What constitutes a safe sleep environment for babies?
7 Safe Sleep Recommendations
(Whether or Not You Share Sleep with Your Baby)
1. Infants should sleep on firm clean surfaces, in the absence of smoke, under light (comfortable) blanketing. Their heads should never be covered.
2. Whether your baby sleeps in a crib or in the parental bed, the mattress should be firm, and it should fit tightly against the headboard so that an infant cannot fall into a ledge face down and smother.
3. The bed should not have any stuffed animals or pillows around the infant.
4. An infant should never be placed to sleep on top of a pillow.
5. Sheepskins or other fluffy material, and especially bean bag mattresses, should never be used.
6. Water beds can be dangerous. The mattress should always tightly fit within the bed frame.
7. Infants should never sleep on couches or sofas, with or without adults. They can slip down into the crevices or get wedged against the back of a couch.
9 More Safety Tips for Families Who Share Sleep
1. If bed-sharing, ideally, both parents should agree and feel comfortable with the decision. Each bed-sharer should agree that he or she is equally responsible for the infant and acknowledge that the infant is present . Both parents should think of themselves as primary caregivers.
2. If you sleep with your baby, it is important to be aware that adult beds were not designed to assure infant safety!
3. Since contact with other bodies increases the infant's skin temperature, babies should be wrapped lightly in the co-sleeping environment. Obviously, if the room temperature is already warm (above 70° F) the baby should not be covered with any heavy blankets, sheets or other materials. A good test is to consider whether you are comfortable; if you are, then the baby probably is as well.
4. Persons on sedatives, medications or drugs, or intoxicated
5. Infants under a year old should not sleep with other siblings
6. If the mother has excessively long hair it should be tied up to prevent entanglement around the infant's neck. (Yes, it has really happened!)
7. Extremely obese persons, who may not feel how close their infant is, may wish to have the infant sleep alongside but on a different surface.
8. It is important to realize that the physical and social conditions under which infant-parent co-sleeping occur, in all it's diverse forms, can and will determine the risks or benefits of sharing sleep. What goes on in bed is what matters.
9. Finally, though it is not a pleasant thought to consider, it may be important to reflect on whether you would think that you suffocated your baby if, under the most unlikely scenario, your baby died from SIDS while in your bed. Just as babies can die from SIDS in a risk-free solitary sleep environment, it remains possible for a baby to die in a risk-free bed-sharing environment. Just make sure, as much as this is possible, that you would not assume that, if the baby died, that either you or your spouse would think that bed-sharing contributed to the death, or that one of your really suffocated your infant by accident. That SIDS can, indeed, occur, where safe bed-sharing, breastfeeding and complete nurturing and care for the infant has occurred, makes this question worth discussing with your partner.
While I do not recommend any particular type of sleeping arrangement to any parent, since I do not know the circumstances within which particular parents live, I do recommend a parent consider all of the possible choices, and to become as informed as is possible, matching what they learn with what they think can work the best for their family.
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Learn the advantages of sharing sleep with your baby
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Explore what sleeping arrangement is right for you
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Find out if co-sleeping will help your baby sleep through the night
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Discover what the long-term effects are for your kids
What are the advantages of having our baby sleep with us?
Some obvious advantages can include:
- The baby will know that you are there, and can respond emotionally and physiologically in potentially beneficial ways. Recent studies show that babies will breastfeed more often, with less disruption to mother's sleep, and the baby will receive more sleep compared with solitary-sleeping breastfeeding babies.
- Babies arouse more frequently, but for shorter average durations, than if the baby slept apart, and spend less time in deeper stages of sleep. This is especially beneficial for babies with arousal deficiencies.
- Babies cry significantly less in the co-sleeping environment. This means that more energy can be put into growth, maintenance and protective immune responses.
- Breastfeeding is enhanced. More breastfeeding, which accompanies co-sleeping, also can be translated into less disease and morbidity.
- Proximity of the infant potentially permits the parents to respond to changes in the baby's status, such as if the infant were choking or struggling to breathe. Proximity makes it more likely that if a baby were fighting to remove a blanket from it's head, the parent might here the event and intercede.
- Working mothers and fathers who feel guilty of not having enough time to be with their babies during the day can feel better about nurturing and interacting with their baby during the night, hence, further augmenting and cementing their relationships. Given the right family culture, co-sleeping can make mother, dad and baby feel very good indeed.
