Thoughts on the AAP recommendations
So here’s the actual text of the new AAP policy statement on cosleeping, pacifier use, and SIDS. To be honest, my immediate reaction was that I was glad that my kids are past that stage, so I don’t have two more things to stress about. (We coslept with each of the boys until they were about 6 months old and got too squirmy to be comfortable bed-partners. Both of them used pacifiers minimally but are confirmed finger-suckers.)
I was sort of annoyed by the front-page Washington Post article on it, which seems to blame working mothers for turning to cosleeping because they don’t have enough time to bond with their babies during the day. It does mention improved breastfeeding and bonding as possible benefits of cosleeping, but doesn’t talk at all about the number 1 reason we coslept, which is that I got a LOT more sleep and was a more functional human being.
I just don’t think I would have made it through those first few months if every time they fed, I had to get out of bed, go downstairs, pick up the kid, stay awake while nursing him, soothe him to sleep, and then go back upstairs to try to fall asleep again while calculating in my head how soon I’d have to get up for the day. And we tried the approach that AAP recommends– having the baby sleep in the same room, but in a crib, and it was the worst of both worlds for us. I woke up every time the baby whimpered in his sleep, but he wasn’t soothed by my presence.
Interestingly, Sunday’s Post had a front-page article on the health risks of not getting enough sleep. And the NY Times had an article a couple of weeks ago on a study that found a significant fraction of people with depressive symptoms improved after being treated for sleep apnea. I think people in general, and doctors in particular, wildly underestimate just how overwhelming the lack of sleep in early parenthood can be. It’s something that everyone knows about ("baby keeping you up?"), but people rarely take seriously,
I wish the AAP statement had included data on how much they think their recommendations could reduce the SIDS rate so that parents could make some reasonable assessment of the risk. Following the widespread adoption of the Back to Sleep campaign, the US SIDS rate is 0.52 per 1,000 or around 2,500 deaths per year, about half of what it was before. I’d have a better sense of how to respond to the recommendations if I knew whether they think these recommendations can drop it in half again, or just by a percent or two.
Update: The NY Times has a new article on parents who are putting their babies to sleep on their bellies in spite of the recommendations (because they sleep better that way). It ends with this surprisingly sympathetic quote from Dr. Kattwinkel, chairman of the AAP committee on SIDS:
"There is some justification to mothers who want to accept some of the risk factors and not others," he said. "You can follow all the risk factors and your baby may still die of SIDS. But as a national organization, we need to warn the public about it. Any pediatrician who didn’t would not be responsible."
October 11th, 2005 at 1:49 am
Oh boy does your second sentence resonate with me! Fortunately I feel confident enough from my experiences with #1 to not succumb to pressure either way with #2, but … well, geez louise.
This time around, we’re trying the arm’s reach cosleeper. Crossing my fingers and hoping it lets me get more sleep by having baby be nearby so I don’t have to fully wake up to feed, and yet far enough away that I don’t stay awake all night worrying about rolling over. Last time, we did crib-in-our-bedroom for 8 weeks, and from 8w to 7m I would get up 3-5 times a night to feed him in his room down the hall. It was hell but cosleeping just didn’t work for us.
I think you’re right on about the lack of sleep. Lack of it affects every single aspect of life. A huge portion of the world has gone through it, so you’d think that they’d remember… but then that amnesia hits us all about how bad it *really* was. Even as I wake up 6 or 7 times a night to go to the bathroom at 37w pregnant, I still have to remind myself how much harder it is to get up only 3 times a night to spend an hour feeding a baby.
October 11th, 2005 at 10:42 am
People definitely underestimate what waking up 3 (or more!) times a night to feed an infant does to you both physically and mentally. Plus, as time goes on and the newborn turns 2 months, 3 months, 12 months old, it’s assumed that sleep deprivation is no longer an issue. Untrue! I’d love to see studies that explore sleep deprivation of moms (dads, too) with small kids. I don’t feel I’ve slept through the night in years. I know that’s not entirely true, but the good sleep is irregular and infrequent.
I think I may have had a point here–other than just a rant–but I no longer remember what it is… Ah, the joys of sleep deprivation…
October 11th, 2005 at 11:09 am
The other thing that those “on the back” advocates never really seem to acknowledge is that babies really do want to sleep on their bellies–at least, mine sure did. After trying the back thing a few times and having *no* luck with it, just a crying baby, I gave up and let him sleep on his belly when he wasn’t sleeping with me.
And yeah, he usually slept in the same room, where I could check on him, and when he slept with me I pushed the pillows out of the way and the covers too, but, eh. Not to be cavalier about SIDS, but the reality is that the vast majority of co-sleeping babies do just fine, right?
