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Co-Sleeping Safety Studies



 
 
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Old August 31st 04, 01:04 AM
Joshua Levy
external usenet poster
 
Posts: n/a
Default Co-Sleeping Safety Studies

|
Co-Sleeping Safety Data (Update 4: Aug 2004)

This is a annotated bibliography covering the safety of co-sleeping
with
infants. I have included EVERY study, which I can find an on-line
abstract
(or the entire paper is on line) in English, which meets the following
criteria:
1. The research was published in 2000 or later.
2. The research was peer reviewed.
3. The research focused on actual death rates (not suspected causes
or
mechanisms).
4. The research compared death rates for co-sleepers vs.
non-co-sleepers.
5. The research was done in developed (not third world) countries.
This bibliography does NOT include editorials, opinion pieces, or
letters to
the editor. The main sources for these abstracts are PubMed, SCIRUS,
and web
archives of medical journals. If you find any other studies, please
tell me,
so I can add them.


Summary: of the ten studies found, eight found co-sleeping to be more
dangerous
than cot sleeping, and two studies found no added danger from
co-sleeping. No
study found co-sleeping safer than cot sleeping. Not one. Some of
the studies
focused on SIDS, some focused on suffocation, some covered both. The
two largest
studies (one in the US the other in Europe) both found co-sleeping
more dangerous.

Quotes from the Research:

"The most conservative estimate showed that the risk of
suffocation increased by 20-fold when infants were placed to sleep in
adult
beds rather than in cribs. The public should be clearly informed of
the
attendant risks." [SCHE03]

"Almost all SIDS deaths in Alaska occurred in association with prone
sleeping,
bed sharing, or sleeping outside a crib." [GESS01]

"bed sharing showed an increased risk of dying accidentally, when
compared
with infants sleeping in designated infant containers" [BEAL00]

"RESULTS: In a multivariate analysis, co-sleeping significantly
increased the risk of SIDS both as a usual practice (adjusted
OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period
(adjusted OR 16.47; 95% CI 3.73 to 72.75)." [MCGA03]

"Bed-sharing appears to increase the proportion of unexplained deaths,
regardless of the position of the infant." [THOG00]

The Papers:

[BEAL00]
Sudden infant death syndrome in South Australia 1968-97. Part 3: is
bed sharing
safe for infants?
Beal SM, Byard RW
J Paediatr Child Health 2000 Dec 36:552-4
http://reviews.bmn.com/medline/searc...9&refer=scirus
"bed sharing showed an increased risk of dying accidentally, when
compared
with infants sleeping in designated infant containers"

[CARP04]
Sudden unexplained infant death in 20 regions in Europe: case control
study
R G Carpenter, L M Irgens, P S Blair, P D England, P Fleming, J Huber,
G Jorch, P Schreuder
Lancet 2004; 363: 185-91
http://www.thelancet.com
"For mothers who did not smoke during pregnancy, OR for
bed-sharing was
very small (at 2 weeks 2·4 [1·2-4·6]) and only significant during
the
first 8 weeks of life."
One way to phrase this in a one sentence headline is:
Co-sleeping with children under 2 months old was a significant
risk factor for SIDS.

[CARR01]
Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at
Death
Cindie Carroll-Pankhurst and Edward A. Mortimer Jr
PEDIATRICS Vol. 107 No. 3 March 2001, pp. 530-536
http://pediatrics.aappublications.or...ode=pediatrics
"By demonstrating that among an urban population at high risk for
SIDS,
bedsharing is strongly associated with a younger age at death,
independent
of any other factors, this study provides evidence of a
relationship
between some SIDS-like deaths and parent-infant bedsharing,
particularly
if the parent is large."

