Elsevier

Sleep Medicine Reviews

Volume 10, Issue 6, December 2006, Pages 407-417
Sleep Medicine Reviews

Clinical Review
Co-sleeping, an ancient practice: issues of the past and present, and possibilities for the future

https://doi.org/10.1016/j.smrv.2005.12.001Get rights and content

Summary

Co-sleeping—infants sharing the mother's sleep space—has prevailed throughout human evolution, and continued over the centuries of western civilization despite controversy and blame of co-sleeping mothers for the deaths of their infants. By the past century, “crib death” was recognized, later identified as Sudden Infant Death Syndrome (SIDS), and generally found to occur more frequently during bed sharing. Pediatricians warned parents of the dangers of SIDS and other risks of bed sharing, and the frequency of bed sharing decreased markedly over the years. However, during recent decades, bed sharing began to increase, though major issues were raised, including: whether bed sharing actually exacerbates or is protective against the occurrence of SIDS, whether the practice facilitates breast feeding, whether bed sharing is beneficial for an infant's development, and other concerns. Dissention may soon be diminished by use of a crib which opens at the mother's bed-side and is becoming a popular approach to mother-and-infant closeness through the night.

Introduction

Throughout most of human existence, mothers and their infants have shared the same sleeping space—with close physical contact, she could provide the infant with needed warmth and nutrition, as well as protection from predators. Thus, the practice referred to as “co-sleeping” was essential to an infant's survival.

However, during the most recent millennia, change—the essence of evolution—occurred in many aspects of human behavior: as the nomadic life was abandoned, different environments and climates were adapted to, permanent dwellings were built, and cribs of primitive types were made for infants to sleep separately from their mother.1 Thus, co-sleeping became more a matter of choice for the mother than a behavior pattern required for the infant's survival. However, from the time of co-sleeping as an alternative practice, it became an issue associated with turbulence and controversy which persists to the present day.

The issues posed by co-sleeping (in recent years referred to as “bed sharing”) as an optional practice have changed over time; and these changes are considered as the context for emergence of more recent—and still disparate—views. However, change has been greatest during the last century, especially the later decades as a vast amount of research on the hazards and potential benefits of co-sleeping has been produced around the world. The issues have been confounded by recognition of the Sudden Infant Death Syndrome (SIDS) phenomenon, which may or may not occur during co-sleeping. Accordingly, the history of the major issues regarding co-sleeping will be addressed, including reasons for this sleeping pattern being abandoned by many—and the beginnings of a resurgence during the past century.

Section snippets

Co-sleeping in the Western world before the 20th century

From the first century BC, Egyptian mothers who slept with their infants were held responsible if they died, as the mother was considered guilty of intentionally smothering the infant. In the 1200s in Germany, mothers were forbidden to take an infant under 3 years into their bed at night. Over subsequent centuries, mothers in various areas of the industrialized world were punished if their infants died while sleeping with them, and laws were passed forbidding parents to let their infant sleep

Bed sharing in non-industrialized societies during the 20th century

The term “bed sharing” came to replace “co-sleeping” because it is seen as more specific to mothers sharing their sleeping space with their infant.

The question of bed sharing has been addressed during the past century from cross-cultural anthropological studies. These have made available data on many aspects of different cultures, such as the physical environment, social and family structure, and eating and sleeping practices.

From a study of 27 societies, it was found that in 24 of the

Bed sharing in the 20th century in industrial societies

Cultural changes seem to occur at a more rapid pace over time, and sleeping practices during the 20th century are no exception to this generalization. During the first quarter of the 1900s, bed sharing with the mother and possibly other members of the family was common, sometimes in very large beds designed for the family. Exceptions were mainly seen in the upper strata of society, composed of those living in houses with more than a single room. Over time, cribs rapidly began to take the place

Issues of concern for bed sharing and crib death

At about the middle of the recent century, the issue of infant crib death was joined with that of bed sharing.

In California, in response to parents’ concern for the perceived high death rate among infants, Child Fatality Review Boards were formed with the objective of determining factors related to infant mortality; and such teams were then organized throughout the country. The objective was to identify causes of infant deaths, with the hope of developing prevention strategies.6

The frequent

Avoidable risk factors found to be associated with bed sharing

While cribs are currently designed to meet safety standards for infants, adult beds are designed for adult needs and comfort. In addition to the risks already noted, others remain an ongoing possibility, including laying over by a parent or anyone else who may be sharing the bed.10

In a 3-year study in England of 325 infants under 4 months who died unexpectedly and 1300 controls, factors that were found to place infants at risk when bed sharing included: an infant sharing the parents’ bed for

Opposing views: the benefits of bed sharing

Despite growing evidence for risks associated with bed sharing, advocates of this sleep practice hold the view that bed sharing is the most “natural” form of sleep-and-care giving because of its long history as a behavior of the human species. Thus, it is suggested that the infant is physiologically designed for the conditions of this form of mother-infant interaction.20 However, a contrary view has been articulated: “It is as specious to argue that the practice of co-sleeping is entirely

Sleep patterns and risk for SIDS

Sleep architecture at every age is affected by, and reflects, physiological and neurophysiological proceses and the immune system of an individual. Further, the basic significance of the sleep states shown in early infancy is apparent in relationships found between early sleep patterns and later development.34 Researchers are giving growing consideration to the possibility that some victims of SIDS may have been vulnerable because of central neural deviancy prior to the event. That is, early

Issues for future SIDS research

Much has been learned about SIDS, both when infants sleep in a crib and when they share the mother's bed. However, there is still no reliable way to either predict or prevent SIDS, as the cause(s) remain unknown.50 It is generally expected that, with continued research, the mechanism underlying SIDS will ultimately be defined and described as a specific physiological event. And it is currently concluded, from research findings, that the physiological changes or deficits involve both arousal

A shift in perspective on infants’ sleeping environment

With respect to advice on an optimal sleep environment for infants during the early postnatal months, there is growing agreement that the number of remedial risk factors that have been well documented from extensive research argues against bed sharing for most families.

A dramatic shift in perspective is “in the wind.” That is, even some of the most ardent advocates of bed sharing among researchers, as well as others writing for the popular media, have begun to consider the possible desirability

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