Co-Sleeping With Infants: Science, Public Policy, and Parents Civil Rights, with James McKenna, PhD



well one of the important distinctions

that needs to be made both in research

and in discussions that parents have

because it is one that really can change

the behavior of people has to do with

defining and getting it right what

co-sleeping means versus what bed

sharing means versus what sofa sharing

means co-sleeping is referring to any

situation in which a mother and baby or

father and baby or a committed caregiver

and a baby are within sensory range of

each other can detect each other in

terms of seeing and hearing and feeling

and perhaps even smelling so that the

each of the participants can detect and

respond to those signals and cues of the

other because it changes for the baby

the baby's physiology in very very

important ways there are as many ways to

Co sleep with your baby as there are

cultures doing it thousands of different

ways depending upon where you are in our

culture one way would be to have your

baby in bed with you call bed sharing

another way to do it would be to have

your baby sleeping alongside in a

bassinet within arm's reach you know or

in a pack and play the Navajo Indians

put a baby on a cradle board and lean

the cradle board right next to a modern

bed that's their way of Co sleeping some

moms around the world sleep on a hammock

with their baby some you know on a

raised platform so it isn't really so

much what the physical structure looks

like on which it takes place though the

safety issues you don't need to be

raised but it's very important that the

actual proximity and contact takes place

because that's what is biologically

appropriate for example in terms of the

ways this can be misused

that cheering is often used as kind of a

proxy for any and all co-sleeping so in

other words somebody might seem it say

something like oh I heard that

co-sleeping is extremely dangerous just

five babies died last week or last month

in Detroit no sleeping and what they are

talking about isn't perhaps co-sleeping

they're talking specifically either

about sofas sleeping recliners sleeping

or bed sharing which can be in many ways

either safe or dangerous let me explain

that sharing may be safe or dangerous

depending on is specifically how it's

done I always suggest to parents that a

breastfeeding mother baby pair is much

safer in a bed then is in a bottle

feeding mother baby pair because the

physiology of breastfeeding is very

different in both the mother and the


in terms of sensitivities to the

presence of the other they aroused in

relationship to each other awake a lot

to be the baby's place lower on the arm

of the mom down a to mid level of her

body to get to and from the breasts and

the babies always put on its back the

baby doesn't care to move just wants to

be you know as close to its mother as as


so co-sleeping needs to be further

distinguished and the questions someone

might say oh co-sleeping book what kind

of co-sleeping are you referring to

you know bed sharing you know sofas

sleeping a recliner sleeping oh and sofa

sleeping and recliner sleeping now there

are two forms that are always dangerous

you want to avoid them but that is a

form of code of sleeping but it's an

unsafe variety so one could always say

to somebody for example oh you know one

way in which you can sleep with your

baby and it's always safe one form of

co-sleeping it's called separate surface

co-sleeping some people like to call it

room sharing meaning you're in the same

room but personally I don't like that

term because it kind of dissed

says what's really being shared it's not

the inert walls of this room that are

being shared and that's protected by

babies and indeed because room sharing

is protective it's really a person

sharing it's the mother or the father

who's committed to that baby in the room

that's changing something about that

baby and making that baby healthier and

safer for it's night sleep it's

proactive so you know separate surface

code sleeping or person sharing but on

separate surfaces it's extremely

important and always safe well an

important question to ask is why bed

sharing why sleep with your baby and in

some ways it's a very critical question

to ask it's one that's really ignored by

public health officials that wished it

would go away well it's not going to go

away because we live in a breastfeeding

culture now and breastfeeding is in fact

functionally interrelated it's sleeping

close to baby in one way or another the

baby's not going to be found down the

hall because human breast milk is very

calorie light there's not much protein

there's not much fat lots of sugars it

burns fast but it's perfect for good

brain growth of our human infant brains

the problem is that babies need to feed

about every hour and a half to two hours

and that's what they do

so mothers even if they don't plan it

they find oh hmm I get more sleep if I

have my baby closer and closer and

babies negotiate even further and they

like being next to their moms and indeed

there you go

moms like pleasing their babies babies

like getting those sensations of warmth

and protectiveness that they're designed

to enjoy and respond positively to and

thus you get in our culture now

bed-sharing what happens when they bed

share well babies breastfeed two to

three to four times more frequently than

if they were sleeping down the hall that

boosts their immune systems while their

bed sharing they oxygenate they arouse

more frequently these are all very

protective and related differences

