Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
17 Jan

Co-Sleeping: The Risks and the Benefits

Co-SleepingCo-sleeping, bed sharing, or whatever else you want to call it – is an abomination of a behavior that no self-respecting mammal engages in. If you don’t believe me, consider how other mammals handle their kids. You know the old can and string phones we used to make as kids? New chimpanzee parents will string a vine between two empty coconut shell halves, placing one half in the baby chimp’s nest in the next tree over and the other half in the parents’ nest, allowing them to monitor the baby’s cries and activity during the night. If the baby wakes up, they’ll swing on over to the other tree and produce a hairy teat until the little chimp quiets down. Then it’s back to bed. The first thing female voles do after giving birth is dig a separate hole in the ground where the infants will sleep. Same with gophers. Kangaroos are famous for their pouches, which for years researchers assumed the mothers used to keep their infants safe, with easy access to the nipples. But in actuality, the kangaroo pouch is used to store shrubs, grasses, various other edible plants, and boxing gloves, as well as cover up their breasts (kangaroos are incredibly shy and modest creatures).

That’s all nonsense, of course, in case you couldn’t tell already. Mammals are huge co-sleepers and bed-sharers. Heck, they exclusively breastfeed, avoid epidurals, give birth at home, and, in the case of marine mammals, are totally into the whole water birth thing. And, from what I understand, the North American deer population is solely responsible for the petition to bring Mothering back to print form (their hooves preclude them from typing, or else they’d totally read the online version). You might say that mammals are the hippies of the animal kingdom. But wait – we’re mammals, too. Doesn’t it make sense for us to share beds with our young children, or maybe share bedrooms? At the very least, shouldn’t we explore the possibility that sleeping with our infants – a behavior that many new parents are drawn toward – is safe and maybe even beneficial?

I’m going to level with you guys before I write anything more: I’m a big proponent of co-sleeping. Carrie and I did it with our kids, and I’m convinced it was the right move. It brought us closer to our kids and to each other. It helped us sleep, when sleep was a hot commodity. I certainly understand why some folks are hesitant to promote or attempt it, but I’m pretty biased in favor of co-sleeping for obvious reasons (it just seems to work).

I gave this topic a brief mention in Monday’s post, and the reader response made me feel like writing a more comprehensive series of posts on the subject was in order. So let’s look at the possible risks and benefits.

Is co-sleeping safe?

First, let’s define co-sleeping. Co-sleeping can refer to three different practices:

  • Room-sharing, where the baby sleeps in the same room as the parents but in a separate bed/crib.
  • Bed-sharing, where the baby sleeps in the same bed as the parents.
  • Couch-sharing, where the baby sleeps with the parent(s) on the couch or sofa.

Are there risks associated with the various types of co-sleeping? Somewhat.

Room-sharing is strongly associated with a reduced risk of sudden infant death syndrome (SIDS), and the American Academy of Pediatrics actually recommends that parents room-share early on. That’s a great start!

Couch-sharing is inherently dangerous, due to the increased chance of the baby falling between the cushions and being pushed up against the back to suffocate.

Bed-sharing is the controversial one. It can be dangerous, if certain precautions aren’t taken, but it also appears to have a host of benefits if done the right way (which I’ll discuss below). Unfortunately, little distinction is made between couch-sharing and bed-sharing when people talk about co-sleeping – even though the two are worlds apart. Even the purported links between bed-sharing and increased danger to the babies are tenuous and confounded by other variables, like drug and alcohol usage, smoking, and poverty. One study, in fact, found that when you control for maternal tobacco usage, the risk vanishes altogether, while a more recent meta-analysis concluded that “there may be an association between bed-sharing and sudden infant death syndrome (SIDS) among smokers (however defined), but the evidence is not as consistent among nonsmokers.” And other studies have found that “non-elective” bed-sharing, where parents (often impoverished single mothers) co-sleep because of circumstance (crib too expensive, tiny apartment, etc.) rather than choice, is a risk for infant death (PDF). But can the results of co-sleeping as it’s often practiced in impoverished, at-risk households where cribs are a luxury and education about safe bed-sharing is nonexistent serve as indictments of co-sleeping in general?

The fact remains that bed-sharing is the evolutionary norm for mammals, including humans. That can’t be argued. According to James McKenna, perhaps the most prolific co-sleeping researcher, “There exist no ethnographic examples outside of Western, industrialized countries of infants sleeping outside the mother’s room—away from her company.” (PDF) If anything, solitary sleeping is the global and historical aberration. Indeed, in many countries and regions where bed-sharing is prevalent and culturally ingrained, like Sweden, Japan, Hong Kong, and Beijing, SIDS rates are low.

If bed-sharing were always a dangerous behavior, I have to think the instinct to do so would have been weeded out and eradicated from most traditions, rather than solidified as a cultural mainstay. After all, killing the young is unequivocally bad for the fitness of a species.

Is co-sleeping worth any potential risks?

Well, let’s look at the benefits.

