The Risks And Benefits Of Bed-Sharing With Your Baby

Dr. Enrique Jacome

A question to all you parents out there: would you share your bed with your infant? This question is likely to encourage a diverse range of answers, as it is certainly a controversial topic. Some studies say bed-sharing with baby is beneficial, while others have linked the practice to serious health risks. So, what are new parents to do?

Both the American Academy of Pediatrics (AAP) and the US Consumer Product Safety Commission strongly recommend against bed-sharing with an infant - defined as sleeping on the same surface as an infant, such as a chair, sofa or bed.

But according to a 2013 study from the National Institutes of Health (NIH), the percentage of infants who share a bed with a parent, another caregiver or a child more than doubled between 1993 and 2010, from 6.5% to 13.5%.

Some of you may be surprised by this increase, given the well-documented health risks that have been linked to infant bed-sharing.

Earlier this year, Medical News Today reported on a study from the AAP citing bed-sharing as the primary cause of sudden infant death syndrome (SIDS) - the leading cause of death among infants aged 1-12 months.

The study, published in the journal Pediatrics, found that among 8,207 infant deaths from 24 US states occurring between 2004-2012, 69% of infants were bed-sharing at the time of death.

"Bed-sharing may increase the risk of overheating, rebreathing or airway obstruction, head covering and exposure to tobacco smoke. All of these are risk factors for SIDS," Dr. Michael Goodstein, clinical associate professor of pediatrics at Pennsylvania State University and a member of the AAP Task Force for SIDS, told MNT, adding:

"Furthermore, bed-sharing in an adult bed not designed for infant safety exposes the infant to additional risks for accidental injury and death, such as suffocation, asphyxia, entrapment, falls and strangulation.

Infants - particularly those in the first 3 months of life and those born prematurely and/or with low birth weight - are at highest risk, possibly because immature motor skills and muscle strength make it difficult to escape potential threats."

More recently, another study from the AAP found that even sleeping with an infant on a sofa significantly increases the risk of SIDS. Of 9,073 sleep-related infant deaths, researchers found that 12.9% occurred on sofas. The majority of these infants were sharing the sofa with another individual when they died.

Aside from the study statistics, some reports have shown that the risks of infant death as a result of bed-sharing are very real.

In 2012, UK newspaper The Daily Mail reported on the deaths of 3-week-old twin babies in Idaho, who died after their mother accidentally suffocated them while they were sleeping in her bed. A few months later, the newspaper reported on another incident, in which a mother accidentally suffocated her baby while rolling over him in her sleep.

Most recently, a report from WQAD.com revealed that a man and woman had been charged for the death of their 4-month-old baby, after sleeping beside the baby while under the influence and rolling on top of him.

According to the AAP, bed-sharing is particularly risky if a parent is very tired, has been smoking, using alcohol or has taken drugs.

Such reports prompt the question: if bed-sharing can put an infant's life at risk, why are more parents taking up the practice?

Bed-sharing and breastfeeding

The primary reason many mothers choose to bed-share with their infant is to promote prolonged breastfeeding. 

The Academy of Breastfeeding Medicine support bed-sharing when it comes to breastfeeding. And last year, a study published in JAMA Pediatrics suggested that mothers who regularly bed-share with their infants are more likely to breastfeed for longer. Numerous other studies have reached the same conclusion.

But it is not just the studies that hail bed-sharing for promoting breastfeeding. Pediatrician Dr. William Sears is possibly the most famous advocate for bed-sharing, after openly supporting the practice in The Baby Book in 1993.

"Put yourself behind the eyes of your baby," Dr. Sears told The Huffington Post in 2011. "Ask, 'If I were baby Johnny or baby Suzy, where would I rather sleep?' In a dark lonely room behind bars, or nestled next to my favorite person in the world, inches away from my favorite cuisine?"

For many mothers, breastfeeding can be a struggle. They have to pull themselves out of bed on numerous occasions throughout the night and try to stay awake while their infant feeds; doing this night after night can be exhausting, causing many mothers to give up breastfeeding altogether.

This is why many parents see bed-sharing as a viable option; the baby can feed while the mother can get more sleep.

Citing the benefits of bed-sharing for breastfeeding in a blog for The Huffington Post, Diana West, of La Leche League International - a nonprofit organization that promotes breastfeeding - says:

"Bed-sharing works so well because breastfeeding mothers and babies are hardwired to be together during vulnerable sleep periods. When they bed-share, the baby's happier and doesn't have to cry to get the mother's attention, and she doesn't have to get out of bed - she just latches the baby on and maybe even falls back to sleep."