between a bed sharing baby and a

solitary sleeping baby the arousal is

that babies exhibit in relationship to

their parents who may have

two or three seconds before leads to an

oxygenation they rating tain higher

oxygen levels they simply will as well

spend more time in lighter stages of

sleep which is an advantage for babies

that are so premature at birth that is

where all premature at birth with only

25% of our brain volume that's who we

are but this requires us to learn how to

arouse to protect ourselves from apneas

you don't want a baby that has an

arousal deficiency that has difficulty

arousing being pushed into really

artificial deeper stages of sleep by

virtue of sensory isolation from the

mother but that's exactly what happens

sensory isolation permits babies to

sleep long and hard before they're

really ready to accommodate it by virtue

of having an equal ability to get out of

a deep pattern of sleep should they need

to two can conclude or to terminate in


that's like breathing pause so what we

find in the bed sharing situation is

potentially life-saving significance is

that babies one get a lot of practice

arousing which is a defense mechanism

against apneas or oxygen depletion

and/or they spend a greater amount of

time in the lighter stages of sleep to

which they're better designed to awake

from in order to terminate those avenues

so breastfeeding is increased

oxygenation body temperature is

maintained at a better level that's to

the immature babies needs etc you find

light stage and more arousing and all of

these things reflect the normative

biological expected patterns of sleep

for our human infants it's probably

important to point out that Co sleeping

we know is biologically appropriate and

evolved now how it's specifically done

is the big issue of debate and there are

safe ways to do it and there are unsafe

ways to do it but we do know this that

cross-culturally those cultures for

which Co sleeping is the norm

and we're associated with that is a lack

of maternal smoking and a lack of drug

use and/or alcohol during co-sleeping

those countries all over the world have

this have either the lowest SIDS rates

on record or the cultures aren't even

aware of such a phenomenon of a

supposedly healthy infant not waking up

and dying during the night it's just

completely unknown in Asian and Chinese

countries in Japan that has the norm of

code sleeping you know on futons etc

have once again for an industrialized

society the lowest rates measure at all

what that's telling us is it isn't that

there's an inherent danger at all to

sleeping with your baby on the same

surface but there are ways that we can

specifically learn as to how to reduce

the risks that could be associated with

it the problem with our own culture at

the moment is that all ways to reduce

and minimize risks of bed sharing have

been extracted from hospital brochures

and parents are not being able to know

that this is their right to get that

information I use as an example

requirements related to asking people to

participate in your research for a

subject consent form and it is by law

necessary to state what the benefits and

the risks are of that participation so

all the information has to be disclosed

but medical authorities in our own

country including levels of government

organization County agencies have

decided that parents don't need to know

what in fact can reduce risks of


they simply should not do it I feel

that's both unethical and that taxpayer

money deserves to be put in and used to

support what parents need and want they

are the only individuals and the only

entity that has the right to make a

decision about where their baby is going

to sleep this is an inherent civil

liberty it is a right that every baby is

born to have access to its mother's body

and it's right by every mother and

father to decide exactly in a relational

context where they want their baby to

sleep it's often in

very greatly by breastfeeding because

breastfeeding is so much easier and so

easily managed by mothers in terms of

her and the baby getting more sleep and

her you know not having to walk down the

hall and resell the baby has fed so one

of the difficulties going on in our

country is a very negative image and

presentation of the bed sharing issue

and oversimplified one is being

presented when it's a complex issue bed

sharing is not a discrete little

variable you know either do it or you

don't and it's all the same and you get

the same function in the same outcome

you don't it depends very specifically

on the details of how it's done for

example I'm a mother that smoked during

your pregnancy has injured its baby's

brains to arouse that would not be the

baby to be put into a bed sharing

environment we already know that other

children in bed is a danger to babies we

know for example the putting a baby

prone in any and sleep environment is

dangerous and puts the baby at risk for

SIDS we know that heavy duvets is

dangerous we know that gaps between the

headboard and the mattress or having a

light table to close and creating gaps

into which babies can fall is dangerous

and should be removed

we know this these are adverse factors

these are factors that enormous Lea

increase the threats of a baby dying or

something deleterious happening during

the bed sharing these aren't

imaginations these are practical simple

to understand issues that American

parents are not being told because

someone is making a decision for them

that they simply do not need to know and

that is both unethical and inappropriate

and we need to be taking our attention

