An opinion piece in the LA Times promoting co-sleeping between infants and mothers is generating a lot of discussion in the mommy blogosphere.
Entitled It’s OK to sleep next to your infant child. In fact, it’s beneficial was written by Robert and Sarah LeVine, scholars in education and human development. It’s meant to counter the empirical scientific evidence that co-sleeping increases the risk of sudden infant death syndrome (SIDS). The LeVines don’t dispute the scientific evidence; they offer what they consider conflicting evidence.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Asian babies have the lowest risk of SIDS; that’s why Japan’s low rate of SIDS tells us nothing about co-sleeping.[/pullquote]
Specifically:
…In Japan — a large, rich, modern country — parents universally sleep with their infants, yet their infant mortality rate is one of the lowest in the world — 2.8 deaths per 1,000 live births versus 6.2 in the United States — and their rate of sudden infant death syndrome, or SIDS, is roughly half the U.S. rate.
The claim is injudicious at best and deeply disingenuous at worst.
First, the risks of co-sleeping are known to be increased with soft bedding, and parents who are impaired by alcohol or drugs. It’s entirely possible that decreased death rate of co-sleeping in Japan is the result of different bedding or lower incidence of alcohol or drug use among Japanese parents.
Even more important, SIDS has a different incidence among different ethnic groups.
CDC data from the US show that Asian babies have the lowest rate of SIDS in the US, approximately 1/3 the rate of African-American babies and nearly 1/2 the rate of non-Hispanic white babies. Considering that Asian babies have the lowest risk of SIDS; the fact that Japan, which is almost exclusively Asian, has a very low rate of SIDS is only to be expected. Therefore, the low SIDS rate in Japan tells us NOTHING about the risks of co-sleeping.
Why do the LeVines believe it is important to promote co-sleeping — so important that it’s worth misleading mothers with claims about Japan? They think that co-sleeping promotes children’s emotional health:
Christine Gross-Loh writes in her 2013 book, “Parenting Without Borders”: “After years of living [in Japan] on and off, my husband and I (and even our kids) have noticed that most children — the same children who sleep with their parents every night — take care of themselves and their belongings, work out peer conflicts, and show mature social behavior and self-regulation at a young age. Japanese parents expect their kids to be independent by taking care of themselves and being socially responsible. They expect them to help contribute to the household or school community by being capable and self-reliant.”
Their conclusion?
…[T]he proven benefits of mother-infant co-sleeping far outweigh the largely imaginary risks. Putting a baby in a separate room at night encumbers parents and leads to their exhaustion without guaranteeing the safety or future character development of their children.
Really? Japan has an extraordinarily high rate of teen suicide, among the highest in the industrialized world. It’s hard to imagine a more chilling indicator of poor child emotional health than that.
So Japan has high rates of co-sleeping and high rates of teen suicide. Coincidence?
Almost certainly. And that illustrates how drawing conclusions from correlations can be terribly misleading.
Co-sleeping increases the risk of sudden infant death; there’s no question about it and therefore mothers need to know. The increase is not dramatic and some mothers may decide that it is worth the risk for them.
It doesn’t matter what ancient peoples supposedly did in pre-history or what the Japanese do today. To imply otherwise is terribly misleading and chillingly irresponsible.
“You literally just admitted that the co-sleeping is only dangerous with the wrong bedding you dumb thot”
She did not say “only” she said “increased with”. Can you read? Also if you are going to call someone a “dumb thot” make sure you can spell first ok you dumb TWAT.
You literally just admitted that the co-sleeping is only dangerous with the wrong bedding you dumb thot
If you lived in Japan you could understand this. What a horribly unscientific article. Co-sleeping has been shown to be beneficial for both mother and baby. The fact that a work-centered, high-pressure culture starts barraging these kids as teens has nothing to do with co-sleeping. Jesus Christ. This shit passes for “skepticism” and journalism? Bless you, dear author, but this article’s argument illogical.
“So Japan has high rates of co-sleeping and high rates of teen suicide. Coincidence?
****Almost certainly.**** And that illustrates how drawing conclusions from correlations can be terribly misleading.”
She wasn’t claiming co-sleeping caused teen suicide.
This is an incredibly stupid article. Asians in America cosleep, too. Second and third generations in America cosleep. American Indians are genetically Asian. Are you really so ignorant not to realize this?
Good gravy! How about Japan reinforces all of those “good” things in their schools and society? They make the children clean the classrooms, serve lunch, etc. That could have a whole lot to do with it!!!! Where I leave in Eastern Africa the first thing families wanted was a 2nd damned blanket so the parents could do what they wanted under THEIR blanket while the kiddos slept under theirs! Geesh. I really think some Moms just fear the kid growing up and forcing them back into the workplace. It’s not that bad ladies.
Oh my gosh, co sleeping has nothing to do with how independently a child behaves during the day. You see kids as young as in the first grade take the subway to class, sometimes changing trains.This has a TON to do with how safe the country is, the prevalence of mass transit plus parental and societal expectations for how children should behave. It really doesn’t have a lot to do with independence, but societal trust is the driving point behind this independence. That’s if someone was at least minutely familiar with how Japan operates. This article explains it, and how kids as young as 2 and 3 are sent on “errands” (like going into the convenience store and buying something while the parent waits outside). http://www.citylab.com/commute/2015/09/why-are-little-kids-in-japan-so-independent/407590/ And this documentary https://www.japantoday.com/category/lifestyle/view/documentary-looks-at-why-japanese-parents-let-young-kids-walk-to-school-by-themselves
I’m not sure if I missed your tone, “Eater”, but did you miss the point of the article?
The whole point is that two independent features of Japanese society – co-sleeping and child/teen suicide rates – may be correlated, but not causally related.
http://pathologyexpert.blogspot.hu/2016/09/don-share-bed-with-your-baby.html?m=1
Ugh — This is excruciatingly embarrassing for me to admit, but I co-slept with my baby in the beginning months of his life. It was not 100% co-sleeping, but I had a cradle/porta crib type thing next to the bed. When he would want to nurse at night (we were exclusively breastfeeding), I would nurse him until he fell asleep and then put him back into his cradle. Sometimes, though, I’d fall asleep before I got him back into his crib.
Nothing ever happened, thank God, but my mother was constantly telling me how dangerous it was. So, of course, I went online and there was just TONS of information out there saying how it was totally “natural”. I mean, how else are you going to exclusively nurse a baby in the night six and seven times? It’s not like our cave-woman ancestors took their newborn babies and let them sleep on a rock in some other wing of the cave for the wolves to eat, right?
Breastfeeding is just not necessarily conducive with having a child sleep in a separate room, or even a separate bed, and I think sometimes the impetus for this type of thing is to make people not feel bad for doing something they do out of exhaustion. Breastfed babies nurse a lot more than bottle-fed babies, and mothers wouldn’t be able to do it, if they had to get up in the night six or seven times (which is about how frequently my baby ate during the nights – though I am sure there are babies that probably nurse less frequently).
Anyway, lesson learned on my part. Nights will definitely be a lot different with the next baby.
not necessarily. Both my eff and ebf kids slept between 11 and 5 by their 2nd month.
Hi, MB. Individual babies vary enormously in early sleep patterns, no matter how they are fed. They can be habituated to different patterns through certain strategies as they get older, but none of these are reliable.
It sounds like what you did – separate cot next to the bed – gave you the best of both worlds. If you occasionally fell asleep with the baby in bed, don’t bash yourself up over it. A child needs a smart, caring parent who is open-minded and not driven by strict ideology. You sound like one of those parents. You can certainly try another strategy with the next baby, but remember that the baby might have a different sleep pattern to the first.
I put a single bed next to my bed so baby was on a separate surface and in own baby safe bedding and I could just pop out my quite large breasts and feed while dozing off and we were sleeping on separate surfaces. Problem came with next feed when I used the other breast and had to stay awake, but I figured out how to feed from the upper breast in the same fashion. I only started doing this when my babies were about four or five months old and rolling and moving themselves. Before that they are in a crib next to my bed and I got up and sat in a chair. The thing with the chair though was that I fell asleep while feeding fairly often too, and that was definitely not safe. My bed next to bed solution probably wasn’t that wise looking back, but I felt at the time that I was doing something safer. I suspect I wasn’t. But I did it with both kids.
