I was dismayed to read of the three babies who recently died in Eastern Oregon of ascribed asphyxiation while co-sleeping. The East Oregonian reprinted an editorial that originally appeared in the Baker City Herald on Aug. 14, which advocated avoidance of all co-sleeping as "sound advice."

While co-sleeping is dangerous in some circumstances, it is beneficial in others. Co-sleeping should be avoided if someone in the bed has been drinking alcohol, smoking, or using mind-altering or behavior modifying drugs. Some surfaces are unsafe for co-sleeping. Co-sleeping should be avoided on sofas, waterbeds, and beds with pillows close to the baby, stuffed animals, and loose bedding. Beds must also be carefully located in the room so there is no danger of the baby being trapped between the bed and the wall or furniture. Babies should be placed in the supine position in the bed. If other children sleep in the family bed, the mother's body should be placed between the baby and the other children.

Unfortunately, without careful death scene evaluation and detailed interviews with co-sleepers, it is difficult to accurately attribute the cause of death for co-sleeping babies. While the incidence of SIDS is lower for co-sleeping babies than for crib-sleeping babies, sadly, SIDS still can occur in the family bed. Cross-cultural and observational studies point to some important benefits of co-sleeping. Co-sleeping infants breastfeed more frequently throughout the night which enhances growth, development, and milk production. Co-sleeping promotes maternal-infant nighttime interaction which helps to regulate breathing and neurological development. Observational studies indicate that mothers do not habituate to their baby's presence in the bed. This means no matter how accustomed the mother is to sleeping with the baby, she still is responsive to the baby's position and needs in the absence of other sense-dulling exposures such as alcohol or drugs.

Co-sleeping can be a beautiful bonding experience for a mother and baby. It can also facilitate nighttime breastfeeding and the baby's neurological development. Families who choose to co-sleep should create a safe sleep environment so the benefits of co-sleeping will be enjoyed and the dangers avoided. We grieve the loss of the sleeping babies, and hope to avoid more tragedy through conscientious sleeping decisions.

Caroline Peterson,

DC, CPM, PhD, MPH

Portland

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