The Family Bed: A Normal Part of Family Dynamics?

Location, location, location… where should babies sleep?  This has increasingly become a very hot topic amongst parents and in the medical community due to all the conflicting information about bed sharing and co-sleeping.  Before I go any further, it is important to differentiate co-sleeping from bed sharing.  Co-sleeping refers to sleeping in ‘close proximity’ (approximately an arms length apart) with the baby, in the same room as the parents—this may be on the same or separate surface.  Bed-sharing, also called the ‘family bed’, describes a sleep arrangement where the family members sleep on the same surface.  Deciding on where the baby sleeps is an important one that depends on the individual and unique circumstances of each family.  Based on an informal survey I took of the families in my community, bed-sharing is not necessarily considered an option before the baby arrives.  For some parents, it was a given that babies should sleep in their own room.  As a result, many hours were spent on furnishing and decorating the baby’s room.  However, once the baby arrived and parents realized how inconvenient it is to go back and forth from one room to the other, they then decided to move the crib or bassinette into their own room.  Other parents decided right from the start to co-sleep with their babies.  Interestingly, parents from both groups ended up bringing their babies into bed with them at some point out of convenience even though they had never planned to bed-share, and they often did it in secrecy.  If you can relate to these parents, you are definitely not alone!  Recent research in the US shows that 62% of babies end up in their parents’ bed at night, and this persisted throughout the first year despite receiving negative feedback from friends and families (86%) about where their babies sleep.  Seventy percent of these parents were also less likely to tell their health care providers about bed sharing (Kendall-Tackett et al. 2010).

 

So why is it that so many parents initially do not consider bed-sharing an option?  Here are a few common reasons:

 

• Public-health initiatives & media: Bed sharing is frequently being villainized in the news and by health care providers or public health initiatives as a cause of infant death.  For example, in 2007, Ontario’s Deputy Chief Coroner announced that the “only safe sleeping environment for a baby is in a crib with a proper-fitting mattress”.  More recently, Quebec’s coroner also deemed bed sharing as dangerous with an increased risk of suffocation.
• Lack of rest: Parents worry that bringing their baby into the same bed with them will interfere with their quality and quantity of sleep
• Dependence: Parents also worry that bed sharing will spoil the baby, make them more dependent for longer and create bad habits for the future (e.g. they will never be able to move their children into their own room).

 

What does the research actually say about these concerns?

 

• Though unsafe sleeping arrangements (whether in a separate crib or in the parents’ bed) may be dangerous and increase the risk of infant suffocation, bed sharing as a whole should not be deemed dangerous.  In fact, SIDS researcher, James McKenna states that infants who sleep with their parents under safe conditions, either bed-sharing or co-sleeping have decreased risk of SIDS.  In countries where co-sleeping nearly universal, such as Hong Kong and Japan, SIDS rates are among the lowest on record.  Also, Dr. Helen Ball has found in her research of parent-infant sleep patterns that mothers instinctively position their bodies (lay on their side with their arm stretched out and hips and knees flexed—see picture below) to protect the baby and prevent any possible roll-over.

For guidelines on safe bed-sharing, visit http://cosleeping.nd.edu/safe-co-sleeping-guidelines/

• Both babies and mothers sleep better when bed-sharing, as they synchronize their sleep and wake patterns and drift between cycles with minimal interruption.  Breastfeeding mothers who bed shared reported significantly more sleep in a 24 hour period than breastfeeding mothers who slept separately (Quillin and Glenn, 2004).
• It has been found that babies who co-sleep or bed share are actually more independent and self sufficient at an earlier age.  This should not be surprising as psychologists in the early 1900’s such as Erik Erikson identified proper attachment in the first years of life as the foundation of proper psychosocial development.  Keller and Goldberg found that the capacity for self-sufficiency, social interaction with peers, and “problem solving” skills were enhanced by routine co-sleeping from birth (Keller & Goldberg, 2004).

 

There are many additional benefits to bed sharing, including breastfeeding promotion.  Considering that breastfeeding is the biologically normal way to feed, it makes sense that parent-baby sleep contact is also the biological norm.  This was apparent in Dr. Kendall-Tackett’s study as mothers who ended up bed sharing reported that despite all the negative pressure from health care providers or public-health initiatives, they still did it because they felt it was the “right way to do it” or because “it was the only way that worked for them” (Kendall-Tackett et al. 2010).

 

Therefore, when deciding where the baby is going to sleep, strongly consider bed-sharing as an option and educate yourself about safe ways to do it.  This way, you do not find yourself falling asleep in an unsafe arrangement.  Also, take time to figure out what works best for your family.  As Helen Ball states, “there is no simple message about bed-sharing that will fit the needs of all families”.  Each family has their own unique circumstances and preferences, which may require some creativity.    For example, consider expanding your bed’s limits by placing another mattress against your mattress to give more space for each member.  If your family decides that bed-sharing is not the best choice, please keep in mind that co-sleeping, at least for the first 6 months, is the widely accepted recommendation (even by the Canadian Paediatrics Society) for all babies regardless of their feeding method.

 

References

Ball H. Bed-sharing and co-sleeping. New Digest. 2009; 48: 22-27.

Kendall-Tackett K, Cong Z, Hale TW. Mother-Infant Sleep Locations and Nighttime Feeding Behavior. Clinical Lactation. 2010; 1: 27-31.

Keller MA and Goldberg WA. Cosleeping: help or hindrance for young children’s independence? Infant and Child Development. 2004; 13:369-368.

McKenna JJ, Ball HL, Gettler LT. Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys Anthropol. 2007;Suppl 45:133-61.

McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev. 2005; 6(2):134-52.

Quillin S, Glenn L. Interaction Between Feeding Method and Co-Sleeping on Maternal-Newborn Sleep. JOGGN. 2004; 33(5): 580–588