Bed Sharing
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Co-sleeping or bed sharing is a practice in which babies and young
child A child () is a human being between the stages of childbirth, birth and puberty, or between the Development of the human body, developmental period of infancy and puberty. The term may also refer to an unborn human being. In English-speaking ...
ren
sleep Sleep is a state of reduced mental and physical activity in which consciousness is altered and certain Sensory nervous system, sensory activity is inhibited. During sleep, there is a marked decrease in muscle activity and interactions with th ...
close to one or both
parents A parent is either the progenitor of a child or, in humans, it can refer to a caregiver or legal guardian, generally called an adoptive parent or step-parent. Parents who are progenitors are first-degree relatives and have 50% genetic meet. ...
, as opposed to in a separate room. Co-sleeping individuals sleep in sensory proximity to one another, where the individual senses the presence of others. This sensory proximity can either be triggered by touch, smell, taste, or noise. Therefore, the individuals can be a few centimeters away or on the other side of the room and still have an effect on the other. It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used. Bed-sharing, a practice in which babies and young children sleep in the same bed with one or both parents, is a subset of co-sleeping. Co-bedding refers to infants (typically twins or higher-order multiples) sharing the same bed. Whether cosleeping or using another sleep surface, it is considered important for the baby to be in the same room as an adult, committed caregiver for all sleeps—day and night—in early life. This is known to reduce the risk of
SIDS Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and ...
by 50 per cent. Some organizations such as Red Nose Australia recommend this for the first 12 months of life and others such as the
NHS The National Health Service (NHS) is the term for the publicly funded health care, publicly funded healthcare systems of the United Kingdom: the National Health Service (England), NHS Scotland, NHS Wales, and Health and Social Care (Northern ...
recommend it for the first 6 months.


Introduction

Bed-sharing among married couples is standard practice in many parts of the world outside of
North America North America is a continent in the Northern Hemisphere, Northern and Western Hemisphere, Western hemispheres. North America is bordered to the north by the Arctic Ocean, to the east by the Atlantic Ocean, to the southeast by South Ameri ...
,
Europe Europe is a continent located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west, the Mediterranean Sea to the south, and Asia to the east ...
and
Australia Australia, officially the Commonwealth of Australia, is a country comprising mainland Australia, the mainland of the Australia (continent), Australian continent, the island of Tasmania and list of islands of Australia, numerous smaller isl ...
, and even in the latter areas a significant minority of children have shared a bed with their parents at some point in childhood. One 2006 study of children age 3–10 in
India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
reported 93% of children bed-sharing while a 2006 study of children in
Kentucky Kentucky (, ), officially the Commonwealth of Kentucky, is a landlocked U.S. state, state in the Southeastern United States, Southeastern region of the United States. It borders Illinois, Indiana, and Ohio to the north, West Virginia to the ...
in the
United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...
reported 15% of
infants In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to juveniles of ...
and
toddlers A toddler is a child approximately 1 to 3 years old, though definitions vary. The toddler years are a time of great cognitive, emotional and social development. The word is derived from "toddle", which means to walk unsteadily, as children at thi ...
2 weeks to 2 years engage in bed-sharing. Bed-sharing was widely practiced in all areas up to the 19th century, until the advent of giving the child his or her own room and the crib. In many parts of the world, bed-sharing simply has the practical benefit of keeping the child warm at night. Bed-sharing has been relatively recently re-introduced into Western culture by practitioners of
attachment parenting Attachment parenting (AP) is a parenting philosophy that proposes methods aiming to promote the attachment of mother and infant not only by maximal parental empathy and responsiveness but also by continuous bodily closeness and touch. The term ' ...
. Proponents hold that bed-sharing saves babies' lives (especially in conjunction with
nursing Nursing is a health care profession that "integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alle ...
),Sleeping with Baby: ABC TV Catalyst, 21 July 2011
/ref> promotes bonding, enables the parents to get more
sleep Sleep is a state of reduced mental and physical activity in which consciousness is altered and certain Sensory nervous system, sensory activity is inhibited. During sleep, there is a marked decrease in muscle activity and interactions with th ...
and facilitates breastfeeding. Older babies can breastfeed during the night without waking their mother. Opponents argue that co-sleeping is stressful for the child when they are not co-sleeping. They also cite concerns that a parent may smother the childConsumer Product Safety Commission
or promote an unhealthy dependence of the child on the parent(s). Because children become accustomed to behaviors learned in early experiences, bed-sharing in infancy will also increase the likelihood of these children to crawl into their parent's bed in ages past infancy.


Health and safety

Health care professionals disagree about bed-sharing techniques, effectiveness, and ethics.Mace, S. Where should babies sleep? Community Pract. 2006 Jun; 79(6):180–3. However, safe cosleeping and bedsharing guidelines can be found o
Lullaby Trust
where as organisations such a
UNICEF
outline the primary factors leading to hazardous cosleeping. Traditional and cultural bedsharing and caregiving practices have also been found to reduce risk of SIDS for certain populations. But this is found to be opposite in others, increasing deaths categorised within SUDI.


