Proponents of the "family bed" figure they may have been set back years in public acceptance, and if that's the case, the U.S. Consumer Product Safety Commission will be happy.
The idea of parents and children sharing a bed is a highly emotional topic, and the commission stirred those emotions recently with a stern warning against the practice.
Those who believe in it speak of a warm, tender, secure environment. The commission chairwoman, Ann Brown, suggests the opposite: that it is a dangerous place for children even if parents are well-meaning.
The commission has been warning against the practice for 10 years, but on Sept. 29 it reissued the caution, fortified with figures linking the deaths of 515 infants from 1990-97 to bed-sharing. Immediately those figures fell into dispute among the family-bed ranks. Nevertheless, it was Brown's statement accompanying the report that became a bull's-eye for criticism.
"Don't sleep with your baby or put the baby down to sleep in an adult bed," Brown recommended. "The only safe place for babies is in a crib that meets current safety standards and has a firm, tight-fitting mattress."
Part of that makes perfect sense, according to James McKenna, a professor of biological anthropology who runs a mother-baby behavioral sleep lab at the University of Notre Dame in South Bend, Ind. An infant placed alone in an adult bed is in danger, he said, if that adult bed is not childproofed. The vast majority of the deaths cited, 394, were attributed to babies dying because they were in inadequately prepared adult beds, not because they were sleeping with adults who rolled on top of them.
Among the 394 deaths were children wedged between a mattress and a wall or bed frame. Steps must be taken to prevent such cases, McKenna said, and the commission has a responsibility to say so.
But he takes strong exception to Brown's statement against bed-sharing.
"What she did was move from a descriptive analysis of hazards to draw conclusions about causation. There is no evidence for that. Because we find some instances where children died in adult beds, this becomes the argument against all bed-sharing? That's completely ridiculous. The other part of it is that they communicated by way of the U.S. government that mothers' and fathers' bodies are no more responsive to their babies' moves and touches than their mattresses are."
About a quarter of the 515 deaths were due to overlays, as they are called, when an adult rolls on top of an infant, and it is those figures that drew the criticism of McKenna and others.
The commission said only 2 of the 121 deaths involving overlays could be attributed to alcohol use, but far more needs to be known about all of those cases, McKenna said, including who was rolling onto the children, what condition the adults were in, whether they were obese, whether the mattresses were too soft, etc. The report did not differentiate between parents and other caregivers, nor did it say whether the infants who died were in families that practiced bed-sharing. Its conclusions conflict with the information he has gathered while watching mothers and their children slumber in his sleep lab for the last 18 years, he added.
The report's information was anecdotal, McKenna explained, and therefore cannot be classified as a serious scientific study. The commission acknowledged that the information was anecdotal, saying it was the only way to retrieve the information in this case, but added that the findings nevertheless were serious enough to demand an airing.
"The bottom line here is that this is important safety information that parents should have," said Russ Rader, a spokesman for the commission. "It would be negligent of us to withhold this information if we have it. The worst statement you can hear from a parent who has lost a child in a preventable incident is, `If I'd only known there was a risk here.' "
"We have had a large reaction," Brown said of the report. "It's caused a real national conversation, which I'm delighted about. We knew it was controversial, but we could not duck it. We thought this was information we had to have out there. The main thing is that this really has caused a lot of comment pro and con. That is our charge, to bring out information to parents. Then parents can decide with their pediatricians what they want to do. But it would have been criminal of us to have the information and not bring it out."
For perspective, it should be noted that the 515 figure is gargantuan by safety commission standards. Last year's recall of 9.6 million portable playpens, one of the largest recalls of children's products in U.S. history, involved only eight deaths over 15 years. So 515 looks like the Titanic on the commission's radar.
Katie Allison Granju of Knoxville, Tenn., a proponent of bed-sharing and frequent writer on parenting issues, sees fallacy in the numbers, however, when even more children die alone in their cribs each year, many of them due to the yet-unexplained Sudden Infant Death Syndrome, which claims about 3,000 babies in the United States annually, according to the American SIDS Institute. She asked why the commission would not instead sound an alarm about that.
"Our solitary-sleeping babies have the highest rates of `crib death' in the world. Intriguing data indicates that SIDS rates remain low among communities of co-sleeping Asians who immigrate to the United States, but the number of deaths rises in relation to the amount of time these families live here, possibly because of the adoption of American-style customs such as crib-sleeping and bottle-feeding for babies. Exclusive breastfeeding, which has now been determined to significantly lower an infant's statistical risk for SIDS, along with a host of other potentially fatal maladies, is much more common among mothers and babies who sleep together, in the United States or elsewhere," Granju says.
Making comparisons about SIDS in industrialized countries versus Third World countries can be tricky, however, according to Betty McEntire, executive director of the American SIDS Institute, a not-for-profit research organization in Atlanta, because medical reporting can vary so widely. She did acknowledge, however, that in some cultures where sleeping arrangements involve whole families, SIDS rates are sometimes lower.
McEntire did make a significant statement on bed-sharing, though, at a time when other leading children's health organizations, including the SIDS Alliance, were siding with the safety commission.
She said that when mothers ask her if they should sleep with their children, she replies, "If you can provide a safe sleep environment with your baby, it's fine." But she was adamant about the conditions of safety. For example, that doesn't mean using big, billowy mattresses, comforters and blankets. "But if someone is inclined to do it right, why not?"
McKenna feels the same way, and he gives a great deal of credit to a mother's natural ability not to roll onto her child.
McKenna, who by no means preaches bed-sharing though he strongly supports it, figures it comes down to this: His research on non-smoking, non-drinking, non-drug-using mothers and their babies sleeping together is virtually all positive, and as long as parents take every step possible to ensure that the baby cannot fall into a dangerous situation, he sees a great deal to gain in a child's emotional and physical development.
Eliane Proctor of Westmont said her family of five--husband Mike and daughters aged 6, 4 and 1 1/2--all sleeps together. They sleep with queen- and full-sized beds pushed together.
"We imagine newborns as little helpless things," she said. "But if you rolled on a newborn, you'd be surprised at how hard they can kick. I can't imagine that new moms, completely exhausted, wouldn't instantly wake up at the same time if they rolled on their baby."
Proctor said bed-sharing provided her rest during breastfeeding and got her and the children on the same sleeping schedule.
"With the baby there in bed, I didn't have to run off to another room in the middle of the night," said Sheryl Denson of Medinah, who at various times had all three of her girls, now aged 8, 6 and 3, in the family bed. "For me, it made parenting and breastfeeding easier. I never had a problem rolling over on them. I don't have any problem not rolling off the bed at night, so why would I have a problem rolling onto them? And I think it met their emotional needs. I've never had any trouble with the girls separating from me. But it really is a philosophy, and it may not work for everybody."