eLetters to:

ARTICLE: N. J. Scheers, George W. Rutherford, and James S. Kemp Where Should Infants Sleep? A Comparison of Risk for Suffocation of Infants Sleeping in Cribs, Adult Beds, and Other Sleeping Locations Pediatrics 2003; 112: 883-889 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

eLetters published:

Bedsharing and breastfeeding

Sarah J Husband   (6 October 2003)

Re: Bedsharing and breastfeeding

C. Jeanean Slamen   (7 October 2003)

Co-sleeping benefits outweigh risks

Anna V Young   (8 October 2003)

Author's response

James S. kemp   (9 October 2003)

Bed Sharing or not?

Krystyna E Henderson   (13 October 2003)

Concerns about Infant Sleep Article

Jennifer L Feltwell, Stephanie Fulton, Thomas L. Wilding, and Frances Groen   (16 October 2003)

Safety is the issue, not where a child sleeps.

Nancy Volkers   (6 January 2004)

Bedsharing and breastfeeding 6 October 2003
Sarah J Husband, Mother of 4 week old infant None Send letter to journal: Re: Bedsharing and breastfeeding sarah{at}andastar.demon.co.uk Sarah J Husband	Dear sirs, As a breastfeeding mother, i have found that all the information that I have read on bedsharing makes a total distinction between whether the mother is breast or bottle feeding. Only breastfeeding infants are recommended to share the mother's bed as bottle feeding mothers have been found to treat the infant as another adult in the bed and turn their backs on them in their sleep (amongst other things). Have you been able to determine the SIDs rate between bottle feeding and breast feeding infants? Have you been able to determine the SIDS rate between those deaths where the parents have followed all the guidelines (UNICEF) and those where they haven't? Surely this is more important to parents to enable them to make a properly informed choice of place to sleep their infant? Sarah Husband, UK housewife and mother to 4 week old Megan who are both enjoying breastfeeding and bedsharing.
Re: Bedsharing and breastfeeding 7 October 2003
C. Jeanean Slamen, former breastfeeding mother Send letter to journal: Re: Re: Bedsharing and breastfeeding jslamen{at}pdq.net C. Jeanean Slamen	I'm always alarmed when raw data for suffocation deaths is lumped for statistical analysis. I did not (yet) purchase the full article online -- - I've read only the abstract. As a mother who breastfed both children in a family bed situation 16 and 18 years ago, I am discouraged that no analysis was made of breastfeeding vs. bottlefeeding in the data collected. Breastfeeding mothers are highly aware of the baby's positioning and safety during the night, as opposed to what I believe the awareness level is of non- breastfeeding parents. In earlier published data collection on "family bed" suffocations, I also recall that drug- or alcohol-impaired adult presence in the bed with infants has a high correlation with suffocation or other injurious outcomes. Even crib-sleeping babies who are "safer" from suffocation can still be endangered and accidentally killed by impaired parents... Ignoring this data is not responsible when formulating statements on the safety of babies. When trumpeting these statistical analyses to the popular press (where I became aware of them)as proof of the dangers of family bed situations (the common arrangement in most of the world), you could also mention the possible contributing factors that weren't considered. Jeanean Slamen Houston, Texas
Co-sleeping benefits outweigh risks 8 October 2003
Anna V Young, Mother none Send letter to journal: Re: Co-sleeping benefits outweigh risks avjyoung{at}shaw.ca Anna V Young	This study fails to mention some important facts. The study looks only at babies who died of suffocation and does not include those who died of SIDS (ie death from no known reason). In the US in 1997 (one of the years in the study), 50 infants died from crib suffocation, compared with 2705 who died from SIDS, mostly alone in cribs. A substantial body of research shows that co-sleeping dramatically reduces the risk of SIDS in infants. If those 2705 babies had been sleeping close to a responsible caregiver, far fewer of them would have died. Cribs are not safe substitutes for caregivers. The study also makes the assumption that babies who died in adult beds did so during the night while adults were sleeping in the bed with them. The conclusion makes it clear that the risk of suffocation increased when infants were "placed to sleep on adult beds". No mention of the close presence of a responsible caregiver. A US Consumer Product Safety Commission review of infant suffocation deaths in the US from 1980 to 1999 found that 92 % of babies died while alone. Most of these deaths happened when the baby became stuck or got something pressed against the face or neck. The majority of these deaths could have been prevented by following co-sleeping guidelines issued by many organisations. Media articles about the study state that 25.5 per 100,000 babies in the United States died sleeping in adult beds, compared to 0.63 per 100,000 deaths among babies sleeping in cribs. If figures for SIDS are added in, 34.1 per 100,000 deaths occurred among babies in cribs. So , if you take SIDS into consideration and the fact that many suffocation deaths could have been prevented, the figures are very different. In percentage terms, 0.0341% of deaths occurred in cribs and 0.0255% occurred in adult beds (the majority of which could have been prevented). These percentages hardly justify the alarmist comments made by the author of the study, nor his conclusions that babies are safer in cribs. Dr Kemp obviously holds strong views on the subject of co-sleeping and has allowed his feelings to influence this study, which looks at a very small part of the whole picture. The study may have achieved its objectives, but it has done nothing to achieve the larger objective of reducing infant death. Anna Young, Victoria, BC Canada
Author's response 9 October 2003