“I put a single bed next to my bed so baby was on a separate surface and in own baby safe bedding.”
Single bed = unsafe sleep surface for infants.
Any and all baby bedding except a fitted sheet = unsafe bedding in infant sleep environment.
Beds moved together can move out of place and create risk of entrapment and wedging.
If the death had occurred with baby sleeping in that set up it would have been recorded as sleep-related infant death with multiple sleep environment risks present. And that’s typical for 90% of all sleep-related SUIDs.
“Far outweigh the largely imaginary risks” …..are these people nuts!
They have a book to sell.
There’s a big backlash from actual pediatric and forensic experts:
https://www.facebook.com/TheBabyGuyNYC/posts/10154142678717087?hc_location=ufi
https://www.facebook.com/dinacalamur/posts/10153906003301398?hc_location=ufi
https://www.facebook.com/DrJudyMelinekMD/posts/967302886714471?hc_location=ufi
In all fairness, the Japanese have a pretty unique concept of death. In Shintoism, the division between the living and the dead is more……porous than in Abrahamic traditions. When you combine that with the pressure cooker that is a Japanese high school, it makes sense that Japan has a high teen suicide rate.
Isn’t high school in Japan like the 10th level of hell? I always thought the undue academic and social pressure was what caused the high suicide rate among Japanese teens. It’s incredibly sad.
OT: Lisa Ling wrote a massively biased article about why she regrets her repeat, planned CS for her second daughter.
She manages to find all sorts of graphs but fails to realize that a low-risk pregnancy can become a “shit, this is BAD” pregnancy in a matter of seconds and also misses any discussion of the rates of uterine rupture in a VBA1C.
Likewise, how sucky is it to get all the pelvic floor damage of a partially completed trial of labor, then need a CS? Or a crash CS when you are bleeding crazily from the rupture and the baby’s heart rate is in the 20’s and falling?
I feel for her that she got an infection at her incision site; those are horrible. But her husband’s suspicion that she contracted it at the hospital isn’t enough to blame the hospital for the infection. We each have a whole lot of bacteria on our skin and some of them are pathogenic (says the impetigo queen).
There is an attached video that I skipped. Perhaps that’s where the actual facts are…..
http://money.cnn.com/this-is-birth-with-lisa-ling/?why-i-regret-my-scheduled-c-section
Ugh I just came here to post that. I didn’t watch the video but the article was bad enough. She even trotted out the retracted “10-15% WHO C-section” line. Part 2 touts the benefits of home births and midwives but leaves out the risks – ” studies show that planned out-of-hospital births attended by Certified Professional Midwives are associated with dramatically lower instances of induced labor, labor augmentation, anesthesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery and C-section.” How convenient that it doesn’t mention the increased rate of brain injury and death.
How, how, how, would an out of hospital birth NOT result in dramatically lower instances of induction, augmentation, anaesthesia, etc? Non-medical personnel can NOT legally administer these things! They do not exist in an out of hospital birth with a CPM, at least not legally (we all know there are CPMs that jab their patients with oxytocin when the shit hits the fan). Why is this touted as so amazing and wonderful? It’s a foregone conclusion!
I once read a fiction novel about a lay midwife who gets charged with manslaughter after a homebirthing woman dies in her care. The lay midwife, knowingly, illegally carried things in her “kit” like Pitocin, not to mention blue cohosh, unregulated of course).
(“Midwives” by Chris Bohjalian. The first-person narrator is the adult daughter of the midwife, thirteen at the time of the death, who grew up to become an OB-GYN.)
You know, hiding up in the haymow of our barn when you reach 36 weeks will also lower all of those things as well. Dramatically. As an added bonus – or added detraction- we have barn cats who would probably decide you make an interesting petting post. You’d also hear the lowing of cows which can be soothing or annoying. You’d get all the same increased risks of infant mortality and morbidity as well, but your kid would also get a nicely jump-started microbial colonization. Plus, I think really bad allergies might make labor pains less…or at least give you something to be miserable about between contractions since maternal misery is a big portion of the NCB appeal.
Really, the only downside with this example is that once one of our farm workers found you, we’d have you transported to the hospital post haste rather than pretending that this was a good idea.
More cowbell … uh, cow stories. I love them. Brings out the James Herriot fangirl in me. Please keep them coming, Mel!
My husband wanted me to add: “After you give birth, you will probably be helped out to cleaning up the placenta by cats. Well, or a cow if it falls into one of the pens. Of course, we can’t rule out raccoons. And rats. There’s nothing more natural than a rat. We’ve practically co-evolved together.”
This thread made my day!
I like how stupid that that whole ‘lowered intervention’ thing is.
OF COURSE you’re going to have a lower rate of ‘interventions’, induction, c section or anything else when the person who is assisting you CANNOT offer those things.
That like saying that people who go to the doctor are more likely to take medication than those who do not go see a doctor. No shit Sherlock. Doesn’t mean you are healthy or that what you are doing is either safe or smart.
^^ This.
The WHO hasn’t exactly retracted that, the last time I looked. Rather, they say that is the ideal rate to avoid mortality. Elsewhere they say that that rate doesn’t include the c-sections necessary to avoid harm to the mother and child. They don’t put those two sentences together in the same place. The first is when they talk about c-sections and the second is put in the FAQ about c-sections or some FAQ on birth. It’s as clear as mud.
Actually, they HAVE retracted it. Soundly.
“Dr Marleen Temmerman, Director of WHO Department of Reproductive Health and Research including HRP states, “These conclusions highlight the value of caesarean section in saving the lives of mothers and newborns. They also illustrate how important it is to ensure caesarean sections are provided to the women in need – and to not just focus on achieving any specific rate.” ”
http://www.who.int/reproductivehealth/topics/maternal_perinatal/cs-statement/en/
Where are all the dead babies in Norway, where the c-section rate is under 7%?
It’s not. It’s 16%.
Ha! I just came here to post that, too.
Shouldn’t it be that parents need to know? Don’t fathers get a say in the safety of where their kids sleep? The double edged sword of mommies alone are responsible for infant care, and mommies have some special “radar” when it comes to infants/children while daddies are clueless/have no parental instincts or responsibilities sometimes gets exhausting.
Sorry for the rant. I have just spent the past week listening to the people in the next department do the “girls are like this , do this and enjoy that” and “boys are naturally like this and that”. That these people are 20 years younger than me is even more depressing.
I think the gendering of very young children has actually gotten worse. Used to be, all babies were dressed the same and they weren’t really gendered for 2-3 years, now they differentiate them at birth. I don’t get it, I don’t see much difference for infants, except when changing diapers.
I know, right?! Soo much pink and ruffles in the girls section. I’m trying to find pants for my daughter but the baby girls section seems to be all leggings. So I wandered into the boys section, where i also found an adorable baby dragon jacket in green and grey. Meanwhile, I sent my guys off to dunkin donuts both wearing my little pony shirts.
Seriously? I’m old enough to remember back into the 60s quite well. People didn’t know the sex of the baby before birth then, so all the clothes bought for newborns before the baby was born, e.g. for a baby shower, were “gender neutral” but as soon as the baby was born clothes denoting the sex were bought, ribbons put into little girls’ hair even before they really had hair, etc. Little girls had dresses for special occasions like going to church. It was actually the same through the 80s when I had mine!
I wouldn’t be surprised to learn that it’s getting worse. Last year, when I was spending a lot of time lurking on pregnancy forums, I was struck by the level of obsessiveness around finding out the baby’s sex as early as possible in order to be able to buy the “right” newborn clothes and paint the nursery the “right” colour. My daughter crossed her legs at the 20-week scan, which was fine with me, but most of my friends and colleagues seemed to assume that I’d have to run out for a private gender scan asap, to save my baby from the hideous fate of having to wear neutral colours for the first few weeks. In fact, I still mostly dress her in yellow at six months because I envy her ability to wear yellow without her skin looking like old cheese (unlike me!).
We don’t know the gender of our baby yet and I like the idea of stocking up on gender-neutral clothes that can be reused or passed on.
I’ve found three outfits so far: Yellow duckies onesie, yellow turtles with “I was worth the wait” layette and a white, blue and green monster onesie.