Page three:
Explore what sleeping arrangement is right for you
Page four:
Find out if co-sleeping will help your baby sleep through the night
Page five:
Discover what the long-term effects are for your kids
What is the "proper" sleeping arrangement for me and my baby?
There is no one best way to arrange your baby's sleep. How well one approach works is, as always, determined by factors specific to each family and baby (temperament, sensitivity, etc.), which are not known to an advice giver or expert. Try to remember that you know your baby better than anyone. Become informed, but make your own decision and feel good about it.
How you and your baby's other caregivers feel about privacy and separation as well as the physical circumstances of your house can make a difference as to what approach or practice might work best. For example, some parents who go to bed much later than the baby feel more comfortable if the baby is kept nearby, where, for example, the baby can be easily seen or heard. In these cases, the baby may not be officially "put to bed" in the sense of being placed in a room where all contact is broken. Rather, in these instances the parents might place the baby in an open hall in a bassinet, or let the baby sleep in a bassinet in the living room, or in a carrier seat, close enough to permit a kind of informal monitoring.
Interestingly, infants and older babies fall asleep more easily in the context of family noise, rather than in silence, as is generally thought. This is because the baby probably feels more secure hearing a caregiver
Some parents may choose to put their baby in a separate room with the door closed, where sensory access between the baby and other family members is not likely. My preference is never to close the door to a baby's room, since babies find sleep when they need it, and they were not designed biologically or psychologically to sleep in complete social isolation.
Some parents find it comforting to put some kind of baby monitor in the room, which is fine, except that a more appropriate use would be to turn the amplifiers around and pump family noise into the baby's room, letting the baby monitor the parents and siblings, rather than the other way around. At least 50 years of human developmental research show that babies respond positively to physical and psychological sensory signals (sounds, sights, smells, touch, movement) from others so they feel that they are not alone. We might presume that this "social noise" gives young children a sense of security
Page four:
Find out if co-sleeping will help your baby sleep through the night
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Discover what the long-term effects are for your kids
Will our baby sleep through the night sooner if he or she shares our bed?
No longitudinal data exists that can answer this question. A variety of scientific studies indicate that the baby's own maturational rate, as influenced by its unique internal needs to awaken, to feed, to find reassurance, or to oxygenate, are as much influencing factors in night waking and sleeping through the night as is sleep location.
When infants and parents co-sleep, the infants are for the most part undetected by the parent, and the infant, upon feeling the parent's presence, returns to sleep without awakening the parent, so the question of sleeping through the night becomes less relevant.
Interestingly, laboratory studies reveal that the average duration of infant and maternal awakenings in the co-sleeping environment are shorter on average than the awakenings mothers and babies experience when baby awakens in another room and requires intervention before going back to sleep.
From a biological perspective, it is appropriate for babies to awaken during the night during the first year of life. In fact, although infants can be conditioned to sleep long and hard alone, and without intervention and, hence, fulfill the cultural expectation that the should sleep through the night, the fact remains that they were not designed to do so, and it may not be either in their best biological or psychological interest.
As always, parental goals and needs lead parents to interpret their infant's behavior, including night awakenings, very differently. For example, many parents do not worry about night awakenings because when their babies sleep next to them, the infants are content and less likely to awaken and remain distressed.
Years ago Dr. Tom Anders observed that babies awaken for short periods throughout the night without parental knowledge, even where they sleep in a crib, alone. Some babies will simply go back to sleep while others, presumably with different needs and sensitivities, will awaken and signal their need for contact with the parent. This is not necessarily a sign of immaturity, stubbornness or an attempt to manipulate.
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Discover what the long-term effects are for your kids
What are the long-term effects on my baby?
While advocates of solitary infant sleeping arrangements have claimed any number of benefits of infant sleeping alone, the truth of the matter is, none of these supposed benefits have been shown to be true through scientific studies.
The great irony is that, not only have benefits of solitary infant sleep NOT been demonstrated, but recent studies are beginning to show the opposite. It is not, for example, solitary sleeping arrangements that produce strong independence, social competence, feeling of high self esteem, ability to handle stress, strong gender or sex identities, but it is social or co-sleeping patterns that might, indeed, contribute to the emergence of these characteristics.
