Meet Your New Roommate - Your Baby

Advice comes from many people when you have a newborn. Just spending a few minutes online searching and you will be overwhelmed with opinions on how to breastfeed, how to get your infant to sleep longer, and the best remedy for colic. I nearly fell off my chair when I read the recent headlines regarding new sleep guidelines from the American Academy of Pediatrics. The task force for this guideline recommends that babies sleep in their parents’ rooms for the 1st year of life. I rubbed my eyes and read again. Could this be true?

We as pediatricians have been combating SIDS, sudden infant death syndrome, since the 1990s and with great success. Rates dropped over 50%, but the success plateaued following the Back to Sleep Campaign and there remains a steady rate of around 3,500 deaths of babies per year in the US from SIDS. This makes SIDS still the largest cause of infant mortality in the US after the 1st month of life.

I saw many of my colleagues also raise an eyebrow regarding the possible negative impacts on a family of room sharing with an infant. I hardly slept when my kids shared our room for the first 3-4 months. I celebrated moving them out so that they could learn how to self sooth and put themselves to sleep. But I won’t lie, I happily moved them out so I did not wake to every hiccup, sneeze, and grunt. In fact, many parents are quick to respond to these noises and ultimately unintentionally get into the bad habit of waking the infant by picking them up out of concern.

My worry with the recommendation is that parents are deprived of sleep which has the unintended effect of endangering the babies and hurting the parent’s health. According to the NY Times, when one of the members of the task force was questioned about the unintended consequences of rooming with the infant, she responded that the panel had not given great thought to parents’ sleep and stated “Parents will probably need to get used to it.” Later she indicated that the recommendation covered the entire first year “to be on the prudent side,” but admitted, as I would also point out, that the first 4-6 months were really the most important. The majority of SIDS cases occur in this age range.

Interestingly, no new evidence has emerged on this issue since the last recommendation was published in 2011. All of the evidence is predicated on case control studies which are one of the weaker design studies in research. On top of that the data was actually collected PRIOR to the Back to Sleep Campaign and only in European countries. Who is to say that sharing a bedroom now and in the US will have the same effect?
My goal for families is to do everything possible to lower the chance of SIDS, but I also want to do this in ways that are likely to work, and more importantly unlikely to cause harm to family or infant. Families I see are already hypervigilant about their infant crying. This added recommendation to keep infants in the parent’s room potentially adds further stress as parents are left with the impression they need to now hover over their baby. Even worse, what will be the impact of this recommendation on sleep training and self-soothing and regulation which families are wrestling with much more than in the past?

While I have, and will continue to discuss this with families, it is in the larger context of balancing real and perceived risks and benefits. Hopefully the new recommendations will not add further feelings of guilt to already overworked parents or lead to more sleep challenges in the toddler who relies on the close proximity of a parent to fall asleep. Of course, I always hope for the best but prepare for the worst.

Michael Martin, MD

Einstein Pediatric / 2235 Cedar Lane / Vienna, VA 221812 / www.einsteinpeds.com / 703-344-7330