Little girl clothes are so short and tight! Ugh. I like cute stuff but I like my kids to wear clothes for running around and playing. I was in for a rude awakening when Inhad to search high and low for anything other than short-shorts for my one year old…. And of course the boy shorts are practically pants.
Uggggghhh…I’d be ranting a lot harder. 😛
That drives me CRAZY. My brother does this with his son and step-daughter. He thinks because he has one of each he can proclaim that boys and girls follow along exactly like his kids. When my other brother told us they were expecting a boy after having 2 girls, they got to listen to all of the “boys are this and girls are this” nonsense that absolutely contradicted my experience with my son and daughter (my son is quiet, cautious, and sweet and content to sit at a table and play games all day long even when he was 3 or 4 years old. My daughter cannot sit still for more than 2 minutes, and is constantly climbing anything and everything, jumping off things, and being generally wild. My niece and nephew are the opposites in disposition). People are individuals – the rest is all construct. Let them be.
If i went by my own family, I’d say boys adore pink and my little pony and only women can fix cars
My father played the flute and piccolo in his high school marching band. My grandmother was an airplane mechanic in the US Army Air Corps (when they still called it that). My son is a ballet dancer and figure skater. I fix my own cars, do most of the household repairs, and am a mathematician.
Yeah, my family doesn’t do gender stereotypes well at all.
THIS is why I decided not to find out the sex prior to birth. When my little girl was born, those family members who knew she was a girl insisted that “it’s obvious she looks like a girl”, whereas strangers in the street said “cute – is it a boy or a girl?”
Oh goodness, I got into it with my nan-in-law yesterday because she keeps harping on about how my youngest looks better with a buzzcut “because he looks like a boy now. You wouldn’t want to look like a giiiirl now would you?” Him: *looks at her weirdly* Me: “He looks like a boy regardless of the length of his hair because he IS a boy. Besides, there’s nothing wrong with looking like a girl. I happen to resemble one, are you saying that’s bad?”
ugh, i refuse buzz cuts on my boy and usually my husband goes along with my preference for his hair, too.
So I’m actually a buzz cut fan. At least until the boy expresses a preference for something else.
you haven’t seen Dem’s lumpy dome! lol
Oh, I’m not a fan either but he decided to play hairdresser and ended up with a bald patch in the middle of his bowlcut. It all had to come off to fix it, he loathes the clippers, and it wasn’t much fun at all. I’m letting it grow out because I like how the longer hair softens his features and I love being able to see the colour variations.
You could have put a monk’s cowl on him and he could have cosplayed the heck out of that until his hair filled in…
Get a buzzcut for the whole family. That’ll fix her.
Actually…the look on her face when I told her that the middle kiddo wants her head shaved over our summer holidays was absolutely priceless and I wish I’d taken a photo.
How is kiddo doing these days? Did Nan-in-law ever get the stick out of her butt?
The kids are fantastic – All growing up very quickly, working hard at school, making solid friendships, playing nicely with each other, and enjoying the new puppy. Currently (finally) in the diagnostic process for ASD, ADHD, and EDS-III for the older two – the youngest kiddo has ASD, EDS-III, and oral dyspraxia/severe language delay, which makes getting the older two diagnosed a bit easier. The gendered and ableist stereotypes around ASD and ADHD have definitely impacted on organising a diagnosis and support for all of them.
Nan-in-law has not chilled out, but she has other things to worry about now, like all of her great-grandchildren being on the spectrum. Thankfully, the paediatrician our extended family sees is awesome at explaining things from the kid’s perspective, and she’s finally starting to understand the sensory and communication challenges they’re experiencing (and why she shouldn’t take it personally).
Then there’s my fellow Moms who trash everything Dad tries to do–why? He doesn’t do it Mom’s way.
Mommying isn’t a lifetime, being a Mother is. The goal is produce an adult. Dads seem to still get that. Not all Moms do.
I agree that the risks for a full-term healthy infant of non-smoking non-drug using parents who exclusively breastfeed and practice “safe” co-sleeping are relatively low. But how many practice safe co-sleeping?
Answer: Nobody knows.
Anecdotally I’m bombarded by readers who are co-sleeping in horribly unsafe situations but are unaware that it’s not OK. Sleeping with a child face down on their chest, sleeping on a recliner, sleeping in a family bed with other older kids with them, etc. These are not idiots or unloving people but simply educated adults who lack key information about co-sleeping.
We see unsafe co-sleeping modeled everywhere including the cover image of this article, featuring a parent with a down comforter and thick pillows co-sleeping with an infant.
Let’s just add that even the definition of co-sleeping shifts all over the place. It can mean anything and everything from “kid on parent” to “kid in same bed with parent” to “kid in sidecar type cot” or “kid in cot in same room as parents’ bed”. The only thing not qualifying is “kid in separate room from parents”. So this is not particularly helpful in actually measuring risks, when wildly different things are counted as one.
Right? My daughter slept in an “arms-reach” sidecar-type crib for the first 6 months. We coslept?
I use “bedsharing” to parse it out further, but they now have these bed-within-a-bed type cosleeper things, and I have to wonder how safe those are as well. One would think they’d be better than nothing, but who knows.
Yeah, with my kid for the first couple of months I simply put the bassinet on the bed with me (it’s a king and I’m single) but I really wouldn’t call that ‘co-sleeping’. I moved him to the crib shortly thereafter, though the crib was very close to my bed.
“But how many practice safe co-sleeping? Answer: Nobody knows.”
The Milk Meg made a call to her followers to post images of their *safe* bedsharing that she would use to illustrate her blog on how cribs ruine motherhood. Last time I waddled through hundreds of images posted not a single one depicted anything like dr McKenna’s recipe, or Japan default floorsharing on a mat for that matter. https://www.facebook.com/themilkmeg/posts/1012752022111982
Positional asphyxia is a risk which is very much under the radar and it needs to be discussed more openly. It’s not scare-mongering, letting your baby sleep in a bouncy chair, a car seat or whatever that it wasn’t designed for is not safe. You may get away with it but that does not mitigate the risk-it’s back to the drunk driving analogy of risk. I’ve had a couple of cases of newborns left to sleep in a bouncy chair-these were fabric with no back support and it meant that the baby’s torso was pushed into a C shape. Combine this with the heavyweight newborn head and the floppy neck means that they simply cannot breathe and asphyxiate.
A number of years ago there was a motorised cot that gently rocked the baby to sleep. Unfortunately, what happened was that it gently rocked and rolled the baby into the side of the cot where the baby ended up being wedged in the corner and couldn’t extricate himself-there were a number of deaths and near-misses associated with this style of cot before they were taken off the market. The cot was investigated and researchers filmed babies actually sleeping in the cot and monitored them and their reactions when the cot rocked (under very close supervision, with consent of the parents, with the babies being immediately removed when necessary), and it showed just how useless babies are at moving in the first couple of months-essentially they aren’t capable of any purposeful movement, no matter how magical your thinking is that they can crawl or manoeuvre to position themselves ‘instinctively’. They can’t-you put a newborn face down and they stay face down. You put a newborn on top of a pillow and gravity means he’ll slip down and not be able to stop himself slipping.
I give a talk to midwives regularly about this as part of pathology and autopsies. I have a series of photos that I took from the internet-easily accessed ones of daddy sleeping on the sofa with baby, or baby sleeping facedown on the rug etc and I’ve paired these with ‘scene’ photographs of babies who have died-the investigating officers use a doll to recreate the scene in which the baby was found dead (these aren’t photos of the deceased baby)-they are identical. It hammers home just how dangerous the sleeping environment can be.
Take a baby sleeping on top of dad on the sofa-dad on his back, baby on his chest, face cutely snuggling into daddy’s beard, his hands on the baby to stop the baby rolling off. Once dad falls asleep, the weight of his hands clamped on the baby’s back will be enough to stop the child breathing-it doesn’t take much pressure at all. And yet I see people posting pictures of this scenario regularly, usually with comments like ‘dada and baby both exhausted..’ My friends are tired of me screaming at the internet about this-OK, there may be mama there taking the picture, but all it takes is for her to go to the bathroom, go to make coffee, fall asleep herself and 3 minutes later, thats all the time needed for that infant to die.