[FERN03]
Sleep Environment and the Risk of Sudden Infant Death Syndrome in an
Urban
Population: The Chicago Infant Mortality Study
Fern R. Hauck, Stanislaw M. Herman, Mark Donovan, Solomon Iyasu,
Cathryn Merrick
Moore, Edmund Donoghue, Robert H. Kirschner, and Marian Willinger
Pediatrics 2003; 111: 1207-1214
http://pediatrics.aappublications.or.../111/5/S1/1207
"Several factors related to the sleep environment during last
sleep were
associated with higher risk of SIDS: ... bed sharing overall (OR:
2.7;
95% CI: 1.8–4.2), bed sharing with parent(s) alone (OR: 1.9; 95%
CI:
1.2–3.1), and bed sharing in other combinations (OR: 5.4; 95% CI:
2.8–10.2)"

[GESS01]
Association between sudden infant death syndrome and prone sleep
position,
bed sharing, and sleeping outside an infant crib in Alaska.
Gessner BD, Ives GC, Perham-Hester KA.
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
"Almost all SIDS deaths in Alaska occurred in association with
prone
sleeping, bed sharing, or sleeping outside a crib."

[IYAS03]
Risk factors for sudden infant death syndrome among northern plains
Indians.
Iyasu S, Randall LL, Welty TK, Hsia J, Kinney HC, Mandell F, McClain
M, Randall
B, Habbe D, Wilson H, Willinger M. JAMA. 2002 Dec 4;288(21):2717-23.
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Found that infants who died were more likely to co-sleep (59.4%
vs.
55.4%), but this relation was not statistically significant.

[MCGA03]
Factors relating to the infant's last sleep environment in sudden
infant
death syndrome in the Republic of Ireland.
McGarvey C, McDonnell M, Chong A, O'Regan M, Matthews T.
Arch Dis Child. 2003 Dec;88(12):1058-64.
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14670769
"RESULTS: In a multivariate analysis, co-sleeping significantly
increased the risk of SIDS both as a usual practice (adjusted
OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period
(adjusted OR 16.47; 95% CI 3.73 to 72.75). ... CONCLUSION:
Co-sleeping should be avoided in infants who are 20 weeks of
age"

[SCHE03]
Where Should Infants Sleep? A Comparison of Risk for Suffocation of
Infants Sleeping in Cribs,
Adult Beds, and Other Sleeping Locations
N. J. Scheers, PhD, George W. Rutherford, MS and James S. Kemp, MD
PEDIATRICS Vol. 112 No. 4 October 2003, pp. 883-889
http://pediatrics.aappublications.or...ode=pediatrics
"Reported deaths of infants who suffocated on sleep surfaces other
than those designed for infants are increasing. The most
conservative
estimate showed that the risk of suffocation increased by 20-fold
when
infants were placed to sleep in adult beds rather than in cribs.
The
public should be clearly informed of the attendant risks."

[THOG00]
Sleep position and bed-sharing in sudden infant deaths: An examination
of
autopsy findings
Jon R. Thogmartin MD, Charles F. Siebert, Jr MD and William A. Pellan
AS
From Palm Beach County Medical Examiner Office, West Palm Beach,
Florida.
http://www.sciencedirect.com/science...f85336bdc6f88d
The Journal of Pediatrics Volume 138, Issue 2 , February 2001, Pages
212-217
"Bed-sharing appears to increase the proportion of unexplained
deaths,
regardless of the position of the infant."

[WILL03]
Are risk factors for sudden infant death syndrome different at night?
Williams SM, Mitchell EA, Taylor BJ.
Department of Preventive and Social Medicine, Dunedin School of
Medicine,
University of Otago, New Zealand.
Arch Dis Child. 2002 Oct;87(4):274-8.
"The interactions between time of death and bed sharing, not
sleeping
in a cot or bassinet, ... [several other factors] were also
significant,
or almost so."

Papers Not Listed

[ARNE01]
Changes in the epidemiological pattern of sudden infant death syndrome
in southeast
Norway, 1984-1998: implications for future prevention and research.
Arnestad M, Andersen M, Vege A , Rognum TO
Arch Dis Child 2001 Aug 85:108-15
"For SIDS victims, an increase in the number of infants found dead
while
co-sleeping is seen"
This paper was not included above because it was unclear if the quote
was due
to the popularity of co-sleeping, or if the rate of death was
increasing.