October 11th, 2005 at 11:19 am
“I think people in general, and doctors in particular, wildly underestimate just how overwhelming the lack of sleep in early parenthood can be.”
no doubt! i’m certain that sleep deprivation was a major factor in my post-partum depression. the first 3 months of my son’s life were hell for me. i did the cosleeping thing with him, but that really didn’t help me get any more sleep until his nursing schedule slowed down at night – at around 3 months. up to that point, he nursed for an hour, about every 2 hours, round the clock. nothing prepared me for that. i was a mess, but i had one huge, fat, happy, healthy baby!
i was also single, and if it weren’t for my mother (we lived with her), i’m pretty sure i would’ve killed myself, my baby, or both. i know that sounds awful but i was in a bad place back then. which just reminds me how lucky i am to have a loving, supportive family. not all single mothers are so lucky.
October 11th, 2005 at 11:23 am
Keep in mind that docs are trained to be idiots about sleep, thanks to med school and the macho bullshit surrounding it. Talk to med students, talk especially to residents (and especially the ones complaining that the new 240h/month work limits cut into their education), and a lot of the time, you’re talking to polite, amazingly repressed, well-educated zombies. The culture they live in says “No sleep? Suck it up, Baby Jane, or head across the street to dental school.”
Also keep in mind that sleep docs don’t talk to baby docs. Different budget lines, dontcha know. You have to leave the connection-making to the morning talk-show hosts.
October 11th, 2005 at 11:40 am
I read through the report, and my problem with it is that there are a range of behaviors, and instead of giving us a ranked list that corresponds to the behavior, and its relation to infant death, they just give a series of authoritarian recommendations. For example, in describing co-sleeping, they mention that studies show increased risk for smokers/and for alcohol use. They mention that the risk is increased for young (<11 weeks, or <8 week) old infants. But, the conclusion is a blanket recommendation against bed sharing. And, in order to uncover that information, you have to parse an academic report, and read through numbers like odds ratios.
I wish the reports could be made in a different structure, one that attributes the weight of evidence & the potential outcomes into the recommendation.
And, I do agree with the other comment here -- which is that they are underestimating the consequences of decreased sleep for the caregiver. Then, people would be able to make decisions about their behavior without dismissing the data, but balancing their own personal needs.
My cosleeping began with the end of my maternity leave, when I needed to be functional during the day. That's how I balanced my decision (including a kind of vague knowledge that the risks were higher for younger infants).
bj
PS: I wonder what decisions breastfeeding pediatric nurses and physicians make about bed-sharing. That would be an interesting statistic.
October 11th, 2005 at 12:49 pm
My husband firmly believes that nuanced messages are just too complicated for public health campaigns, which is why we so often get spoon-fed blanket recommendations. You can’t really develop a catchy phrase (“Back to sleep”) around circumstances (“Cosleeping is okay if you don’t smoke or don’t drink and don’t use blankets or heavy comforters or pillows around the baby”). Successful public health campaigns seem to focus on clear, succinct and – for better or worse – absolute recommendations. I think the AAP would rather go that route than, say, the flop of a new food pyramid which is very pretty with its rainbow colors but too complicated and convoluted for most people to understand at a glance. Better to have an imperfect message that sticks than a perfect one that is too long or hard to understand or remember.
October 11th, 2005 at 1:21 pm
Another stomach sleeping mama here. I think we need to learn to ignore all this “advice” and follow our own instincts. I will go to the grave absolutely mystified as to why other people care so much about how we raise our children — I can barely keep track of what goes on in my own house, never mind the homes of other people.
October 11th, 2005 at 1:26 pm
Yes, yes, yes…I totally agree. I also co-slept very carefully with both kids for about 6-7 months each. There is just no way I could have gotten up 3-4 times a night, gone to the baby’s room, spent 20-40 minutes nursing/changing etc., and gone back to bed and lived through it. And I wasn’t working at all during that time; if I’d had a job, it would have been even more crucial to get some rest. We tried the baby in the crib down the hall routine the first week and the baby wouldn’t sleep, and I nearly dropped her when I dozed off in the glider. We did use the co-sleeper some, but as you said, it was worse than a separate room– the baby wanted to be touching me, and I would wake up at every grunt she/he made.
The statistics I’ve seen on co-sleeping deaths, and I can’t find a link now, indicate that really there’s not so many in the first place (just to say there are other risks that might merit more worry) , and many are from being trapped in the bed frame– which was not an issue with our bed. So I too question how many lives would really be saved if no one co-slept. Certainly my kids were at much higher risk of, say, my having a car accident, or dropping a kitchen knife on them, or letting them roll off the changing table, because I was inattentive from sleeping enough.
I also agree that the problem of lack of sleep is not given enough attention in general, and in mothers (okay, parents, but especially mothers) of young children in particular. I adore my kids, but physically and emotionally it has been very difficult few years for me, and much of that is because I am so exhausted all the time. People say they understand, but until you’ve experienced that kind of fatigue, it’s hard to grasp how sleep deprivation changes your whole outlook.