“the weight of his hands clamped on the baby’s back will be enough to stop the child breathing-it doesn’t take much pressure at all.” – so that’s a thing I thought I was being silly for worrying about and avoiding; thank you for affirming that it is actually a valid concern.
Absolutely. Co-sleeping on a sofa is known to be unsafe with a relative risk far greater than co-sleeping in bed. The generally ‘smaller than a bed’ size of most sofas means that the parent and baby will be squashed together-if the parents moves, that will manoeuvre the baby’s body into various positions. If the baby slips off the parents body he can end up squashed between the parent and the back of the sofa and end up asphyxiated, either between the parent and the back of the sofa, or wedged with his face in the angle between the bottom and the back of the sofa. If he is held to the parents body, the deadweight of the parents hands once asleep can cause mechanical asphyxiation. In fact, the safest scenario is if the baby rolls off the sofa completely and onto the floor. A fall from a low height generally does no harm other than giving the kid a start, and his crying will alert the parent to get him into his cot properly.
I’ve had case after case of all of these scenarios, and now that I’m coming to the end of my career in paediatric and perinatal pathology, this means that I have seen an awful lot of sad little corpses, many of which died needlessly, and it frankly upsets me.
Once a baby is bigger, the risks are much less. Once a baby has head control, or can roll or raise up his upper body then he can begin to start getting himself out of trouble, but when they are little tiny newborns, they can do nothing to help themselves.
Pediatric and perinatal pathology would be terribly hard work, and I’m amazed by people who are able to take on that responsibility and the emotional weight that comes with it.
Those risks are why we had a portacot in the lounge room, so I could nap on the couch and the babies could sleep safely. On the few occasions where we fell asleep together, it was always where they had no weight on them and where they couldn’t easily get squashed but that was probably just luck. I still don’t feel comfortable resting my hands on their backs while napping even though the youngest is 3 because I know that for myself, I stop breathing properly when there’s weight on my chest and it’s just not worth the risk.
I loved my job usually-the vast majority of my cases were fetal loss, miscarriage and stillbirth, and babies with abnormalities, or those who were premature and died in infancy. All of these cases are carried out with parental consent, so we are working in partnership with the parents to find out as much as we can about why the baby died, or what the syndrome was, and any information we find will help the family for the future, both in dealing with grief and also for future pregnancies and accurate risk counselling. Thankfully the SIDS/SUDI/cot death cases was only a very small part of the job numbers-wise.
Swings and swing-like devices (RNP) are mostly used during the most vulnerable period – our guest sleep *expert* recommends them from 0-3 months. Plus to swaddle the baby and put them in a swing to sleep.
Wait a minute – you are the infant sleep *expert* that recommends swings as sleep surface FOR NEWBORNS EVEN. https://www.preciouslittlesleep.com/the-ultimate-baby-swing-sleep-guide-for-swing-hating-babies/
Puuuuuuuke. Nice red herring attempt though with that whole “there are more dangerous things out there”. You are the very fucking online *expert* advice ignorance that makes getting the accurate safe sleep message through to the parents so hard.
A significant problem when looking at population data is how the cause of death is coded-if you are pulling data from the medical certificate of the cause of death to try and determine how many cases of SIDS you have, you will only find the ones coded as SIDS. When we’ve looked at our historical cases, many were coded as ‘Interstitial pneumonitis’ for example, which weren’t picked up in the first trawl. Its basically a nonsense diagnosis giving a spurious medical cause of death rather than saying SIDS-unknown cause.
And there is data to suggest that different types of pathologists prefer to use different terminology, so it depends on whether the death is examined by a specialist paediatric pathologist, a forensic pathologist or a histopathologist-each group tends to favour different terms (in paeds we use SUDI, but forensics tend to use SIDS). Its possible that the ‘low’ rate in some countries is because they certify the death as due to ‘interstitial pneumonitis’ or other similar medical terms.
“Demon licked the face of the infant” accounts for a quite frightening rate of possible SIDS/SUID in that one study into something else from Indonesia I stumbled across – there were 969 babies born during study period, 94 infant deaths of which: 13 listed as cause of death asphyxia + 5 listed as cause death sudden death + 9 deaths listed with cause of death unclassified ( suspected SIDS because verbal autopsy was inconclusive and the parents explained how demon licked the baby’s face during the night and infant was found blue and unresponsive). I’ll try to dig up the link.
People used to think cats could suffocate babies here in the US. The idea was the cat would try to lick the babies’ mouth area looking for milk and lay on their faces.
http://www.livescience.com/22449-do-cats-really-kill-babies-by-sucking-away-their-breath.html
I actually had a nursing instructor who believed this, back in the 60s.
On a similar note, there was Oscar, the nursing home cat. It was claimed that he could predict deaths, and he would go and nap with those patients in the nursing home in the hours before they died to help them transition. Being a domestic slave to 3 cats, my theory about this is that cats are selfish, lazy, spoilt little monsters, and Oscar knew that these people were nice and warm but didn’t move too much so they would provide a comfortable sleeping environment for him. Babies might be the same-nice and warm, smell of milk, don’t move too much when they are very tiny and that is why cats like to sleep on top of them. Once they get to a couple of months old and start moving a lot more (and develop a bit more muscle power so they can dislodge large feline lumps) they are no longer an attractive sleeping surface.
You are actually very nice towards Oscar’s motivation. My family figured he was guarding the person to be the cat on the spot when the body was available for snacking.
I love cats. Turns out non-cat people find my claim that I find it comforting that our cats view us as a food provider when we are alive and a food source when we are dead as a healthy outlook for an animal “to be creepy”. To me, it’s the only sensible outlook. After all, cats are very small carnivores. Let’s not pretend they can’t figure out what meat looks like.
I’m very comfortable with the fact that being a single woman living many miles from my family, there is a decent risk that if I collapse and die suddenly, my cats will have a snack on me before I’m discovered. In my will I’ve attached a lump sum to each cat I may have at the time of my death so that no one will put them down if I am found half-eaten (money goes to the person who will look after them for the rest of their natural life). Not that I mentioned being half-eaten in the will, that would call into question the bit about ‘being of sound mind’!
My grandmother believed this as recently as two years ago.
My mom-in-law believes this today. She was harping on my sister-in-law to get rid of their cat when their son was born. She stopped eventually mainly because sis-in-law and I both mentioned that we were raised in multi-cat household with a total of 9 children in the households and no one was smothered by a cat.
*On a completely unrelated note – completely! – my mom-in-law hates the idea of indoor animals and indoor cats as a specific. But that’s just an interesting side note, not any portion of her motivation….allegedly.
I’d hate to ask what she thinks of indoor rabbits…
Bunnies are an outside pet. You can keep them in your barn. (I’m betting.)
Yeah, try telling that to my super attached, super affectionate, and super snuggly bunny; she’d sit on my chest as protest! (And then pee on everyone…)
I do know a few people that have outside rabbits, but inside works for us and I can’t imagine anything different.
Please do; my sister-in-law is Indonesian, I must ask her about demons and other folklore next time we talk.
Sorry
but the arguments here are terrible. She writes that ‘Asian’ societies
have the lowest rates of SIDS’ but doesn’t specify what she means by
‘Asia.’ All of Asia? Well, that’s pretty big, stretching as it does from
the Urals to Japan. Does she mean ‘East
Asia’ (which she seems to imply). In that case, will she tell us why
East Asians have lower rates of SIDS? No she won’t. Do they co-sleep
more, less? Is she implying that it’s genetic? Mention is made of firmer
mattresses and fewer pillows and blankets. In that case, why wouldn’t
it be okay to co-sleep…if you had a firm mattress and fewer blankets
and pillows? Poor science always makes me question underlying motives.
She doesn’t know. No one knows. It has simply been noted that Asiatic people in the US has a lower rate of SIDS (which, yea, is pretty vague, probably lumps a lot of ethnicity together, just like ‘caucasian’ or ‘african american’ does)
The point its: For some reason, even in the US, it seems asiatic people, including people of Japanese descent, have a lower rate of SIDS. We don’t know why. But therefore we can’t compare the SIDS rate of Japan with the USA. Because there appear to be something else very important going on that we haven’t figured out yet. And until we figure out what it is, such a comparison is nothing but a fake argument.