[WILL01]
Scott Med J. 2001 Apr;46(2):43-7.
Sudden unexpected infant deaths in Dundee, 1882-1891: overlying or
SIDS?
Williams FL, Lang GA, Mage DT.
"It might be prudent to inform parents that co-sleeping is a risk
factor
for SIDS and that it should therefore be avoided."
Although this study technically fulfills all the requirements, it's
focus on
deaths over 100 years ago caused me not to list it above.

[MUKA99]
Leg Med (Tokyo). 1999 Sep;1(1):18-24.
Sleeping environments as risk factors of sudden infant death syndrome
in Japan.
Mukai T, Tamaki N, Sato Y, Ohno Y, Miyazaki T, Nagamori H, Hara S,
Endo T.
Department of Forensic Medicine, Tokyo Medical University, 160-8402,
Tokyo,
Japan
"In addition, the co-sleeping habit, which was not uncommon in
Japan, seems
to contribute to certain deaths of infants whose causes of death
were
controversial. In the investigation of SIDS, therefore, the
sleeping
environments, such as bedclothes and the co-sleeping habit, as
well as
the sleeping position should be taken into consideration as risk
factors."
This study was published one year before my cut-off, so it is not
included
above. However because many people claim data from Japan shows the
safety of
co-sleeping, including it here.

Complaints About These Papers

Some people claim that co-sleeping deaths are very rare, and that the
benefits
of co-sleeping more than make up for the dangers. The first part
(rarity)
is clearly wrong. SIDS is the #3 cause of infant deaths (under 1 year
old)
according to CDC data. All types of accidents are the #7.

The American CDC keeps count of deaths from specific causes:
124 - Motor vehicle accidents
380 - Accidental suffocation and strangulation in bed
2035 - Sudden infant death syndrome
All data is from http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf
mostly from page 24, and the pages just before and after. Data is
from the table titled "Infant deaths and infant mortality rates for
130 selected causes: United States, final 2001 and preliminary 2002".

For a snapshot of one county:
"The Marion County, Indiana Fatality Review Team reports that
unsafe
sleeping conditions contributed to the deaths of 57 infants from
1996-1999. In 1998, more infants died in Marion Country from bed
sharing than from not being protected in a child car safety
seat."
This quote is from pedtalk 07 Oct 2002."

As for the second part (relative benefits), that is a personal value
judgement,
but for me, nothing is worse than the death of a child.

As for specific complaints:

1. The most common complaint about these studies is that they did not
cover
"safe co-sleeping", but rather reported data from all co-sleepers. So
people
claim that they follow "safe co-sleeping guidelines" so the research
does not
apply to them.

The first thing to remember is that no one follows safe-sleeping
guidelines,
because there are none, or rather: there are dozens, all different!
And
none of them have been found to work. There is not a single study
anywhere
that I found which reported the same risk of death while "safe"
co-sleeping
(under any set of rules) as compared to crib sleeping. None.

The second thing to remember is that, for a public health issue (like
co-sleeping), measuring the death rate for the whole population IS the
right
thing to do. The question of the safety of co-sleeping is one of the
safety for the whole population, not little groups of it.

2. Some co-sleeping proponents will complain that a study mixed up
SIDS deaths
with suffocation deaths. This argument turns into a two-step dance
like this:
when presented with a study showing co-sleeping leads to higher SIDS
death rates they say "but the study confuses SIDS and suffocation" so
it's worthless. When presented with a study showing co-sleeping leads
to higher suffocation death rates they say "but the study confuses
suffocation with SIDS" so it's worthless. In fact, it doesn't matter.
A baby who dies of SIDS is just as dead as one who dies of
suffocation.
Some of the studies listed above examined all night time deaths
[IYAS03, THOG00], some covered SIDS only [CARR01, GESS01], others
covered suffocation only [SCHE03]. All found the same result: higher
death rates for co-sleeping children.