Co-sleeping makes breastfeeding easier. By now, we all know how hugely beneficial breastfeeding is to a child’s development and health. Breastmilk confers immunological benefits, transfers commensal gut bacteria, and promotes bonding and closeness between mother and child. It’s nutritious (especially if the mother’s diet is nutritious), and it’s the only food everyone agrees we’re designed to consume. Further, breastfeeding is strongly and consistently associated with a lack of SIDS, a link far more consistent than the unclear link between certain types of co-sleeping and SIDS. All signs point to breastfeeding being a good move for both mother and child, so we should promote behaviors that make it easier to do. Across multiple populations and countries, including Sweden, Malaysia, and Brazil, bed-sharing is consistently associated with higher rates of breastfeeding. It may be that women who breastfeed are more likely to co-sleep, but it’s pretty obvious that not having to get up and walk to another room to feed will make breastfeeding easier.

Co-sleeping, particularly bed-sharing, helps mother and child grow attuned to each other’s sleep and awakening patterns. In one study, researchers ran sleep studies on 20 habitual co-sleeping pairs and 15 habitual solitary sleeping pairs. The co-sleepers woke more frequently, but their awakenings tended to overlap (co-sleeping moms and babies woke up at the same time) and the total nocturnal wakefulness was not increased due to decreased duration of awakenings (co-sleeping moms and babies got back to sleep faster). This allowed co-sleeping moms to respond to their children’s cries more quickly and accurately, thereby enhancing their ability to monitor the status of their children and, the researchers suggest, improving their capacity for caregiving.

Co-sleeping improves sleep. Sure, as mentioned above, you might wake up more frequently, but each awakening is far less disruptive since you don’t have to stumble over to an entirely different room in the dark. You slip right back to sleep. Most successful co-sleepers cite “improved sleep” as an important factor in their decision to do it. One study even found that breastfeeding combined with bed-sharing allowed both mother and infant to get more sleep. Some researchers theorize that these “lighter” sleep periods are even protective against SIDS in their own right.

Co-sleeping modifies the parental response to night wakings. One study found that while co-sleepers saw night wakings as normal and nothing to freak out about, parents of solitary sleepers found night wakings to be highly disruptive. If a stressor doesn’t actually register as a stressor, is it stressful? Probably not.

Co-sleeping normalizes the stress response in children. For infants, cortisol regulation in response to physical stress should be “moderate,” rather than heightened. Babies who are solitary sleepers show greater sensitivity to mild stressors, like a bathing session. In response to a stressor, one study showed that the solitary sleepers secreted more cortisol than normal, while the co-slept child secreted the “right” amount. Another study found that co-sleeping had a positive effect on babies’ cortisol regulation at 12 months. Despite “common sense” claims that co-sleeping babies will become more dependent and unable to deal with stressors, the opposite appears to be true.

Co-sleeping facilitates the bond between parent and child. Skin-to-skin contact promotes the release of oxytocin, a powerful hormone and neurotransmitter that solidifies and strengthens the bond between people.

Co-sleeping may result in better-adjusted, more independent children and adults. While you might think that co-sleeping children grow up to be dependent and helpless, most research suggests this is not the case. Some studies even show that children who co-slept as infants grow up to be more self reliant and independent. Others suggest that co-sleeping reduces tantrums, produces less “fearful” children, boosts self-esteem later in life, and helps both males and females become comfortable with intimacy as adults (among many other possible psychological benefits). At the very least, co-sleeping doesn’t create needy, dependent kids.

Next week, I’ll explain how to co-sleep the right, safe way. I’ll also tell you what not to do, along with a few alternatives to bed-sharing. Until then, do what feels right. If you’re intellectually convinced of the benefits of co-sleeping but can’t quite shake the feeling that you’re going to smother your child, don’t co-sleep. It should be a natural behavior that reduces stress, not a cortisol-laden one.

Thanks for reading folks! Be sure to leave your thoughts in the comment section; be civil. This can be a testy subject.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Im a huge fan of co-sleeping!

    With my first I was “brain washed” by society and thinking it was bad/harmful. Then after being woken up numerous times at times (8-12), feeling like a zombie for nearly the first year I finally had enough of getting up and going down the hall to nurse my son. I brought him in my bed. I needed to SURVIVE motherhood. Co-sleeping allowed me to get more rest. I threw out all the lame things I heard about cosleeping and relied on my maternal intuition!

    I co-slept with my 2nd son and I cosleep with my 3rd son currently.

    As a lactation counselor and doula I’m also a big fan of co-sleeping.

    Room-sharing and bed-sharing are great ways to survive parenthood with young children and enable bonding.

    Cindy wrote on January 23rd, 2013
  2. I think maybe it’s a symptom of Americans and other westerners having too many rooms in their home. I won’t be having any babies, but if I did, they’d definitely go in the same room with me, at least until they sleep through the night. But probably longer. Because I also believe small children should share a room. So you keep the newborn with you until it’s old enough to go in with the others.