Could be partly socioeconomic, could be partly due to alcohol consumption. Asian-Americans, especially East Asians, drink substantially less than than other Americans on average.
Which could be cultural, or could be due to some genes that are surprisingly common in that population which make drinking alcohol far less fun. Specifically, they have variant forms of some of the enzymes that metabolize alcohol. My husband has the most severe form, with variants of two different genes, and alcohol in any concentration just makes him feel horribly sick, with no actual drunk part. I’ve heard that half of East Asians have at least one variant gene.
Or, it could be that some causes of sudden infant death are at least partly genetic, and the genes vary in prevalence among ethnic populations, but that’s less plausible at the moment, I think.
Ha, the name of the gene that turns those with the loss-of-function red post-alcohol was one of my questions at our little Scientific Jeopardy game last week. Asians (as a big lump of a group) do have certain genetic commonalities that you wouldn’t know if you didn’t do the study…
You seem to have missed the point, Robert Anasi. The point of the article is that the many features of Japanese – or any – society may NOT be causally related.
Maybe read it again.
I have one Japanese friend who personally know 3 friends that killed themselves by varies means within 6 months after they gave birth to their babies respectfully in Tokeyo. Funny how LeVine did not address the high suicide rate across the board in Japan in their book.
How do they view PPD in Japan? (I’m asking because I don’t know, I’ve never been there either.)
According to my friend, in general they view any metal health issues as a sign of weakness and bring sham to the family. it is really hard to ask for help due to stigma and even you seek helps, it is hard to get access to resources.
It’s not even just that they draw conclusions from correlation. It’s that they include additional information that could be potentially causative right in their text and apparently don’t even realize they have done so.
Well, gosh! Seems to me like adult expectations of children that differ significantly from American ones are a lot more likely to influence the differences in young Japanese children’s behavior (that they anecdotally observed) than co-sleeping. And expectations of how independent children ought to be at various ages (and how independence is defined) vary significantly across cultures. Imagining differing social norms influencing social behavior!
If you’re going to try to set up co-sleeping as THE CAUSE responsible for a particular effect without taking into account any of the many confounding factors, at least be smart enough to just pretend those confounding factors don’t exist, rather than noting them without even apparently realizing that that’s what you’re doing. Your argument will be dishonest and sloppy but you will look slightly less silly.
Plus, they don’t introduce any evidence for that; it’s simply a set of observations made without any sign of paying attention to things like SES.
I’m sure we could drop some Japanese researchers off in agricultural areas of the US and they would be amazed to see children as young as 5 raising animals to be shown and sold at the fair. This fact alone could explain the capitalist views of the USA!
What they miss as well is how differently kids behave in front of adults – especially in a honor-based society. You rarely have to drag your 6 year old out to feed their rabbits in front of visitors…..
I do the autopsies on these babies-in the UK we don’t use the term SIDS anymore, it’s imprecise and gives a false impression that it is a single disease/condition/syndrome. We prefer SUDI-sudden unexpected death in infancy, and that can be further classified as cause ascertained (whether natural or unnatural), or unascertained.
What we have increasingly recognised over the past few years is that contrary to the various charitable organisations insistence that SIDS can happen to anyone, it happens in those families where parenting could be called disorganised or chaotic. Almost 70% of our co sleeping deaths occurs in babies who were sleeping with a parent or parents who had been taking drugs or drunk alcohol, and in the majority of those cases the final co sleeping event was spontaneous- the baby was in their own cot, parent came home drunk, picked baby up for a cuddle and fell asleep on the sofa or in bed.
Co-sleeping, when it’s planned and managed, and with risks reduced (no drugs or alcohol, firm surface, no great soggy duvets, keep room cool etc) isn’t the hazardous activity-the hazards generally come from whatever else the parent is doing, particularly smoking or drinking.
Bit of a generalisation, but it’s got to the state now where if a baby dies in their own cot we more often than not find a definite natural cause.
Co sleeping is a natural thing to do, and any risks can be hugely mitigated as long as parents don’t smoke or drink. A small proportion of our co sleeping deaths are horrible accidents that in retrospect could maybe have been prevented ( in this group I include babies who fall down the gap between the bed and the wall and get wedged and become asphyxiated, or a baby who rolled out of bed and landed head first into a waste paper basket that had been lined with a plastic bag, or a baby who had been put up on the pillows but had slipped down the gap between the two pillows at the top of the bed and the pillows then moved over her face due to the parents shifting position. Also, I had a case where the parent had made a nest for her baby by sitting in a cross legged position semi reclining and put the baby on the bedspread, but then fell asleep and turned over, entrapping the baby in the bedspread. Stupid, careless mistakes, but ones which could be very difficult to predict, and very difficult to think through when you’re crying with exhaustion.
Co sleeping risk is very difficult to assess across populations because of differences in behaviour. I’m quite sure Japanese mothers tend not to drink alcohol to the extent my regional mothers do, for example.
I think you make some excellent points. I didn’t personally feel comfortable with bedsharing. But if the choices are between planned bedsharing in as safe an environment as possible and risking falling asleep accidentally in an unsafe situation, then I think it may very well be safer to bedshare.
Some of the cases I’ve seen have been an awful combination of circumstances-we had one baby who had an overgrowth genetic condition and so was far bigger than the average baby. He rolled out of bed (or got pushed out by the movement of his parents body) and got trapped between the side of the bed and the wall-if he’d been normal baby sized he would have simply fallen on the floor but he ended up asphyxiating.
Some parents cocoon the baby in bed with pillows all around them to stop them falling, but that is so dangerous. Rolling out of bed onto the floor isn’t going to hurt a baby, it’s only a very short drop and most babies bounce quite well. But if he’s rolling, the risk of rolling into the pillow and then being unable to roll himself back out of it is far higher.
It reminds me a bit of a situation we see sometimes in hospital, primarily in elderly patients with dementia. In an attempt to stop them falling out of bed, the cotsides are put up. Unfortunately that has lead to several people suffocating after getting caught between the cotsides and the mattress (not to mention injuries from climbing over the cotsides or getting limbs tangled in them). The safest option is actually to put the mattress on the floor, but that looks bad so it doesn’t happen.
One of my saddest cases was a co-sleeping death in hospital-mum had had a CS and the baby was in a cot beside her. She kept bringing the baby into bed with her and the midwives kept putting the baby back into the cot. The bed cotsides had been put up because the mum was still dopey after the CS and medication, and somehow she got the baby back into bed with her, and a couple of hours later the baby was found trapped and squashed between her bottom and the cotsides, he was less than 1 day old. The hospital had a policy that babies roomed in with the mother and there was a nursery he could have been admitted to.
Jesus christ, that poor baby and that poor family.
Don’t they make co-sleeping platforms that attach to the bed, where the baby can sleep on a proper surface, no soft bedding interfering etc. but where the parents can also have easy access for night feeds etc? That seems to me like the best option if you’re going to co-sleep.
Yes, a couple of my medical friends have used those. They are called bedside co-sleeper cots or similar.
They do, and I used one. But, it doesn’t give you a free pass. Although the sidecar sleeper had no bedding other than a tightly fitted sheet, a parent can roll around and push bedding from the adult bed into the sidecar (or a pillow, or anything else in the adult bed). I’d say it definitely reduces the risk, but does not eliminate it like a free-standing crib does.
I would also imagine that if you’re breastfeeding in bed while half asleep (which is often touted as a benefit of bedsharing), there’s a fair risk that you won’t be awake enough to put the baby back in the sidecar.
One of the community midwives who visited shortly after my daughter’s birth suggested taking her into my bed and cocooning her with pillows so she couldn’t fall out. I’d mentioned that my daughter wouldn’t settle well in her crib and she looked at me as though I were nuts and said “Why don’t you just take her in your bed? It’s fine as long as you follow the guidelines”. Then she described the cocooning arrangement, which bore absolutely no relation to UK safe sleeping guidelines at all and completely contradicted the advice given by my health visitor. I think my mouth actually dropped open. It’s no surprise that parents get confused when mixed messages like that are being sent out.
Same here – I have friends who chose to bedshare after taking all the steps recommended by the NHS to reduce the risk of accidents. I wouldn’t have done it myself because I’m a heavy sleeper, but I don’t think that it was necessarily the wrong choice in their particular circumstances, if the alternative was accidental unplanned co-sleeping on a sofa or damage to their mental health due to extreme lack of sleep. I’m aware that I was quite lucky in that I had a baby who was a decent sleeper, plus a lot of support from my parents who live close by, so I never hit the level of desperation due to sleep deprivation that some new parents reach.
What bothers me is that bedsharing gets promoted in some circles as being inherently protective against SIDS, which leads to a really cavalier attitude in those circles to the need to create a safer bedsharing environment (because any advice on how to prevent accidental suffocation is obviously just a conspiracy by Big Crib to demonise bedsharing). I’ve seen women on natural parenting forums cheerfully describe some very dubious sleeping arrangements (bedsharing with the whole family including very mobile toddlers in the same bed, having a tiny newborn next to them completely covered by a thick duvet, even sleeping with a baby still attached to them in a sling) because they’d read that their maternal intuition and the special bond created by breastfeeding would protect their baby from any harm. Plus “crib death only happens in cribs – that’s why they call it “crib death””.
My husband and I know we can’t bed-share safely. He sleeps like a log unless the words “The cows are out are uttered”. We’re both overweight. Our bed has two separate mattresses with the perfect size gap to trap a newborn so one or both of us could roll on top of the baby.
I sympathize – I wasn’t even comfortable sharing a bed with my cat when he was a kitten, because I know how I thrash around in my sleep!
I wish the dangers of sleeping with a baby were brought up more in the family leave discussions. My husband is the stay-at-home parent and I had maternity leave for both of my children. SIDS was my worst nightmare with my babies. Due to the fact that we were both home 24 hours a day, we traded shifts and were both well rested. He would stay up with the baby until 2 am and I would sleep from 7pm to 2am uninterrupted. Then he could sleep from 2am until 9am uninterrupted. We were both able to nap as needed as well and also took turns getting full nights of sleep as needed. It was awesome and I can see now how very lucky we were. This could never have happened if he had to go back to work right after their births. Whoever was on shift with the little one stayed up and watched TV, cleaned, rocked the baby, whatever. There are probably only a handful of times with each kid that they were ever even in our bed, and always when we were awake. We got really lucky that both were good sleepers by 4 months or so and then we only had to get up once a night for feedings.
I think that’s a really good point – employers who behave badly over parental leave are actually putting babies at risk, because sleep-deprived new parents make less-than-ideal judgement calls.
As a single mother with retired parents living virtually across the road, I was actually luckier than a lot of my married friends. My mum and stepfather kindly offered to take turns doing shifts with the baby, whereas most of my friends had nobody to trade shifts with. Their husbands had to go back to work almost immediately, their employers having bullied them into declining or postponing their full paternity leave. I don’t think it’s a coincidence that I’m the only one of my friendship group who didn’t end up taking her baby into an adult bed to sleep out of sheer desperation.
The problem with that is that *safe*bedsharing cannot be quantified accurately because it inevitably never occurs in real life in its ideal form. An infant who is *safe* bedsharing with their non-smoker, sober, breastfeeding mother is still sleeping on unsafe sleep surface to begin with. Any and all bedding is unsafe bedding, another risk factor. If the caregiver falls asleep while (breast)feeding that’s another additional risk factor that cannot be controlled, in that case coupled with no one awake who made sure that the infant was placed on their back to sleep, which is unsafe sleep position.
That’s why the current evidence census is that there is no safe bedsharing. Most recent round up of the risks was done by dr Rachel Moon for her 2016 Safe Sleep Update presentation:
I think the difficulty is that the public health message has to be clear and unambiguous so that all parents can understand it. It is easier and more impactful to say ‘Do not sleep with your baby until they are one year of age’ than it is to say ‘it’s safer to sleep with your baby if you do this, this and this, but not if you do this, and you can modify your risk by doing that and that, and increase it if you do the other’. SUDI/SIDS is a complex issue and the risk varies with individual infants (the risk is higher in babies who are premature, twins, IUGR etc), but from a public health point of view, the message has to be simple and direct and not capable of being misinterpreted, so it gets distilled down to ‘no co-sleeping’. This isn’t particularly helpful as it demonizes those parents who do make a conscious decision to co-sleep and plan accordingly.
A healthy infant placed on unsafe sleep surface that is adult bed by either parents who have made decision to bedshare, or by those who haven’t, and then the caregiver falls asleep, is at same risk because no amount of magical thinking will alter the product specifications of an adult bed mattress. In fact, the little data that is available on this says that infants who are in the adult be to breastfeed and are then placed back to sleep in a safe crib are not at increased risk of SIDS ( those would be the infants like my babies who bedshared in adult bed accidentally because the mother did not plan or intend to bedshare but passed out while night nursing and woke up several hours later). http://www.phac-aspc.gc.ca/hp-ps/dca-dea/stages-etapes/childhood-enfance_0-2/sids/pbs-ppl-eng.php
No one is out to demonize parents, but what we keep hearing in our safe infant sleep group from parents who used to bedshare is that once the safe sleep message is adequately conveyed in detail and not just simply saying don’t do this or that, but explaining the mechanism or risks behind infant sleeping in swings or using crib bumpers or bedsharing is the kind of understanding that in return results in family planning to be dedicated to safe infant sleep practices. Where in the past they only looked for validation, they now look for accurate information. As a layperson on the internet and without anything to reference except hypothetical *safe* bedsharing recipes I cannot say if their baby would be *almost just as safe* if they bedshared in absence of known risk factors. What I do know is that virtually no one in real life bedshares *safely*, and that the theoretical guidelines like the ones peddled by LLL are actually instructing parents to go against current product safety warnings ( use of bed rails for children under 2, use of toddler bed for children under 15-18 months are both explicitly warned against by CPSC and manufacturers). https://www.facebook.com/safeinfantsleepalliance/posts/507529032775765
So since you mention the risk of swings, what is the risk relative to sleeping on a standard adult bed? Higher or lower? What about a rock and play? Or an infant carseat? Because anecdotally it would seem that the kids who will sleep in devices spend a lot of time in them.
If perfection is not to be achieved it would be nice to know the best options to get to sleep. Because at some point the vast majority of us do what we have to do get sleep. Or go insane (in my case, literally!)
Perfection? The aim of recommendation against bedsharing is to place the infants for sleep in a safe sleep environment which gives them the best shot at not dying from sleep-related infant death. To have as a starting point a safe sleep surface. If some parents are willing to entertain one particular risk ( sleeping in swings) because it’s less relatively dangerous than bedsharing in adult bed, or if they are making risk-benefit analysis based on likelihood of swing being unsafe if you only use it for afternoon naps instead of night sleeping, science does not have much to offer. That recent study of infant sleep practices observed via video monitoring provides a scary insight into how many extremely vulnerable infants in the youngest age group were placed in car seats, swings and other (devices) as their primary sleep location.
That’s why advocates of unsafe sleep have it easy compared to those of us trying to spread awareness about safe sleep recommendations in their entirety – they can just pick whatever they want and claim how it’s safe enough or *safer enough* than something else that is dangerous. As a layperson on the internet I really do not want to carry anyone’s baby on my conscience because in our group in order to go easy on parents who are transitioning from bedsharing we allowed someone to tell them to go ahead and use RNP because it’s less of a risk than bedsharing.
The best on offer ATM is the expert opinion that you should never feed your baby on a sofa or a couch if there is any risk of you falling asleep, and in that case adult bed is a safer place to feed your child.
The problem is also that some babies simply refuse to sleep in a cot. That’s when you end up with hallucinatingly exhausted caregivers falling asleep with them on armchairs. I see the point about the distillation of the message, but equally I think we have to be aware that for better or for worse some people are not going to have the option of following best practice guidelines. With that in mind, as we know that some ways of co-sleeping are more risky than others, parents are going to need this information too.
I am acquainted with a few people who were sure they were doing safe bedsharing, but ended up with babies falling off the bed and hitting furniture on the way down, or being pinned between the headboard and the mattress. (The children were okay.)
I read a description of what sounded like safe bedsharing but it sure didn’t sound comfortable: on a thin futon on the floor, no blankets or pillows, mom wearing a sweater, thick socks and sweatpants (in layers if needed) and baby in a sleep sack. Reality is most parents won’t do this.
