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Jun
01

Why We Never Ask: “Is It Safe for Infants to Sleep Alone?”

Author // James J. McKenna, PhD

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Why We Never Ask: “Is It Safe for Infants to Sleep Alone?”
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Historical Origins of Scientific Bias in the Bed-sharing SIDS “Debate”


“ Bad science sets out to make a point, looks neither to the left nor to the right but only straight ahead for evidence that supports the point it sets out to make. When it finds evidence it likes, it gathers it tenderly and subjects it to little or no testing.”

– Mark Vonnegut, The Boston Globe, October 24, 1999.


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“ Don’t sleep with your baby or put the baby down to sleep in an adult bed. The only safe place for babies to sleep is a crib that meets current safety standards and has a tight-fitting mattress.”

– Ann Brown, Commissioner, Consumer Product Safety Commission United States of America, September 29, 1999.


The debate about where infants should sleep and which hazards associated with different sleep environments are worth solving has never taken place on a level social or scientific playing field.

Moral beliefs about how and where infants and children should sleep in western cultures are both tied to, and reflected in, the methods and conditions used to study infant sleep. Data collected on solitary, bottle-fed infants currently serves as the “gold standard” in research methodology, despite the fact that both breastfeeding and forms of cosleeping are reaching historic highs. Thus, the pediatric sleep research community increasingly finds itself at odds with the behavior of the families it attempts to serve. This incongruity illustrates how tenacious traditional social and medical values and conventional understandings of infant sleep have become and why contemporary families feel so confused, frustrated, and unsupported.

Inflammatory rhetoric, value judgments, mistaken presumptions, and reliance on anecdotal data play a major role in assisting anti-bed–sharing/co-sleeping researchers to promote their views. For example, the well-established distinctions between bed-sharing and dangerous couch sleeping have been ignored and used to inflate “ bed-sharing” death statistics. Research findings also fail to account for the difference between the practice of bed-sharing and modifiable factors, which may be associated with bed-sharing. Such conclusions move from evidence-based science to social ideology, making value-based judgments about what “problems” are worth solving and which are not.

In this commentary, I call attention to the cultural and historical origins of western moral beliefs about how infants should sleep, and the scientific practices that continue to define what constitutes healthy and desirable infant sleep. I also review our cultural history and propose an explanation as to how and why anti-bed–sharing researchers have used poor quality data to generate sweeping public health recommendations. This knowledge is critical if we are to move beyond the erroneous assumption that mother–infant co-sleeping is pathological rather than overwhelmingly adaptive and deserves to be supported for those parents who practice it.

Critics of co-sleeping in the form of bed-sharing declare, “cribs are designed for babies while adult beds are not,” and to a certain extent this is true. But since pediatric models of infant health, disease, and illness are necessarily derived from human biology, it is appropriate to remember that the only true “baby-designed” sleep object or environment is the mother’s body. This fact, however, cannot serve as an analytic endpoint for understanding safe sleeping environments for infants. Specific environmental factors including dangerous furniture, bedding practices, and drugdesensitized parental bodies can transform an otherwise adaptive sleeping arrangement into a risky or dangerous one. To assume, a priori, that the normal, sober, attentive sleeping body of a human mother represents a risk to her infant reveals an appalling lack of understanding of how natural selection shaped maternal sleep physiology in relationship to infant needs and vulnerabilities. Such a view irresponsibly disregards peer-reviewed scientific research showing unequivocally the human mother’s ability to respond to her infant’s needs while sleeping, even in the deepest stages of sleep.

A scientifically appropriate beginning point for studies of safe sleeping arrangements must include the mother by the infant’s side, co-sleeping. This fact is ignored, dismissed, or otherwise rejected by many physicians and western sleep and SIDS scientists. Ignorance of the biological significance of mother–infant co-sleeping with nighttime breastfeeding should no longer be tolerated by health professionals, scientists, or parents.


How Cultural Folk Assumptions About Infant Sleep Achieved Scientific Validation

The cultural reasons that explain the willingness of the pediatric/medical community to adopt invalid assumptions and use anecdotal data as a basis to recommend against all bed-sharing is easy to understand. Unfortunately, these same reasons make it difficult to successfully counteract anti-bed–sharing research and recent moves to use cosleeping or bed-sharing as a reason to diagnose an infant’s death as asphyxiation instead of SIDS. So entrenched are these assumptions and false stereotypes about co-sleeping that contemporary researchers and reviewers reading anti-bed–sharing reports are not likely to notice how and where the authors’ cultural assumptions, preferences, and biased interpretations are substituted for logically-deducted scientific truths. These biases prevent researchers from acknowledging the overwhelming number of deaths involve not co-sleeping, but infants sleeping alone.

For at least a century, western social and moral values have served as the basis for defining how and where infants should sleep. Specific concerns including protecting the husband– wife pair, and the perceived need to produce independent and secure infants through enforced nighttime separation, provided the initial basis for defining uninterrupted solitary infant sleep as “normal” and “healthy.”