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When To Put Kids In Their Own Bed - Part II

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When To Put Kids In Their Own Bed - Part II

Children's Health

When To Put Kids In Their Own Bed - Part II

When To Put Kids In Their Own Bed - Part II

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A recent study by the Centers for Disease Control (CDC) explores infant deaths alongside an overall recent increase in parents sleeping in the same bed as their children. In a follow-up to earlier conversation, regular contributor Leslie Morgan Steiner and Dr. Carrie Shapiro-Mendoza, co-author of the CDC study, discuss how to practice safe co-sleeping.

JOHN YDSTIE, host:

I'm John Ydstie, and this is Tell Me More from NPR News. Michel Martin is away today. Coming up, letters from the Civil War in Tell Me More About Black History.

But first, they say it takes a village to raise a child, but maybe you just need a few moms in your corner. Every Tuesday, Tell Me More speaks with a diverse group of parents for their common sense and savvy parenting advice, and some of that advice can be controversial, like Tell Me More's recent segment about co-sleeping. That's the practice of some parents who choose to sleep with their infant children.

At that time, we spoke with a co-sleeping advocate, Dr. James McKenna. He's the director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. He had this to say about the benefits of parents sharing their beds with their babies.

(Soundbite of Dr. James McKenna discussing the benefits of co-sleeping on Tell Me More, February 3rd, 2009)

Dr. JAMES MCKENNA (Director, Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame): There's about six or seven studies that show that people that have a history of having slept with their parents from childhood actually are more comfortable with their gender and sexual identities, more affectionate, have higher levels of self-esteem, and are generally thought to be more resilient when they confront life's typical kinds of problems.

YDSTIE: However, the vast majority of medical professionals discourage co-sleeping, saying that it's dangerous for babies. And according to a recent study by the Centers for Disease Control and Prevention, infant deaths due to accidental suffocation and strangulation in bed are on the rise.

For more about the co-sleeping debate, I'm joined by Dr. Carrie Shapiro-Mendoza, a co-author of the CDC study. Also with us is Leslie Morgan Steiner, a regular guest in our parenting segments. Welcome to both of you.

LESLIE MORGAN STEINER: Great to be here.

Dr. CARRIE SHAPIRO-MENDOZA (Co-Author, CDC Study): Thank you for having me.

YDSTIE: We'll get to you in a moment, Leslie. But first, Dr. Shapiro-Mendoza, please tell me about the CDC study and how it defines accidental suffocation and strangulation in bed. What does that mean, exactly?

Dr. SHAPIRO-MENDOZA: OK. Well, let me start by telling you the reason why we did this study is that we had been hearing in the field anecdotally that medical examiners and coroners, those are the people that complete the death certificate, were moving away from reporting deaths as SIDS and were moving toward calling these deaths accidental suffocation and strangulation in bed.

YDSTIE: And SIDS is Sudden Infant Death Syndrome?

Dr. SHAPIRO-MENDOZA: Right. SIDS, Sudden Infant Death Syndrome, is the sudden death of an infant under a year of age, which remains unexplained after a thorough case investigation and that means a complete autopsy, an examination of the death scene, and a review of the clinical history. And it's really difficult to distinguish between SIDS and these accidental suffocations on autopsy alone. You really need a thorough death scene investigation, and even with that it's difficult.

These categories of accidental suffocation and strangulation in bed is one big category, and it actually includes a baby being suffocated by being possibly face down on soft bedding or on a pillow or a waterbed mattress. It could be from overlaying, or someone rolling on top of or against the infant while sleeping. It could be from the infant being wedged or entrapped between the mattress of the bed and a wall. It could even occur from strangulation by asphyxiation, such as when a cord, from maybe a Venetian blind, is hanging in the infant's sleep area, and the infant is strangulated on the cord. So, what the study was really about was this broad category of deaths known as accidental suffocation and strangulation in bed. It included all of those elements.

YDSTIE: So, it could include a parent sleeping with the child, but it could include many other things as well?

Dr. SHAPIRO-MENDOZA: Yes, it could, and with the data that I had from the death certificate, there was no way to be able to distinguish what the actual mechanism was.

YDSTIE: And you chose to do this study because of a sudden increase in these kinds of deaths?

Dr. SHAPIRO-MENDOZA: We chose to do this study because we had been hearing, again, in the field, that medical examiners and coroners that in some areas were shying away from using SIDS as a cause of death and were more likely to classify these deaths as a suffocation death.

YDSTIE: And why did you choose to analyze the data from 1984 to 2004?

Dr. SHAPIRO-MENDOZA: We wanted to look at how the frequency of deaths had been changing over time and changing trends. There's several things that happened during this time period. The definition of SIDS itself wasn't recognized until the - 1970 about, and in 1991, the National Institute of Health and several colleagues developed a new definition for SIDS. In that year, they said in order for a death to be classified SIDS, that you needed a thorough case investigation, again, a death scene investigation, an autopsy, and review of the clinical history.

Also, in 1990 - up until that time, there was no standards or protocols in place that told medical examiners or coroners or law enforcement how to conduct an actual death scene investigation. And in 1996, CDC developed guidelines and a investigation reporting form to actually help standardize the way that death scene investigations of those infant deaths that were sudden and unexpected should be performed.

YDSTIE: I also understand that one thing that was found - maybe this was before your study, but that there were more black male infants four months of age disproportionately affected. Is that part of your study, or is that information that you had before?

