co-sleepingI appreciate the many comments I received about my blog post on bed-sharing. The acceptance I saw of opposing viewpoints contributed to a healthy conversation. It allowed us to think more deeply, and I thank you for that.

The question of whether you feel comfortable sharing your bed with your baby is highly personal, and I respect the varied opinions. During my 15 years as a pediatrician, my observation has been that parents make decisions about their children’s health by reviewing a variety of sources, and then assessing the risks and benefits.

On any topic, I believe my job as a pediatrician is to give you the most up-to-date information available, add my own best advice as an experienced physician and then encourage parents to make their own decisions. So, as a response to my recent post, I provide here some comments and additional data for further consideration.

Many of you commented that in other countries parents co-sleep, so why shouldn’t we? The devil is in the details, and those details are often hard to find.

For example, the specific bed-sharing practices in those countries with high rates of bed-sharing and low rates of Sudden-Infant Death Syndrome (SIDS) are often different than in the United States. Parents in these other countries often sleep on the ground, a floor or very firm surface (like a futon), and use no heavy bedcovers.

Also, the rate of alcohol consumption and body mass index of the parents is often quite different than in our Western culture. And there is the use of prescription drugs in the United States to consider.

Data reviewed by the American Academy of Pediatrics (AAP) task force shows some particularly high-risk situations for bed-sharing. Preterm babies — with their decreased muscle tone, lack of strong self-waking cycles and less developed lungs and brains — are at higher risk of SIDS, and are especially at risk when bed-sharing with their parents.

The following additional risk factors appear to greatly increase the incidence of infant sleep-related deaths:

  • One or both parents smoke: 2.3-17.7 times increased risk.
  • Infant is under 3 months old: 4.7-10 times increased risk.
  • Infant is on an extra-soft surface such as waterbed, couch or armchair: 5-67 times (yes, 67 times) increased risk.
  • Parent has consumed any alcohol: twofold increased risk.
  • Multiple bed-sharers: fivefold increased risk.

Bed-sharing with a non-parent: fivefold increased risk.

The number of babies under one year of age who die in sleep-related deaths is about 2,500 each year. Out of all the babies in the United States, that is a very small percentage. Yes, the odds are small that this terrible tragedy will happen to you. Even if you bed-share in the circumstances above, your risk is still low. But how low is low enough?

That might prompt you to ask: Can you come up with the probability of a sleep-related death for a baby sleeping with her mother

a) on a firm mattress

b) without covers

c) with a mom who has had no alcohol or drugs, and

d) is a healthy, full-term infant?

The AAP has not been able to parse out enough reliable data to make such a calculation. And then there are always more unknowns; like, how do you figure in a mom’s exhaustion level on any given night?

It’s nearly impossible. For all these reasons, the AAP deemed it safest to advise against bed-sharing.

Ultimately, for me as a mom, all the data and debate about bed-sharing boiled down to this: If my precious baby Jack or Liesl died in bed with me, as unlikely as that would be, could I ever live with my decision to sleep with them? My own answer was, “No.”

I have sat and cried with families whose babies died in bed. The focus at that point became comforting them and looking for ways to help these parents handle their unthinkable loss. With those experiences in mind, I want to do everything possible to prevent other families from suffering the same potentially preventable disaster.

Perhaps our conversation has provided you with more information, or at least prompts you to think in more ways about this controversial subject. That’s my goal.