"She automatically lies on her side facing the baby with her lower arm up and knee bent," West adds. "This creates a protected 'cove' that keeps her from rolling toward the baby and prevents anyone else from rolling into that space. The baby stays oriented toward her breasts in that safe cove, away from pillows. Their sleep-wake cycles synchronize so that they both have low-stress, low-level arousals through the night."

"This instinctive and mutually beneficial behavior probably explains why research has shown that the new mothers who get the most sleep are the ones who breastfeed exclusively and bed-share," she says.

Dr. Goodstein told us, however, that there have been no studies assessing whether room-sharing with an infant rather than bed-sharing also promotes breastfeeding.

What are the other potential benefits and risks of bed-sharing?

Contrary to the majority of research on bed-sharing, some health care professionals claim bed-sharing with an infant actually reduces the risk of SIDS - if it is done safely.

Dr. Sears is one of these, noting that in countries where bed-sharing is common practice - such as Asia, Africa and parts of Europe - SIDS rates are at their lowest. "While there could be many other factors contributing to the lower incidence of SIDS in these cultures, all the population studies I've seen have come to the same conclusion: safe co-sleeping lowers the SIDS risk," Dr. Sears says on his website.

Dr. Goodstein, however, believes there is not enough evidence to support this claim.

Studies have suggested that bed-sharing with an infant also increases bonding between parent and baby. Talking to Fox News last year, pediatrician Dr. Susan Markel says:

"Babies have an inborn need to be touched and held. They enjoy having physical closeness day and night, and this kind of connection is essential to meet a baby's needs for warmth, comfort and security."

But some health care professionals believe the risk of SIDS outweighs the potential benefits of bed-sharing. What is more, bed-sharing may present other downfalls.

"Many [parents] believe that if you allow children to sleep in your bed from birth, it can be hard to persuade them to move out later," Sarah Crown, editor of the UK's biggest community network for parents, Mumsnet, told MNT.

In addition, some parents believe bed-sharing with an infant will make them more dependent on others as they get older. "I think it teaches kids that they almost need that constant contact and interaction in order to feel that safety, security and confidence in themselves," Jennifer Zinzi - a mother of two who strongly opposes bed-sharing - told Fox News.

A 2011 study published in the journal Pediatrics, however, found that bed-sharing at age 1-3 years poses no negative long-term effects for a child's behavior and cognition at the age of 5 years.

'No golden rule' for bed-sharing

Despite the ongoing debate surrounding bed-sharing, it seems child health organizations and health care professionals are in agreement about one thing: the decision to bed-share with infants is solely down to the parents.

"There is no golden rule," Crown told us. "It's about what suits you and your family more than anything. But Mumsnet users find that talking to those who've been there and done that, and sharing wisdom and support on the often vexed question of sleeping in the early days, is invaluable."

Dr. Goodstein added:

"I think that at the end of the day, parents want to be the best they can be and provide the best for their babies. As providers and child advocates, we want to assist parents by providing the best information to allow infants to not just be healthy, but to thrive and reach their full potential.

We need to work together. We need to do everything we can to promote breastfeeding. We also need to promote infant sleep safety."

AAP recommendations for safe infant sleeping environments

As mentioned previously, the AAP do not support bed-sharing. Instead, they recommend room-sharing, meaning parents should sleep in the same room as their infants but not on the same surface.

In their latest policy statement, the AAP recommend that babies should be placed on their back to sleep - known as the supine position - in a safety-approved crib, bassinet or portable crib/play yard. These should have a firm mattress covered by a fitted sheet.

The policy statement also recommends that no soft objects, such as pillows, pillow-like toys, quilts, comforters and sheepskins should be within the infant's sleeping environment, as these could increase the risk of SIDS, suffocation, entrapment and strangulation.

Furthermore, babies should sleep in a smoke-free environment, and their environment should not be too warm as this may increase the risk of SIDS.

The AAP say parents should consider using a pacifier at bedtime, as this has been shown to reduce the risk of SIDS, but should avoid the use of commercial devices marketed to reduce SIDS risk due to the lack of supporting evidence that they work.

"Helping parents to understand why they should follow these recommendations could lead to better compliance in the home," said Dr. Goodstein.

Safer bed-sharing

Parents may choose to bed-share with their child, or there may be those occasions where it happens unexpectedly.

The Baby Friendly Initiative from UNICEF - a global children's charity - provides recommendations for safer bed-sharing.

They note that it is not safe to bed-share in the early months of a baby's life, or if they are preterm or of a small birth weight.

An infant should be kept away from pillows to avoid the risk of suffocation, UNICEF recommend, and parents should ensure the infant is unable to fall out of the bed or become trapped between the mattress and wall.

Parents should also ensure bedclothes do not cover the baby's face, and infants should not be left alone on the bed in case they move into a dangerous position.

Furthermore, parents should not share a bed with their child if they are a smoker or have taken drugs or consumed alcohol.