3. Another argument sometimes heard is "but co-sleeping is natural, so
it must be safe, people co-slept for thousands of years, and still
do in many part of the world". This is not really a complant about
the studies, but an alternate argument that they must somehow be
flawed. But this argument itself is deeply flawed, the thousands
of years that people co-slept also had infant death rates much higher
than we have now! In many places and times, HALF the babies died,
a death rate that would never be acceptable now. Similarly, the
places
in the world today where co-sleeping is very popular often have
infant mortality rates far higher than the US. Indeed, this whole
argument can be phrased as an anti-cosleeping one: people in
[Primative
Society] co-sleep as a matter of course, and have a much higher death
rate than US babies, who don't. Or, ten thousand years ago, everyone
co-sleep, and the infant death rate was over 100 times higher than it
is now.



Some Famous Papers That Didn't Make It (and Why)

The McKenna papers are very popular on AP and co-sleeping web sites,
but none are included for two reasons: they are all way too old, and
none of them measured actualy death rates in children. Really! These
papers which supposedly justify co-sleeping as an anti-SIDS method
NEVER studied babies who died of SIDS!

A more serious problem with McKenna's work is that it was based on
a discredited theory of SIDS. The modern view of McKenna work is
that is shows a serious problem with co-sleeping. That co-sleeping
infants are under stress. For example:

[HUNS02]
The sleep of co-sleeping infants when they are not co-sleeping:
evidence
that co-sleeping is stressful
Hunsley M, Thoman EB Dev Psychobiol. 2002
Jan;40(1):14-22.
http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
"Each of these differences indicates a markedly lower arousal
level in the long-term co-sleeping infants. This sleep pattern
has been repeatedly found to be an indicator of stress. We infer
that a major source of stress for these infants is the experience
of sleep disturbance documented for infants when they were
co-sleeping.
Based on extensive evidence for long-term effects of early
stress, we
conclude that co-sleeping should have significant implications
for
infants' neurobehavioral development."

The famous 1999 study by the Consumer Product Safty Commission (a US
government department responsible for regulating cribs and beds) is
not
included here because it was published one year before the cut off.
It found
serious risk associated with co-sleeping, just as all the studies here
did.

Many people ask about Dr. Sears's research, but I can not find a
single
peer-reviewed paper ever published by Dr. Sears. I have looked at
some of
his web pages, and although they often state that co-sleeping is
protective of
SIDS, the papers he cites are typically very old (mid 1980s to 1990s).
He
cites papers my McKenna and others in the same lab: Moska, and
Richard, which
did not study infants with SIDS at all.

Some people talk about a study published in the Sept/Oct issue of
Mothering
Magazine, entitled "How the Stats Really Stack Up: Cosleeping Is Twice
As Safe". This article was an opinion piece; it did not report on
original
research, and was not peer reviewed. Basically, it took the 1999
Consumer
Product Safety Commission's report, and then ignored about 2/3 of the
deaths in adult beds, while counting all of the deaths in cribs, and
then
it reinterpreted the data, in order to find a conclusion opposite from
the conclusion of the people who actually did the study. (Mothering
magazine
covers lots of quack medical theories with regular articles on
vaccenes
causing autism, HIV not causing AIDS, AZT not helping babies, and
"Debunking
Fluoride" and so on.)



Other web pages I've seen have vague references to "New Zealand
studies" or
"British studies", which are not specific enough to track down. I
suspect
they refer to very old research, but it is impossible to tell.

General Background Information

Odds ratios (OR) are a way of measuring extra risk. An equally risky
activity would have an OR of 1.0 Something three times as dangerous
would have an OR of 3.0. For various reasons, odds ratios of less
than 2.0 are not usually considered significant.

For comparison, the OR for getting lung cancer if you smoke is 20.0.
  #2  
Old August 31st 04, 08:14 AM
john
external usenet poster
 
Posts: n/a
Default

we found having a baby bed beside our bed was the answer, then you don't
have to get out of bed to breastfeed. It seems age related, the deaths. My
kids would still like to bed share at 10 years.