James S. kemp, associate professor of pediatrics Saint Louis University School of Medicine Send letter to journal: Re: Author's response kempj{at}slu.edu James S. kemp	I stand by our research in the Oct. 6 issue of Pediatrics that shows babies who share beds with their parents are as much as 40 times more likely to suffocate compared to babies who sleep in cribs. It had been my hope that parents could use the hard statistical data that demonstrates the riskiness of bedsharing to make decisions to keep their babies safe. In our Western culture, adults sleep on beds that have soft pillows and plush bedding. While these beds are comfortable for adults, they are unsafe for babies. In other parts of the world, adults sleep on surfaces without soft covers and fluffy pillows. These sleep surfaces may be safe for babies, although data substantiating this are rare. The beds that most of the Western world sleep on are not. Parents who choose to bring their infants into their cushy adult beds need to know they are taking an unnecessary risk, then assess their actions. In addition, I know of no data that say that babies taken to bed to breast feed are somehow safer than those taken to bed and bottle fed. There are several reports of babies taken to bed solely to breast feed who have died suddenly and unexpectedly. Some parents might prefer to remain ignorant that sharing a bed with their infant can have life-threatening consequences. They characterize the idea that co-sleeping is hazardous as an "urban myth." They dismiss the statistics that show the dangers of bed-sharing as alarmist. Our research was an objective study that quantified the number of babies who suffocated in adult beds, compared to those who suffocated in cribs. The research was not designed to scare parents. Rather, the research should empower parents. I feel certain that the vast majority of parents would rather have information to do everything within their power to nurture their infants and demonstrate the ultimate parental bonding. The safest place for a baby to sleep is in a crib. James S. Kemp Associate professor of pediatrics, Saint Louis University School of Medicine Director of Sleep Disorders program, SSM Cardinal Glennon Children's Hospital
Bed Sharing or not? 13 October 2003
Krystyna E Henderson, breastfeeding cousellor La Leche League Great Britian Send letter to journal: Re: Bed Sharing or not? llgb{at}wsds.co.uk Krystyna E Henderson	In addition to the queries already brough up by previous respondants, I would like to query the 'responsibility' of any care-givers (if, indeed the babies were placed in adult beds with care-givers,rather than in adult beds on their own). It has already been shown that infants who bed-share with adults who smoke, drink heavily or take recreational drugs are more likely to die. This new study does not appear to take into account such data. Without a more detailed explanation of the data that has been used for such studies there is a serious likelyhood that parents are given misleading information. Parents have a right to make informed choices about how to care for their children, but informed choice can only take place when all variables have been accounted for before results are released to the press.
Concerns about Infant Sleep Article 16 October 2003
Jennifer L Feltwell, RN, Mother None, Stephanie Fulton, Thomas L. Wilding, and Frances Groen Send letter to journal: Re: Concerns about Infant Sleep Article feltwellfamily{at}yahoo.com Jennifer L Feltwell, et al.	As the mother of three beautiful girls I can fully understand your concern about infant suffocation and see why you recommended the crib as the safest place for infants. On the other hand, it seems you need to recognize your own biases in favor of cribs and against co-sleeping. If you were not so, then you would more carefully seperate the many variables and risks associated with co-sleeping as mentioned by earlier respondents and also recommend ways to make co-sleeping more safe rather than not an option at all. You give no recognition at all to the important benefits of bonding, breastfeeding and better sleep that many parents enjoy through co-sleeping. A more careful study and more thoughtful recommendations would be the best way to empower parents to keep their children safe and do what is right for their individual family. We co-slept with each of our daughters for the first two years of their lives and cannot imagine having to put them into a crib instead of snuggling and nursing with them for all those nights. There are many things in life that have inherent risk, but as with most things, it cannot always be all or none. We have to minimize the risks and decide what is right for our family. Please help us to minimize the risk, but not our options. Thank you.
Safety is the issue, not where a child sleeps. 6 January 2004
Nancy Volkers, medical writer Send letter to journal: Re: Safety is the issue, not where a child sleeps. ourhouse{at}bayserve.net Nancy Volkers	Dr. Kemp: If soft pillows and plush bedding are the culprits, rather than adult beds per se, than perhaps that is what should be communicated. Instead, your study concludes that sleeping in any adult bed is not safe for a child. That is akin to saying that riding in a car is not safe for a child, therefore no child should ride in a car, without mentioning that the situation can be made much safer by using a car seat and proper restraints. Children can sleep safely in adult beds if pillows and soft bedding are kept away from the child's face, and if their parents are alcohol- and drug-free. (I am not going to address the many benefits of cosleeping vs crib-sleeping, but parents do consider both benefits AND risks when making decisions about where their child sleeps -- just as people weigh risks and benefits in other situations.) How many of the children who died in adult beds were left alone in them, and how many were sleeping with their parent or parents at the time? Had any of the parents been drinking or taking narcotics? This information would be a valuable addition to your research, as would an inclusion of estimates on the reduction in SIDS deaths due to cosleeping. I agree with previous letters: there will always be risk. Just because there have been reports of infants dying suddenly during breastfeeding in an adult bed does not mean I should stop breastfeeding my daughter in our bed. People drop dead while exercising and no one encourages us not to exercise! Parents would be better served by being educated on the safest ways to put their children to sleep, whether they choose to cosleep or use a crib.