Sleeping With Your Baby for the First Year

Over the last week, the country has been in a bit of an uproar when the American Academy of Pediatrics (AAP) released their newest guidelines regarding babies and their sleep. Many of the recommendations were considered to be "old news" and fairly common sense, such as laying baby on their backs to sleep, sleep should occur on a firm surface, no bumper pads on the crib, etc. But there was a new recommendation that took everyone by surprise and created a stir among parents.

It was recommended that infants sleep in the parents’ room for the first twelve months of life.

It details that babies under the age of six months should sleep in the same room as their parents, and ideally, this arrangement should last until the child has turned one year of age. The leading push for this recommendation is that the risk of SIDS (Sudden Infant Death Syndrome) is lessened if the parents and child are sleeping in the same room. However, what the recommendation doesn't do, is explain WHY.

In the release, the AAP was clear that there was no evidence correlating moving a child to their own room before their first birthday and creating an increased chance of SIDS occurring, but nonetheless, the AAP chose to make the recommendation of room sharing for the first twelve months. This has significant implications for parents who wonder what the best thing to do is for their child.

Why the Recommendation?

​These recommendations have potential to create unnecessary stress and guilt for parents who don't want to have their child be one of the tragic 3500 infant deaths from sleep per year, but yet also want to make sure that they are getting their sleep to be healthy parents for their child. There is mounting evidence and data showing that parents who are sleep deprived are at serious risk for health issues, psychological distress and are more likely to experience postpartum depression/anxiety, which all have very significant effect on the baby as well. Despite knowing this, the AAP does not seem to take into account of the maternal and paternal health factors that their recommendations can affect. 

What isn't helping is that is that the recommendation that the AAP put forth isn't explicitly clear on whether it's basing their findings on results shown from a specific sleep scenario or a combination thereof. The studies that the AAP cites were examining different sleep situations, such as:

1. Sharing the room vs. separate room
2. Sharing the room vs. bed-sharing
3. Sharing the room vs. having the infant sleep on other surfaces (e.g., a couch, in another room with a sibling, etc.).

The problem with examining scenario #1 as a possible scenario of risk is that room sharing and separate rooms on the face DO NOT increase the chances of SIDS in the absence of risk factors attributed to infant deaths. In either case, if parents are following safe sleep rules, having their child in their room or in a different room, will not increase the risk of SIDS. However, that scenario is listed anyway in the AAP's recommendations.

With that kind of ambiguity in the reasoning of the recommendation, it can make it distressing for parents to know what exactly is the best decision to make for their child and themselves.  

Additionally, what is also frustrating is that some of the studies used to come up with the recommendations have some issues within themselves. In one study cited, completed in 1996, showed that babies were at a greater risk from SIDS while sleeping in separate rooms. What it doesn't tell you, is that some of those babies in the study were also sleeping on their stomachs, as this study was done before the "Back to Sleep" movement when it was strongly encouraged that parents placed their babies on their backs for sleep.

At least one of the studies used to develop the newest recommendations showed no findings in that sleeping in a different room or in the same room had any impact on SIDS, but found that there was a higher risk of SIDS if the parents smoked or if the child fell asleep on a couch or armchair versus a firm surface, such as a crib mattress.

While the AAP recommendation comes from a place of wanting to provide sound recommendations for parents with infants, unfortunately, they are limited to using published research and studies, despite the fact that the studies don't completely explain why a correlation exists, or even if there really is one.

Numbers Don't Lie

​What is clear that is that the first six months of a child's life is at the greatest risk for SIDS to occur. It also shows that while the risk of SIDS occurring after 6 months is still there, it drops off significantly. 

Adapted from AAP, Technical Report: SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.

​It would appear that the recommendation to room share for the first six months is sound, given that the first six months carries the greatest risk. However, research also shows that parents make the choice to move their child out of their room by six months, because sleep for both the parents and the child was less than ideal. One study showed that parents who room shared averaged 2 hours and 20 minutes of uninterrupted sleep, leading to an average of 6.5 hours a sleep each night. Given that it is recommended that adults get 7-9 hours of sleep every night, parents who room share are getting less sleep that they need, which leads to sleep deprivation and other health concerns, especially if the sleep deprivation that they experience lasts for a significant period of time.

Babies, around four months of age, start becoming much more acutely aware of sounds within their environment and can more easily be awoken by noises made by their parents or environmental sounds occurring within the bedroom. This can lead to multiple night wakings from the baby and the parents start dealing with consistent disruption in their sleep. When this happens, everyone is losing sleep and the effects of prolonged sleep deprivation can become a reality for parents and their child.

While this can be good news in the respect that the more frequent check ins from the parents will help prevent SIDS from occurring, it also means that the health of the parent is suffering, and this is something to not take lightly.

What Do I Do?

Parents who decide that they want to move their child to their own room and adhere to the best recommendations regarding the sleep environment for their child well before the child turns one year of age, i.e. no loose bedding, placing baby on their backs, sleep occurring on a firm surface, etc., are doing the right thing.

Parents who decide that they want to room share with their child for the full 12 months as well as follow the sleep environment recommendations for the child's bed are doing the right thing.

The bottom line? Parents need to do what they feel is right for them and their families. Some parents know that their sleep and health would suffer if they shared a room with their child for a whole year, so making the decision to move their child out of their room before the 12 months is up, is what is best for them. Other parents feel much better about keeping their child in the same room with them for the first twelve months, so making that choice is the best decision for them. 

With the release of the new sleep guidelines from the AAP, it is important for parents to consider the big picture of what is occurring while their child is sleeping. They should consider all recommendations made by the AAP in their most recent guidelines and determine which scenario best works for their family and develop a sleeping environment that makes sense for their child, themselves, and their health. 

What are your thoughts about the new sleep guidelines? Will it change what you do?
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