Dr. SHAPIRO-MENDOZA: That was part of our study. Excuse me. That was part of our study. What we found in looking at these data that were categorized in this way is that male infants, black male infants especially, were disproportionately affected. And the same thing occurs when you look at SIDS deaths.

YDSTIE: And did you come up with causes? Were - did you come to any conclusions about why this vast increase?

Dr. SHAPIRO-MENDOZA: No. We can speculate - we think that the reason for this increase, there was about maybe a hundred deaths in 1984 that were attributed to accidental suffocation and strangulation in bed to about 400 deaths in the latest year of the data that we looked at, I think, 2004.

We think that - again, we don't have clear proof, but we think that maybe medical examiners and coroners have been moving away from assigning SIDS as a cause of death, and they're more likely to report these deaths either as unknown cause or accidental suffocation and strangulation in bed. And perhaps this might be due to a more thorough death scene investigation.

YDSTIE: I want to get to our other guest, Leslie Morgan Steiner, in a just a moment, but before that, Dr. Shapiro-Mendoza, I'd like to get your reaction to another comment by Dr. McKenna made about co-sleeping and about the study that you coauthored.

Dr. SHAPIRO-MENDOZA: OK.

(Soundbite of Dr. James McKenna discussing the benefits of co-sleeping on Tell Me More, February 3rd, 2009)

Dr. MCKENNA: There's no evidence in the paper whatsoever that looks at causal factors of babies dying in beds. There's no explanations of how these babies died. They are just very gross characterizations of a baby being in a bed or a crib, and they suffocated.

YDSTIE: How do you respond to that criticism? Is it fair?

Dr. SHAPIRO-MENDOZA: I'm not so sure that's a criticism. I think that's what the paper was about. It was looking at this category of deaths that were known as accidental suffocation and strangulation in bed, and you really can't differentiate if the baby was suffocated, again, with soft bedding or a pillow, was overlaid by a caregiver or a sibling, was trapped between a mattress and a wall.

This really - the data that I had was real limited as far as being able to come up with a actual mechanism that caused the suffocation. And we really need better data here in the United States to be able to figure out what these mechanisms are if we want to prevent these deaths in the future.

YDSTIE: Leslie Morgan Steiner, you have three children, and you told us that your oldest and youngest children slept in their cribs, but that your second child, the diva as you described her in previous programs, slept in bed with you.

(Soundbite of laughter)

YDSTIE: Why did you decide to do that? And were you ever afraid that you might hurt your daughter?

LESLIE MORGAN STEINER: I was never afraid that I would hurt my daughter because I never fell asleep when she was in the bed. I always put her in a little bassinet before I went to sleep, so I wasn't afraid of that. And I think the, you know, the terrible thing about this subject is that the death of a child, particularly an infant, is just one of the saddest things a mother can possibly contemplate.

But what I've seen in the book I wrote, "Mommy Wars" and then the work-family balance blogs that I've written over the years, is that there's a more pernicious problem, and that is that when studies like this come out, whether it's about co-sleeping or about how long you're supposed to breastfeed or whether day care is safe or how many kids get kidnapped every year, it affects every parent out there because of this incredible fear that becomes part of your parenting. And we live in a time of hyper-parenting. And I think that parents should be very careful to not sleep in a dangerous way with their child.

But I think that, in some ways, the way these studies are presented does more harm to the widespread parenting population than good because what - being on the receiving end of this sort of information, especially as a young mom who is, sort of - part of what goes on with having a little baby is that you're worried about everything - is that you become absolutely terrified and you think that all these studies are telling you again and again that you're not doing it right, that you're a bad mom. And in this case, you're either a bad mom because you co-sleep or you're a bad mom because you don't co-sleep, and it's very hard to feel that you're a good mother in this country today.

YDSTIE: Dr. Shapiro-Mendoza, are you concerned that medical advice like that, warning parents that they should never co-sleep with their infants, just maybe drives the practice underground or alarms parents unnecessarily?

Dr. SHAPIRO-MENDOZA: I'm not sure that that was advice that I gave, but I really encourage parents, because this is such a tragic event for families and caregivers when this occurs, but naturally parents are concerned about their infants, and they want to protect their infants. And I think having discussions with your pediatrician or primary care provider are absolutely important to address this subject. And work with them to help decide the best environment for their infant to sleep in.

YDSTIE: Leslie, could your own pediatrician have told you about co-sleeping that you might have found helpful?

MORGAN STEINER: Well, I think the advice that I heard a lot was to make sure that there was no soft bedding, no pillows, no comforters or quilts or blankets that the child could suffocate on, and it was very clear to me that, you know, a baby is not mobile, and so you could easily imagine how a baby's mouth and nose could get trapped somewhere, whether under your own body or a pillow or a blanket. And so, I think that message has gotten through loud and clear.

The message that I wish that I had heard and that I try to communicate to other moms is that there is no perfect way to be a mother in this country, and I just wish that - I don't think anybody doing the research is trying to make parents feel bad, but I think that that is the unintended consequence because we - as a culture we feel, sort of, like we own motherhood and we own parenthood, and we have the right to tell parents how they should or should not raise their children. And this is a very small number of tragedies. And...

YDSTIE: We're going to have to wrap it now, but thanks to both of you very much. Dr. Carrie Shapiro-Mendoza, is with the Centers for Disease Control and Prevention. She joined us from Atlanta. And Leslie Morgan Steiner, a regular Tell Me More contributor, joined us from our studios in Washington. Thank you both.

MORGAN STEINER: Thank you very much.

Dr. SHAPIRO-MENDOZA: Thank you.

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