>JVandenberg wrote: >> >> There are ways to make co-sleeping safer. Just because there have been >> accidents does not mean that the whole practice of co-sleeping should be >> abandoned: >> >> - if using alcohol, recreational drugs, or medications that cause >> drowsiness, or are experiencing extreme exhaustion, a parent may find >> that they are less likely to be aware of baby?s presence in the bed. If >> partner is less responsive or aware, can avoid placing baby between >> parents and place baby on the other side instead. >> ? mattresses - it may be of benefit to use a firm mattress with well >> fitting covers >> ? minimize the use of extra pillows and blankets which could reduce the >> airflow to baby >> ? waterbeds can be a hazard - can reduce the risk by adding a firm >> board under baby. >> ? avoid falls - can place the bed against the wall & place child >> between mother and the wall, use a crib or a safety rail beside the bed >> or place the mattress on the floor. Beware of entrapment dangers and pad >> any spaces. >> -remove headboard or footboards if they have bars with spaces larger >> than 6 cm >> ? use couches with caution - baby may become caught between gaps in >> cushions >> ? very large breasted or very obese mothers may need to use careful >> positioning of baby at the breast if sleeping while baby is nursing to >> ensure baby has a clear area to breathe. >> ? adjust sleeping arrangements as needed as baby develops new skills - >> rolling over, crawling, climbing > At 10:57 PM 10/3/99 -0400, Graham Barden wrote: >Saying something like " There are ways to make co-sleeping >safer" is the same thing as saying it must be un-safe to start >with. And remember, we are promoting breast feeding to the >un-washed masses. If you recommend co-sleeping to the >un-enlightened, infants will die. Saying "Just because there >have been accidents..." is saying "Just because a few babies >died..." I think the use of the word "accident" is missing the >point. Most people think you put Band-Aids on "accidents". You >bury co-sleeping "accidents". Boy, I don't even know where to start. Actually I do. Both of my daughters slept in our bed until they were about two months old. Our older one needed to be held, we estimate, about 23.5 hours per day. It was simple: hold her, sleep with her, and she's happy; put her down, and she cries. Our second child was somewhat easier. But between two and three months of age both of them got to the point where they could comfortably sleep by themselves relatively well. So for those who say "health care providers can't relate", I'll say I (and I'm sure a number of others on this list) definitely can! If this recommendation had come out seven years ago, though, I'll admit it would have been a real dilemma. In response to Janet's and Graham's posts: I agree with Graham. The list Janet posted is all well and good, but, to quote Graham, "we are promoting breast feeding to the un-washed masses." Is any health care provider who tells parents it's O.K. to co-sleep prepared to present that list in verbal (or ideally written) form? I think, for those who believe the study has merit, bed-sharing will become another item to discuss at a well child visit, giving the risks and benefits. Parents will obviously continue to sleep with their infants and young children - it'll be our job to give them the necessary information so they can make an informed decision. For those who think it's a low-priority topic, we changed an entire vaccine schedule in order to prevent about 6-12 cases of polio (and we're talking - in general - morbidity, not mortality) each year. If about 60 kids a year are truly dying due to co-sleeping you're darn right we better take it seriously! Would those who will continue to give parents a total go-ahead to continue bed-sharing also be willing to continue giving all OPV? To continue the analogy, I'll bet some cases of VAPP in immunocompromised contacts could have been prevented by 30 seconds of questioning the parents before the dose was given. If this wasn't done on a regular basis, do you think that those who continue to promote bed-sharing are going to take the time to make sure it's done "more safely" (by discussing the list which Janet posted)? Another analogy - parental smoking around their children. When I was growing up a large number of the parents in the neighborhood smoked - all of them indoors. Now, for those parents in my practice who do smoke, 99% go outside (or at least say they do). How many years did it take before parents were convinced it was detrimental to their children's health? And how many more years before they were willing to do something about it? How's this for yet another analogy? Car seats. I wasn't a pediatrician when the idea