Known risks

There are certain dangerous behaviors that increase SIDS and should be avoided whether placing a baby in a crib or co-sleeping: infants should always sleep on their backs on a firm surface (not waterbeds, pillows, recliners, or couches), mattresses should intersect the bedframe tightly, there should be no stuffed animals or soft toys near the baby, blankets should be light, a baby's head should never be covered, and other SIDS risk factors should be avoided.McKenna, James, "Safe Co-Sleeping Guidelines"
/ref> In addition some parents pose threats to infants due to their behaviors and conditions, such as smoking or drinking heavily, taking drugs, a history of skin infections, obesity, or any other specific risk-increasing traits. Co-sleeping also increases the risks of suffocation and strangulation. The soft quality of the mattresses, comforters, and pillows may suffocate the infants. Some experts, then, recommend that the
bed A bed is a piece of furniture that is used as a place to sleep, rest, and relax. Most modern beds consist of a soft, cushioned mattress on a bed frame. The mattress rests either on a solid base, often wood slats, or a sprung base. Many beds ...
should be firm, and should not be a
waterbed A waterbed, water mattress, or flotation mattress is a bed or mattress filled with water. Waterbeds intended for medical therapies appear in various reports through the 19th century. The modern version, invented in San Francisco and patented in ...
or
couch A couch, also known as a sofa, settee, chesterfield, or davenport, is a cushioned piece of furniture that can seat multiple people. It is commonly found in the form of a bench with upholstered armrests and is often fitted with springs a ...
; and that heavy
quilt A quilt is a multi-layered textile, traditionally composed of two or more layers of fabric or fiber. Commonly three layers are used with a filler material. These layers traditionally include a woven cloth top, a layer of padding, batting or w ...
s, comforters, and
pillow A pillow is a support of the body at rest for comfort, therapy, or decoration. Pillows are used in different variations by many species, including humans. Some types of pillows include throw pillows, body pillows, decorative pillows, and man ...
s should not be used. Another common advice given to prevent suffocation is to keep a baby on its back, not its stomach.MedicineNet.com
.
Parents who roll over during their sleep could inadvertently crush and/or suffocate their child, especially if they are heavy sleepers, over-tired or over-exhausted and/or obese. There is also the risk of the baby falling to a hard floor, or getting wedged between the bed and the wall or headboard. A proposed solution to these problems is the bedside bassinet, in which, rather than bed-sharing, the baby's bed is placed next to the parent's bed. Another precaution recommended by experts is that young children should never sleep next to babies under nine months of age. A 2008 report explored the relationship between ad hoc parental behaviors similar to traditional co-sleeping methodology, though the study's subjects typically utilized cribs and other paraphernalia counter to co-sleeping models. While babies who had been exposed to behaviors reminiscent of co-sleeping had significant problems with sleep later in life, the study concluded that the parental behaviors were a reaction to already-present sleep difficulties. Most relationships between parental behavior and sleeping trouble were not statistically significant when controlled for those preexisting conditions. Further, typical co-sleeping parental behavior, like maternal presence at onset of sleep, were found to be protective factors against sleep problems.


Association with sudden infant death syndrome (SIDS)

Co-sleeping can often be regarded as an unnecessary practice that can be associated with issues such as
sudden infant death syndrome Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and ...
(SIDS). However, research shows that opinions vary in the association between SIDS and co-sleeping. The most controversial issue regarding SIDS is whether bed sharing is a main cause, and whether it should be avoided or encouraged. Some research indicates that SIDS risk increases with co-sleeping, particularly bed-sharing; other research indicates that co-sleeping done in an "appropriate and safe" manner reduces SIDS risk. As an example of the latter, the Pacific Islands Families study, conducted in New Zealand, indicated that the adoption of safe bed-sharing and room-sharing practices were saving infant lives, and found no examples of an infant dying from SIDS.


Arguments in favor

One study reported mothers getting more sleep and breast-feeding by co-sleeping than other arrangements. Parents also experience less exhaustion with such ease in feeding and comforting their child by simply reaching over to the child. As a result, co-sleeping also increases the responsiveness of parents to their child's needs. It has been argued that co-sleeping evolved over five million years, that it alters the infant's sleep experience and the number of maternal inspections of the infant, and that it provides a beginning point for considering possibly unconventional ways of helping reduce the risk of
sudden infant death syndrome Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and ...
(SIDS). Stress hormones are lower in mothers and babies who co-sleep, specifically the balance of the stress hormone cortisol, the control of which is essential for a baby's healthy growth. In studies with animals, infants who stayed close to their mothers had higher levels of growth hormones and enzymes necessary for brain and heart growth. Also, the physiology of co-sleeping babies is more stable, including more stable temperatures, more regular heart rhythms, and fewer long pauses in breathing than babies who sleep alone. Besides physical developmental advantages, co-sleeping may also promote long-term emotional health. In long-term follow-up studies of infants who slept with their parents and those who slept alone, the children who co-slept were happier, less anxious, had higher self-esteem, were less likely to be afraid of sleep, had fewer behavioral problems, tended to be more comfortable with intimacy, and were generally more independent as adults.


