Cosleeping vs bed sharing for 4 month old

[xuanang01]

Recently, my baby has started consistently waking up and screaming, unable to get back to sleep, while in her crib. We’re currently in a huge life transition that involves a ton of driving and hotels, so I’m hoping she improves once she settles down. At the moment, I am only getting 3-4 hours of sleep a night. She will only tolerate being held by me, not my partner. I am hoping all this is a phase, but I’m trying to make plans for if it isn’t.

The problem is that I am about to go back to flying a helicopter. Flying on so little sleep can be extremely dangerous. Sleep training is not something that would work for our family, and I’m trying to find the best way to keep us both safe. I think bedsharing using the safe sleep seven looks like a good option, especially as it’s so common in other countries (I’m in the US). Things like Emily Oster’s assessment and the Notre Dame sleep study things make me think it will be safe, but I’m also reluctant because it’s what I want to believe.

Does anyone have additional studies that control for risk factors? Anecdotes about how bedsharing saved the day or ruined your lives? Any suggestions or thoughts are welcome!

 

[orlando_wcbc]

@xuanang01 I would never recommend bed sharing with a baby. I did it with my babies and it was stupid of me. There were several close calls with them. I know somebody whose baby did die while bed sharing. It shook me to the core hearing her personal story. She followed all the recommendations. She exclusively breastfed. It was only her and the baby in the bed. No blankets or pillows were around. She didn't smoke or drink alcohol. It only took one hour of sleeping for it to happen. The baby was one month old. He rolled himself where his head was angled into her body and suffocated. She had to go to therapy for years. I could never live with myself if my baby died due to bed sharing. That's the biggest reason I don't recommend it. Nobody should have to go through that. A side car bassinet is the best alternative to bed sharing. I wanted to save money and not buy a $100 bassinet. That was foolish of me. If I have another baby, that's the first thing I'm going to buy. Bed sharing is not safe.

 

[macdawg]

@orlando_wcbc I hear you and understand your reasoning, but I don’t love the delivery. Your friends story is awful and my heart goes out to them. However, driving a car is “not safe”. I have known people to die in car accidents. That doesn’t mean I’m not going to do it. Life is about mitigating risks, not avoiding all risk. And realistically, the likelihood of tragedy resulting from safe-as-possible cosleeping might be far less than piloting a helicopter impaired by sleep deprivation.
I hope I’m not coming off as callous, and I do really understand your point of view. I just think an “all or nothing” approach to safety risks isn’t sustainable or reasonable for most parents. It’s up to each parent to assess risks for themselves and blanket statements like this feel a bit shame-y to me.

 

[regondifan]

@macdawg It wasn’t even close to shame-y except towards themself. It was clearly self reflective. If you felt shame based on what was written extremely kindly that seems like a you issue and maybe some of your own introspection is also in order so you can understand why you felt that way. This is a public forum and not all information is going to be delivered in a perfect way for you.

 

[sawry1]

@macdawg THANK YOU!

 

[joew1983]

@xuanang01 Hi OP - I personally would not bedshare in this situation. If you don't want to sleep train, I would take shifts with a partner. I have a lot of empathy for what sounds like a very dangerous and very cool career - but here to say that bedsharing is also risky, even if you follow 'safety guidelines.' Personally, I would find a way to make shifts between you and your partner work or hire a night nurse until baby is a bit older.

However, everyone needs to make the risk assessment for their own family—I'm not you and I'm not in the circumstances you are. I did a deep dive into the research a bit back. Perhaps it will be useful to you.

Broadly - SIDS risk tends to fall by 4-6 months but other sleep related deaths (sudden, unexpected infant deaths or SUID is the category) do not necessarily fall at the same time. SUID is the leading cause of injury-related death in babies, and it is more risky than the peak risk your child will face at any point in their childhood for any other injury-related death (car accident, drowning, firearms). SIDS deaths encompass about 30% of SUIDs, on average.

We know that 'safe' bedsharing (broadly defined in research as intentional, exclusively breastfed infant, non smoking and sober parents) increases the risk of just SIDS by 4-5x, in comparison to being placed alone/on back/in crib. We don't know how much, if at all, safe bedsharing increases the risks of SUID overall.

People will cite the safe sleep seven and James McKenna's research (the Notre Dame sleep study you refer to). I write about both in the post above, but broadly, the safe sleep seven is a set of guidelines compiled together by La Leche League but not necessarily researched based. James McKenna's research is primarily observational anthropology, and hasn't been validated on any actual death data of children, and I wouldn't personally use it in making safety decisions for my kid. (Happy to expand on either of these statements as I know people feel strongly about this research.)