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New Report Highlights Potential Links Between Weight, Physical Activity And Breast Cancer Survival

Dr. Enrique Jacome

The AICR has released the Continuous Update Project (CUP) Report on Breast Cancer Survivors in the US. This report is their most in-depth review of worldwide research conducted into breast cancer survivors and the lifestyle factors affecting their survival.

This is the first time that their research has identified potential links between diet, weight, physical activity and longer survival for women diagnosed with breast cancer.

In 2007, AICR/WCRF published a report on the lifestyle-cancer link. Today, 7 years later, their advice has not changed: eating a plant-based diet, maintaining a healthy weight, and getting regular physical activity remain the best strategies for all cancer survivors.

The report found some evidence suggesting that women who eat more foods containing fiber and soy may have a lower risk of dying following a diagnosis of breast cancer, and women eating a diet high in fat and saturated fat may have increased risk of dying following a diagnosis of breast cancer. However, these findings are not strong enough to merit specific recommendations for breast cancer survivors.

This research is important because there are over 3.1 million breast cancer survivors in the U.S. Every year, more than 232,000 women are diagnosed with breast cancer. Increasing numbers of women are surviving as methods of diagnosis and treatment improve.

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New Study Reaffirms Eating Breakfast Reduces Cravings, Overeating In Late-Teen Girls

Dr. Enrique Jacome

A small study finds when late-teen girls eat breakfast, it raises levels of a chemical in the brain's reward center that may help them stop craving sweet foods and overeating during the rest of the day. 

Writing in the Nutrition Journal, a team from the University of Missouri in Columbia, notes that since over a third of American teenagers are overweight or obese and most of them will remain so in adulthood, focusing on young adults is an important way to prevent the perpetuation of the obesity epidemic.

The Centers for Disease Control (CDC) report many teenagers don't eat breakfast and this likely increases the chance they will overeat and put on weight, they add.

Heather Leidy, an assistant professor of nutrition and exercise physiology, and colleagues, explain that the number of US teens struggling with obesity - which raises the risk they will have life-long health problems - has quadrupled in the last 30 years.

In their study of a small group of young women, they found eating breakfast increases levels of the brain's reward chemical dopamine which is involved in controlling impulses. As these levels increase, they appear to reduce food cravings and overeating.

They suggest understanding how dopamine changes in the brain affect food cravings could helps us develop better ways to prevent and treat obesity.

Prof. Leidy says they found, "people experience a dramatic decline in cravings for sweet foods when they eat breakfast."

"However," she adds, "breakfasts that are high in protein also reduced cravings for savory - or high-fat - foods. On the other hand, if breakfast is skipped, these cravings continue to rise throughout the day."

For their randomized, crossover study, the team recruited 20 overweight girls aged between 18 and 20 who normally skipped breakfast. Each participant underwent three types of 7-day eating patterns.

In one pattern, the participants ate a 350-calorie breakfast with normal amounts of protein, in another pattern they ate a 350-calorie breakfast with high protein, and in the third pattern, they skipped breakfast. After completing a 7- day pattern, they then had a 7-day "washing out period" before embarking on the next 7-day pattern.

In each of the 7-day patterns, on the morning of the seventh day, the girls underwent assessments, which included filling in food craving questionnaires. Fluctuation in dopamine was also assessed by checking dopamine metabolite homovanillic acid levels in regular blood samples taken through the morning.

Eating breakfast followed by reduced cravings

The results showed both breakfast meals were followed by reduced cravings for sweet and savory foods and higher levels of dopamine metabolite.

Also, compared to a normal-protein breakfast, the high-protein breakfast tended to be followed by greater reductions in cravings for savory food and sustained levels in dopamine metabolite up until lunch.

Prof. Leidy explains that when we eat, our brain releases dopamine, which stimulates feelings of reward. This response is an important part of eating because it helps to regulate food intake. However:

"Dopamine levels are blunted in individuals who are overweight or obese, which means that it takes much more stimulation - or food - to elicit feelings of reward; we saw similar responses within breakfast-skippers.

To counteract the tendencies to overeat and to prevent weight gain that occurs as a result of overeating, we tried to identify dietary behaviors that provide these feelings of reward while reducing cravings for high-fat foods. Eating breakfast, particularly a breakfast high in protein, seems to do that."

Although the study only included young women, the team believes the findings also apply to all adults.

More and more Americans skipping breakfast

More and more Americans are skipping breakfast, Prof. Leidy continues, and this is linked to food cravings, overeating and obesity:

"It used to be that nearly 100% of American adults, kids and teens were eating breakfast," she adds, "but over the last 50 years, we have seen a decrease in eating frequency and an increase in obesity."

