Kim Mulford, The (Cherry Hill, N.J.) Courier-Post
When Nicole Nimchuk first started sleeping with her baby, she didn't talk about it. She had gone back to work when he was 6 weeks old, and tucking her little boy next to her at night made breastfeeding easier.
Eight years later, she's doing the same with her second son, even though she has heard the safe-sleep recommendations: Put baby to sleep on his back, in his own crib or bassinet in the same room as his mother, with no other soft bedding or stuffed animals near him. She follows the recommendations, except for the part about putting her 1-year-old in his own crib.
STORY: Despite risk, more infants sharing beds
These days, she is open about her family's sleeping arrangements. She knows many other moms in her holistic mothers' group who do it, too.
"I agree there have to be some safety precautions, but I think moms have been sleeping next to their babies for millions of years," said Nimchuk, a 31-year-old Pennsauken, N.J., Web designer who now works from home.
It's a controversial practice.
In the United States, the percentage of infants sleeping with an adult or sibling has doubled since 1993, according to government figures. Nearly 14 percent of the nearly 19,000 adults surveyed in 2010 said their infants usually shared a bed, either with parents or another child, instead of sleeping alone in a crib. Bed-sharing, or co-sleeping, is most common among black and Hispanic families; nearly one-third of black parents surveyed said their baby slept with an adult or another child.
Published in the journal JAMA Pediatrics, the study did not examine infant deaths or accidents associated with bed-sharing. However, that same year, 629 infants died from accidental suffocation or strangulation while sleeping in a bed, according to the Centers for Disease Control and Prevention.
Such statistics are compelling, said Dr. Lori Feldman-Winter, a Cooper University Health pediatrician. She wonders if bed-sharing is more common than the report indicated.
"The alarming thing in this study is the differences that exist with bed-sharing based on demographics, particularly with African-Americans. Very often, bed-sharing occurs out of need, not necessarily out of a desire to bed-share.
"The question is why? What circumstances have led to the bed-sharing? How were they feeding their babies? To analyze that variable really hasn't been done effectively; science has not yet shed light on that."
To reduce those rates, the SIDS (Sudden Infant Death Syndrome) Center of New Jersey has focused its educational efforts on reaching new moms through hospitals, postpartum nurses, WIC offices, Head Start and child-care centers, and child protection agencies.
As a result, said program director Barbara Ostfeld, bed-sharing rates in the state saw a dramatic 32 percent decline among black families between 2003 and 2010. The rates among Hispanic families barely budged during that period and increased about 4 percent among white families.
It's a challenge to change families' sleep practices, she explained. Even when cribs are donated to families who bed-share because of economic reasons, she said, education is needed to persuade mothers to use them.
"People have deep, personal cultural desires in this regard," Ostfeld said. "A lot of people do it for breastfeeding reasons. Others do it for completely different reasons. Although our hearts are in the right place, the reality is when we look at the death scene investigations, half of the babies who died in SIDS (cases) were in bed-sharing situations."
Indeed, the SIDS Center of New Jersey reports there is a fivefold increase in the risk of death among infants who sleep in a bed, even when infants are breastfed and neither parent smokes, drinks alcohol or does drugs.
"We look at autopsy photos every day," Ostfeld added. "In so many of these cases, a slight change in the sleep environment would have made the difference."
But the scientific community is still debating whether bed-sharing itself is dangerous or if other factors are contributing to the deaths. A JAMA Pediatrics editorial published with the bed-sharing study cited earlier research that found many infants died while sleeping on sofas, with parents who smoked or had been drinking.
And bed-sharing has benefits, the editorial stated, such as making it easier to breastfeed at night.
That's why Laura Pratte of Medford slept with her babies, who are now ages 6 and 8. She tried following the safe-sleep guidelines with her son but ended up falling asleep with him while he nursed. Without someone next to him, he would only nap for 20 minutes at a time, she said.
Pratte, a 35-year-old high school teacher, said that she planned on using a crib before she had children. "But when you have a baby who won't sleep in the crib but will sleep with you - I feel that's more important.
"You just want your kid to sleep, be comfortable and happy," she said.
But bed-sharing horrifies Susan Hollander, whose infant daughter died in her sleep in 1993. The following year, Hollander and her husband founded the CJ Foundation for SIDS, a national nonprofit based in Hackensack that works to eliminate sleep-related infant deaths.
She said more grassroots efforts are needed to teach parents why they shouldn't share their beds with babies.
"It's not something I would ever, ever do ... even if I was breastfeeding," said Hollander, a mother of three. "I have breastfed my children. And I did not bring them into bed with me."
Hollander thinks bed-sharing is likely more common than reported. And because reporting practices vary widely among medical examiners, she believes national statistics about infant sleep-related deaths aren't providing an accurate picture of what causes those deaths. She serves on a state panel that reviews sudden unexpected infant deaths in New Jersey.
"I'm sure most adults, when they put a child in the bed with them, don't do it because they want a bad result," said Hollander. "They don't really think the end result is going to be death for their child. But I say ... why risk a child's life if you don't have to?"
In 2012, the Eunice Kennedy Shriver National Institute of Child Health and Human Development launched its "Safe to Sleep" campaign, advising families how to create a safe sleep environment for their infants.
While following the American Academy of Pediatrics' guidelines, it acknowledges mothers' desire to co-sleep and offers an alternative. One of its "safe sleep" images depicts a mother in her bed, with her infant in a three-sided co-sleeper next to it.
Feldman-Winter said she thinks more research is needed to find out why families share their beds and what factors make it unsafe. But that's not easy to do, she said.
"If more and more families come forward and describe what's happening in the night, there may be a way to define ways to make it safer," Feldman-Winter said. "There are potentially ways to make it safer."