great post! As you know, I love sleeping with my babies. Nothing more natural or wonderful in the whole world.

June 2, 2009 | Unregistered CommenterLoukia

When my twins were infants it was either co-sleeping or death by lack of sleep.

CaveMother: Unfortunately, the evidence overall does not support the claim that bedsharing prevents SIDS, however carefully it's done. Although epidemiological studies seem to have shown an association between bedsharing and lower SIDS rates, this has not been supported by more detailed studies that have actually compared SIDS babies with surviving babies to look at the differences between them. The latter studies – called case-control studies – are more accurate than epidemiological studies, because you don't get the same number of possible confounding factors as you do when trying to compare different societies in which all sorts of factors could be different and account for the SIDS rate differences. Case-control studies just haven't supported the claims that bedsharing could reduce SIDS rates. Surviving babies in these studies were no more likely than SIDS babies to have been bedsharing, no matter how many other factors were taken into account and adjusted for.

What's worrying, however, is that more recent case-control studies have looked at how age affects the association between bedsharing and SIDS, and what they've found is that, for the babies in the first few months of life, babies who died of SIDS were *more* likely to have been bedsharing than babies who didn't die. Even when other factors such as sleeping position, firmness of mattress, heaviness of bedding, parental smoking, breastfeeding, and other potentially relevant things were adjusted for. In other words, the evidence shows that, for babies in the first few months of life, bedsharing almost certainly makes SIDS *more* likely, not less. On top of which, there's the rare but possible risk of smothering even with safety precautions.

I think this has to be kept in perspective, as Annie said – it's going to be a very low risk in cases where parents do everything possible to bedshare safely. But, unfortunately, there *is* evidence linking bedsharing to SIDS deaths for very young babies, and I do think parents need to know that. I agree with Annie that there needs to be advice about co-sleeping as safely as possible if you are going to do it, but the advice does also need to make it clear that, in terms of safety, even optimised bedsharing is still second-best to optimised crib sleeping.

June 5, 2009 | Unregistered CommenterSarah V.

Momma of 6 – Yes, I co-slept with both my children, and loved it. However, by the time my second child was born, I had read more of the research, and reluctantly decided that it was better to avoid it for the first few months. Fortunately, she settled well in her Moses basket, so I was able to put off bedsharing until she was a little older. Yes, it was a pain having to stay awake during night feeds during those early months, and, yes, I'd much have preferred it if the evidence didn't show an increased risk, but I can't ignore decent-quality studies just because they don't say what I'd like them to say.

Your question about whether it was an inconvenience not to be able to go to bed drunk or high was offensive and uncalled for.

June 5, 2009 | Unregistered CommenterSarah V.

@Sarah V: I think one of the additional problems with interpreting these stats are the varying definitions of SIDS. In Ontario, there are zero SIDS cases resulting from bed sharing according to the coroner. However, that is only because a bed sharing death is automatically classified as an "unsafe sleeping environment" and therefore is not considered SIDS. SIDS, in Ontario, evidently only happens in cribs and bassinets.

June 5, 2009 | Unregistered Commenterphdinparenting

Yes, that's an issue. If the studies in question were done in populations where SIDS cases in bedsharers are likely to be misdiagnosed, that would lead to the risk of bedsharing-associated SIDS being underestimated. In other words, we have to question even the studies that didn't show an increased association between SIDS and bedsharing, because they could well be underestimating the association and thus could be missing an increased risk of SIDS associated with bedsharing that actually does exist.

June 6, 2009 | Unregistered CommenterSarah V.

@Sarah V. Or potentially the opposite, of course. The data just isn't good enough to know one way or another. Deaths happen in cribs, no matter how "safe" you make them. Deaths happen during bed sharing, no matter how "safe" you make it. No sleep environment is 100% safe. So we should focus on trying to eliminate conditions in both bed sharing and crib sleeping that we know are dangerous, rather than vilifying one or the other outright.

June 6, 2009 | Unregistered Commenterphdinparenting

Annie: In fact, it's much less likely to be 'the opposite', because the researchers in most of the studies checked out the original reports on all of the SIDS cases they studied quite carefully (looking at police reports of the original scene, etc.). So, if smothering deaths while bedsharing were getting misdiagnosed as SIDS cases, that would generally be picked up by the researchers who then wouldn't have included those cases. If SIDS deaths while bedsharing were getting misdiagnosed as smothering cases, then that generally *wouldn't* be picked up in those sorts of studies. (The Blair et al study from 1999 is an exception, by the way – they checked out all sudden unexpected infant deaths to come up with a subset of SIDS cases.) So, it's much more likely that the research would be underestimating the strength of a SIDS-bedsharing link than overestimating it.

