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Between the Headlines: Cosleeping is Not to Blame

Yesterday, a case-control study looking at SIDS risk factors  was published on BMJ.  Since then, news stories have sprang up across the US with headlines like “WARNING: Co-sleeping With Your Infant Can Kill Them” and “Over Half of Cot Deaths Linked to Cosleeping.”  These headlines are meant to grab your attention–and scare the living fire out of you.  (They worked, didn’t they?)  However, once you take a closer look, you’ll see that these news articles not only are misrepresenting the findings (big shock), they’re kind of missing the point.  (It’s also worthy to note that apparently, the folks in the UK did not have that problem.)

The four-year study (“Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England”) was done by a group of researchers at the University of Bristol.  They took 80 cases of infants who died of SIDS and compared that to 82 high risk infants  and a control group of 87 randomly selected infants.  The purpose of the study was to see if socioeconomic status was linked to the rate of SIDS deaths and whether the factors in SIDS  deaths had changed over time.

Of the 80 SIDS infants, 54% of them had died while cosleeping.  (This right here is the statistic that all the news headlines are grabbing.)  Many of them were cosleeping on a sofa.  There was also an incredibly high amount of drug and alcohol use (31% as opposed to only 3% in the control groups).  Sixty percent of the mothers in the SIDS group smoked.  One fifth of the SIDS infants were  sleeping with pillows when they died.  A quarter (26%) were born prematurely, another quarter in poor health (28%).  That’s a lot of numbers to throw at you, so what does it mean?

It means that there were several risk factors going on with the SIDS cases they studied.  As the researchers said, the high percentage of SIDS deaths while cosleeping could be “explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs” and other risk factors.  Also, they mentioned that the low number of cases could be effecting their findings, and that should be taken into consideration when you’re trying to sort through the numbers. It was never the intention of the researchers to cause a panic over cosleeping in general.  They recommended greater education on safe cosleeping practices, not the elimination of cosleeping altogether.  In their conclusion, they said:

Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk…are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.

And yet… we have news articles stating that “Researchers warn against sleeping with your baby” (hmm, not exactly) and “Co-sleeping is the Key Culprit in Sudden Infant Deaths” (if you’re drunk, high, and sleeping on a couch).   As I’ve said before, why don’t we have headlines warning about the dangers of crib sleeping every time a baby dies in their crib? After every safety recall, why don’t we have headlines like “Cribs: Safe Haven or Dangerous Contraption” or “Your Baby’s Crib Could be a Death Trap”?  In this case, I’d just like to see something a little more accurate.   How about “Ignorance Key Culprit in Sudden Infant Deaths”?    

I have a serious problem with being lumped in with cases like Shianna Sexton in Wales.  Seven month old Shianna died while cosleeping with her incredibly intoxicated mother, Ann-Maria Elsbury.  Her grandmother found her with a blanket over her head, and there seems to be some question as to whether Ann-Maria actually slept on top of the infant or not.  They were sleeping in a single bed.  Ann-Maria was about four times over the drunk driving limit when she took Shianna to bed, and had been smoking not only cigarettes but pot as well.  In the article, Ann-Maria said “I know they say don’t put them in your bed but I always have.”  (Did anyone tell her not to smoke around her children, or do drugs, or care for her children while incredibly intoxicated?) It was also said that there was a need to “point out to mothers in robust terms that sleeping with their children was dangerous.” 

In this case, and so many others that I read about, sharing a bed was just one factor in many that led a baby’s death.  It is horrible, heartbreaking, and could have been prevented–but to compare a situation like that to the families who choose to cosleep in a safe, healthy manner is kind of ridiculous and a little insulting.  I am not stoned out of my mind when I take my baby to bed.  I make sure my bed is a safe environment for the both of us before going to sleep.  I cosleep responsibly, and so do many other families. Pointing to case like Ann-Maria’s and telling me, “See, don’t cosleep with your baby, it’s unsafe!” is like pointing to the woman who left her baby in the car overnight and saying, “Don’t put your baby in the car, it’s dangerous!”    

We need to do everything we can to prevent these deaths.  There needs to be more education about safe sleeping practices (wherever your baby happens to sleep) and ways to reduce the risk of SIDS.  But be sure to take a closer look before you condemn cosleeping altogether.