"I'm reminded of a debate the famous pediatrician Robert Mendelsohn, MD had
with a psychiatrist. The panellist asked them about the Family Bed
(everyone sleeping together). "It's a terrible idea," said the psychiatrist.
"I'd never sleep with my children. It fosters dependency, it confuses them
sexually, it's just plain wrong." The moderator asked if Dr. Mendelsohn
would care to respond. "I agree with the psychiatrist," said Dr. Mendelsohn.
"Psychiatrists should not sleep with their children. But for everyone else,
it's just wonderful. I gives infants the warmth and security they seek. It
enhances emotional health and it brings the family closer."--Ted Koren DC


"Joshua Levy" wrote in message
om...
|
Co-Sleeping Safety Data (Update 4: Aug 2004)

This is a annotated bibliography covering the safety of co-sleeping
with
infants. I have included EVERY study, which I can find an on-line
abstract
(or the entire paper is on line) in English, which meets the following
criteria:
1. The research was published in 2000 or later.
2. The research was peer reviewed.
3. The research focused on actual death rates (not suspected causes
or
mechanisms).
4. The research compared death rates for co-sleepers vs.
non-co-sleepers.
5. The research was done in developed (not third world) countries.
This bibliography does NOT include editorials, opinion pieces, or
letters to
the editor. The main sources for these abstracts are PubMed, SCIRUS,
and web
archives of medical journals. If you find any other studies, please
tell me,
so I can add them.


Summary: of the ten studies found, eight found co-sleeping to be more
dangerous
than cot sleeping, and two studies found no added danger from
co-sleeping. No
study found co-sleeping safer than cot sleeping. Not one. Some of
the studies
focused on SIDS, some focused on suffocation, some covered both. The
two largest
studies (one in the US the other in Europe) both found co-sleeping
more dangerous.

Quotes from the Research:

"The most conservative estimate showed that the risk of
suffocation increased by 20-fold when infants were placed to sleep in
adult
beds rather than in cribs. The public should be clearly informed of
the
attendant risks." [SCHE03]

"Almost all SIDS deaths in Alaska occurred in association with prone
sleeping,
bed sharing, or sleeping outside a crib." [GESS01]

"bed sharing showed an increased risk of dying accidentally, when
compared
with infants sleeping in designated infant containers" [BEAL00]

"RESULTS: In a multivariate analysis, co-sleeping significantly
increased the risk of SIDS both as a usual practice (adjusted
OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period
(adjusted OR 16.47; 95% CI 3.73 to 72.75)." [MCGA03]

"Bed-sharing appears to increase the proportion of unexplained deaths,
regardless of the position of the infant." [THOG00]

The Papers:

[BEAL00]
Sudden infant death syndrome in South Australia 1968-97. Part 3: is
bed sharing
safe for infants?
Beal SM, Byard RW
J Paediatr Child Health 2000 Dec 36:552-4

http://reviews.bmn.com/medline/searc...9&refer=scirus
"bed sharing showed an increased risk of dying accidentally, when
compared
with infants sleeping in designated infant containers"

[CARP04]
Sudden unexplained infant death in 20 regions in Europe: case control
study
R G Carpenter, L M Irgens, P S Blair, P D England, P Fleming, J Huber,
G Jorch, P Schreuder
Lancet 2004; 363: 185-91
http://www.thelancet.com
"For mothers who did not smoke during pregnancy, OR for
bed-sharing was
very small (at 2 weeks 2·4 [1·2-4·6]) and only significant during
the
first 8 weeks of life."
One way to phrase this in a one sentence headline is:
Co-sleeping with children under 2 months old was a significant
risk factor for SIDS.

[CARR01]
Sudden Infant Death Syndrome, Bedsharing, Parental Weight, and Age at
Death
Cindie Carroll-Pankhurst and Edward A. Mortimer Jr
PEDIATRICS Vol. 107 No. 3 March 2001, pp. 530-536

http://pediatrics.aappublications.or...ode=pediatrics
"By demonstrating that among an urban population at high risk for
SIDS,
bedsharing is strongly associated with a younger age at death,
independent
of any other factors, this study provides evidence of a
relationship
between some SIDS-like deaths and parent-infant bedsharing,
particularly
if the parent is large."