Products for infants

There are several products that claim they can be used to facilitate safe co-sleeping with an infant however these claims are not evidence based: * special-purpose bedside
bassinet A bassinet, bassinette, or cradle is a bed specifically for babies from birth to about four months. Bassinets are generally designed to work with fixed legs or caster wheels, while cradles are generally designed to provide a rocking or glidi ...
s, sidecar sleepers and bedside sleepers, which attach directly to the side of an adult bed and are open to the parent's side, but have barriers on the other three sides. * bed top co-sleeping products designed to prevent the baby from rolling off the adult bed and to absorb
breastmilk Breast milk (sometimes spelled as breastmilk) or mother's milk is milk produced by the mammary glands in the breasts of women. Breast milk is the primary source of nutrition for newborn infants, comprising fats, proteins, carbohydrates, and a va ...
and other nighttime leaks. * side rails to prevent the child from rolling off the adult bed. * co-sleeping infant enclosures which are placed directly in the adult bed. * specially designed separate sleeping bags for parents and infants which prevent covers being inadvertently pulled over the baby's head. * wahakura : A simple woven basket that allows babies to safely sleep in the same bed as parents.


Prevalence

A study of a small population in
Northeast England North East England, commonly referred to simply as the North East within England, is one of nine official regions of England. It consists of County Durham , Northumberland, Tyne and Wear and part of northern North Yorkshire. It is the least ...
showed a variety of nighttime parenting strategies and that 65% of the sample had bed-shared, 95% of them having done so with both parents. The study reported that some of the parents found bedsharing effective, yet were covert in their practices, fearing disapproval of health professionals and relatives. A
National Center for Health Statistics The National Center for Health Statistics (NCHS) is a U.S. government agency that provides statistical information to guide actions and policies to improve the public health of the American people. It is a unit of the Centers for Disease Control ...
survey from 1991 to 1999 found that 25% of American families always, or almost always, slept with their baby in bed, 42% slept with their baby sometimes, and 32% never bed-shared with their baby.


Factors


Socioeconomic factors

Initial assumptions on co-sleeping may place it in a context of income and socioeconomic status. Generally, families of low
socioeconomic Economics () is a behavioral science that studies the Production (economics), production, distribution (economics), distribution, and Consumption (economics), consumption of goods and services. Economics focuses on the behaviour and interac ...
status will be unable to afford a separate room for a child while those of high socioeconomic status can more easily afford a home with a sufficient number of rooms. However, statistical data shows the prevalence of co-sleeping in wealthy Japanese families and the ability of poor Western families to still find a separate space for their child, suggests that the acceptance of co-sleeping is a result of culture.


Cultural factors

Several studies show that the prevalence of co-sleeping is a result of cultural preference. In a study of 19 nations, a trend emerged, depicting a widely accepted practice of co-sleeping in Asian, African, and Latin American countries, while European and North American countries rarely practiced it. This trend resulted mostly from the respective fears of parents: Asian, African, and Latin American parents worried about the separation between the parents and the child, while European and North American parents feared a lack of privacy for both the parents and the child.


See also

*
Infant bed An infant bed (commonly called a cot in British English, and, in American English, a crib, or far less commonly, stock) is a small bed especially for infants and very young children. Infant beds are a historically recent development intended to ...
*
Overlying Overlaying or overlying is the act of accidentally smothering a child to death by rolling over it during sleep. Athelstan Braxton Hicks, the Deputy Coroner for London and Surrey, noted in 1889 that "during the last ten months no less than 500 cas ...


References


Further reading

*Moreno MA, Rivara FP. Bed Sharing: A Controversial but Common Practice.
JAMA Pediatrics ''JAMA Pediatrics'' is a monthly peer-reviewed medical journal published by the American Medical Association. It covers all aspects of pediatrics. The journal was established in 1911 as the ''American Journal of Diseases of Children'' and renamed i ...
. 2013;167:1088. *Jackson, Deborah. ''Three in a Bed: The Benefits of Sharing Your Bed with Your Baby,'' New York:
Bloomsbury Bloomsbury is a district in the West End of London, part of the London Borough of Camden in England. It is considered a fashionable residential area, and is the location of numerous cultural institution, cultural, intellectual, and educational ...
, 1999. * McKenna, James J. ''Sleeping with Your Baby,'' Washington, D.C.: Platypus Media, 2007. * * Thevenin, Tine. ''The Family Bed,'' New Jersey: Avery Publishing Group, 1987. * Simard, V., et al. (2008). The Predictive Role of Maladaptive Parental Behaviors, Early Sleep Problems, and Child/Mother Psychological Factors. ''Archives of Pediatrics and Adolescent Medicine'' Available at: http://archpedi.ama-assn.org/cgi/content/short/162/4/360 {{Parenting, state=collapsed Breastfeeding Childhood Infancy Parenting Sleep Intimate relationships