By Robert LeVine and Sarah LeVine
Parents everywhere tend to think that the way they raise their children is the best way, and Americans are no exception. Contemporary American parents seek to optimize their children’s lives, treat them as equals, and reduce their risk of harm to zero; anything less may seem negligent. Yet many of the practices Americans hold as sacred are quite rare in other countries — and the burdens Americans place on themselves are often unwarranted. One of the major challenges in the first year of parenting, any new mom or dad can tell you, is training a child to sleep. American middle-class parents routinely put their infants to sleep in a separate bed or a separate room, on the assumption that there might be serious risks to having the baby next to them. This is largely due to expert advice: The American Academy of Pediatrics advises against parent-child co-sleeping, or “bed-sharing,” citing safety concerns from accidental suffocation or falls. Doctors worry that tired — or intoxicated — parents will roll onto their infants in the middle of the night without realizing it. Putting babies in cribs or cots in a separate room is also customary in Britain, Germany and other parts of Western Europe.
"In most of the rest of the world...parents think it’s downright cruel to put a baby in a separate room or even a separate bed. Who would be so heartless?"
In most of the rest of the world, however, parent-child co-sleeping is well-established, as we have found in our studies in Africa (Nigeria, Kenya and Zambia), Asia (Nepal, India) and Latin America (Mexico, Colombia) and as other anthropologists have reported from other sites in those areas. Indeed, many parents think it’s downright cruel to have a baby sleep alone. Who would do such a heartless thing? Of course non-Western countries tend to have higher infant mortality rates, but there’s no reason to think that has anything to do with co-sleeping.
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. There’s reason to believe that co-sleeping isn’t just safe, but also beneficial. The biological anthropologist James McKenna, who has investigated mother-child co-sleeping at his Mother-Baby Sleep Laboratory at the University of Notre Dame, has provided detailed evidence of the physiological synchronization between mother and infant when they sleep together, especially when the mother also breastfeeds responsively. He considers this arrangement optimal and calls it “breastsleeping.” When we asked mothers of the Gusii tribe in Kenya, where co-sleeping is common, whether their babies slept through the night, they didn’t know what we were talking about — why should babies wake up? When we compare Gusii and American mothers, it is the Americans who seem to make infant care more complicated and difficult by putting their infant to sleep in a separate room, setting the stage for sleep disruption due to infant crying. American parents may also worry that sharing a bed increases a child’s dependence on his parents, yet Japanese children appear to be just as mature and independent as American children.
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.”
To the editor: As Executive Director of Inter-Agency Council on Abuse and Neglect (ICAN), I am compelled to respond to the recent Times Op-Ed of September 18, 2016 titled "It's OK to sleep next to your infant child. In fact, it's beneficial.” Any child death is a tragedy, especially a preventable one. The ICAN Child Death Review Team has seen countless preventable deaths involving infants sleeping in adult beds with parents and, in some cases, siblings. These infants have died needlessly. Alarmed at seeing a high yearly trend of 69 infant deaths due to infants sharing a bed with adults or placed in unsafe sleep circumstances, ICAN and First 5LA conducted a public safety campaign. In 2014, we saw the fruits of this campaign, the number of these deaths fell to 35. Unfortunately, they still represent over half of the undetermined child deaths in Los Angeles County. Rather than promoting bed-sharing/co-sleeping, we need to continue to educate parents on the deadly risk they are taking. The profound heartbreak of losing a child profoundly outweighs any benefits of co-sleeping with an infant. ICAN encourages breastfeeding and room-sharing with an infant, but it is never safe to sleep in the same bed with an infant. No parent should have to wake up to a tragedy.
Deanne Tilton Durfee Executive Director L.A. County Inter-Agency Council on Child Abuse and Neglect Chairperson National Center on Child Fatality Review
To the editor: The risks of sharing your bed with your infant are not “imaginary,” contrary to the opinion expressed by Robert LeVine and Sarah LeVine. An adult bed poses very real risks of sudden infant death syndrome (SIDS), unintentional suffocation, strangulation or entrapment to an infant. Sleep-related infant deaths claim more babies between 1 month and 1 year of age than any other cause. ( “It’s more than OK to sleep next to your infant,” Opinion, Sept. 18) Multiple studies bear this out. That’s why the American Academy of Pediatrics advises against bed-sharing. The safest place for an infant to sleep is in a separate crib or bassinet with a tight-fitting sheet and nothing else, preferably in the parents’ bedroom for up to a year.
Benard Dreyer, MD, Elk Grove Village, Ill. The writer is president of the American Academy of Pediatrics.
To the editor: The opinion piece cites the work of James McKenna, who suggests that bed-sharing is not dangerous, but even beneficial. This goes against official recommendations of the AAP, which have been comprehensively researched, and which recommend room-sharing, but not bed-sharing. That is, babies should sleep in the same room as parents, but not on the same sleeping surface (bed). This article gives dangerous advice, which may increase the number of babies dying of SIDS, suffocation or asphyxiation.
Thomas G. Keens, MD, Los Angeles The writer is chair of the California SIDS Advisory Council.
To the editor: As a pediatrician and public health professional, I am deeply troubled by this opinion piece. The AAP and the National Institutes of Health offer expert guidance that bed-sharing is in fact a significant risk factor for accidental suffocation, sudden unexpected infant death (SUID) and SIDS. I do not think this risk is adequately reflected in the opinion. Aside from the risk of accidental layover by the parent, bed-sharing also introduces blankets and pillows, which further increases the risk of accidental infant suffocation. Parents need to understand that this practice is not risk free. It is also erroneous to equate the infant sleep environment in Japan (typically a firm mat or futon bedding) with the U.S. (fluffy mattresses, pillows and blankets).
David L. Nunez, MD Seal Beach The writer is the Maternal Child and Adolescent Health Medical Director, Orange County
To the editor: As a board-certified forensic pathologist and medical examiner practicing in Florida, I am dismayed by the op-ed advocating bed-sharing with infants. I have performed multiple autopsies on infants who were co-sleeping with their parents or siblings. Many times, these infants end up face down, wedged into soft bedding or the cushions of a couch, or between the mattress and the wall, just to name a few situations. Rollovers can also be a cause of asphyxia. The risks are not to be underestimated.
Kelly Devers, MD, Tampa, Fla.