Parents are often given conflicting information about how to put their newborn to bed – information that can prove lethal, a new study warns.
The American Academy of Pediatrics’ “back to sleep” campaign, started in 1992, has helped limit so-called sudden unexpected infant deaths in older babies, but newborns are still dying too often, according to the study, published Wednesday in The Journal of Pediatrics.
From 1995-2014, there were 8,869 sudden unexpected infant deaths in the United States – nearly a third of them in the first week.
“I don’t think people have recognized the risk of sudden unexpected infant death in early weeks and days of life,” said Joel Bass, the lead researcher on the study and chairman of the department of pediatrics at Newton-Wellesley Hospital outside Boston.
Bass, the father of five, said the safest way for newborns to sleep is alone in a crib with no pillows, bumpers or decorations. And moms should sit up in hard chairs while breastfeeding or hand the baby to dad in the middle of the night to bottle feed with expressed milk or formula, Bass said.
“The danger to the baby is getting their face to a soft surface,” he said.
There’s no disagreement about that.
But some strongly disagree with Bass and the American Academy of Pediatrics that parents shouldn’t share a bed with their child.
James McKenna, a biological anthropologist at Notre Dame University, said his own research suggests that breastfed babies are safest and have the best outcomes if they are allowed to sleep with their parents – what he calls “breastsleeping.”
Lying together helps the baby regulate its heart-rate, metabolism, blood pressure and temperature, he said. “The baby’s habitat is the mother’s body,” he said.
Both parents and child won’t sleep as deeply – but that’s good, said McKenna, who directs the mother-baby behavioral sleep lab at the University of Notre Dame in Indiana. Deep sleep is dangerous for a newborn because it makes it harder for them to regulate their breathing and shift gears to wake up. Shallow sleep keeps parents attentive and less likely to roll over or smother their baby, he said.
Staff can get fired at most hospitals for even mentioning bed sharing, McKenna said, but his research shows that large numbers of parents do it – usually without telling their doctor.
Parents, he said, “have every right to become fully informed” about how to co-sleep safely, by keeping the child away from pillows, blankets and cracks between mattresses and headboards.
Jay Gordon, a pediatrician in private practice in Los Angeles, said he agrees with McKenna that a healthy, full-term baby is safer co-sleeping than sleeping alone.
It’s not realistic to tell mothers they need to sit up to breastfeed, said Gordon, who has been in practice for 40 years and is on the professional advisory board for La Leche League, a breastfeeding advocacy organization. “It makes mothering unpardonably harder when you tell a mother that she can’t rest when the baby rests,” he said.
There is universal agreement that parents who are impaired by drugs or alcohol shouldn’t be sleeping with newborns.
And there’s nothing wrong, Gordon said, with putting the baby in a bassinet or a co-sleeper right next to the bed, where the baby can still benefit from the parents’ steady breathing, and parents are likely to hear if the baby gets into trouble.
Experts also disagree on the issue of pacifiers. Bass says they should be used from Day 1 because they help prevent sudden unexpected infant deaths – a broad category that includes sudden infant death syndrome or SIDS.
But Annie Trostel, a health education specialist at Texas Children’s Hospital, said she recommends a pacifier only once breastfeeding is established to avoid so-called nipple confusion.
In addition to not using a pacifier, other risk factors for SIDS include exposure to cigarettes or tobacco, overheating, premature or low birth-weight and lack of breastfeeding, Trostel said. The baby should be put to sleep in a crib with nothing else in it and should not sleep with parents, she said.
Monique Satpute, a neonatologist at Mount Washington Pediatric Hospital, a non-profit children’s hospital in Baltimore, supports both breastfeeding and plenty of skin-to-skin contact between mother and baby. But she is strongly opposed to co-sleeping, which she says poses a significant risk to babies.
“We definitely don’t recommend it here in the hospital,” Satpute said. “Put the baby in a safe place to sleep, and you get your own rest as well.”