Findings reignite SIDS debate about where babies should sleep
Last October, the American Academy of Paediatrics (AAP) released a new policy statement advising that babies should sleep in the same room as their parents but in their own cot for the first year of their life, in order to prevent sudden infant death syndrome (SIDS).
Despite the AAP's recommendations, room sharing between babies and mothers beyond the first four months is associated with less sleep for babies and unsafe sleeping practices that the original guidelines hoped to prevent, according to Penn State College of Medicine researchers.
While room sharing can be justified for the first six months based on the fact that 90 percent of SIDS cases happen in this timeframe, Dr Ian Paul, a professor of paediatrics, said evidence was lacking for the six to twelve month recommendation made by the AAP, which also conflicts with infant-sleep expert guidance.
Dr Paul says that this lack of evidence led the research team to address the question of the effects of parent-baby room sharing on sleep habits and quality:
"Inadequate infant sleep can lead to obesity, poor sleep later in life and can negatively affect parents. Many paediatricians and sleep experts question the room-sharing recommendation until one year because infants begin to experience separation anxiety in the second half of the first year, making it problematic to change sleep locations at that stage. Waiting too long can have negative effects on sleep quality for both parents and infants in both the short and long term."
To study the link between room-sharing and sleep outcomes, the researchers used data they had already collected from the INSIGHT study, which included 279 mothers who delivered at Penn State Medical Center, and their babies. A questionnaire was completed by mothers when their babies were four and nine months old and assessed sleep duration, location, night waking, night feedings, bedtime routines and sleep behaviours. Sleep duration, location and patterns were also assessed at twelve and thirty months.
The findings showed that children who already slept independently in their own room at four months averaged 45 minutes longer stretches of continuous sleep than those who shared a room with a parent. At nine months, the gap widened: Those who learned to sleep independently by four months had sleep stretches that averaged one hour and 40 minutes longer than babies who were still sleeping in their parent's room (542 minutes vs. 442 minutes respectively). Total sleep over the night was also greater for the babies who were in their own room.
These early decisions by parents had lasting effects. At 30 months, babies who had room-shared at nine months slept, on average, 45 minutes less per night than those who were independent sleepers at four and nine months.
Room sharing also affected sleep safety. Babies who shared a room at 4 months were more likely to have a blanket, pillow or other unapproved object that could increase chances of SIDS in their crib than those who slept in their own room. Dr Paul says that babies who shared a room were more likely to be moved into their parent's bed overnight at both four and nine months old:
"Perhaps our most troubling finding was that room-sharing was associated with overnight transitions to bed-sharing, which is strongly discouraged by the American Academy of Paediatrics. Bed-sharing overnight was more common in our sample among four- and nine-month-olds who began the night on a separate surface in their parents' room."
The professor notes that breastfeeding outcomes were not different between groups at age four months and beyond, but says the study questions the AAP's recommendation to room-share for the entire first year:
"Our findings showing poorer sleep-related outcomes and more unsafe sleep practices for babies who room-share beyond early infancy suggest that the American Academy of Paediatrics should reconsider and revise the recommendation pending evidence to support it."