Robin Barker July 16, 2012
Victorian coroner John Olle ... says parents shouldn't sleep with their babies. Photo: John Woudstra
Victorian coroner John Olle has opened a can of worms by stating categorically that parents should not sleep with their babies.
His comments followed an investigation into the deaths of four babies found to be sleeping with their parents at the time of their deaths. The babies' deaths were described as sudden infant death syndrome (SIDS) category 2; in other words, unexplained deaths with one or more features present that may have been associated with the deaths. It is not clear what these other features were; co-sleeping per se, or other factors such as parental smoking, drug taking, obesity, the baby being placed in the middle of the bed or any of the other numerous identified factors which put babies at risk when co-sleeping.
Olle requested health professionals provide consistent and clear messages on the risks of co-sleeping. I understand his frustration, but the confusion surrounding co-sleeping is bound to continue until parents are told categorically not to bed-share under any circumstances.
Some families will continue to co-sleep regardless of any recommendations to the contrary, but for many, bed-sharing continues because the message we are all receiving is that the level of risk remains uncertain enough that authorities are reluctant to give a blanket statement against co-sleeping under any circumstances.
Olle himself is reported as saying that it is still not clear whether co-sleeping itself conferred increased risk of sudden unexpected death in infants, or whether increased risk occurred only in the presence of particular unsafe practices and circumstances.
Before going any further I would like to declare that I am not a fan of co-sleeping, either personally or professionally, and that during my decades of clinical work the majority of parents I saw were not keen to sleep with their babies. Leaving aside the safety aspects, many find sharing beds with babies and toddlers involves a degree of discomfort and irritation they find intolerable. The toddler rarely gives up bed-sharing voluntarily and changing the arrangements before the toddler is ready invariably entails painful strategies. As a health professional who has had to frequently help parents deal with this, I decided long ago that it was easier not to share beds in the first place.
Nevertheless I am very much aware that for those whom it suits the closeness and convenience of co-sleeping is special and that, for some parents, co-sleeping is an important part of their child-raising philosophy.
I have always believed in giving parents safe options whenever possible, so over the years I have never attempted to dissuade parents keen on co-sleeping. Indeed, I include bed-sharing as an option for unsettled babies and older persistent night-wakers when the parents are reluctant to try other strategies, such as the dreaded ''controlled crying''.
Co-sleeping has run the gamut over the decades. For much of last century it was frowned upon for reasons that mostly seem related to discipline - fears of spoiling or turning baby into a little tyrant - although safety was probably an issue as well. In the '80s and '90s the pendulum swung dramatically the other way - co-sleeping was not only promoted as being super-safe but offered as the preferred choice of committed, caring parents. Promoted vigorously by many health professionals including two notable paediatricians, William Sears in the US and Jack Newman in Canada, co-sleeping was not only declared to lower the risk of SIDS but came with inflated claims that ''sharing sleep'' was a crucial part of ''attached'' parenting ensuring optimum emotional and social development.
In a flush of enthusiasm - no doubt to negate the years when babies and parents were separated for most of their hospital stay - maternity hospitals went with the pendulum and started encouraging mothers to share their beds with newborns.
During the last decade, however, it has become obvious that under certain conditions co-sleeping is dangerous. It increases the risk of fatal sleep accidents, such as babies being smothered, falling between mattresses and bed-heads, falling out of beds, or being overlaid by adults. After several fatal accidents here and overseas, maternity hospitals no longer allow bed-sharing.
There has, understandably, been a great reluctance on the part of co-sleeping adherents to acknowledge this. They now accept that the rules must be followed if it is to be done safely but still seem loath to consider that keeping the baby out of the parental bed, at least in the first six months, is safer.
One big reason for the confusion, particularly in relation to the advice that health professionals give, is that while the SIDS and KIDS website, sidsandkids.org, does say ''sleep baby in a cot next to your bed for the first six to twelve months'', it then goes on to provide (in the frequently asked questions link), a long list of safety requirements for parents who wish to co-sleep. This gives the impression that co-sleeping is a reasonable option when under certain circumstances.
Some parents will always disregard sensible advice, however parents are more likely to take recommendations seriously when they are evidence-based, unequivocal and obviously in their baby's best interest. The recommendations to sleep baby on the back, sleep baby with face and head uncovered, and keep baby in a smoke-free environment are explicit. Alternatives are not offered. But the recommendation relating to separate sleeping has a degree of ambivalence, giving the strong impression that co-sleeping continues to be a reasonably safe option.
Robin Barker is a registered nurse and midwife and the author of Baby Love (Pan Macmillan).