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Suck This (I Will Breastfeed Wherever I Please)

NursingA few months ago, I went to lunch with a friend of mine.  Predictably, halfway through the meal, J wanted to nurse.  As I settled him down to the task, she made a comment about it weirding her out.  “It’s just food,” I told her.  “No, it isn’t,” she said firmly.

I changed the subject after that, but the comment has stayed with me, along with the many others made by family, friends, and complete strangers. I remember feeling embarrassed, like I should apologize for needing to feed my son in her presence. 

I know I’m not the only one who faces such negative attitudes towards breastfeeding.  Go to any parenting forum, and you’ll find at least one post about some poor mom trying to deal with criticism.  In fact, La Leche League has an entire forum devoted to dealing with criticism.  You’ll find stories of strangers telling breastfeeding moms that it’s “disgusting,” that they’re being “indecent,” husbands pressuring their wives to give it up, family members asking them to leave the room to nurse, and doctors paying lip service to breastfeeding while encouraging the use of formula.  I personally have been asked to take my baby in the bathroom to feed him, told (at the beginning) that I needed to supplement with formula because he wanted to nurse all the time, and told I was spoiling him by feeding him on demand (why is it spoiling a baby to nurse him, but not to give him a bottle?).  My doctor, while being a pretty cool doctor in general, seems unsure about the fact that I’m still breastfeeding, and when J was four months old the people in the WIC office expressed shock that I was “still breastfeeding.”  That’s not counting disapproving looks I frequently receive when nursing in public, even though I am decently covered and try to place myself in the most discrete location so as not to offend anyone. 

It is frustrating and disheartening.  I didn’t start out feeling self-conscious about breastfeeding, but I quickly learned to be.  It’s no wonder that so many moms give up breastfeeding, or don’t try at all.

Despite the Breast is Best campaign, which strives to promote breastfeeding in order to improve general health, the majority of Americans remain fairly uneducated about breastfeeding, and the negative attitudes remain.  Even doctors seem to lack critical knowledge of breastfeeding, which is why we see a lot of instances where supplementing is encouraged.  In one survey, it was found that only 37% of pediatricians encouraged breastfeeding for the first year, and most of them felt that formula feeding was equal to breastfeeding.  The majority of them had not been to any sort of presentation on  breastfeeding for at least three years, and admitted to needing more education about breastfeeding.  Without doctor support, many women not only lack the encouragement they need to breastfeed successfully, but also lack vital information–or in some cases, receive incorrect information.  For example, as I said before, I was told that I needed to supplement in the beginning, but all that would have done is reduce my milk supply.  A lot of women fall into that trap, where they are told to supplement with formula, but then they are not keeping up with baby’s demand, so they have to supplement more and more, and eventually they give up breastfeeding altogether.

The campaign has not been totally ineffective.  Most Americans seem to agree that breastfeeding provides a lot of health benefits for mom and baby, which is an improvement.  Yet many still feel that women should not breastfeed in public and feel grossed out by breastfeeding in general.  It seems that the attitude is Breast is Okay, but Bottle is Better.  I guess I shouldn’t be too surprised.  After all, you can’t turn on the TV or open a magazine without seeing an ad for formula that claims in some way to provide the same benefits as breast milk.  And isn’t bottle feeding easier/more convenient/less embarrassing?  And don’t you have to stop breastfeeding as soon as they get teeth anyway?  The misconceptions abound, fueled by a multi-million dollar ad budget.  (For more on this, there’s a really wonderful blog post  about formula ad campaigns.) 

At the same time, I know a lot of moms who feel pressured to breastfeed and feel like they’re bad moms if they end up bottle feeding for whatever reason. Yet  there’s all this negative feedback about breastfeeding, especially in public.   You really can’t win.  (And just so everyone is clear:  I am not in any way against those who bottle-feed.  My issue is with attitudes towards breastfeeding, not other’s parenting choices.  🙂

