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When is co-bedding appropriate?


First and foremost, co-bedding can be very dangerous for your baby. However, at the same time there are benefits to co-bedding when certain precautions are taken to minimize the potentially deadly risks. Medical evidence shows that when mothers and babies co-bed breastfeeding can be more successful, there is a greater sense of attachment and satisfaction, and the baby (though not always the mother) can possibly sleep better. These sound like great outcomes that any physician would like to promote. And there are so many studies out of Asia and Africa showing high rates of successful co-bedding and breastfeeding along with lower Sudden Infant Death Syndrome (or SIDS) rates. So why is this practice discouraged in the U.S.? 

When one looks closer at the scientific literature you quickly notice a pattern. The places where these studies are taking place show distinct cultural differences when compared to the U.S. In many parts of Asia and Africa women sleep on thin mats placed flat on the ground and they use minimal bedding, pillows, and blankets. Often, husbands are relegated to a different sleeping environment during this initial transition period. These women also tend to have a healthy weight, meaning lower amounts of extra body fat. They rarely smoke, drink alcohol, or use medications that can alter their ability to wake up quickly and easily. Lastly, these mothers are often well supported by other female members of their family and community. They can often spend time lounging with their infant the first few days to weeks while others pitch-in to make sure chores and meals are completed. This helps the new mothers to heal faster and to be less sleep deprived. I’m sure some mothers here in the U.S. are reading this with a hint of longing for similar support. 

Unfortunately, many mothers in the U.S. are unable to match many of these conditions. Transitioning from a pillow-top mattress to a thin woven floor mat with no pillows and minimal blankets seems impossibly drastic. For others it would mean dad would have to go sleep in the guest room or on the couch. Some women who use tobacco, alcohol, or medications may not be able to give up these exposures. Many mothers may be struggling with a weight issue given our current rates of obesity in the U.S. And rarely do U.S. mothers have personal assistants to keep the household running while they take a long nap. But what happens if you don’t make these lifestyle adjustments and decide to still trying co-bedding? 

Co-bedding without adhering to the above precautions will actually increase, not decrease, your child’s risk for SIDS. Until an infant is about 6-months-old they're not strong enough nor coordinated enough to protect their own airway from being smothered.

For example, when a heavy blanket is laid across an infant’s nose and mouth, they cannot wiggle out from under it. With each breath less and less oxygen gets to the baby’s brain. And the immature brain of the newborn, especially for premie infants, often won’t send danger signals to wake the infant about this very perilous situation.

When infants sleep in modern beds they're at risk for being covered by bedding and pillows. They risk rolling into their parents, or vise versa, and being smothered without ever struggling to wake the adult. Infants can become trapped between a bed and wall, or even fall off the bed.  Even laying on too much cushioning can position an infant so they can’t take deep enough breaths. And, the commonly exhausted parent with the best of intentions to sleep lightly will eventually dream deeply and not be aware of their surroundings.

Infants dying of a co-bedding accident are a terrible tragedy, but even worse these occurrences are not uncommon. I am sad to know that co-bedding rates are increasing especially among minority mothers, according to recent studies. Often this is due to a lack of knowledge and that certainly means physicians are partly to blame. Our country made remarkable progress when the American Academy of Pediatrics launched the Back-to-Sleep campaign in the 1990’s and the SIDS rate dropped dramatically. Putting infants on their backs and in their own sleeping environments every time has saved countless lives. It would be heartbreaking to see the rates of SIDS start climbing again because mothers were not properly informed. Please share this information with any new mothers you know, and be sure to offer a helping hand as they enjoy this special period in their lives.

About Amy Seery MD