or giving our attention to these issues

and demanding from our county agencies

that this information be revealed and be

promoted because it's going to save

lives I have to say that it's been very

interesting watching during the last 20

years participating and watching and

being very proud of how parents are

taking the responsibility on themselves

to find ways to become empowered

when there is a big event in the news

for example that seems to take aim and

gives a very simple explanation why

babies died in a bed sharing environment

and oh by the way what I mean by that is

that yes babies

tragically will die in a bed sharing

environment but they will have died

because they were sleeping prone in the

bed sharing environment or a child that

shouldn't have been in the bed over-over

laid that baby in in bed and or the

mother smoked during a pregnancy and

what we don't usually hear in the news

is what the specific factor is

associated with the death that actually

explains the death as opposed to just

simply the practice bed sharing because

there's an enormous range of differences

between what constitutes a safe bed

sharing environment and a dangerous safe

environment that kind of information I

was alluding to earlier that parents

need to know so we need to conceptualize

what parents are going to need in the

future and why it's important to change

these public health policies we were

mentioning it will not be subject to

cultural nullification as breadth

breastfeeding spreads the absolute

connectedness with the baby sleeping

with the mother and the way the baby's

biology is designed to want to sleep

with the mother and the mother designed

biologically to want to please the baby

who wants to sleep with him that is not

going away and I do think that it's

going to be our responsibility to

further promote the empowerment of

parents to remind them that this is only

their decision to make that medical

authorities and citizens and civil

agents and county officials they are

there to provide all the information

that they need to make the best

decisions for their families and so in

the future but my laboratory will be

doing is trying to promote information

appearance that gives them the

confidence to be able to stand up when

county officials make very vitriolic and

inappropriate comments about the

irresponsibility of parents who bedchair

and I see that tide turning when I see a

big event on the news and you look

at the comments made following an

article on the internet I just sit back

and I go wow parents have really learned

a lot they know what the scientific

counterpoint is to the coroner getting

up and saying five new babies died last

week in Wisconsin and what the parents

will say is will tell me that's very

fine but I want to know was the baby

sleeping prone did the mother smoke were

there other children in the bed because

that's what's explaining the death and

that's a very important sign that the

parents are becoming informed and being

convinced that it's only their choice to

make I like to remind parents to the

only power some of these people have

over us is what we choose to give them

and it's very important for them to know

that they retained that liberty and that

opportunity and privilege to make those

decisions for their children there's one

interesting new bit of news coming out

of the lab we just published a paper in

social science and medicine and we

documented four very specific cases of

mothers different levels of the

socio-economic spectrum who all

compromise and take risks but yet very

carefully gauge the likelihood of the

risks that they do take we're really

seriously injured their babies no

environment necessarily can always be

perfect and it can't because the

resources that women have are unequal

both in terms of education and material

resources but they will always do the

best that they can and there will always

be trade-offs and there will always be

some risks that we take and the

important thing is to realize that you

will always have women and fathers in

these situations and insofar as you're

able to give them all the more

information the kinds of risks that

they're willing to take will be more

educated ones and in fact they will be

the ones that would be much less

significant to the health of their child

so what we tried to do in this paper is

listen to what parents tell us about why

even knowing something could be

potentially dangerous why is it that

they might

that risk and what we find is they very

diligently and very systematically

structure the levels of risks they

perceive but they do it based on the

amount of information they have and when

they have the information they know

where the risks are too great and should

not be overcome like if you smoke during

your pregnancy or if you're drunk or

desensitized by drugs but you would be

shocked at what parents sometimes do not

specifically know but in part I'm not

surprised because so much information is

being held back that should otherwise be

open and widely disseminated in our

population and what our lab tries to do

is keep parents up to date through our

website of WWE in ddu it's a completely

non commercial site we don't get any

money from that site it's all

information it dispenses articles for

free and powerpoints and guidelines and

what every professional should know very

simple material and so it's its purposes

only to create opportunities for parents

to learn and professionals to learn and

the media to learn and to create a

better health environment for mothers

and babies