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Is a Family Bed Safe?

Infant health and safety issues go in and out of fashion. For example, in the early 1970s, everyone thought formula was better than breast milk; now that opinion has been reversed. At one time, babies wore high, rigid shoes that were supposed to help them walk; now doctors say kids learn to walk best when barefoot. The latest round of confusing advice: The Consumer Product Safety Commission (CPSC) and the Juvenile Product Manufacturers Association (JPMA) are launching a campaign urging parents to put babies to sleep only in their cribs, even as some popular experts are encouraging parents to co-sleep with their babies in their own adult bed.

The CPSC recently announced that each year, more than 60 American babies younger than age 2 die from suffocation or strangulation in adult beds. (In comparison, just over 30 babies die from those causes in cribs.) The problem is, the CPSC doesn't have firm information on how, exactly, all of these deaths in adult beds occur. Researchers gather data from hospitals and coroners' records, and those papers rarely specify the exact conditions at death, explains Jacqueline Elder, CPSC's acting director of the office of hazard identification and reduction. For instance, we don't know how many babies who died in adult beds were sleeping alone.

Some documents list "entrapment," which usually means the baby was stuck between the mattress and a wall, headboard, or footboard; others note falls; still others blame suffocation in soft bedding. But in those cases, it's impossible to know if the baby was left alone on the bed (which is always dangerous) or somehow rolled away from a parent.

In 58 out of 180 cases in a three-year period, infants died in adult beds due to "overlying," which means someone rolled onto them and caused accidental suffocation. Elder says the CPSC has no idea if parents only were involved in these cases or if siblings could have caused the overlying; it's also not clear if any parents were using drugs or alcohol at the time, which could have impaired their ability to wake up and move off the baby.

All of these details are important because they cloud the issue of whether sleeping with a baby in your bed is unsafe or if parental negligence is the real problem. James McKenna, PhD, director of the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame, and a vocal co-sleeping advocate, argues that bed sharing is natural and -- assuming that the parents are sober -- safe. By pushing for cribs, the CPSC is ignoring a parent's instinct to be near his or her baby, he says.

In fact, studies from England and New Zealand show a decreased risk of SIDS in babies who co-sleep. (There aren't any U.S. studies that replicate this data.) McKenna has attached EEG electrodes to the scalps of sleeping moms and babies nestled next to each other and found that their patterns of arousal were in sync. According to McKenna, babies who sleep next to parents gain the skill of rousing themselves quickly, which is the best defense against long sleep apneas, or pauses in breathing. He's also found that mothers who co-sleep are more attuned to their baby's subtle breathing shifts and often wake if something is wrong.

Most mothers know at a gut level what kind of sleep situation they want their family to have. But even people who don't consider themselves co-sleepers are likely to drag their baby into bed with them for that 3:00 feeding or when the baby is sick and having a tough night. People are going to at least occasionally sleep with their children, no matter what the CPSC says, so the important thing is to teach them to do it safely.

A bed isn't designed for infant safety, so parents need to take certain steps. Based on the details available and a lot of guesswork on the part of investigators, the following are thought to be the main hazards of an adult bed for an infant and what you can do about them:

1. A mattress that's pushed up against something: If an infant rolls between a mattress and a wall, he can get stuck and suffocate. Data collected by the CPSC also indicates that some infants have gotten caught between mattresses and headboards or footboards, or between the bed and another piece of furniture, so it's crucial to be sure there aren't gaps in those areas. Your best bet? Don't use headboards or footboards for now, and position the entire bed at least a foot away from anything else.

2. Overlying: McKenna says that there's little to no risk of a healthy, sober parent rolling on top of a baby and causing suffocation. But parents who drink, do drugs, or even smoke cigarettes -- which increases the risk of sudden infant death syndrome (SIDS) for their child -- should put their baby in a crib. In his new book, Good Nights (Griffin Trade Paperback), Jay Gordon, MD, also warns that an obese parent may not be as aware of his or her position in relation to the baby. Finally, keep older children from joining you in the bed -- they're less conscientious than adults.

3. Soft bedding: Anything soft is a suffocation risk for a baby who accidentally rolls over and can't roll himself back. If a baby gets stuck with his mouth against a fluffy comforter, for instance, he might not be able to breathe or will keep rebreathing the same air until there's no oxygen left. Put your comforter away and instead use light, cotton, breathable blankets (like the kind used in cribs), and never pull them above baby's waist. Or put your baby in a blanket sleeper, bundle yourself up, and put away your covers entirely. You may find you all sleep fine without them. It's best to forego pillows, too. Also be sure you're using a firm mattress. Never put your baby to sleep on a waterbed or a couch -- both are major suffocation hazards. Finally, keep your baby sleeping on his back.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.