There is a risk calculator here, however, my main caution with that calculator is that the baseline risk they show is for all SIDS (not SUID) deaths. It does't compare how much more or less risky your choices are compared to keeping your kiddo alone/on their back/in a crib is—it compares all SIDS deaths (inclusive of sleep on swings, accidentally falling asleep on the couch, etc etc) to whatever your choice is. If you're in a scenario in which you're deciding whether to bedshare or keep doing ABC, the calculator will be less useful.

 

[fangorn]

@joew1983 This is very solid info. Just want to say thank you for compiling and explaining so well! Also newer parent here who has read a ton and done a lot of research and had never seen the term SUID - totally makes sense to describe the broader category.

 

[sarahsknight]

@xuanang01 I am personally not comfortable with the risk of bedsharing. A family friend lost their infant to bedsharing earlier this year. I don’t think I could ever actually sleep if an infant was in bed with me due to anxiety. But I’d speak to your baby’s doctor and get their input on what the least risky choice would be for your family.

To avoid bedsharing, I’d recommend working with your partner to set up sleep shifts where you each get at least 4 unbroken hours a day, preferably 6 or even 8. This will mean less time spent with your partner during the day, but it’s better in terms of your safety than having your sleep broken up.

As far as baby not “tolerating” being held by your partner - you know that isn’t sustainable. If you got sick or hurt and had to stay in the hospital for a while, would the baby just not sleep until you were discharged? Of course you can’t sleep train now when you’re in the middle of a huge transition period, but I would still make it a priority to find a way for baby to sleep without you, whether that’s contact napping with your partner, or sleeping in their crib.

One thing I haven’t seen mentioned in the comments yet is that bedsharing can negatively impact adults’ sleep quality. Obviously sleep deprivation is dangerous for anyone, but given that you’re piloting helicopters, I would be very nervous about whether you can get adequate rest to do your job safely if baby is always sleeping in your bed when you’re in there. I’ll grab a link that goes into this, but I think that’s probably something to bring up with the doctor whenever you discuss the risks of bedsharing. You don’t want to assume that bedsharing is going to lead to you getting enough sleep, then find out that it doesn’t, but be left with no contingency plans for getting yourself enough rest to be safe at work.

 

[cherish616]

@xuanang01 People don’t get lambasted for moving their kids to separate rooms earlier than 6 months even though that drastically increases SIDS risk. But we love to shame bedsharing parents. Formula feeding also increases SIDS risk, but formula use is hugely popular.

We don’t have sufficient data. Part of this is due to lack of reporting. Many bedsharing parents don’t report doing so because of fear of repercussions or backlash. Another thing that skews the data is reporting from unsafe or accidental bedsharing. What makes this a systemic problem is that parents aren’t taught how to safely bedshare from the get-go. It’s a lot like trying to teach abstinence in high school sex education classes. It goes against what is biologically normal instead of actually giving people tools in an attempt to keep everybody safe.

James McKenna is one of the only people to study bedsharing in real time. I encourage you to look into his work.

We had to safely bedshare. Go ahead, downvote me. We had to. I have OAD/FMER, and the only way my baby could feed for months was with me laying down. If you think that someone can breastfeed at 3 AM and stay awake while being pumped full of sleepy hormones and laying down…I don’t know what to tell you. It was much safer to set up a safe sleep space and plan for it.

I’d also love to hear solutions from some of the people Who are strictly anti-cosleeping for parents who are deaf, physically disabled, etc. how do you propose they respond to their babies in the middle of the night?

Sleeping with your baby and breastfeeding overnight is biologically normal. Prolactin increases overnight.

If you are exclusively breast-feeding, it is worth looking in to how you can safely share sleeping space with your baby.

 

[daphne1]

@cherish616 I really like your comparison to abstinence-only sex ed. Sure, it’s safer, but in the real world bed-sharing is going to happen (I started bed-sharing because I accidentally fell asleep once breastfeed my baby in an armchair at 3 am out of exhaustion and completely freaked myself out). Let’s give people the tools to assess the risk and make the safest possible decisions for their situations.

 

[cherish616]

@daphne1 Absolutely. We say that breast is best and give people 0 tools to help assist protecting their breastfeeding journey.

 

[joew1983]

@cherish616 Just a correction on the above - the AAP actually recently updated their guidance on roomsharing. It used to be twelve months and now the guidance is "about six to twelve months."

The AAP actually doesn't cite any recent studies that find a benefit after ~6 months. Before six months, room sharing reduces the risk of SUID by ~50% assuming the baby is sleeping alone, on their back and in a crib.

James McKenna is an interesting one. I dove into his research when I wrote my OP on SIDS and read his papers. I wouldn't call him the primary researcher on bedsharing - he actually hasn't published any studies since 2007 (he has published some letters to the editor since). I had heard so often that he was such a key researcher to look at when it came to SIDS and cosleeping.

But... that's not actually what he studies, at all. He does good research on mother/baby dyad behavior, but his research isn't actually about SIDS. His research is relatively small scale experiments about how mothers and babies behave, and theorizes on bedsharing safety. Basically, he observes mother infant behavior and formulates a theory of what might happen to promote safety, and publishes the theory.