I completely agree with you that we shouldn't 'vilify' parents who do things in a less-than-optimal way, whether it's bedsharing in the early months, formula-feeding, or any of the other imperfect behaviours parents manage along the way. I'm talking about *informing* parents. There is good evidence suggesting an increased risk with bedsharing in the early months no matter how safe you try to make it, so parents should be told that crib sleeping is best (at least in the early months) in the same way that they're told that breastfeeding is best. I agree that parents should also be advised on how to minimise bedsharing risk in cases where they do bedshare, but I also think that this should be done in a context of making it clear that crib sleeping is still the optimum method to choose wherever this is feasible.

June 6, 2009 | Unregistered CommenterSarah V.

@ Sarah V. If we are going to be picky about language here, then it is important to note that "safest" isn't necessarily "best". The http://www.phdinparenting.com/2009/01/09/cosleeping-benefits/" rel="nofollow">benefits of bed sharing need to be weighed against any potential increased risk. If safety was the only consideration in life, I would stay home every day. Too dangerous to leave the house. I would certainly never get in a car.

June 6, 2009 | Unregistered Commenterphdinparenting

Annie: Again, the same considerations apply to advocating breastfeeding over formula-feeding. Health considerations aren't the only ones we take into account when making our decisions about how to do something, and, if a mother is having major problems with breastfeeding that are affecting her relationship with her baby or her ability to care for the rest of her family, then formula-feeding may well be best for that individual woman. Despite knowing that, I don't have a problem with the 'breast is best' message on the level of public health messages, because I do think that in a more generalised sense it is true.

Likewise, if a baby absolutely won't sleep in a crib no matter what you try, then optimised bedsharing may be better for that particular family than having the parents reduced to exhausted wrecks. Public health information on both topics should be put across in such a way as to avoid placing blame on the shoulders of parents who end up doing things in a less than ideal way, and to avoid exaggerating the risks associated with the other method – I certainly don't think it's called for to refer to the alternatives as dangerous or inferior or the other sorts of highly pejorative terms that come up in these contexts. But my main point here is that public health information does have to make parents aware of the fact that there does appear to be a small increased risk associated with crib sharing in the early months even when efforts are made to make it safer. Regardless of how that point is phrased, it does need to be in there, because parents do have a right to know what the research says about the safest ways of doing things.

June 7, 2009 | Unregistered CommenterSarah V.

@ Sarah V
I am glad that it sounds as though you were able to make the best decisions for your family based on the research that **you** found which supported **your** feelings and which were supplied by sources **you** happen to trust. I personally have never found such evidence (at least, not provided by sources that **I** would trust). In fact, according to sources **I** trust implicitly, I have only ever read that bed-sharing – when done properly – is **the** safest place for a baby to sleep (newborn or otherwise) due in part to the way moms and babies share breathing patterns, babies respond to the smell and touch of their mother and the way that body heat is more easily able to be regulated.
Ultimately there are statistics and information sources available to support ALL sides of any argument and sleep/bed-sharing can be debated until everyone is “blue in the face” without either side being able to change the mind’s of the other. That’s okay. We just need to be willing to follow our hearts after doing *our* research and parent *our* children in the best way we know how. Your way is right for you. That doesn’t mean that the stats and reports *I* read are wrong; they are just different.
Your babies are lucky that you read and try to do the very best you can for them. My babies are also very lucky that I do the same, even when my path is different.

PS - Be careful how you word things. I would suggest that it be said that "parents do have a right to know what MY research - the research **I** have chosen to read - says about the safest ways of doing things."

June 7, 2009 | Unregistered CommenterSam

Sam: I chose to read every bit of research I could lay my hands on on the subject. I read the ones that pro-bedsharers told me supported their argument, and I'd be willing to bet that I've checked out the same sources as you have or equivalents. I also tried to find the highest-quality research I could in this area, which meant case-control studies (studies directly comparing SIDS and non-SIDS babies). I've got hold of every one of those that I could find. The reason I 'happen to trust' the source they came from - PubMed - is because it's the internationally used method of filing all peer-reviewed studies, and looking on there is the best way to get a full picture of the good-quality research done in any area. I checked out the pro-bedsharing arguments very carefully and found that they were consistently using poorer-quality research.

