Last November, we reviewed the A,B,Cs of safe infant sleep environments (Alone, on the Back, in a Crib) and considered new guidelines in the American Academy of Pediatrics’ updated policy statement on protecting babies from SIDS and other sleep-related deaths:
But it’s this recommendation that sent shockwaves through the pediatric community last week:
It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months.
For some parents, this is a no-brainer. For others (and for this pediatrician), the recommendation that babies sleep in the same room as their parents for 6-12 months is a head-scratcher…
In a new study published last week in Pediatrics, researchers were also scratching their heads after finding some problems with this recommendation that infants sleep in the same room as their parents for the first 6-12 months:
Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.
The authors of the study from the Ashley Nicole Shellenberger SIDS Research Fund at the Penn State College of Medicine go to great lengths to highlight the importance of good sleep habits, which should be instilled in a child’s earliest days:
The importance of getting an adequate night’s sleep has been increasingly recognized by professional societies including the American Academy of Pediatrics (AAP) and the American Academy of Sleep Medicine. Inadequate sleep has been associated with poorer cognitive, psychomotor, physical, and socioemotional development, which includes emotion regulation, mood, and behavior in infancy and childhood. Insufficient sleep is generally accepted as an important risk factor for obesity, with links between sleep and weight beginning in infancy. Short sleep duration during infancy is also associated with inadequate sleep later in childhood, emphasizing the importance of developing healthy sleep-related behaviors during the first months after birth. Also, infant sleep has a bidirectional relationship with parent outcomes as demonstrated by associations between infant sleep and parental sleep, maternal sensitivity, relationship quality, parental emotional health, and parenting practices.
For all parameters of infant sleep that were studied, there were significant differences between independent sleepers and non-independent (room-sharing) infants:
> By 4 months of age, the average number of night awakenings in both groups of infants was similar, although independent sleepers required fewer nighttime feedings.
> Independent sleepers had longer stretches of uninterrupted sleep (sleep consolidation) than room-sharers.
> Room-sharing resulted in twice the odds of requiring feeding to get back to sleep.
> If an infant was sleeping independently by 9 months of age, he was a better sleeper — sleeping more than 45 minutes longer each night by the time he was 30 months old — than the toddler who was still sharing a room with his parents at 9 months old. However, taking naps into account, there were no differences in total daily sleep duration among the two groups.
> Independent sleepers were more likely to develop consistent bedtime routines and being put to bed by 8 pm compared to room-sharers. Non-independent sleepers tended to have bedtimes after 8 pm and had lower odds than independent sleepers of being put to sleep drowsy but awake.
But it was these findings that pediatricians will find most troubling:
At 4 months of age, room-sharing infants had greater odds of having an unapproved object (blankets, pillows, positioners, etc) on their sleep surface than those who were sleeping independently… Additionally, room-sharing parents with infants at 4 months of age had over 4 times the odds of bringing their infant into their bed overnight than those parenting early independent sleepers… Similarly, at 9 months of age, room-sharing parents had 4 times the odds than those who were sleeping independently of bringing their infant into their bed after waking overnight.
Alexandria Bachert examines how these findings conflict with the AAP’s revised policy statement:
“Our findings showing poorer sleep-related outcomes and more unsafe sleep practices among dyads who room-share beyond early infancy and suggest that the AAP should reconsider and revise the recommendation pending evidence to support room-sharing through the age of 1 year,” Paul explained to MedPage Today.
He commented that he was surprised by the AAP recommendation because it conflicts with sleep expert guidance, which recognizes developmental changes that occur over the first year.
“The suggestion that parents wait to move the infant out of their bedroom until the end of the first year, when separation anxiety is normative and increasing, is likely to result in frustrated parents and unhappy infants. It also conflicts with other data that room-sharing is associated with more sleep disruption for mothers,” wrote Paul in an email.
As the saying goes: “More studies are needed.”