CHICAGO — James Robinson will tell you the hardest part of his son’s death was having to face his fiancee.
The Chicago man blames himself for bringing 7-week-old D’Angelo into bed with him that fateful night. But after spending the day at the hospital with their older son, who had been diagnosed with cancer that day, Robinson feared that if his newborn cried, he’d be too exhausted to hear. So he put his arm around him, as if to form a shield, and the two drifted off to sleep.
When he awoke, the first thing he saw were his son’s bluish lips.
At its worst, the controversial practice of bed-sharing — typically defined as when infants sleep in the same bed as their parents — has stolen babies from their families, usually when a well-intentioned parent rolls over on the baby and suffocates him or her.
At its best, advocates say the practice can strengthen bonds between parent and child, facilitate breast-feeding and cure sleepless nights.
As the number of parents who choose to bed-share appears to be on the rise, the debate over its safety continues to heat up.
In Illinois between 2008 and 2010, bed-sharing was the culprit in at least 190 infant deaths, according to state data.
In Lake County, Ill., a recent spate of infant bed-sharing deaths — eight between March 2010 and June 2011 — caught the attention of Coroner Artis Yancey, who has since sought to educate parents on the issue. He now distributes material on safe sleeping practices and keeps a crib in his office for parents who need one. So far, he said he’s given away three.
“It’s a tragic thing,” he said. “It should be the happiest time of (parents’) lives, and it turns out to be the worst time of their lives.”
Public health officials, researchers and distraught parents are also stepping up efforts to spread the word on safe-sleeping practices for infants. Illinois legislators passed two laws aimed at curbing sleep-related infant deaths. One, which went into effect this month. requires additional training for day care providers. The other, implemented last year, mandates that hospitals provide new parents with safe sleeping information.
In an article published this week, a Centers for Disease Control and Prevention senior scientist called for better reporting of Sudden Unexpected Infant Death, including whether an infant died while bed-sharing.
“These deaths seem to be increasing, and we want to understand why. To do that, we need better data,” said the scientist, Carrie Shapiro-Mendoza, who previously led a study that found infant deaths blamed on accidental strangulation and suffocation in bed quadrupled from 1984 to 2004.
And in October, the American Academy of Pediatrics released a policy advising against bed-sharing while stating when parents sleep in the same room as a baby — but not in the same bed — the risk of Sudden Infant Death Syndrome can be cut by as much as 50 percent.
Since experts came out in the early 1990s with the recommendation of placing babies on their backs to sleep, deaths from SIDS have dropped dramatically, said pediatrician Rachel Moon, a SIDS researcher at Children’s National Medical Center in Washington, D.C., and lead author of the academy’s policy. But Moon said deaths from some of the most common bed-sharing causes, such as suffocation, are on the rise.
Because each circumstance is different, it’s hard to quantify the risks of bed-sharing, so “we can’t say it’s safe. We can’t recommend it for anybody,” Moon said.
In Cook County, 27 infants died in cases involving bed-sharing since 2008, according to the medical examiner’s office. Lake County had 15 bed-sharing deaths during that time, and Will County had seven, while Kane, DuPage and McHenry counties each reported two or fewer bed-sharing deaths, county officials reported. The youngest in the six-county area was 4 days old.
Yet James McKenna, director of the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame, maintains that an outright ban on bed-sharing is “a social judgment and not a science.”
Barring risk factors like substance abuse, which he said aren’t taken into account in the numbers, McKenna believes bed-sharing can be done safely and with great benefit to the mother and baby. While he doesn’t recommend bed-sharing for babies who are bottle fed, he believes that mothers who are breast feeding have a greater sense of their babies’ presence and typically sleep in a safer, protective position. He said parents should be allowed to make educated decisions on bed-sharing without feeling like they’re doing something wrong.
“Moms just aren’t these passive, lethal weapons they’re being portrayed to be,” he said.
In November, a Milwaukee ad campaign sponsored by a nonprofit showed a baby sleeping in an adult bed next to a knife and words underneath that read, “Your baby sleeping with you can be just as dangerous.”
Katie Martinson, a Woodridge mother of four and registered nurse, said she has bed-shared with all of her children. Her youngest, who is 3 months old, goes to sleep in her bassinet but moves into her parents’ bed as soon as she wakes for her first feeding.
“I think I could resent (breast feeding) if I was slogging out of bed constantly,” said Martinson, 30. “But this way, (babies) don’t really fully wake up. They just kind of dream-feed.”
Martinson, who teaches childbirth education classes, said she informs parents inquiring about bed-sharing of the American Academy of Pediatrics’ recommendations.
“I also say in many other parts of the world, this is how it’s done,” she said. “People sleep with their babies in bed with them.”
Sarah Grunner said her 2 ½-year-old son has been sleeping in his parents’ bed since birth. The decision was a joint one with her husband and it gave her, as a working mother, another opportunity to bond with her son.