I talked to a friend of mine about this, and she said she thought it was more of a modesty thing: that people just don’t want to see something they shouldn’t.  I thought about it, and while that may be true in some cases, I think as a generalization it doesn’t work.  (Besides, I have an issue with the idea that women’s bodies are something that should not be revealed, unless of course you’re at Hooters or an act on America’s Got Talent.)  For one thing, no one seems to have a problem with skimpy bathing suits, and they’re way more revealing than the average woman breastfeeding.  For another, it’s not just actual breastfeeding that freaks people out, but breast milk as well.  There was an article in Parent’s magazine just last month about a lady who was trying to bring home milk she had expressed during vacation.  It was really quite amusing to read about people’s reactions, and yet it got me thinking… why is breast milk, this amazing fluid specifically designed to provide the perfect nutrition for our babies, treated as something gross/weird?  Why do we see so many instances on TV shows/movies where someone inadvertently picks up a bottle of breast milk or, God forbid, drinks it? (I know I’ve seen it on Friends, Look Who’s Talking, Seinfeld.. and I don’t even watch TV!)  I have never seen this happen with formula (and have you *smelled* that stuff?). 

I don’t get it.  I really want to understand, but I just don’t.  Is it that breasts are viewed as  sexual objects in our culture?  Is it simply the lack of education?  The result of formula marketing campaigns?  An extension of sexism?  What, please tell me, so we can fix it. 

When we trust the makers of baby formula more than we do our own ability to nourish our babies, we lose a chance to claim an aspect of our power as women. Thinking that baby formula is as good as breast milk is believing that thirty years of technology is superior to three million years of nature’s evolution. Countless women have regained trust in their bodies through nursing their children, even if they weren’t sure at first that they could do it. It is an act of female power, and I think of it as feminism in its purest form.” —– Christine Northrup M.D.

Coming Out of the Cosleeping Closet (and Why That’s Okay)

That’s right: I cosleep with my baby.  It is not something I do because I’m too lazy or inept to make him sleep on his own, or because I have some unhealthy need to make him overly dependent on me, or because I am simply too stupid to know better.  It was not a “bad habit” that we formed.  It is a conscious decision that I made based on research and what felt right for us.

This is a topic that has come up a lot for me recently.  There’s been discussions with fellow co-sleepers about lying about our sleeping practices, comments from family and friends about how I need to just put him in his own bed, and a couple of blog posts condemning cosleeping as unsafe, unhealthy, and even abusive.  Frankly, I’m sick of it.  I’m tired of constantly explaining my parenting choices.  I’m tired of feeling like I need to hide something that is very rewarding and healthy for my child and I. 

There were two blog posts in particular that inspired my response.  One, which I cannot seem to find again, angrily condemned all cosleeping parents and claimed that the practice is a form of child abuse.  (What, you provide loving care to your infant all night long from the warmth and comfort of your own bed!  What horrible parenting!)  The other is somewhat less offensive, simply stating that the practice is too risky to be beneficial.   It mentions that cosleeping encourages more breastfeeding, helps both mothers and babies get more sleep during the night because wakings are more frequent but shorter, and helps build a strong attachment between mother and baby–all of which he claims are unimportant.  Oh, yes, sleep, nourishment, and attachment are all unimportant to a growing baby. 

Interestingly, both of these posts were written by men.  I have no idea if either one of them have children or not.  Everyone has a right to their own opinion, and I respect that.  However, I would like to take this opportunity to present the other side of the story. 

The number one point that is brought up against cosleeping is that is unsafe. As stated in the above blog, according to the CPSC, there were 515 deaths of children under two that were linked in some way to bedsharing between 1990 and 1997.  So… in seven years, about 500 deaths occurred while cosleeping.   That’s about 70 per year.  Most of the deaths that occur while bedsharing are linked to overly soft bedding, sleeping with more than one child (toddlers are not aware of their movements and can roll on top of an infant), drug or alcohol use, sleeping with someone other than the primary caregiver (ie, the mother), sleeping with someone who smokes, or sleeping on the couch–all of which are discouraged because they are known to be unsafe.  The issue wasn’t that they were cosleeping: the issue was that they were not being smart about it. 

Compare that to the 2600 infants that die each year due to SIDS.  (For a more recent comparison, in the three years between 1999 and 2001, there were 180 infant deaths that occurred while bedsharing.  That’s only 1.5% of the total SIDS deaths.) That’s right, folks, more babies die in their cribs or in child care centers than while sharing a bed.  (In fact, a high percentage of SIDS deaths occur in child care centers.  And we won’t even go into the other injuries and deaths that are reported while in child care settings.)  That’s not even including the number of injuries or non-SIDS related deaths that have occurred while an infant is sleeping alone.  As Dr. James McKenna said in his article published in Pediatric Respiratory Reviews:

Most USA and other western infants die from SIDS or from fatal accidents during solitary sleep outside the supervision of a committed adult. Moreover, the overwhelming number of suspected accidental overlays or fatal accidents occur not within breast feeding bedsharing communities but in urban poverty, where multiple independent SIDS risk factors converge and bottle feeding rather than breast feeding predominates. 

If you want to argue that all cosleeping is unsafe because there is a risk of injury or death, then the argument would logically need to be extended to crib sleeping as well.  How many times do we hear of a crib being recalled because of reported injuries or deaths? My portable crib was recently recalled because there had been over 10,000 reports of the sides collapsing and injuring the infants–and killing several of them.  Of course, that argument won’t be made, because there is a profit to be made by selling cribs.  Isn’t it interesting that one of the main campaigns against co-sleeping (and for crib sleeping, of course) is run by the JPMA?  Let’s see… the JPMA is a group crib manufacturers, right? Who do you think benefits from pushing crib sleeping–oh, perhaps the JPMA? 

I think the problem here is not where the infant was sleeping, but lack of education.  Just as we have learned about the importance of putting babies to sleep on their backs, we need to learn about safe cosleeping practices.   Just as you would a crib, check to make sure there’s no gaps that the baby can fall through or get stuck in.  Sleep on a firm mattress, and skip the heavy blankets and extra pillows. Dress the baby appropriately so s/he doesn’t get overheated.  Don’t cosleep if you are a smoker, are using medications, drink alcohol, or use drugs.  (And this is where I refrain from a well deserved “No shit, Sherlock.”)  Point is, if you follow some simple safety guidelines (and have a little bit of common sense), cosleeping can be done safely.  It was put very well in an article written by Young and Flemming:

“There is no published evidence of any increased risk to a baby from sharing a bed with a firm mattress with parents who do not smoke and have not consumed alcohol or other drugs providing the bedding is arranged so that it cannot slip over the baby’s head, and the baby is not sleeping on a pillow, or under an adult duvet.”
 
Now that I have fully covered the safety issues (some might say, too fully), there’s still the question of why cosleep at all?   There are many benefits to cosleeping for both mother and baby.  For one thing, it encourages breastfeeding, which means more nourishment and also reduced risk of SIDS (since both breastfeeding and night sucking have been linked to reducing the risk of SIDS, hence the AAP’s recommendation to put baby to bed with a pacifier).  In fact, cosleeping infants nurse twice as often and drink three times as much milk as crib sleepers. Parents get at least as much sleep while cosleeping, if not more, because waking periods are more frequent, but shorter.  (As a mom, I know sleep is very important to me.)  Cosleeping babies tend to cry a lot less at night than crib sleepers (actually, J almost never cries at night, and when he does, it’s usually because of an illness or teething).  There’s an increased sense of attachment and a chance to reconnect for working moms.  When babies sleep in the same room as their primary caretakers (which is a form of cosleeping), the risk of SIDS is reduced by 50% (which is why even the AAP recommends that babies sleep in the same room as their parents for the first few months of life).  
 
The benefits of cosleeping last long after the transition to solitary sleeping.  Multiple studies have shown that children who shared a bed with their parents as infants tend to be less fearful, have fewer tantrums, and exhibit more independence than those who were never allowed to share a bed.  Later on in life, it is linked with higher self-esteem, self-confidence, and intimacy, as well as a lower incidence of mental health issues.  While these findings cannot be said to be directly caused by cosleeping (and are probably due to a combination of factors, such as the type of parenting style that tends towards cosleeping), it’s important to note that cosleeping does NOT cause children to be overly dependent, fearful, sexual deviants, or any of the other claims that I have heard about the emotional impact of cosleeping.  In fact, it seems to be that the opposite is true.

 

Besides all of this information, the bottom line is this:  I treasure the time I spend sleeping with my baby, and I wouldn’t miss it for the world.  I take all the necessary safety precautions, and I know that I am caring for my baby in a way that works well for the two of us.  There are some people who do not feel that way, and I would never suggest that they should share a bed with their baby.  (Especially if you fit one of the criteria on the bedsharing no-no list, such as being excessively overweight, smoking, drinking, having sleep disorders, or basically anything that could impair your ability to sleep safely with a wee one.)  I do not want to seem like I am saying that cosleeping is the only way, or even a better way, because it’s not for everyone.  I know several wonderful, loving, attached, kick-ass parents who choose not to bedshare, and this is the right choice for them. 

