SIDS in infants reduced by sharing room with parents, despite what alleged pediatric sleep expert at Yale opines
Last week, I attended an online talk by Dr. Bruce Perry—psychiatrist and child trauma expert—hosted by CASEL entitled Return to School during COVID 19: Helping Children and Families Manage Stress and Build Resilience. (If you haven’t read The Boy Who Was Raised a Dog, I highly recommend it. The stories are so moving, you will cry at least once. And the last chapter is an absolutely brilliant summary of the solutions and impediments we face in our society.) It was an excellent talk, and if I can find a link to the archive, I will post it here.
At one point when he was mentioning the effects of childhood trauma on the ability for school kids to focus and learn, my mind wandered to infancy and the sorts of trauma an infant might encounter. I realized that being separated from their parents—with all the appearances of abandonment—could be one of the most stressful things an infant could experience. And this is exactly what many of us do in the industrialized world by giving kids their own room/nursery and putting them down to sleep for the night there, even when they are quite young.
I want to be clear that I do not blame anyone who is doing (or has done) this. It is the socially acceptable way to raise children in our society. But it is in many ways completely counter to the way that our ancestors—even those not many generations removed from us—raised their babies. The concept of having private rooms for every member of the family is quite new, and was certainly not available to the vast majority of people until very recently. It makes complete sense that our genes which have been honed over tens of millions of years and hundreds of thousands of generations have been honed to crave connection with parents and alloparents. And individuals that were denied that connection—even in what we rational adults would recognize as completely safe environments—could be easily interpreted by the child as abandonment thus triggering anxiety and fear and elevating stress levels which negatively impacts the ability to not only sleep but to do other things that a stress-free state would require: digestion, growth, ongoing maintenance and repair…
I decided to do a bit of research to see if the connection between separation anxiety and adverse health responses had been documented in research. Lo and behold I found a 2016 study published by the American Academy of Pediatrics found a 50% reduction in SIDS for infants who room shared—that is, slept in the same room as the parents, but importantly not in the parents’ bed (because that can lead to suffocation).
Disturbingly the second search result for SIDS room sharing was a blog post penned by Dr. Craig Canapari, ostensibly a pediatric sleep expert at Yale University and Director of the Pediatric Sleep Center. (I will not link to the post as I do not want to give any additional weight to it in search results.) The title of this 2017 blog post is “Why Room Sharing in Infancy Isn't Necessary for Safe Sleep.” This was quite eye-opening as the research paper’s conclusion ran counter to this assertion.
Reading the post, it’s pretty clear Dr. Canapari is unimpressed with the research. He has a few paragraphs of intro, but then gets right into sowing fear, uncertainty and doubt: “…[T]he new recommendation [is] that parents room share—but not bed share—for AT LEAST six months, and ideally up to one year of age, claiming that this could reduce the risk of babies dying in their sleep by ‘up to 50%’. Let that sink in for a minute. The American Academy of Pediatrics said that if you have your baby in his own room, he is twice as likely to die. Does that freak you out? It would freak me out.” So the good doctor has an emotional reaction to the results of a scientific paper and feels the need to regurgitate that onto his readers.
It doesn’t get any better. The entire piece is 1,376 words long. 9% (122 words) is devoted to the intro. 5% (68 words) is devoted to “What’s good about room sharing”—and that includes those five words which are the title of that brief section. The conclusion section comprises 19% (260 words), and it is also cast in the language of FUD (fear, uncertainty and doubt—I’m worried…, I’m concerned…, I believe that sleeping in separate rooms is safe…). The remaining 67% is dedicated to three sections poking holes in the study results: The Problems with Room Sharing, The Problems with the Room Sharing Recommendation, Room sharing may be associated with decreased sleep and increased risk to babies. That last section is about another paper on a similar topic that looked at different things. You are excused if you might have been led to believe that these data all come from one study; the author seems to have no problem conflating the findings from these two studies, slipping the second one in close to the end, pointing out the incongruences and throwing up his hands and saying, I can't figure this out.¯\_(ツ)_/¯
In that second study, you know where that “increased risk to babies” comes from? an independent variable that just so happened to be correlated with room sharing: “Room sharing infants were twice as likely to have an unapproved soft object on their sleep surface.” All that tells me is that there is more education that needs to be done for all parents—whether or not they room share—about things not to put in with their sleeping baby. It really seems as if Dr. Canapari is eager to throw out the baby with the bathwater.
I won’t let the authors of the second paper off the hook here. Their conclusion is overly conservative, but I can understand why—for liability reasons—they would err on the side of caution. Still, their concerns are for the 6–12 month range, and cite “poorer sleep-related outcomes and more unsafe sleep practices”. But these factors are not tied together. Clearly there needs to be a study done, but my hypothesis is that if parents who engage in room sharing also are taught and comply with all other safe sleep best practices, I strongly suspect room sharing with be shown to be at worst neutral and more likely a positive regarding SIDS.
A few more entries down on those search results is this post from Wise Mommies, which I find to be a much more fair and balanced view of the room sharing/SIDS connection.
So why am I writing this? Because I believe Dr. Canapari’s blog post quite literally endangers infants. Harried new parents—who are no doubt struggling to do everything they need to while trying to figure out parenting best practices—are wont to Google something like SIDS room sharing, see Room Sharing in Infancy Isn't Necessary for Safe Sleep as advice from a Yale pediatric sleep expert and move on with their life. Even if they do click through and read, they are going to be overwhelmed by so much FUD and a view from nowhere, that most will again just conclude that it’s not a clear win. It will dissuade them from even doing any further exploration on the subject. And that is a travesty.
We humans and all of our primate ancestors have been sleeping in the same space as our infants for tens if not hundreds of millions of years. Yes, they had alloparents to help them out to minimize sleep deprivation. And they didn’t have access to all of this plastic and cloth from China which can do more harm than good for infants, especially during sleep. But let’s not conflate these issues. If we really had been designed to sleep separated from our offspring, you would see primates in nature and indigenous tribes doing it. I for one am siding with a hundred million years of evolution on this one.