I slept on a tatami mat on the floor for over a month this summer ( don’t ask). I would in a heartbeat offer to shut up about AAP recommendations to every parent who was willing to bedshare while sleeping on a mat on the floor with no blankets or pillows and a baby in a sleep sack – because bedsharing rates would fall down to almost zero in no time. 😀
I am another data point. When she was an infant, I took a nap with my baby in the middle of a queen sized bed. I woke up to her cries after she rolled (and rolled and rolled) off and onto the floor. I was terrified, felt like a horrible mother, but I grateful to have the opportunity to learn that lesson with no lasting ill effects.
Yeah, I just saw a bad one of a parent falling asleep and baby getting wedged between pillows and asphyxiating. No drugs, no alcohol, just tired parent. I had horrible visions of this as a new mother and was so glad when the kids got older.
70% is extreme – in USA only one state ( Alaska) has the majority of bedsharing deaths happening with drugs or alcohol as additional risk factor present ( large minority population where that is prevalent too). That percentage rarely pings back above 15% of all SUID cases in other states.
The problem with UK wide data is that even he most recent reports are largely missing data on sleep environment risks – in 2013 only 16% of child death cases reviewed had bedsharing (cosleeping) information available. That’s insanely inadequate because “approximately two thirds of all completed child death reviews were for children aged under 1 year. ” https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/223697/SFR26_2013_Text_v2.pdf In USA the death scene investigation and data collection standards for CDR availability of such information are at 95-98%: http://www.jpeds.com/article/S0022-3476(16)30001-4/fulltext
As for Japan – I would take their SIDS/SUID/sleep-related infant death statistics with major reserve. Despite recent introduction of even more mandatory autopsy and investigation protocols their autopsy rates and completed investigation rates for SUID are still critically low. http://www.sciencedirect.com/science/article/pii/S0379073899002182
Apparently a system similar to CDR process and use of standardized DSI protocols and review algorithms is – being introduced in Japan: ” July 2014 paper by CDC researchers published in the Pediatrics journal outlines the rigorous classification criteria used in the registry, including a flow chart that leads officials through layers of questions — such as where and how the body was found, and whether any factors for suffocation were present — so they can classify sudden infant deaths more accurately. Such a systematic review should also be adopted in Japan, Kai argues. In April, the Cabinet Office made it mandatory for municipalities to set up a third-party panel of experts to investigate deaths and serious accidents at nurseries through interviews with family members and nursery staff as well as SIDS experts. But the measure, implemented through a notice issued by ministries, not legislation, contains no penalty clause for operators that fail to report cases, a Cabinet Office official acknowledged.” http://www.japantimes.co.jp/news/2016/08/25/national/social-issues/infant-deaths-underscore-accountability-gaps-japans-nurseries/#.V9-P9zXIp80
At best, this makes any and all Japan data inadequate grounds for making any claims about infant sleep environment risk factors in America or UK. At worst, we get the LeVines making preposterously fallacious claims about safety of bedsharing in America because “low SIDS rate in Japan”.
Thank you for your insights mabelcruet, much appreaciated even though they are always a chilling read.
I should have have said that our ‘Co-sleeping with alcohol using parent’ rate is considerably higher than anywhere else in the country. We have a region wide uniform protocol which lists all the data which we need the police to obtain so our data is fairly robust. There is a national protocol of what information should be gathered about SUDI cases, and the recommendation is that every death should be investigated by a specialist pathlogist, but this can vary in different areas depending on the coroner involved-some coroners designate a forensic pathologist or a general pathologist to do the case and so it could be a little variable, but with the child death review panels in place this should help.
Which area of the UK are you in mabel?
Thanks for the edit. Still, that 40% is indicative of a very scary context. 🙁
I know-it’s a big public health issue here. Part of the protocol of investigation after an infant death is that the parent is asked to consent to drug and alcohol testing, so any positive result no matter the level is considered as evidence of co sleeping whilst under the influence of drugs/alcohol. However, this is obviously going to be many hours after the baby’s time of death and time of discovery. The police did attempt to prosecute some cases under the 1929 Childrens act which makes it a criminal offence to be responsible for the care of a child under 3 whilst intoxicated. The problem is that we don’t know exactly when the infant died (sometime during the night), we don’t know what the parents levels were at the time of death, and we don’t know the relative position of parental and infant bodies or what the exact mechanism of death actually was. The burden of proof in a criminal case is beyond all reasonable doubt and we are nowhere near that. Personally I’m not sure a prosecution in these cases is the appropriate way to go anyway, but it means that we continue to get parents who drink whilst co sleeping.
That’s a line that I’m happy I do not have to draw in any capacity – the one that when crossed turns accidental unsafe sleep infant death into a manslaughter charge.
From intervention side of things targeted awareness campaigns in high risk populations have had positive effects. I would like to see some solid science behind the offering of safe sleep boxes to the high risk bedsharing parents and maybe in the future witness that being incorporated into official campaigns.
I’m not a big fan of parents registered at risk signing pledges because that does not seem to work at all. I would personally like to see more funding poured into accurately identifying infants at extreme risk of sleep-related SUID and giving authority to child services to remove them to safety. Those would include infants born into families with history of unsafe sleep infant deaths, drug or alcohol use of caregiver while being in charge of the kids, and their confirmed intention to disregard safe sleep advice – like this case: http://ktla.com/2016/09/08/pennsylvania-mother-charged-after-second-baby-she-co-slept-with-dies-affidavit/
That is horrible reading. Being medical and not legal/police, I’m glad I don’t have to make the call either. For all cases, we attend a child death review and this is attended not only by police, but by the family doctor, midwives/health visitors who dealt with the family, social services and various other agencies. Once the police have decided there is no criminal case, it’s up to the local child protection services to decide what to do with the family-what level of support they will need, what level of input, entering into a ‘care of the next infant’ programme, and so on. In some cases, there were features that might not have been the cause of death but were relevant to the death and for the care of other children-babies who were significantly underweight, or who had ulcerated nappy rash, scabies, or where the scene photographs showed awful levels of deprivation. This all aims to support the family and provide education and training for them, rather than being pejorative in nature. We have some cases from really awful social backgrounds, where the mum genuinely didn’t know that giving a newborn milky tea instead of milk wasn’t suitable, for example, and if she had another baby there would need to be a decision about what would be best for that new baby.
But for mothers who were determined to ignore the advice I’ve no idea what social services would do here-generally removing children is a last step.
The risk increase is debatable – the fact that infants sleeping in a safe sleep environment as recommended by AAP ( alone, on their back, in a safe crib) prevents them isn’t.
Another key point is that 9 out of 10 sleep-related infant deaths are preventable. There are 4000 of them each year in USA according to NIH: https://www.nichd.nih.gov/sts/Pages/default.aspx
That’s 3 600 infants who can be saved each year if their parents for a moment place more value on risk prevention than on relative risk increase when making decisions about where their baby will sleep.
Of those 4000 sleep-related infant deaths half or more happen to babies sleeping in an adult bed and/or bedsharing according to NCDR-CRS data.
That’s 2000 bedsharing deaths in USA a year. It’s a staggering death toll that makes the LeVines and their calling of the risks of bedsharing “imaginary” in that article a complete insult, and it definitely is a risk increase compared to safe sleep ABC that I would call dramatic.
I am going to quibble with one thing. I appreciate your technical expertise, but the following judgement call:
“That’s 3 600 infants who can be saved each year if their parents for a moment place more value on risk prevention than on relative risk increase when making decisions about where their baby will sleep.”
Doesn’t recognize the cost of (mostly) maternal sleep deprivation. I had two different newborns who WOULD NOT NAP on their own. They would be out and would wake up 10 minutes after being oh-so-gently placed in the crib. With my first child I tried so so hard to get her to nap in a crib. And was incredibly sleep deprived, which led to or exacerbated PPA. I passed out on the couch with the baby (risk factor anyone?) and almost fell asleep while driving several times. My conscious decision to nap with the second child once per day – a time when neither of us slept particularly deeply – kept me much more sane and functional. That was because I placed value on my health and safety.
Maternal sleep deprivation is among mothers who resort to bedsharing out of despair mostly driven by attempting to exclusively breastfeed. If only lactavism didn’t preach that even a single bottle of formula will ruin your child/their precious microbiome for life.
