The debate
A separate room or bed for the baby is an unknown luxury in many developing countries, where financial hardship excludes this possibility. But in developed countries, the issue has been hotly debated.

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Many doctors remain passionately opposed to the idea of sharing a bed with your baby for a host of reasons. Many say that it's dangerous and that it has, in some cases, led to sudden infant death syndrome (SIDS).

Dr Chris Idzikowski, director of the Edinburgh Sleep Centre, says that although he believes co-sleeping is generally a safe exercise, each situation is different. "A couple of studies have shown negative effects of co-sleeping, but it has also been noted that these 'negative' effects are culturally dependant. What's viewed as a problem in one society is not viewed as a problem in another society."

The argument for co-sleeping
Idzikowski says that the benefits of sharing a bed with your child would include the opportunity to bond with the child and breastfeed in bed at night.

According to the World Health Organization's paper titled Evidence for the Ten Steps to Successful Breastfeeding, children who are breastfed in bed by their mothers while co-sleeping may actually be protected against SIDS.

The research states that "Routinely co-sleeping infants breastfeed three times longer during the night than routinely solitary sleeping infants, suggesting that co-sleeping promotes breastfeeding. The authors also suggested that, by increasing breastfeeding, co-sleeping might protect against SIDS."

Another positive reason for co-sleeping noted in the paper is that "infants in nurseries cry more and their caregivers do not respond as often as mothers who are in the same room. Thus infants, whether breastfed or not, should be in the room with their mothers, throughout the 24 hours, unless there is an unavoidable medical reason why they should be cared for in a nursery."

How does this affect the parent?
"From the sleep laboratory perspective, the least disturbed sleep for any individual at any age is to sleep alone. However, there is no evidence that sleep disturbed by co-sleeping has any adverse effect," Idzikowski says.

He adds that one of the primary benefits of such sleeping arrangements is the emotional bonding between mother and child.

"There are alternative ideas for parents to have their children close to them during the night, the most common of which is keeping the crib beside the bed," he says.

However, he adds that, "co-sleeping when the mother or father have consumed alcohol or drugs, are over-tired or are sleeping in a confined space such as on sofas – which have been shown to increase the risk of infant death nearly fifty-fold - are risk factors for SIDS."

More benefits of co-sleeping
According to Attachment Parenting International (API) the following are some of the benefits of co-sleeping:

• The proximity to the mother may help the infant's nervous system learn to self-regulate during sleep;
• It could prevent SIDS by preventing the infant from entering into a sleep too deep to wake from;
• Parents' own breathing rhythms may help the child to 'remember' to breathe;
• Both parent and infant sleep better, since the infant does not have to wake fully to cry and get a response (since the mother is so close). As a result of this, mothers tend to sleep better and wake less fully;
• Babies get more attention and more breastfeeding takes place – so not only is the infant fed more, the sucking act also increases the flow of oxygen which is better for growth and immune function;
• Studies show mothers who co-sleep are five times more protective – i.e. by fixing the blanket, stroking, and cuddling – which also leads to an increased sensitivity to the child's presence in the bed.

Guidelines for safe co-sleeping
However, all the researchers who are pro co-sleeping are of the same opinion that guidelines need to be followed and that parents need to be educated to ensure their child's safety. These guidelines include:

• Always placing the baby on its back to sleep;
• The baby should always sleep next to the mother, not in-between the mother and father;
• Precautions should be taken to stop the child rolling out of the bed;
• A parent should not share a bed with an infant if the parent is under the influence of alcohol, drugs or sleep-inducing tablets, or if the parents are sleep-deprived;
• Don't allow babysitters or older siblings to sleep with the baby;
• Don't fall asleep with the baby on a couch, beanbag chair or waterbed;
• Don't let the baby sleep unattended on an adult bed;
• Don't overly bundle the baby as they get additional warmth from the mother's body and overheating can cause problems;
• Mothers with long hair should tie it up to prevent it tangling around the baby's neck.

The four prime hazards of co-sleeping include:

• Suffocation caused by an adult rolling on top of or next to the baby;
• Suffocation when an infant gets trapped or wedged between a mattress or headboard, nightstand or wall;
• Suffocation resulting from a baby being face down on a waterbed, regular mattress or on soft bedding such as pillows, blankets or sofas;
• Strangulation in a headboard or foot board that allows part of the baby's body to pass through the area while trapping its head.

When it's time to stop co-sleeping
According to Kidshealth.org, many medical experts agree that it's important to speak to your doctor when you feel it's time to move your baby out of your bed and into its own crib.

This should be done when the baby is about six months old - i.e. before the co-sleeping pattern becomes a habit and other issues, such as separation anxiety, come into play.

Sources:
- Dr Chris Idzikowski, director of the Edinburgh Sleep Centre
- World Health Organisation (www.who.int/nutrition/publications/evidence_ten_step_eng.pdf)
- Kidshealth.org (www.kidshealth.org)
- Attachment Parenting International (www.attachmentparenting.org)

- (Amy Henderson, Health24.com, November 2007)

Read more:
ABC of breastfeeding
Handy tips for successful breastfeeding
 

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