“It’s strange,” said Grunner, of Wheaton, Ill. “It’s more like I’m in tune with what’s happened with him than other things. I don’t hear other noises, but I always know what’s going on with my son. … It’s kind of like being able to assure him that we’re always there, and he feels that immediately. Hopefully that will carry over emotionally as he gets older.”
But all the potential benefits aren’t worth the risk of losing a baby, contends Judith Bannon, executive director of the Pittsburgh-based organization Cribs for Kids.
“If there was anything else killing children at this rate, there would be an outcry from the community,” Bannon said. “You can’t go into people’s home and dictate where the baby sleeps, but you can educate them about safe sleeping for the infant and the consequences of putting them in an unsafe environment.”
Kakuna Smith has channeled her devastation into advocacy. Six years ago, the Dolton, Ill., woman’s 11-week-old daughter died in a bed-sharing accident. She now counsels other parents who’ve lost children while bed-sharing and is a SIDS of Illinois board member.
“I’ll tell anyone who will listen,” said Smith, 34. Her daughter Kamilah’s toys, books and clothes all remain in Smith’s home as reminders, and Smith keeps her pink onesie in a zip-lock bag in her dresser.
“I don’t want the (new-baby) smell to go away,” she said.
Leanita Williams, whose son Messiah died two years ago this month, finds comfort in seeing his framed picture above the fireplace. That cold night, he was fussy after having his shots, so she brought him into bed.
Nothing could have prepared her for planning his funeral days later. Her words are hushed but direct.
“Put (babies) in a crib,” said Williams, 20, of Chicago’s North Austin neighborhood.
Members of the Illinois Child Death Review Team were also struck by an increase in the fatality rate among infants when sleeping in their parents’ bed, said Sherry Barr, of the Illinois Department of Children and Family Services.
The state’s nine Child Death Review teams consist of pediatricians, coroners and other officials who investigate deaths of children in cases where a child was a ward of the state or had been the subject of a DCFS investigation within the prior year. The team may also review cases they feel need further study in the interest of coming up with recommendations that might save the lives of other children, Barr said.
The teams’ work resulted in DCFS partnering with SIDS of Illinois to spread the word on safe sleeping. The effort includes materials distributed to day cares, foster homes and hospitals. SIDS of Illinois also offers a free crib program and other outreach.
“It continues to be an extremely controversial issue,” Barr said. “It’s a difficult battle because people are getting mixed messages.”
Even with the American Academy of Pediatrics’ recommendation against bed-sharing, some doctors or nurses still advise differently, she said. And sometimes parents are just too exhausted or unaware of the high risks, she said.
“The bottom line is, we all have to get on the same page,” said Nancy Maruyama, SIDS of Illinois’ executive director for education and community outreach. “We have so many parents who say, ‘I didn’t know it wasn’t safe.’
“I liken it to the car seat issue,” she said. “Most parents would never consider putting their children in the car without a safety seat. Why wouldn’t you put your baby in a safe crib?”
James Robinson had a bassinet in his bedroom, and every day he regrets not having used it. He wonders how things might have turned out if he hadn’t been so emotionally drained that evening. Or if his fiancee hadn’t spent the night at the hospital with their 4-year-old.
Robinson’s neighbors heard him screaming for help. Later, at the hospital, when the doctors told Robinson there was nothing else they could do, he said he lashed out, pounding his fists into pictures on the hospital walls. He had to be restrained by a security guard.
Even though a few floors separated him and his fiancee, he couldn’t bring himself to tell her what happened. They sent a nurse upstairs instead. When he saw her across the hospital room, all he could do was cry.
The hospital chaplain found him in a crumpled, sobbing heap, and told him that maybe God took one son’s life to spare the other’s.
“Every time I’m down, I repeat that to myself,” he said.
Recommendations for safe sleeping
The American Academy of Pediatrics and SIDS of Illinois advise against allowing infants to sleep in the same bed as parents but offer these recommendations for safe sleeping:
Babies should sleep alone on their backs, in cribs, bassinets or portable playpens that meet the most current safety standards.
Do not use a drop-sided crib.
Do not use bumper pads, pillows, stuffed animals or heavy blankets in cribs. Dress babies in wearable blankets for sleep.
Do not allow babies to sleep on couches, adult beds or waterbeds.
Do not allow smoking near babies.
Although many in the medical community warn against bed-sharing, some supporters say there are safe ways to do it. The Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame recommends:
Babies under 1 should not sleep with other children in the same bed.
Adults taking sedatives, medications or other drugs, or those who are intoxicated or excessively tired, should not bed-share with an infant.
Long hair on the mother should be tied back to prevent entanglement around the infant’s neck.
Obese adults might not be able to bedshare.
Bottle-fed babies should not bed-share but can sleep in their own bassinet or crib next to the mother’s bed.
Sources: American Academy of Pediatrics; SIDS of Illinois; Cribs for Kids; Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame