Possibly Educational

You Don’t Have to Share a Room with Your Baby

Maybe this is just the perma-grouch stage of pregnancy talking, but I’m bugged by some of the (really pretty benign) articles about the new SIDS recommendations. Namely the ones that put emphasis on the room-sharing suggestion.

My issues with this go several layers deep, but let’s start shallow: The official AAP report all these articles are based on only dedicates 6 sentences to this specific suggestion. This isn’t a little report, people. Six sentences is a drop in the bucket. And half of those 6 sentences refer to room-sharing just in terms of being safer than bed-sharing. One sentence states the convenience of room-sharing, and just one sentence refers to a startling statistic with accompanying citations (but more on that in a moment). If the official report can’t come up with more than 6 (not particularly well articulated) sentences on this suggestion, it must not be that important. Even if this is the only new addition to the recommendations, it certainly doesn’t warrant a full article highlighting the change.

What the report does describe at length is the risks of bed-sharing and also the dangers of falling asleep while feeding/holding a baby. It also devotes at least a paragraph each to about a dozen other recommendations for parents, including prenatal care, breastfeeding, immunizations, pacifiers, avoiding cigarette smoke, avoiding alcohol, avoiding overheating, avoiding breathing/pulse monitors etc. Several of these recommendations I hadn’t heard of before! All of this information in one report and journalists are choosing to do an entire article on a flimsy 6-sentence excerpt?

But let’s go back to that impressive-sounding statistic I mentioned. “There is evidence that sleeping in the parents’ room but on a separate surface decreases the risk of SIDS by as much as 50%.” Fifty percent!? Wow, that’s a significant decrease! But compared to what? Compared to bed-sharing? Compared to sleeping in separate rooms? It doesn’t actually specify, but the difference changes the meaning of the stat drastically. And given how much they they talk about bed-sharing in the subsequent paragraphs (and in the statistic sentence itself) I’d guess there’s a 50% decrease in SIDS when parents aren’t bed-sharing. Just a guess, though. I looked through some of the citations and couldn’t find which one had the 50% number.

Also, a 50% reduction may not be as significant as it sounds. Potentially it could mean that in the sample there was one case of SIDS that room-shared and two cases that did not. Fifty percent reduction! In a sample of 20 total babies this is kind of a significant fraction (but only kind of–the sample size is much too small to apply any sweeping statements to the general population), but in a sample of 500, that ratio isn’t really a big deal. Percentages can be so misleading without the context of the actual numbers from the sample.

Let’s also talk a moment about the logistics of this kind of research. The best type of research is randomized and all the other potential factors are controlled for. So to prove that the location of the crib is better in the parents’ room, participants would be randomly assigned where to put the crib (at a predetermined, exact distance from either the parents’ bed or the parents’ room). And then everything else across the participants would have to be the same–same crib, same bedding, same pajamas, same temperature, same feeding, same immunizations… all of the known factors in SIDS would have to be the same, and there are tons. The crib location has to be the only difference in the participants in order to conclusively say whether the crib location (and no other contributing factor) impacts SIDS.

But I can guarantee none of the studies were conducted like this. Partly because it’s unethical, and partly because it’s impossible. When measuring risk, researchers can’t make random assignments. For example, when measuring the risk of smoking vs non-smoking, it’s unethical to assign someone to be part of the smoking group when it’s suspected that smoking has a negative impact on health. It has to be voluntary. Likewise, crib placement would be left up to the parents, along with all the other factors that may or may not contribute to SIDS. And ethics aside, it would be physically (and financially) impossible to ensure that every single factor is the same across all participants. It’s just too much–this is sci-fi territory.

So the best researchers can do is ask as many questions as possible about decisions parents make and hope to notice some trends. And even then, trends aren’t a slam dunk. Repeat after me the stats 1010 mantra: Correlation does not imply causation, correlation does not imply causation. Even if a researcher notes, “Hey, SIDS happens 50% less often in the people who room-share vs people who put babies in a separate room!” this doesn’t necessarily mean room-sharing itself reduces SIDS. It could be that in the sample, people who room-shared were also more likely to breastfeed than non-sharers, and breastfeeding caused the reduction. Or maybe the non-sharers just coincidentally happened to over-bundle their babies more often than room-sharers and that’s the cause. But more likely it’s a combination of multiple factors. Hence the medical mystery that is SIDS–apart from cases of suffocation, it’s not known what causes SIDS, so it’s also not known what prevents SIDS. It could be environmental and preventable, but it could also be something inevitable due to undiscovered physical problems with the baby.

Lastly, with all research complications and poor reporting aside, this recommendation of room-sharing is basically saying, “If you listen to your baby’s every breath while he sleeps, SIDS is less likely to occur.” Which is true, but not actually helpful advice. Constant, 100% vigilance is not a sustainable parenting method. It’s not possible! And frankly, it’s not safe. Sure, you might reduce the risk of SIDS by never sleeping, but you simultaneously increase the risk of car accident, falling asleep while holding the baby, forgetting the baby in the car, and just a multitude of bad decisions. As parents and human beings in general, we have to be ok with allowing a certain amount of risk in our lives, and in the grand scheme of things, the placement of a baby’s crib is a really low-risk parenting decision.

The point is: put the crib wherever works best for you, and don’t feel obligated to share the room because it’ll magically protect your baby from SIDS. Some parents prefer sharing a room with their babies–maybe the parents sleep better having them in the room or maybe they like the convenience. And some parents share out of necessity. But for some of us, not sharing a room works best. Do your thing.

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