Believe me when I say that I do not have an anti-bedsharing axe to grind. I had one of those babies who wouldn't settle in a crib, and I did sleep with him from the time he was a few days old. I found it an absolute sanity-saver and the one thing that made those early months of motherhood manageable and bearable. I loved bedsharing and really looked forward to doing the same thing with my second child. When I had to face the fact that my research was leading me to the conclusion that this was a less safe way of doing things, I really didn't want to believe it at first - I wanted to back away from the whole subject and keep believing what suited me. But I did my best to read the research with as open and impartial a mind as I could possibly manage, and I could not, in all honesty, deny what it showed.

June 7, 2009 | Unregistered CommenterSarah V.

@Sarah V
I am glad your research brought you to a choice that worked for you. As you say "**my** research" and it is indeed the research you have done. As you don't know what research I have used (and I do work in such an environment where I have access to a considerable number of studies too) I don't know that it is fair for you to assume you have "checked out the same sources" I have "or equivalent." As I stated above, you did what was best for YOUR family and that is all a parent can be expected to do.
I don't intend to continue to debate this with you. I support that you have done what you felt it was best to do. I did what I felt was best to do. In all, I think Annie has had the best final word on this topic.

June 7, 2009 | Unregistered CommenterSam

[...] But I think there's a real flaw in the logic of her most recent post criticizing the Ontario coroner for advising parents against letting their children sleep with them. [...]

[...] I have good reasons for it and I won’t let other people call me a bad mother for doing it (so there Ontario coroner). var addthis_pub = 'phdinparenting'; var addthis_language = 'en';var addthis_options = 'email, [...]

[...] is using fear inducing headlines and horror stories to garner readership. But here is the thing. Saying that co-sleeping is dangerous is like saying that riding in a car is dangerous. There is no way to make car travel completely safe, but no method of travel is completely safe.  [...]

Co-sleeping has worked very well for us. Thank you for such a great post!

November 27, 2009 | Unregistered CommenterNadia

Without saying whether bed sharing is good or not I want to point out that you comparison of infant mortality from bed sharing compared to automotive deaths is badly flawed. What would be much more appropriate is counting the number of infant deaths compared to the number of babies that bed share as opposed to the number of births. The risk factor is associated with bed sharing, not being born whereas most people travel by some form of vehicle so it is fair to base that on a percentage of the population. In order for the statistics to be meaningful, the proper statistic needs to be used.

April 3, 2010 | Unregistered CommenterRobert

@Robert:

Everyone needs to be transported somehow and there are lots of options like car, bus, bicycle, walking, train, subway, etc. Everyone needs to sleep somewhere and there are lots of options like bed sharing, crib, playpen, bassinet, swing, dresser drawer, etc.

April 3, 2010 | Unregistered Commenterphdinparenting

Again, while appreciate your article I'm just pointing out a weakness in your argument which you are still not seeing. Let me also mention that I do have my 8 month old daughter sharing a bed with us so I'm not knocking the idea.

In order for the statistic about infant deaths to be useful it should be the number of deaths compared to the number of infants that bed share (which I do not know), not the amount of live births. For example, and only for illustrative purposes, if out of 100,000 live births, only 1,000 shared a bed then the relevant number would be 8.8 deaths per 1,000 children because that would accurately represent the risk involved in bed sharing. As for the automotive example, because nearly the entire population would be exposed to the risk of automotive accidents in some way shape or form, using the entire population would still be substantially accurate.

I hope that helps clarify the point that I was making.

April 3, 2010 | Unregistered CommenterRobert

I read somewhere (sorry, but I don't have the reference right now) that upwards of 70% of parents bring their baby to bed with them at some point. Since most babies are probably spending more time sleeping per day than people usually spend in their cars, I don't think the comparison is that off base. Obviously it isn't a perfect comparison because we don't have perfect stats on the different places people sleep or the different ways that they travel (believe me, I looked...), but I still think it is relevant and appropriate. My point was not to say that the 8.8 out of 100,000 is exactly equivalent, but to say that it is ridiculous given the similarity in the stats that the approaches taken are so vastly different (i.e. saying "don't bed share" versus saying "it is okay to travel by car if you do X, Y and X").

April 4, 2010 | Unregistered Commenterphdinparenting

[...] bankrupt companies that make products that support those practices. I’ve written about this before as it relates to co-sleeping and I’m saddened and angry to have to write about it as it relates to baby [...]

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