AAP ISSUES POLICY, NEW STUDY RELEASED ON BEDSHARING

TO: Affiliate Presidents and Executive Directors
FROM: Phipps Cohe, SIDS Alliance National Public Affairs Director
DATE: 7/25/97

RE: AAP ISSUES POLICY, NEW STUDY RELEASED ON BEDSHARING
EMBARGOED UNTIL AUGUST 4, 1997, 5 P.M., E.T.

There will be two papers pertaining to bedsharing (known also as co-sleeping) in the upcoming issue of Pediatrics, embargoed until August 4, 1997, 5 P.M., E.T. One is a policy statement by the American Academy of Pediatrics (AAP), based upon a review of available data on the topic presented at a conference entitled "Infant Sleep Environment and SIDS Risk," sponsored by the National Institute of Child Health and Human Development (NICHD), in Bethesda, MD, on January 9-10, 1997. The other is a new study demonstrating an advantage to breastfeeding through bedsharing, reported by James McKenna, Ph.D., Sarah Mosko, Ph.D. and Chris Richard, Ph.D. The study, entitled, 'Bedsharing Promotes Breastfeeding," was conducted at Pomona College, Department of Neurology and the University of California, Irvine Department of Neurology.

Dr. McKenna et. al. have long supported the practice of infant-parent bedsharing. He views infant needs--and parental responses to those needs--as a dynamic, interdependent system. In some of his previous studies, bedsharing mothers were found to be more responsive to changes in their babies' sleep patterns, overheating, movements and arousals. His research team has also found that infants who co-sleep with a parent sleep less deeply, and therefore wake more easily. This suggests a possible benefit for babies with arousal deficiencies, believed to be more vulnerable to SIDS. The current study finds bedsharing boosts breastfeeding. It also suggests that since breastfeeding may be beneficial in reducing SIDS risk, increasing opportunities for more frequent and longer breastfeeding at night may make bedsharing protective against SIDS.

Recently, however, any benefits attributed to bedsharing have been clouded by concerns about the safety of the adult bed for infant sleep. Studies in New Zealand (Mitchell et. a1.) have demonstrated increased SIDS risk for an infant co-sleeping with a smoking parent. Studies at Washington University in St. Louis (Thach and Kemp)--and studies by the Consumer Product Safety Commission--have pointed out the dangers to sleeping infants posed by the presence of pillows, comforters and soft surfaces such as waterbeds. A chaotic view of bedsharing has been reported by the Chicago Infant Mortality Study (Hauck), revealing overcrowding or economic exigencies in which SIDS victims were found alongside a variety of people other than their mother (siblings, relatives, or others).

Dr. McKenna has stressed that "it is important to separate the unsafe conditions within which co- sleeping can occur from the behavior itself." Clearly, the same advisories intended for infants sleeping in a crib must apply to an infant sleeping with a parent. In addition to providing a smoke-free environment for the infant, bed-sharing parents must make certain that their infants are sleeping on their backs or sides on a thin, flat mattress without a pillow or any other soft bedding under the infant.

Recognizing that a number of factors determine a parent's decision on whether or not to bedshare with an infant, the AAP Task Force on Infant Positioning and SIDS emphasizes that "while bedsharing may have certain benefits (such as encouraging breastfeeding),...there is no basis at this time for encouraging bedsharing as a strategy to reduce SIDS risk."

KEY POINTS

1. The SIDS Alliance endorses the AAP's policy on bedsharing, which states that there is no basis at this time for encouraging bedsharing as a strategy to reduce SIDS risk. Shared sleeping by a mother and baby has some benefits, but it is inappropriate to suggest a protective effect on SIDS. There are no scientific studies demonstrating that bedsharing reduces SIDS. Conversely, there are studies suggesting that bedsharing, under certain conditions, may actually increase the risk of SIDS.

2. It is important to separate the unsafe conditions within which co-sleeping can occur from the behavior itself. The same recommendations for safest infant sleep advised for solitary crib sleeping must also apply to the "family bed:" don't smoke around the baby and make sure that baby is sleeping on his/her back on a firm, flat mattress. There should be no pillows or other soft bedding items. For baby, this means no sleeping on waterbeds, featherbeds, comforters or sheepskins.

3. Although, in the past, SIDS was known as "crib death," parents and other caretakers should be assured that cribs do not cause SIDS. Cribs, today, are designed to meet specific safety standards for infant use; adult beds, which are not intended for infant use, do not.

4. It should also be noted that no benefits have been shown for infants sleeping with individuals other than the mother.

SIDS EXPERT REFERENCES

John Brooks, MD, Chairman, Department of Pediatrics, Dartmouth-Hitchcock Medical Center; Member, SIDS Task Force, American Academy of Pediatrics; Member, SIDS Alliance Medical and Scientific Advisory Council (603) 650-5459

Bradley Thach, MD, Professor, Department of Pediatrics, Washington University School of Medicine (St. Louis) (314) 454-2339

Fern Hauck, MD, Associate Professor, Department of Family Medicine, Loyola University Medical Center (Chicago) (708) 216-1116

James Kemp, MD, Assistant Professor, Department of Pediatrics, Washington University School of Medicine (St. Louis) (314) 454-2694

Marian Willinger, Ph.D., Administrator, SIDS Research Program, National Institute of Child Health and Human Development (301) 496-3575