October 11th, 2005 at 1:31 pm
I remember one day when my girls were about a year old, reading that sleep deprivation is one of the most common torture devices in prisons and interrogations, and thinking, “yes, yes, of course! ” it really is so debilitating. plus no marks, so you can walk around and still look relatively normal…
October 11th, 2005 at 1:54 pm
I was also rather discomforted by the tone of the Post article and the doctors’ advice. I found the tone on cosleeping particularly interesting, because I think there is a general sense in popular culture that people who cosleep are looney hippy types or super-indulgent spoiler parents who can’t ever exercise any discipline over their children. When I started sleeping with my baby (in that desperation to get a moment’s sleep) I was reluctant to tell anyone that she was sleeping in our bed. I actually dissembled to the pediatrician about it. I never intended to cosleep; it just happened. It wasn’t until I started talking to other new moms that I discovered that so many people casually cosleep (i.e., cosleep without an ideological commitment to a family bed). I think this is also reinforced by the enormous number of step-by-step how-to books on sleep. “If you just follow these three or four easy steps, you and your child will be on the road to better sleep!” Reality is never that simple and easy, and you see so many new moms who *aren’t* able to get these sleep programs to work for them and feel like *they* are the ones who have failed. I read a couple of sleep books, found that none of the “typical” baby profiles fit my daughter, tossed them all, and just did my own thing. Sometimes I think we would all be better off if we just stayed the hell away from parenting how-to books.
I think merseydotes, though, is also onto something about the “succinctness” factor of public health notices. When I coslept with my daughter, I definitely felt that I was very aware of her presence. I would often wake up a moment or two before she did–so I think that I would put more credence in the notion that cosleeping moms who don’t smoke, drink, or otherwise sleep very heavily are more aware of their babies’ biorhythms. I was also careful to dress her lightly and keep her clear of the covers and blankets. But that isn’t a quick, easy to remember and process snippet of advice.
Honestly, I think there was a period of time when she just needed to be close to me in that way. By five or six weeks, she could consistently kick off a swaddle, and would scream when I tried to redo it, but she still needed to have comfort and closeness. So she slept next to me, on her back, with my arm draped lightly over her. When she got to be about 12 weeks, she felt asleep one evening when I put her down in the crib (which I had been using mostly as a baby pen), so at that point she started sleeping on her own until the early morning feeding. By the time she was nine or ten months, though, she had decided that our bed was a better place to play than sleep, so cosleeping ended entirely.
I also wish we had been given some sense of how effective each of these new recommendations would be. As you point out, the data on back-sleeping is really striking. So how much difference would not cosleeping (assuming that you don’t have any of the risk factors like smoking, etc.) really make? Or the other thing, which you don’t mention in this post, the introduction of a pacifier? My daughter would never take a pacifier (she always preferred my nipple, sometimes for hours at a time). Does a pacifier really make *that* much difference? Or is it just a slight statistical shift? I think I am glad that this recommendation came out after she is out of the SIDS window, because I think I would have worried about it, even though there was nothing I could do about it…
October 11th, 2005 at 5:50 pm
I tend to think this recommendation is wildly overblown, as our three all slept with us, with no ill effects. We did not go to bed drunk with them, and roll over and crush them. It was as commenters above said far better for nursing, not having to get up, etc. They still (8,7,4) sneak down the hall at 3 in the morning and crawl in next to us sometimes.
One thing we did, and which I recommend, is put a bed rail on my wife’s side of the bed. Our kids slept between her and the rail. Advantages: she and I could cuddle, less crowded, I wasn’t going to roll over and crush the kid, and kid couldn’t fall out of bed.
That said, there was a hideous cop story couple months ago about a cop (in the Carolinas?) who stopped some guy on suspicion, demanded to know what was the powder in an amulet around his neck, refused to accept his explanation, broke it open to sniff it for drugs, and then spilled the powder on the ground. Guy is suing the cop and his department for big money because the powder was his infant daughter’s ashes, and he had killed her by rolling onto her in bed. So it does happen.
October 11th, 2005 at 9:08 pm
I co-slept with both my children, neither of whom would sleep AT ALL unless in physical contact with at least one parent. I didn’t do it out of any ideological conviction, just out of a desperate need to find something — anything — that would allow us to get a minimal amount of sleep. We were careful about blankets, pillows, and covers, and we slept lightly. And the kids — neither of whom would accept a pacifier — were fine.
Obviously my personal experience doesn’t carry the weight of population statistics, but the statistics I’ve seen also seem to suggest that the risk largely involves parents who are obese or impaired by drugs or alcohol. What disturbs me the most about these blanket recommendations is that they get us no closer to really identifying the cause of most of the SIDS deaths. I mean, if a parent *were* to roll over on an infant, the cause of death wouldn’t be SIDS — it would be being crushed by a parent, right? My guess is that a subset of infants are at high risk for SIDS, and the parents of everyone else are being asked to undergo the tortures of sleep deprivation for no real reason.
It would be like making a blanket recommendation that all pregnant women and children under the age of three should avoid eating peanuts in order to reduce the numbers of deaths resulting from an allergy to peanuts. Maybe such a recommendation would be succesful at cutting those deaths, but it would mean that millions of people with no real risk of peanut allergy would be forced to forego a cheap and tasty source of protein. Oh, and the peanut growers lobby would raise holy hell…
Maybe the problem is that there’s no manufacturers’ lobby for breastfeeding and co-sleeping.
Kidding. Mostly.