[FERN03]
Sleep Environment and the Risk of Sudden Infant Death Syndrome in an
Urban
Population: The Chicago Infant Mortality Study
Fern R. Hauck, Stanislaw M. Herman, Mark Donovan, Solomon Iyasu,
Cathryn Merrick
Moore, Edmund Donoghue, Robert H. Kirschner, and Marian Willinger
Pediatrics 2003; 111: 1207-1214
http://pediatrics.aappublications.or.../111/5/S1/1207
"Several factors related to the sleep environment during last
sleep were
associated with higher risk of SIDS: ... bed sharing overall (OR:
2.7;
95% CI: 1.8-4.2), bed sharing with parent(s) alone (OR: 1.9; 95%
CI:
1.2-3.1), and bed sharing in other combinations (OR: 5.4; 95% CI:
2.8-10.2)"

[GESS01]
Association between sudden infant death syndrome and prone sleep
position,
bed sharing, and sleeping outside an infant crib in Alaska.
Gessner BD, Ives GC, Perham-Hester KA.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
"Almost all SIDS deaths in Alaska occurred in association with
prone
sleeping, bed sharing, or sleeping outside a crib."

[IYAS03]
Risk factors for sudden infant death syndrome among northern plains
Indians.
Iyasu S, Randall LL, Welty TK, Hsia J, Kinney HC, Mandell F, McClain
M, Randall
B, Habbe D, Wilson H, Willinger M. JAMA. 2002 Dec 4;288(21):2717-23.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Found that infants who died were more likely to co-sleep (59.4%
vs.
55.4%), but this relation was not statistically significant.

[MCGA03]
Factors relating to the infant's last sleep environment in sudden
infant
death syndrome in the Republic of Ireland.
McGarvey C, McDonnell M, Chong A, O'Regan M, Matthews T.
Arch Dis Child. 2003 Dec;88(12):1058-64.

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14670769
"RESULTS: In a multivariate analysis, co-sleeping significantly
increased the risk of SIDS both as a usual practice (adjusted
OR 4.31; 95% CI 1.07 to 17.37) and during the last sleep period
(adjusted OR 16.47; 95% CI 3.73 to 72.75). ... CONCLUSION:
Co-sleeping should be avoided in infants who are 20 weeks of
age"

[SCHE03]
Where Should Infants Sleep? A Comparison of Risk for Suffocation of
Infants Sleeping in Cribs,
Adult Beds, and Other Sleeping Locations
N. J. Scheers, PhD, George W. Rutherford, MS and James S. Kemp, MD
PEDIATRICS Vol. 112 No. 4 October 2003, pp. 883-889

http://pediatrics.aappublications.or...ode=pediatrics
"Reported deaths of infants who suffocated on sleep surfaces other
than those designed for infants are increasing. The most
conservative
estimate showed that the risk of suffocation increased by 20-fold
when
infants were placed to sleep in adult beds rather than in cribs.
The
public should be clearly informed of the attendant risks."

[THOG00]
Sleep position and bed-sharing in sudden infant deaths: An examination
of
autopsy findings
Jon R. Thogmartin MD, Charles F. Siebert, Jr MD and William A. Pellan
AS
From Palm Beach County Medical Examiner Office, West Palm Beach,
Florida.

http://www.sciencedirect.com/science...f85336bdc6f88d
The Journal of Pediatrics Volume 138, Issue 2 , February 2001, Pages
212-217
"Bed-sharing appears to increase the proportion of unexplained
deaths,
regardless of the position of the infant."

[WILL03]
Are risk factors for sudden infant death syndrome different at night?
Williams SM, Mitchell EA, Taylor BJ.
Department of Preventive and Social Medicine, Dunedin School of
Medicine,
University of Otago, New Zealand.
Arch Dis Child. 2002 Oct;87(4):274-8.
"The interactions between time of death and bed sharing, not
sleeping
in a cot or bassinet, ... [several other factors] were also
significant,
or almost so."

Papers Not Listed

[ARNE01]
Changes in the epidemiological pattern of sudden infant death syndrome
in southeast
Norway, 1984-1998: implications for future prevention and research.
Arnestad M, Andersen M, Vege A , Rognum TO
Arch Dis Child 2001 Aug 85:108-15
"For SIDS victims, an increase in the number of infants found dead
while
co-sleeping is seen"
This paper was not included above because it was unclear if the quote
was due
to the popularity of co-sleeping, or if the rate of death was
increasing.

[WILL01]
Scott Med J. 2001 Apr;46(2):43-7.
Sudden unexpected infant deaths in Dundee, 1882-1891: overlying or
SIDS?
Williams FL, Lang GA, Mage DT.
"It might be prudent to inform parents that co-sleeping is a risk
factor
for SIDS and that it should therefore be avoided."
Although this study technically fulfills all the requirements, it's
focus on
deaths over 100 years ago caused me not to list it above.

[MUKA99]
Leg Med (Tokyo). 1999 Sep;1(1):18-24.
Sleeping environments as risk factors of sudden infant death syndrome
in Japan.
Mukai T, Tamaki N, Sato Y, Ohno Y, Miyazaki T, Nagamori H, Hara S,
Endo T.
Department of Forensic Medicine, Tokyo Medical University, 160-8402,
Tokyo,
Japan
"In addition, the co-sleeping habit, which was not uncommon in
Japan, seems
to contribute to certain deaths of infants whose causes of death
were
controversial. In the investigation of SIDS, therefore, the
sleeping
environments, such as bedclothes and the co-sleeping habit, as
well as
the sleeping position should be taken into consideration as risk
factors."
This study was published one year before my cut-off, so it is not
included
above. However because many people claim data from Japan shows the
safety of
co-sleeping, including it here.

Complaints About These Papers

Some people claim that co-sleeping deaths are very rare, and that the
benefits
of co-sleeping more than make up for the dangers. The first part
(rarity)
is clearly wrong. SIDS is the #3 cause of infant deaths (under 1 year
old)
according to CDC data. All types of accidents are the #7.

The American CDC keeps count of deaths from specific causes:
124 - Motor vehicle accidents
380 - Accidental suffocation and strangulation in bed
2035 - Sudden infant death syndrome
All data is from http://www.cdc.gov/nchs/data/nvsr/nvsr52/nvsr52_13.pdf
mostly from page 24, and the pages just before and after. Data is
from the table titled "Infant deaths and infant mortality rates for
130 selected causes: United States, final 2001 and preliminary 2002".

For a snapshot of one county:
"The Marion County, Indiana Fatality Review Team reports that
unsafe
sleeping conditions contributed to the deaths of 57 infants from
1996-1999. In 1998, more infants died in Marion Country from bed
sharing than from not being protected in a child car safety
seat."
This quote is from pedtalk 07 Oct 2002."

As for the second part (relative benefits), that is a personal value
judgement,
but for me, nothing is worse than the death of a child.

As for specific complaints:

1. The most common complaint about these studies is that they did not
cover
"safe co-sleeping", but rather reported data from all co-sleepers. So
people
claim that they follow "safe co-sleeping guidelines" so the research
does not
apply to them.

The first thing to remember is that no one follows safe-sleeping
guidelines,
because there are none, or rather: there are dozens, all different!
And
none of them have been found to work. There is not a single study
anywhere
that I found which reported the same risk of death while "safe"
co-sleeping
(under any set of rules) as compared to crib sleeping. None.

The second thing to remember is that, for a public health issue (like
co-sleeping), measuring the death rate for the whole population IS the
right
thing to do. The question of the safety of co-sleeping is one of the
safety for the whole population, not little groups of it.

2. Some co-sleeping proponents will complain that a study mixed up
SIDS deaths
with suffocation deaths. This argument turns into a two-step dance
like this:
when presented with a study showing co-sleeping leads to higher SIDS
death rates they say "but the study confuses SIDS and suffocation" so
it's worthless. When presented with a study showing co-sleeping leads
to higher suffocation death rates they say "but the study confuses
suffocation with SIDS" so it's worthless. In fact, it doesn't matter.
A baby who dies of SIDS is just as dead as one who dies of
suffocation.
Some of the studies listed above examined all night time deaths
[IYAS03, THOG00], some covered SIDS only [CARR01, GESS01], others
covered suffocation only [SCHE03]. All found the same result: higher
death rates for co-sleeping children.

3. Another argument sometimes heard is "but co-sleeping is natural, so
it must be safe, people co-slept for thousands of years, and still
do in many part of the world". This is not really a complant about
the studies, but an alternate argument that they must somehow be
flawed. But this argument itself is deeply flawed, the thousands
of years that people co-slept also had infant death rates much higher
than we have now! In many places and times, HALF the babies died,
a death rate that would never be acceptable now. Similarly, the
places
in the world today where co-sleeping is very popular often have
infant mortality rates far higher than the US. Indeed, this whole
argument can be phrased as an anti-cosleeping one: people in
[Primative
Society] co-sleep as a matter of course, and have a much higher death
rate than US babies, who don't. Or, ten thousand years ago, everyone
co-sleep, and the infant death rate was over 100 times higher than it
is now.



Some Famous Papers That Didn't Make It (and Why)

The McKenna papers are very popular on AP and co-sleeping web sites,
but none are included for two reasons: they are all way too old, and
none of them measured actualy death rates in children. Really! These
papers which supposedly justify co-sleeping as an anti-SIDS method
NEVER studied babies who died of SIDS!

A more serious problem with McKenna's work is that it was based on
a discredited theory of SIDS. The modern view of McKenna work is
that is shows a serious problem with co-sleeping. That co-sleeping
infants are under stress. For example:

[HUNS02]
The sleep of co-sleeping infants when they are not co-sleeping:
evidence
that co-sleeping is stressful
Hunsley M, Thoman EB Dev Psychobiol. 2002
Jan;40(1):14-22.

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
"Each of these differences indicates a markedly lower arousal
level in the long-term co-sleeping infants. This sleep pattern
has been repeatedly found to be an indicator of stress. We infer
that a major source of stress for these infants is the experience
of sleep disturbance documented for infants when they were
co-sleeping.
Based on extensive evidence for long-term effects of early
stress, we
conclude that co-sleeping should have significant implications
for
infants' neurobehavioral development."

The famous 1999 study by the Consumer Product Safty Commission (a US
government department responsible for regulating cribs and beds) is
not
included here because it was published one year before the cut off.
It found
serious risk associated with co-sleeping, just as all the studies here
did.

Many people ask about Dr. Sears's research, but I can not find a
single
peer-reviewed paper ever published by Dr. Sears. I have looked at
some of
his web pages, and although they often state that co-sleeping is
protective of
SIDS, the papers he cites are typically very old (mid 1980s to 1990s).
He
cites papers my McKenna and others in the same lab: Moska, and
Richard, which
did not study infants with SIDS at all.

Some people talk about a study published in the Sept/Oct issue of
Mothering
Magazine, entitled "How the Stats Really Stack Up: Cosleeping Is Twice
As Safe". This article was an opinion piece; it did not report on
original
research, and was not peer reviewed. Basically, it took the 1999
Consumer
Product Safety Commission's report, and then ignored about 2/3 of the
deaths in adult beds, while counting all of the deaths in cribs, and
then
it reinterpreted the data, in order to find a conclusion opposite from
the conclusion of the people who actually did the study. (Mothering
magazine
covers lots of quack medical theories with regular articles on
vaccenes
causing autism, HIV not causing AIDS, AZT not helping babies, and
"Debunking
Fluoride" and so on.)



Other web pages I've seen have vague references to "New Zealand
studies" or
"British studies", which are not specific enough to track down. I
suspect
they refer to very old research, but it is impossible to tell.

General Background Information

Odds ratios (OR) are a way of measuring extra risk. An equally risky
activity would have an OR of 1.0 Something three times as dangerous
would have an OR of 3.0. For various reasons, odds ratios of less
than 2.0 are not usually considered significant.

For comparison, the OR for getting lung cancer if you smoke is 20.0.



 




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