The paper everyone seems to refer when they talk about McKenna to is one where he reviewed 5 mother-infant dyads for 1 night in his lab, then 3 pairs for 3 nights in his lab, then eventually 50 mother-infant dyads (all Hispanic) keeping sleep logs. He wasn’t looking at SIDS but he did look at polysomnographic sleep data and did find that mothers and infants coordinated their arousal patterns. He did not look at any actual SIDS cases (his sample sizes were way too low to see that). His data hasn't been replicated (like I said, he hasn't published in fifteen years so perhaps he's working on something new?), and as far as I can tell, he's never actually tried to prove out his theories using the CDC child death review data, which should be available to him/his students as a researcher.

This is kind of a bummer because I think video data and polsyomnography about bedsharing would be quite interesting to study - how often does overlay happen? How much do infants vs caregivers move? Is there a distance of objects in the sleep space that is optimal? But he doesn't actually study those things.

 

[cherish616]

@joew1983 He specifically calls for the need for further research into SIDS. I certainly never made claim in my above comment that he was a SIDS expert. I said he was one of the only people to research bedsharing in real time- to actually put these dyads in a scenario where they can be observed. I think one of the reasons he is touted as a key researcher, as was your experience, was that nobody else had really done so. There is such a big difference between compiling a bunch of data that doesn’t control for formula/bottle use, what the sleep space looks like, etc, and actually observing what happens when a healthy, nursing mother infant dyad does breastsleep .

It seems we can agree that obviously a lot is missing when our data says that mothers will kill their babies by sleeping with them, but humanity has survived as a species for 200,000+ years while doing just that. Which

 

[annajames2050]

@cherish616 I honestly love your first paragraph. I've felt so much shame for bedsharing and I get so much judgement from family. The same family who chose formula with their own babies and a separate room before baby is 6 months and its just so hypocritical. Sure , I'm increasing my baseline risk, but so are you!

Anyways thanks for articulating everything I wish I could say to them

 

[cherish616]

@annajames2050 Yes. Our culture leans very heavily towards things that separate babies from parents. When parents make choices in that direction, the judgement tends to be less steep. When parents do the opposite-things that are inherently more in line with our biology that keep our babies close- it’s not as universally accepted. There is a shift, however, with BFing vs formula. I know parents who use formula catch judgment now as well. How breastfeeding and sleep are related has not caught up, however.

 

[iovere]

@cherish616 I’ll admit that I am on the “it’s safer not to” side but I totally agree that it is every parent’s personal choice and they can make their own risk assessment based on their situation. I will also admit that I can FEEL that biological pull to sleep together and it is difficult for me each night to put my daughter to sleep in her crib. That being said even if I was interested in attempting it I am on a sedating medication so it would never be safe for us and I’m not willing to take the risk. I currently breastfeed in a nursing chair at night while eating oreos to stay awake

 

[cherish616]

@iovere Oreos FTW! I appreciate all your openness and honesty. That biological pull can be really strong. There are so many things that I see in hindsight set me up to fail in the first months PP because of going against that biological desire. I had severe anxiety to the point where I could not eat or sleep. I would have panic attacks alone in my bedroom while someone else cared for the baby so I could “get some sleep”. I just heard this week that proximity to your baby relieves anxiety, and I’m thinking, “wow, that makes all the sense in the world”. I could have just been with my baby and we both would have suffered less. We didn’t start bedsharing until 3 or 4 months in.

 

[iovere]

@cherish616 No kidding, that makes total sense! Our bonds with our babies truly are amazing!

 

[juliaraine]

@xuanang01 This resource I found very helpful in assessing risk and making my own decisions:

https://www.bfmed.org/assets/Protocol Number 6 2019 Revision.pdf

https://www.npr.org/sections/goatsa...ng-with-your-baby-as-dangerous-as-doctors-say

There is an increased risk, there’s no denying that. But there are ways to mitigate that risk and to engage in harm reduction should you choose this route. At the end of the day the AAP guidelines are the safest and you can never remove all risk upon deviation (and sadly sometimes SIDS happens even when every recommendation is followed), but it sounds like crashing your helicopter from fatigue isn’t very safe either. I wish you the best of luck in determining what is best and safest for you and your family.

Side note: I am incredibly surprised and disappointed by the rhetoric from both sides of this subreddit. I see a lot of knee jerk cultural responses from both the pro and the anti bed sharers and I am disappointed that people aren’t able to clearly discuss this issue and the related risks without insults and fallacious arguments

 

[joew1983]

@juliaraine I am also disappointed to see how much of this thread is opinions represented as fact. This is an area where there has been a LOT of study and assessment. As someone who comes down on the side of anti-bedsharing after revieweing the research, I support us having a rational conversation about what the data shows and doesn't show!