If you’re looking for more information, here are some amazing resources:

Mother-Baby Sleep Laboratory

The Natural Child Project

Attachment Parenting International

Mothering Magazine

 

Happy sleeping, everyone.

Boo for the Boob Tube

Before you can ask, let me tell you:  No, the boy does not want to watch TV.

Yesterday, I took on a new housecleaning client.  I was pretty excited because not only was Mr. Man okay with me bringing the boy, but there would be a toddler friend for him to play with.  That means not only a new playmate for J, but also no baby proofing necessary.  Neat.

Within five minutes of me arriving, the roommate began to repeatedly ask me if I would like her to turn on some cartoons for J. She kept making comments  about it (in her fake french accent mixed with baby talk, which is a whole ‘nother rant) and offering to put in a movie for him.  I was like, “He’s not even one.  He doesn’t watch TV.”

It wasn’t until the two year old came home that I began to understand why the roommate was so determined that J would need to watch TV.  As soon as the girl walked in the house, the TVs came on.  That’s right, plural.  The TV in the livingroom was turned on to Dora, the kitchen TV was something Nickelodeon, and in her bedroom was a constant stream of Disney movies. 

Let me repeat.  The TV in her bedroom.  

Is it just me, or is it just a  little ridiculous that a two year old has a TV (and DVD player) in her room?  Even more ridiculous is the four hours she spent in there, laying on the floor with her bottle, watching that TV.  Her bookshelves in her room are stacked high with movies, not books.  During lunch, her high chair was moved to sit in front of the livingroom TV.  I don’t think there was a moment that little girl wasn’t plugged in.

Now, I admit, I am pretty anti-TV in general, and always have been.  I don’t even understand adults that have a TV in every room, so I guess the kid/TV thing is a little beyond me.  Growing up, I remember watching a couple of shows (Garfield and the Smurfs, namely), but overall I chose to play outside or in my room over watching television.  As an adult, I find myself irritated by most of what’s on TV–and don’t even get me started on commercials.  I do enjoy vegging out once in a while and I love watching movies, but overall, I would just rather it stay off.

But when it comes to kids–especially my kid–I’m more than just a little anti-TV, I’m downright adamant.  There’s too much information out there on the negative impact TV watching has on kids, especially for kids under three.  It has been linked not only to increased aggression and obesity, but also to problems with attention and memory.  According an article I read, a study done by the University of Washington showed that three year olds who watched two hours of television a day had a 20%  increase in attention problems later on, and that chance goes up 10% for every hour watched.  That’s a pretty big deal, especially when you think about the increase in the number of children being diagnosed with ADD, learning disabilities, and behavior problems.  There’s even some question as to whether watching television has a negative impact on toddler’s  language and speech development.  It’s no wonder the American Academy of Pediatrics strongly discourages any TV viewing for children under two.

“But it’s educational.”  While I have to agree that somehow, watching Sesame Street or Dora the Explorer has got to be better than a kid watching something like Power Rangers (is that even a show?  What is on these days?) or adult-themed shows, I think the basic point is that there’s so much more a toddler can be doing with their time.  What happened to playing blocks, going to the park, reading books?  They learn by interacting with their world (and the people in it), and I don’t think they can do that while glued to a TV show.  Even just having it on “for background noise” not only provides them with way too much of the wrong kind of stimulation, it also teaches them that they must some sort of noise going on all the time.  (And this bags the question of whether or not children under three are even capable of learning from what they watch on TV.  While educational programs have shown some benefit for preschool aged children, there seems to be a general consensus that children under three do not learn from TV.)

Before you get mad at me, I am not saying that if you let your kids watch TV, you’re a horrible parent.  I understand that sometimes, zoning out to a TV show is the perfect way to unwind.  Sometimes popping in a movie not only brings you a few minutes of much-needed peace, but it can be a family event that brings you closer  as well.  I am just saying that people need to be smart about their kid’s TV habits, and be  aware of the impact it can have on their development.  Balance TV time with other activities.

And for Pete’s sake, keep the TV out of their bedroom.