Consider the conclusions from these six studies:
- Heron's recent cross-sectional study of middle class English children shows that amongst the children who never slept in their parents' bed, there was a trend to be harder to control, less happy, exhibit a greater number of tantrums. Moreover, he found that those children who never were permitted to bed-share were actually more fearful than children who always slept in their parents bed, for all of the night (1)
- In a survey of adult college age subjects, Lewis and Janda report that males who co-slept with their parents between birth and five years of age had significantly higher self-esteem, experienced less guilt and anxiety, and reported greater frequency of sex. Boys who co-slept between 6 and 11 years of age also had higher self-esteem. For women, co-sleeping during childhood was associated with less discomfort about physical contact and affection as adults. (While these traits may be confounded by parental attitudes, such findings are clearly inconsistent with the folk belief that co-sleeping has detrimental long-term effects on psycho-social development.(2)
- Crawford found that women who co-slept as children had higher self-esteem than those who did not. Indeed, co-sleeping appears to promote confidence, self-esteem, and intimacy, possibly by reflecting an attitude of parental acceptance. (3)
- A study of parents of 86 children in clinics of pediatrics and child psychiatry (ages 2 to 13 years) on military bases (offspring of military personnel) revealed that co-sleeping children received higher evaluations from their teachers than did solitary sleeping children, and they were underrepresented in psychiatric populations compared with children who did not co-sleep. The authors state: "Contrary to expectations, those children who had not had previous professional attention for emotional or behavioral problems co-slept more frequently than did children who were known to have had psychiatric intervention, and lower parental ratings of adaptive functioning. The same finding occurred in a sample of boys one might consider "Oedipal victors" (e.g. three-year-old and older boys who sleep with their mothers in the absence of their fathers) -- a finding which directly opposes traditional analytic thought. (4)
- Again, in England, Heron found that it was the solitary sleeping children who were harder to handle (as reported by their parents) and who did not deal as well with stress, and who were rated as being more dependent on their parents than were the co-sleepers!(1)
- In the largest and possible most systematic study to date, conducted on five different ethnic groups from both Chicago and New York and involving over 1,400 subjects, Mosenkis found far more positive adult outcomes for individuals who co-slept as a child, among almost all ethnic groups. An especially robust finding, which cut across all the ethnic groups, included in the study was that co-sleepers exhibited a feeling of satisfaction with life. But, Mosenkis's main finding went beyond trying to determine easy causal links between sleeping arrangements and adult characteristics or experiences. Perhaps his most important finding was that the interpretation of outcome of cosleeping had to be understood within the context specific to each cultural milieu, and within the context of the nature of social relationships the child has with its family members! For the most part, therefore, it is probably true that neither social sleep (co-sleeping) or solitary sleep as a child correlates with anything in any simple or direct way. Rather, sleeping arrangements can enhance or exacerbate the kind of relationships that characterize the child's daytime relationships and that, therefore, no one function can be associated with sleeping arrangements. Rather than assuming that sleeping arrangement produces a particular type of person, it is probably more accurate to think of sleeping arrangements as part of a larger system of affection and that it is altogether this larger system of attachment relationships, interacting with the child's own special characteristics that produces adult characteristics.
References
1. Heron P. Nonreactive Co-sleeping and Child Behavior: Getting a Good Night's Sleep All Night Every Night. Masters Thesis, University of Bristol, Bristol, United Kingdom , 1994
2. Crawford, M. Parenting practices in the Basque country: Implications of infant and childhood sleeping location for personality development. Ethos 1994, 22;1:42- 82.
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3. Lewis RJ, LH Janda. The relationship between adult sexual adjustment and childhood experience regarding exposure to nudity, sleeping in the parental bed, and parental attitudes toward sexuality. Arch Sex Beh 1988; 17:349-363.. Crawford, M. Parenting practices in the Basque country: Implications of infant and childhood sleeping location for personality development.
4. Forbes JF, Weiss DS, Folen RA. The CO-sleeping habits of military children. Military Medicine 1992; 157:196-200.
5. Mosenkis, J The Effects of Childhood Cosleeping On Later Life Development 1998.
Masters Thesis. University of Chicago. Department of Human Development
Maximizing the Chances of Safe Infant Sleep in the Solitary and Cosleeping (Specifically, Bed-Sharing) Contexts by James J. McKenna, Ph.D., Professor of Biological Anthropology, Director, Mother-Baby Sleep Laboratory, University of Notre Dame.