In January 2014, Medical News Today also learned how metabolic syndrome and poor breakfast habits in childhood may be linked. Metabolic syndrome is a cluster of risk factors that are associated with heart disease, diabetes and stroke.

Researchers in Sweden found metabolic syndrome in adults was related to the type of breakfast those same adults had eaten as children.

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Molecule Discovered That May Protect Women's Eggs

Dr. Enrique Jacome

A new study led by Professor Kui Liu at the University of Gothenburg has identified the key molecule 'Greatwall kinase' which protects women's eggs against problems that can arise during the maturation process.

In order to be able to have a child, a woman needs eggs that can grow and mature. One of these eggs is then fertilised by a sperm, forming an embryo. During the maturation process, the egg needs to go through a number of stages of reductional division, called meiosis. If problems occur during any of these stages, the woman can become infertile. Around 10-15% of all women experience fertility problems.

Human studies are the next stage

Using genetically modified mouse models, Professor Liu's team has now discovered that the molecule Greatwall kinase is of great importance in order for the eggs of the female mouse to be able to complete the first phase and move on to the second meiotic division during the maturation of the egg. When Greatwall kinase is removed from the egg, not all the stages can be completed. Instead, the egg enters an interphase with an abnormal DNA structure and problematic cell cycles. These problems make the females infertile.

Professor Liu believes it is highly likely that Greatwall kinase is important in the human egg maturation process. His group aims to carry out studies on human eggs as the next stage. The Greatwall kinase molecule is important in the regulation of the cell cycle.

"If we discover that there are women whose eggs do not mature due to levels of Greatwall kinase being too low, we can inject the molecule into the egg," says Professor Liu. "Hopefully, the maturation process will thereby be corrected, and eventually the woman may be able to have children."

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First Baby Born After Womb Transplantation

Dr. Enrique Jacome

In September, a 36-year-old Swedish woman became the first ever to give birth from a transplanted womb. A new paper published in The Lancet provides a "proof of concept" report on the case.

"Absolute uterine factor infertility" is the only type of female infertility still considered to be untreatable. This condition is often a consequence of Rokitansky syndrome, which is when a woman is born without a womb. Adoption and surrogacy have so far been the only options for women with absolute uterine factor infertility to acquire motherhood.

However, the news of the first baby to be born from a woman with Rokitansky syndrome who received a womb transplant brings hope to women with forms of absolute uterine factor infertility.

The researchers who performed the transplant - from the University of Gothenburg, Sweden - have been investigating the viability of womb transplantation for over 10 years. Before attempting the procedure in humans, the researchers conducted trials in rodents and non-human primates.

In 2013, the researchers initiated transplants in nine women with absolute uterine factor infertility who had received wombs from live donors. The Swedish woman who recently gave birth was one of these women.

Although two of the women in the trial had to have hysterectomies during the initial months - because of severe infections and thrombosis - the team reported success in the other seven women.

These women began menstruating during the first 2-3 months after transplant. Although occasional episodes of "mild rejection" were detected in some of the women, the researchers were able to overcome this by prescribing a short course of immunosuppression therapy.

Outside of this trial, only two other womb transplants had been attempted. The first of these required the womb to be removed after 3 months, due to progressive uterine necrosis.

The second attempt involved a womb from a deceased donor being transplanted into a woman with Rokitansky syndrome. Although this woman became pregnant twice via embryo transfer, both pregnancies resulted in miscarriage before week 6.

Eggs were fertilized using IVF prior to mother receiving womb transplant

The Swedish woman who gave birth received her womb from a 61-year-old family friend. As the recipient had intact ovaries, she was able to produce eggs, which were then fertilized using IVF prior to the transplant.

A total of 11 embryos were produced and frozen using this method. One year after the womb transplant, one of these embryos was transferred to the transplanted womb.

Prof. Mats Brännström, who led the team of researchers, says that fetal growth was normal through the first 31 weeks of pregnancy. "We found only one episode of mild rejection during the pregnancy that was successfully treated with corticosteroids," he says, "and the woman was working full time until the day before delivery."

As a consequence of preeclampsia, the woman was admitted to hospital at 31 weeks and her baby was delivered by cesarean section 16 hours later.

Although an abnormal fetal heart rate had been detected when the woman was admitted to the hospital, in the days after being born, the baby scored as being in perfect health according to the Apgar rating scale for determining the health of newborns.

The infant was discharged from the neonatal unit after 10 days, and the researchers say that both mom and baby are continuing to do well.

According to Prof. Brännström:

"Our success is based on more than 10 years of intensive animal research and surgical training by our team and opens up the possibility of treating many young females worldwide that suffer from uterine infertility. What is more, we have demonstrated the feasibility of live-donor uterus transplantation, even from a postmenopausal donor."

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