"Untold Dangers" in the Family Bed?

An article in the Spring 1997 issue of "The Community Perspective," a newsletter published by Growing Families International (GFI), claims, "Sleeping with your infant, as recommended by controversial attachment parenting advocates, can often result in infant suffocation…" (emphasis added). The article cites studies that supposedly prove "overlying," or a parent’s body unintentionally suffocating a baby, is "more common than the ‘family bed’ or ‘attachment parenting’ advocates are willing to admit."

It is important to remember that Sudden Infant Death Syndrome was initially called "crib death," for good reason. Far more babies die alone in cribs than from overlying in the parents’ bed, even though literally millions of parents around the world sleep with their babies, and have done so throughout history. In fact, the cultural shift from babies sleeping with their parents throughout the centuries, to sleeping alone in cribs was just that: a cultural shift. It was never studied and determined to be safe, or even wise.

It is simply not the case that one practice is 100% safe, while the other is not. Research strongly suggests, however, that when proper precautions are taken, sharing sleep is safer than leaving a baby to sleep in a crib, alone.

Does overlying happen "often" as GFI claims, so parents should be concerned?

The GFI article cites a number of studies that supposedly prove overlying is a serious risk but several of the studies date from the 1960s and 1970s and have been contradicted by more recent studies.

More recent studies from Australia and New Zealand, also cited in the article, have been re-evaluated, notably by respected SIDS researchers James McKenna and Peter Fleming. Though at first these studies seemed to implicate co-sleeping as one risk factor for unexplained infant death, the re-evaluation discovered a significant proportion of Maori Indians among the subjects of the studies. Once the common Maori practice of smoking was adjusted for, the studies were found not to implicate co-sleeping as a risk factor after all. In other words, increased risk is due not to co-sleeping per se, but to unsafe sleeping conditions, with maternal smoking first and foremost among them. In fact, Dr. McKenna states, "There is no controlled epidemiological study which shows that co-sleeping is dangerous, except where mothers smoke." This revision of the studies' conclusions is widely known among professionals, so to cite these studies as proof that co-sleeping is dangerous reveals, at best, ignorance of current research.

Two of the journals cited in the GFI article are considered in the professional community to be less scientific and less subject to peer review than the leading journals. Even so, they did not give sufficient information to support GFI’s conclusions. The GFI article itself mentioned that in one, "information concerning the parents’ alcohol and drug use was scanty," and some of the deaths may have been "intentional," i.e. murder.
For all these reasons, it cannot be "assumed" that overlying deaths are common, as the GFI article suggests. Since the few studies GFI cites are from lesser known medical journals, and even those studies don't fully back up their claims, one must wonder whether they are citing all the information they view as being "friendly" while ignoring the bulk of scientific research.

Do babies sometimes die because they are "overlaid," or suffocated by the parents? No one can say this never happens, because the cause of death often cannot be explicitly determined. Revising past opinion, expert pathologists now say suffocation as the cause of death cannot always be determined. In other words, a particular death may be thought to result from "overlying" or suffocation, as is claimed in the GFI article, but experts agree that in many cases this is simply a guess. And guesses, of course, often reflect the biases of the people doing the guessing.

Further, it has been shown that in the majority of cases where a child was apparently suffocated, some abnormal sleeping arrangement was present, such as too many people in too small a bed, parents under the influence of sleep-altering drugs or alcohol, or unsafe sleeping surfaces such as couches or bean bags. There are certain basic principles for safe sleep sharing, and these are covered in scientific detail, and very highly referenced from leading journals in SIDS: A Parent’s Guide to Understanding and Preventing Sudden Infant Death, by William Sears, M.D. In that book Dr. Sears cites more than 250 current, reputable, scientific studies on the safety of sleep sharing when properly practiced.

It is also worthy of note that research (including the New Zealand and Australia studies cited by GFI) has shown one particular practice reduces Sudden Infant Death Syndrome by 30-50%: placing a baby to sleep on his or her back, rather than tummy. For this reason, the American Academy of Pediatrics recommends back-sleeping for infants. Yet Growing Families International continues to advocate tummy sleeping because babies "sleep better" and suggests those same studies cannot be trusted on this point. [Note: this information was correct at the time this article was written. However it should be noted that the Ezzos began to back away from overtly recommending tummy sleeping at some point in the late 90's.] In other words, they choose to believe the New Zealand and Australia studies on a point that has been refuted (co-sleeping), and choose to disbelieve them on a point that has been verified (back-sleeping).

The bottom line: it is not unusual for research to produce conflicting results. That is why studies must be published in reputable sources and subjected to peer review, verification, and duplication. No choice is 100% "safe," but the best current research indicates that sharing sleep, when practiced correctly, is best for babies—and safest overall.

This paper appears on the internet at http://www.ezzo.info/Articles/cosleeping. It was compiled from an interview with William Sears, M.D., and with reference to his book SIDS: A Parent’s Guide to Understanding and Preventing Sudden Infant Death (New York: Little, Brown and Company, 1995). James McKenna, Ph.D. was also consulted on some points.