    Traveling on 35 through Iowa once we happened across one of the few things to see in the middle and that was a town with a park filled with historic buildings which included a tiny, tiny cabin in which the family raised 14 children. There was one room plus a loft. The one room had a bed, stove, dining table and chairs. The bed was the impressive part. It was high and fitted with drawers that were beds for the smaller children!!

    betterways wrote on January 23rd, 2013
  3. Thank you! I love showing my disapproving parents an article written from a mans perspective! They think my husband and I have lost our minds. But we love co-sleeping with our now 9 month old!

    Angela S wrote on January 23rd, 2013
  4. I was brought up in India. Almost all parents sleep with their babies next to them. At least they put them in a crib in the same room. Putting an unattended baby in another room would be very weird in India.
    I didn’t have a crib at all nor did my brother, but we were suspended in a vertical hammock like this http://farm2.staticflickr.com/1112/557866022_fd6d168a6f_z.jpg?zz=1
    I got my own bed when space became an issue on the bed.I slept in the same room until 9 for most of the time. At age 10, I was put in a boarding school. I didn’t cry or whine.
    I’ve never had my own room, ever. I am 23 and when I go home, I can sleep in any room, there is no such thing as ‘my room’. I move upstairs when grandparents visit.

    Madhu wrote on January 23rd, 2013
  5. The Mother-Baby Behavioral Sleep Laboratory is an excellent resource for co-sleeping. I’m a Lactation Specialist and LLL. There are definitely ways to safe sleep with your baby and there are definitely wrong ways to do it too! The Academy of Breastfeeding Medicine has a Protocol on it as well.

    http://www.bfmed.org/Media/Files/Protocols/Protocol_6.pdf

    http://cosleeping.nd.edu/

    Lauren Majors wrote on January 23rd, 2013
  6. I co-sleep with my 5 and 2 yr old. Started out of necessity with the first but came to find I love and support it and wish it were more of a ‘norm’ so I didn’t have to constantly defend it to my family. My question for those of you that have shared a bed for a while… how did you manage with 3 children? I am going to have my third in a few months and don’t want to force anyone out of the bed. Both of mine love to snuggle in and both want to be with Mom… but I only have 2 sides. When I tried moving the older ones to te same side I ended up with them sleeping perpendicular to me so they could each be touchng me. (Perependicular sleeping is a HUGE pet peeve of mine and only seems to happen when they are not in their accustomed locations…) My oldest has no interest in moving to her own bed right now, and I have no interest in forcing it, but I’d love to hear how some of you managed with 3 children in a bed (or two beds… which we had for a while but somehow I always ended up sleeping in the ‘crack’).

    Jamie wrote on January 24th, 2013
  7. Of all these comments can someone point to the one where something terrible has actually happened? Normal healthy people in a proper bed don’t have a problem with co-sleeping. like so many things these days everybody chases their tail with ‘what if’ scenarios, how bad it ‘could’ be.. meantime a lot of intelligent people co sleep and get the the benefits that it does, not could, provide and read thier kids the fairy tale of Henny Penny..

    David wrote on January 27th, 2013
  8. This post is perfection, and I will be sharing again and again. I laughed out loud at the opening bit about kangaroos, and the rest is just as easy to read while jam-packed with info that most co-sleeping articles flat-out ignore.

    Janine wrote on January 28th, 2013
  9. I loved co-sleeping with all my children.

    Gato Is Impressed wrote on June 5th, 2013
  10. well, I think we can all agree that it isn’t for some people but it works very well for others. parenting styles are choices and as long as you love, protect, and try to give the child a wonderful life, who can judge your method?

    Emily wrote on August 27th, 2013
  11. I love this write up, thank you for doing this. This is so true. There is much negative press and inaccurate assumption surrounding co-sharing, where the evidence is perhaps flawed. There requires more research which compares as follows: 1. the effects of sleeping in a cot only with a smoking or alcohol influence and then without to compare? 2. the effects of co-sharing in a bed under the influence of alcohol and smoking (separating each drug and again without the influence of drugs. 3.Also separating the breastfeeding and bottle feeding with co-sharing without influence of drugs, as perhaps it is the co-sharing alone which influences positive results and we may be confusing the two. For example, it is going to more popular for breastfeeding babies to co-share. Perhaps its the closeness of co-sharing which brings such health to the child and not the milk itself. How can we know if we do not differentiate? I await an excellent study to be thorough with this as it is so important to get this right as through personal experience, both my children, one breastfed and the other bottle fed where equally as healthy and happy and i co-shared with both. They felt me breathing next to them and i felt them next to me. Yes, we are in the 21st century and we have to think about our relationships with our partners however, no matter how hard we fight it, nature is nature AND it is time we stop feeling guilty for this. thank you for this excellent article.

    Donna wrote on September 2nd, 2013
  12. Mr. Sisson, You are always proving your intelligence. Common sense is very uncommon, but you have your fair share. Thank you. I slept in the same bed as my parents from birth. My three sons slept in the same bed with me from birth. No one ever was crushed or injured in any way. Of course there are some common sense precautions, but the same goes with an infant sleeping alone, or in another room.

    Ginger wrote on November 13th, 2013

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