Crib, not beside mom, safest place for baby to sleep

By Lorrayne Anthony, CP

TORONTO (CP) Many new parents may think their bundle of joy is happiest snuggled between mommy and daddy in the family bed, but Canadian pediatricians say the safest place for baby is in a crib. Babies who sleep in adult beds are more vulnerable to the risks of unexpected death, said Dr. Denis Leduc, one of the authors of recommendations published this week in the journal Paediatrics & Child Health by the Canadian Paediatric Society.

The safest scenario is when the baby is placed in a crib in the parents’ bedroom.

If the crib is in the parents’ room there seems to be an increased safety factor. Preliminary results from a study of cases of sudden infant death syndrome in Quebec between 1991 and 2000 showed that 81 of the 443 cases occurred in sleep environments that were identified as unsafe. These included waterbeds, sofas or recliners, pillows in the bed, or makeshift beds of any kind.

Mothers who smoked during or after pregnancy have a higher risk of having an unexpected infant death, Leduc said, adding the risk increases if the baby shares a bed with the parents.

Another risk is if the mother has consumed alcohol or take sedative medication before sharing a bed with baby.

But one of the most important variables in increasing the risk seems to be a change in sleeping arrangements, Leduc said. He used the example of putting baby to sleep on the tummy for the first time, or bringing a fussy baby into the adult bed when baby usually sleeps in their own crib.

A study published last year in the journal Pediatrics found babies who sleep in adult beds are 40 times more likely to suffocate than those who sleep in standard cribs. The U.S. study looked at reported deaths from 1995 to 1998 and looked at the risks to babies under eight months. The odds of death go up dramatically among babies who use adult beds, Dr. James Kemp, one of the U.S. study’s researchers and an associate professor of pediatrics at Saint Louis University School of Medicine, said in an earlier interview.

Bed-sharing with a baby has been a widely debated issue. While critics have warned against the practice, proponents maintain it’s the best method of bonding and allows for more frequent and longer periods of breastfeeding.

Recognizing that many parents choose to share their bed with their baby, the Canadian Paediatric Society tried to come up with some safety guidelines.

The question is: Do we say never (sleep with a baby in an adult bed), or do we acknowledge that people do it and try to make it as safe as possible? Dr. Sandra Woods, one of the recommendations co-authors, said earlier when the group of pediatricians was trying to draft guidelines. We tried to develop a statement that would say This is how you can do it safely, said Leduc, president-elect of the pediatric Society. We couldn’t do it. No adult bed can be made safe. That’s the problem. But many new moms find sleeping beside baby the only way to ensure the little one gets breast milk whenever they need it.

Mothers who are breastfeeding sleep differently with their babies, said Teresa Pitman, the executive director of La Leche League, Canada. Breastfeeding moms usually sleep facing the baby with their arm over the baby’s head, whereas moms who aren’t breastfeeding tend to sleep with their backs to the baby, she said.

The Quebec numbers did not note whether the babies were breastfed or not.

We do know . . . that breastfeeding protects against SIDS, Leduc said. It’s certainly one thing we don’t want to encroach on to make it less easy for mothers to breastfeed. The recommendations best-case scenario, where baby sleeps in the crib right next to mom, is a good one, Pitman said, as it allows parents to tend to baby’s needs. But she points out what every parent is all too aware of: trying to put baby down after a feed can wake up the little angel, meaning less sleep for the entire household.

Before deciding on a sleep arrangement Pitman urges mothers to research it for themselves and talk to their doctor about minimizing the risk of bed-sharing with the baby.

Canadian Paediatric Society has issued these safety guidelines

• Sleeping with an infant or letting an infant sleep alone on any type of couch, recliner or cushioned chair is dangerous.
• Babies up to one year old should sleep on their backs in cribs meeting Canadian government safety standards.
• Their sleeping area must be free of quilts, comforters, bumper pads, pillows and pillow-like items.
• Having the crib in the parents bedroom is protective against SIDS.
• Infants should not be placed on waterbeds or air mattresses, even for temporary sleeping arrangements.