How Should I Counsel a Mother Using a Bedside Co-Sleeper?

Patient Presentation
A 4-month-old female came to clinic for well child care. The mother reported using a bassinet-style co-sleeper next to her bed for the infant to sleep in. She liked this because she could roll over at night and take the infant into her bed to breastfeed and return the infant to the co-sleeper easily. The mother was a non-smoker and non-drinker. The past medical history showed a full-term infant without prenatal or natal problems. The pertinent physical exam showed a smiling infant with growth parameters between 75-90%. The physical examination was unremarkable.

The diagnosis of a healthy infant was made. The resident physician was not sure how she should counsel the mother about the co-sleeping arrangement. The attending physician tried to quickly look up the American Academy of Pediatrics (AAP) recommendations but could not find the relevant information during clinic. The attending did say that he himself did not recommend co-sleepers because he was afraid of entrapment in the area between the bassinet and the adult bed, in addition to having loose adult bedding around the infant. He did note that there were some co-sleeping products that wall off an area of the adult bed to make a separate sleeping area for the infant in the adult bed. This he did not recommend and knew that the AAP also did not recommend it. The following day, the attending had more time to review the AAP guidelines which does not make a recommendation for or against bedside co-sleepers.

Discussion
Infant sleeping practices are different around the world, but need to provide a warm, safe sleeping environment with as little inconvenience and cost for the family. The AAP recommends that infants use a crib, bassinet, playpen, portable crib, or play yard with a firm mattress with no loose bedding (including pillows, stuffed animals, sleep positioners such as wedges, etc.). “Room-sharing without bed-sharing is recommended” by the AAP to prevent suffocation, strangulation, and entrapment of the infant in an adult bed. The AAP’s extensive technical report with specific recommendations for safe infant sleeping environments are available (see To Learn More below).

Learning Point
Co-sleepers that are located in the adult bed are not recommended by the AAP. Bedside co-sleepers that are located separate from the adult bed but next to it are neither recommended or not recommended by the AAP on the basis that there is not enough data to make a recommendation. The AAP also does not recommend bed rails for infants. Bedrails are placed along the side of the bed and are intended to prevent a larger child such as an older toddler, preschooler or school age child from falling off the side of the bed. Car seats and other sitting devices are also not recommended as places for infants to sleep.

The U.S. Consumer Product Safety Commission and ASTM International are currently working on standards for bedside co-sleepers but these recommendations have not been published. Consumer Reports, an independent, non-profit consumer advocacy organization, does not recommend either co-sleepers that are located in the adult bed or beside the adult bed. They recommend a separate crib for infants and children up to ~4 years of age.

Questions for Further Discussion
1. What are some common sleeping arrangements in your practice location?
2. What parent recommendations do you offer for different sleeping arrangements?
3. How common is sudden infant death syndrome (SIDS) and/or deaths from sleeping environment in your practice location?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: SIDS and Infant and Newborn Care..

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

Arm’s Reach Concepts Recalls Infant Bed-Side Sleepers Due to Entrapment, Suffocation and Fall Hazards. Consumer Product Safety Commission. Available from the Internet at http://www.cpsc.gov/cpscpub/prerel/prhtml11/11187.html (rev. 4/5/2011, cited 3/2/2012).

American Academy of Pediatrics Technical Report. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics. 2011:128;e1341-e1367.

Bassinet Buying Guide. Consumer Reports. Available from the Internet at http://www.consumerreports.org/cro/babies-kids/baby-toddler/bassinets/bassinet-buying-advice/index.htm (rev. 1/2012, cited 3/2/12).

ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
    4. Patient management plans are developed and carried out.
    5. Patients and their families are counseled and educated.
    6. Information technology to support patient care decisions and patient education is used.
    8. Health care services aimed at preventing health problems or maintaining health are provided.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
    14. Knowledge of study designs and statistical methods to appraisal clinical studies and other information on diagnostic and therapeutic effectiveness is applied.
    15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
    16. Learning of students and other health care professionals is facilitated.

  • Interpersonal and Communication Skills
    19. The health professional works effectively with others as a member or leader of a health care team or other professional group.

  • Systems Based Practice
    23. Differing types of medical practice and delivery systems including methods of controlling health care costs and allocating resources are known.
    24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.

    Author

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital