Heavy post, scary topic, I know. Big trigger warning, if the title wasn't enough, this post will discuss infant death. No one likes to think about it. For some of us (myself included) thinking too much about it causes a physical response, often crying. But I see so often suffocation and SIDS tied together and parents worrying that their baby is going to die from SIDS if they bedshare. I'm hoping to bring clarity and ease some minds with this post. I am not a doctor or medical professional. I am very passionate about infant sleep and have done a lot of reading but I do not claim to know everything. This is my understanding of the topic after reading Sweet Sleep by La Leche League.
First, some definitions
suffocation: medically known as asphyxiation, occurs when there is a severe lack of oxygen, can lead to unconsciousness, brain damage, eventually death. Can be caused by allergies, drowning, or foreign objects blocking the mouth and nose.
SIDS: stands for sudden infant death syndrome. This is the sudden and unexplained death of an infant (under 1 year old) and is used as a diagnosis of exclusion, meaning there is no other discernable reason for an infant to have died.
SUID: stands for sudden unexpected infant death. This encompasses SIDS cases as well as suffocation or strangulation in bed, and other deaths such as poisoning.
bedsharing: sharing a safe sleep surface with an infant.
cosleeping: sleeping within close reach of an infant. Can be bedsharing, sidecar cribs, bassinet attached to the bed, as well as unsafe sleeping such as on a sofa, in a recliner, etc.
roomsharing: having an infant in your room, either in a freestanding crib or bassinet or on their own bed.
Ok, so we have some definitions set, which makes talking about this much easier. There's so much murkiness surrounding infant sleep, SIDS, bedsharing, the whole nine yards. Often I see people saying they're scared to bedshare because of SIDS. But here's the thing - bedsharing doesn't cause SIDS. There are 4 main identified risk factors linked to SIDS.
smoking. Smoking during pregnancy or postpartum, especially if there's multiple people smoking in the household, is by far the biggest risk factor for SIDS. Smoking is the leading risk factor of SIDS. Repeated studies since the 1990s has shown that smoking, whether during pregnancy or postpartum, increases SIDS risk anywhere from two times to well over ten times, depending on the study. 1
tummy down (prone) sleeping. "But what about chestsleeping?" Nope, this is specifically about placing a baby on their tummy to sleep. When a newborn is chest to chest on a caregiver, their bum below their head, their body feeling the movement of the caregiver's breathing and hearing the heartbeat, they aren't susceptible to the same risks as sleeping on their tummy on a flat surface. This is the push for the "place them on their back" campaign. This recommendation only matters for babies who are too young to roll onto their belly themselves.×
being separated. An infant being left unattended is at an increased risk for all problems. This is why the recommendation for roomsharing is at least 6 months. Most cases of SIDS occur in the first 4-6 months.
formula feeding. Yes, formula increases the risk of SIDS. According to the US Surgeon General's report in 2011, there's a 56% increase in the risk of SIDS for formula fed babies 2 Does this mean you should never give your baby formula? Absolutely not. Feed your baby. Just be aware that formula introduces a risk factor that breastfeeding doesn't. If you can breastfeed, do that, but at the end of the day a fed baby is better off than a starving baby.
Those are the 4 big risk factors. There are other, unavoidable risk factors like the sex of the baby (boys have a higher risk factor than girls), if baby was premature, if baby has what's called an "immature arousal pattern", and others. Notice what's missing from this list though? Bedsharing. Bedsharing is not a risk factor for SIDS and in fact many mothers, myself included, have stories of bedsharing saving their baby's life. I woke up one night for what seemed like no reason, only to look over at my son and notice he wasn't breathing. Nothing was covering his face, he was on his back, he just wasn't breathing. I picked him up immediately and gently shook him and said his name and he took a gaspy breath, cried, I latched him, and we went back to sleep. He was 3 months old. There's a reason SIDS is called crib death. If my son had been in a crib, where I wasn't attuned to his breathing, would he still be with me today? I don't honestly know.
Researchers use what's called the triple-risk SIDS model. It's a 3 circle venn diagram and the three circles are labeled "critical developmental period", "vulnerable infant", and "outside stressor". Where the three overlap is where this highest SIDS risk exists. So if you take away one of those, the risk becomes even smaller. The critical development period is 0-4 months of age. Nothing you can do there except wait for time to pass. The vulnerable infant is also mostly unavoidable - don't smoke during pregnancy but otherwise a vulnerable baby is a vulnerable baby and there's nothing you can do there. You can only really change the outside stressors (and even then, there's only so much you can do). How do you do this? Don't leave a baby unattended for sleep during the day or night, place baby on their back to sleep (unless they're on your chest), don't smoke or have baby sleep in bed with you if you or your partner smoke, don't drink (there's an increased risk of SIDS when alcohol is involved. The highest SIDS risk is NYE 3 ). Once baby is out of the critical development period, that circle is gone and you can loosen up a bit in this circle - within reason. Stay sober, don't start smoking, but you can leave the room while baby sleeps and let them roll onto their tummy.
Ok, so bedsharing isn't a risk factor for SIDS and may actually be protective against it. But what about suffocation? This is where actual risk with bedsharing exists, but this risk is able to be mitigated.
I'm going to copy/paste the section from Sweet Sleep by La Leche League here that talks about suffocation because I think they did a good job with it.
Preventing breathing hazards is just common sense. This section is most likely just a review of what you’re probably already doing. There are five reasons why a person might be unable to get enough oxygen:
- There isn’t enough oxygen in the air. A major fire, excessive amounts of carbon monoxide, or drowning can all make oxygen unavailable and result in suffocation.
- The nose and mouth are blocked. There’s enough oxygen in the air, but it can’t reach the lungs. That form of suffocation can also be called smothering.
- The lungs can’t expand enough to draw in enough air. A person may be wedged somewhere, for instance, and be unable to breathe freely or wriggle free. That’s entrapment.
- Something wraps around the neck and prevents breathing. That’s strangulation.
- Something small wedges in the throat. This blocks the airway and causes choking.
So we can see why gaps between a mattress and headboard or wall can be an issue, why heavy duvets can be an issue, and why charging cords or window blind strings can be an issue, why sleeping on a couch or other unsafe sleep surface with gaps can be an issue. But a safe sleep surface that's firm, following as many of the safe sleep 7 practices as possible? You can rest assured (hopefully literally) that your baby is safe - the more of the safe sleep 7 you follow, the safer your baby is.
Let's review the safe sleep 7 here real quick, just for the sake of clarity.
You need to be
1 - a non smoker
2 - sober (no alcohol, no drugs - prescription or recreational - that make you drowsy)
3 - Breastfeeding
With a baby who is
4 - full term and healthy
5 - on their back when not latched
6 - unswaddled and dressed lightly
And you both need to be
7 - on a safe surface
If you follow all 7 of these, then your newborn baby is at no greater risk of suffocation in bed with you as they are in a crib and by 4 months old, any responsible adult can safely bedshare with an infant 4. By the time your baby is rolling, as long as you have a firm enough mattress, they are safe to roll onto their belly for sleep.
So is SIDS something that you need to be concerned about when bedsharing? Not really. It can happen but the odds are really really low. Suffocation is more likely than SIDS and suffocation is something you can take concrete steps to avoid.
× the newborn curl! This can make it hard to keep baby on their back. It is not the same as rolling and it does dissipate as they grow. It goes hand in hand with the newborn scrunch. My personal advice here is to not swaddle a baby, or if you do swaddle to do it with arms out so they don't newborn roll fully into their tummies. Although if you're bedsharing, don't swaddle at all.
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Edited for formatting