My exclusively formula fed son was my absolute worst sleeper. I took him to his pediatrician multiple times because I was convinced something was wrong with him. He was extremely restless and wouldn’t sleep more than a few minutes in a ‘safe sleep’ location like his crib or bassinet. I tried everything to get him to sleep safely, but it wasn’t happening. I fell asleep with him multiple times and I knew the risks, and I woke up in a panic every single time, checking for his breathing. We ended up putting him in a swing to sleep for his first 6 months, because it seemed less risky than bed sharing. Was it ideal? No, but I really didn’t know what else to do.
“I knew the risks”.
But did you? Did you really know the mechanism behind positional asphyxia and how easily their airway can become compromised in semisupine position? Did you really know that the fact they sleep better in comfy swings is what places them at increased risk of SIDS due to less arousal points?
Most parents I encounter don’t:
“”Positional asphyxia is a type of suffocation that occurs when the body is put in a position that restricts airflow. In infants, positional asphyxia can
occur when they are placed in a semi-seated osition. Positional asphyxia can occur due to the prominence of the occiput (back of the head), as well as the overall lack of neck muscle strength, which forces the head to slouch forward pushing the infant’s chin down against his/her chest. This body position causes the windpipe to narrow or close.
Imagine a drinking straw and then bend that straw over. This is the picture that we need to have in order to understand what could occur to an infants windpipe when their head flops over in restrictive infant equipment while sleeping.”
https://www.facebook.com/safeinfantsleepalliance/photos/a.493827490812586.1073741828.489671061228229/503335323195136/?type=3&theater
http://ifservices.org/wp-content/uploads/2015/10/Restrictive-sleep_-infants.pdf
I know that swings, car seats, etc are not safe sleeping places. In my exhausted state I rationalized (maybe incorrectly) that the swing was safer than bed sharing. Thankfully he survived it all, but I still cringe thinking about his early months.
Out of curiosity, what do you suggest that parents of difficult sleepers do? My second luckily slept fine on his back on a flat surface, but my first definitely would not have.
If it’s ok with you I’ll make a post with your question in our safe infant sleep support group and give you the feedback from the parents who have been there, done that. I explained earlier the reasons why I don’t allow myself to suggest to anyone which unsafe option would maybe/perhaps be the lesser of the infant sleep environment evils.
I would be interested to read something like that. I think we all want to promote safest sleeping solutions, but I don’t know how we do that when the infant concerned simply won’t countenance it.
The thing is, reality happens. I understand your frustration with the AP insistence that “bedsharing is safe” without really using safe methods. However, at some point you do what you need to to get sleep. And while breastfeeding can certainly be a factor in fatigue blaming that exclusively makes no more sense than insisting exclusive breastfeeding will cure all of society’s ills. All parents of newborns are exhausted! Sometimes exhaustion leads to things happening – like running off the road, or forgetting to buckle the carseat, or leaving a sleeping child in a hot car. We all know these are bad things but sometimes they do happen!
In my case, with my first kid I was caught in this awful cycle of postpartum anxiety, being terrified of SIDS, being unable to sleep after she slept, etc. Meds helped but then I had to go back to work at 8 weeks! My conscious decisions with my second child to prioritize my sleep kept us all healthier, and kept the rest of my family and everyone else on the road safer.
“blaming that exclusively” I believe I said: “mostly driven by”.
Less infants die from all other top ten causes of accidental injury death combined than from sleep-related accidental suffocation, sleep-deprived mothers driving with their babies in the car off the cliff included.
https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_injury_deaths_highlighting_unintentional_injury_2011-a.pdf
By the way, I think the statement “I knew the risks” refers to the fact that StephanieA was terrified waking up in the bed with the baby.
Well maybe, but I can personally attest to the existence of exclusively formula fed newborns who simply will not be put down. It may well be more common in breastfed babies, but this particular infant hadn’t had the boob even once.
If I hadn’t had a husband who had the first five weeks after birth off, a nocturnal brother who was quite happy to sit up until 4am holding said baby while he listened to his university lectures and parents who live locally and are still fairly young and spritely I don’t know what we’d have done. Especially as I was rather unwell and there was also an older toddler to contend with. I imagine it would have involved some form of co-sleeping. In that scenario, knowing which risks are higher than others would have been beneficial.
I don’t think those 2000 or 3600 deaths you quote are due to parents not thinking about the risks. There enough babies who won’t sleep more than a few minutes after you put them down, and their parents need sleep too. In any parenting forum, those parents will be extremely stressed out about how to give their babies safe sleep in a practicable way – they’re quite aware of the risks.
So instead of a blanket “bedsharing kills” message that isn’t very convincing or useful when push comes to shove, showing ways how to minimise risks would probably save more babies. I guess that’s why my hospital showed what to do with a baby in bed and what not.
“So instead of a blanket “bedsharing kills” message that isn’t very convincing or useful when push comes to shove, showing ways how to minimise risks would probably save more babies.”
Nope. When parents are given clear, unambiguous and repeated safe sleep message against bedsharing they listen to it AND that warning will additionally not impact breastfeeding negatively. It’s a win-win. https://www.nih.gov/news-events/news-releases/advising-moms-not-bed-share-infants-does-not-discourage-breastfeeding
When parents are given ambiguous, conflicting message or the watered down version of recommendation against bedsharing like in British Columbia in 2011 and told how “there is no evidence that bedsharing is a risk in the absence of additional risks like smoking or drinking” you get this: http://www.perinatalservicesbc.ca/Documents/Resources/Alerts/BCCSInfantSafeSleepAlert.pdf
“Unsafe Infant Sleep Practices
There has been an increase in infant deaths related to unsafe sleep practices.The BC Coroners Service Child Death Review Unit has identified an increase in infant deaths related to unsafe sleep practices.
Over the past three years, there has been an average of 18 sleep related deaths per year. In 2016, in just under four months (between January 1 and April 28, 2016), 15 infants have died. Almost all were younger than six months of age. Coroner investigations identified that many of these infants died due to:
– suffocation when placed prone on soft blankets or mattresses,
– an overlay by a parent (sleeping together on a bed or couch), or
– suffocation due to head covering by a blanket.
Health care professionals are reminded to ensure that safe sleep practices are discussed with all expectant parents and parents/caregivers with young infants.”
Did I mention that such bedsharing-friendly guidelines in that province from 2011 were the product of BC Perinatal Services ignoring both the Canada PHA safe sleep recommendation against bedsharing and BC Coroner Services five year safe sleep CDR report from 2009 in which the mythical *safe* bedsharing of dr McKenna was named, shamed, and discarded as rubbish in light of evidence? http://www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/child-death-review-unit/reports-publications/archive/sudden-infant-death-report.pdf
Sigh, as someone who lived in Japan, I get very annoyed when people from the West insist that Japan is somehow better because of specific practices. Maybe they do share their beds more than people in the U.S. I honestly have no idea how prolific it is there, because I never asked. But they certainly share their rooms – often because they do not have the space for a separate bedroom. I lived next to a family who had the same type of apartment I did- a single room for sleeping/living, a kitchen, and a bathroom that also had a laundry machine. Space is a huge reason why people share sleeping rooms. Many of them also sleep on futons – a mat on the floor, not the couch thing we call futons. Yet I don’t ever see these things addressed (except as above by Dr. Amy) by those who claim cosleeping is just wonderful because the Japanese do it.
Sorry for the verbal diarrhea. It’s a sore issue with me.
In America I’ve noticed a trend of idealizing foreign cultures, the more “exotic” the better. They inflate the things that are better about the other cultures and ignore the things that are worse.
Some things that occurred to me while reading this:
Japanese families often roll out futons to sleep on the floor – not only is this bedding not nearly as soft as what we’re used to in the U.S., it is also very low to the ground, so no baby could fall out.
Is sleeping in the same room the same thing as co-sleeping in the same bed?
How did these genuises decide that it was co-sleeping that accounts for the Japanese childrens’ ability to care for themselves and their belongings, and not, say, the Japanese culture itself (of which I presume co-sleeping is a part).
This just seems very skimpy on information with a lot of conjecture from a couple of visitors to the country. I’d prefer to see some studies out of Japan to see just how widespread co-sleeping is and what it entails.