of using infant car seats first became popular, but I know for years there was resistance from parents who thought it barbaric that they had to strap their crying baby into a seat where the baby couldn't be seen rather than hold the baby in their lap (and breast feed if that helped calm the baby). Especially that first trip home from the hospital - it's bonding time (after all, it's a short car ride, right? What are the chances of getting in an accident?). Knowing the risks, would anyone even give remote consideration to giving a parent "permission" to nurse a baby while riding in car? Want to carry the analogy further? Make a list, similar to the one above, telling a parent how they can "more safely" nurse a baby in the car (go the speed limit, stop at stop signs, drive defensively, etc.) Now would anyone give the parent permission? Of course not. The problem is that unforeseen accidents - beyond anyone's control - can occur. Even if a co-sleeping parent followed all of the recommendations in the list Janet posted, "stuff happens" - beyond anyone's control. And, as Graham posted, when "stuff" happens with co-sleeping, babies die! How many of the deaths in the study were preventable and could be attributed to parents not knowing and therefore not following the recommendations of the list? Let's assume that following these recommendations would have resulted in fewer deaths (I'm guessing that's probably the case), but some babies will still be killed as a result of bed sharing - even if the parents take all the proper precautions. Let's say there were 30 deaths each year instead of 60? Would co-sleeping still be acceptable? How about 20? 10? At what point do the positives of co-sleeping (and I'll admit there can be a lot) outweigh the risks? What are needed are some really good, solid studies showing death rates of co-sleeping vs. crib-sleeping infants and children, matched for all the necessary variables (nursing, parental smoking, drinking, drug abuse, sleepware, etc.) Now I've got to comment on the article Janet suggested we look at: <http://www.salon.com/mwt/feature/1999/09/30/family_bed_rant/index.html> Here are a few choice quotes from the article (granted, they're taken out of context - but I believe they still get the author's points across and I'm not being misleading by sharing only a few quotes) ------------------------- >From "Get out of my bedroom!" by Peggy O'Mara: "In 1997, the AAP told us to breastfeed and then undermined its own recommendation by telling us to put the baby back in his or her own crib after breastfeeding. Maybe I'm just a lazy mother, but one of the big advantages of breastfeeding is that you don't have to get up and take the baby down the hall. You have the equipment built in." "I refuse to give up my authority as a parent to others, even if they have a lot of degrees and credentials. No one knows my baby as well as I do...I do not want to rely on "experts" for the rest of my life. I want to trust my own unique experience." "This attack must mean that co-sleeping is really catching on in the United States. Good. It should be. It's a good idea! Parents are not stupid. We don't share bad ideas with one another." ----------------------------------- Do I even need to comment? Quotes like these make if very difficult to take anything else said in the article seriously. The author's basic premise is that she knows best, co-sleeping couldn't be dangerous (because she knows best), and she'll darn well do what she pleases in raising her child (because she knows best!). Maybe she does know best, maybe she doesn't. But I don't think she has her baby's best interests in mind if she won't even consider the *possibility* that co-sleeping *could* be potentially dangerous. Having all the facts and making an informed decision is different than making an emotional decision despite known risks. One of the quotes above even makes it clear that she considers bed-sharing a convenience for her, safety be darned. So Janet, and others who take articles like this seriously. Time-warp back about 20 years and substitute the words and/or ideas "don't use a car seat" or "smoking around my child" for the words/ideas "co-sleep", and re-read the article. Gives a little different perspective I think. If the concerns about co-sleeping are found to be true, then picture what we could say about this issue 20 years from now. Having said all that, let me say again that I'm not against co-sleeping under all circumstances. I'm against parents making uninformed decisions. Our job is to present parents with the information, risks, and benefits to the best of our ability. Then they'll do whatever they want with the information - but at least they'll be informed. Michael Sachs, M.D. General Pediatrician