Sleep Review News

by Franklin A. Holman

The Milwaukee Health Department launched a campaign to discourage bed-sharing between parents and their babies. The campaign features posters of babies cuddling butcher knives with a caption stating: YOUR BABY SLEEPING WITH YOU CAN BE JUST AS DANGEROUS. In countless forums discussing the ad, parents and medical professionals are saying the campaign is over the top, and while that may be true, the controversial ad has been effective in getting people talking about the topic. That being said, rather than simply demonizing the act, educating parents who choose to bed-share should be a part of the equation as well.

"I think it is not our business to encourage or discourage co-sleeping. It is a cultural choice most of the time," said Oleg Kouskov, MD, MCR, medical director for pediatric sleep services at St Luke's Sleep Medicine Institute, Boise, Idaho. "Those who work with people of different cultures would probably agree with me, if they ever talked with parents about this issue. Our job is to help them improve safety no matter what parents choose."

The Milwaukee Health Department is taking a different approach, placing their bets on shock value. The goal of the campaign, according to the Health Department, is to reduce the city's overall infant mortality rate in 5 years by at least 10% from 10.4 to no more than 9.4 deaths per 1,000 live births, and to reduce the African-American infant mortality rate by at least 15%.

"We are making progress through increased awareness of the various causes of infant deaths like prematurity, unsafe sleep, and access to quality prenatal care," said Milwaukee Mayor Tom Barrett. "But the fact is, we need to do more to impact the many multiple layers and root-cause factors that affect infant mortality."

To accomplish that goal, the provocative ad will be seen on bus shelters throughout the city.

In playing its role in ensuring infant safety, the American Academy of Pediatrics recommends room-sharing without bed-sharing. According to an AAP policy statement, "There is evidence that this arrangement decreases the risk of SIDS by as much as 50%. In addition, this arrangement is most likely to prevent suffocation, strangulation, and entrapment that might occur when the infant is sleeping in an adult bed."

However, the policy also states, "Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep."

In shocking parents into action with broad messages, as in the case of the Milwaukee Health Department campaign, the ad oversimplifies and overreaches.

Summarizing the state of bed-sharing public health messages, the authors of "Never Sleep with Baby? Or Keep Me Close But Keep Me Safe: Eliminating Inappropriate 'Safe Infant Sleep' Rhetoric in the United States" conclude that effective messages are those that educate and facilitate safe bed-sharing. The authors endorse sharing the dangers of bed-sharing but also acknowledge "that while separate surface co-sleeping in the form of room-sharing should always be recommended, nonetheless, many parents will appreciate and benefit from the opportunity to learn how to reduce the risks associated with bed-sharing."

The presentation of the ad is provocative; it was intentionally designed that way, and because of its nature, this is an issue that people are talking about and that is likely to scare parents into action. Hopefully, the campaign decreases infant deaths, and sleep professionals—by playing a role in educating scared parents about techniques for safe bed-sharing—can pick up where the ad fell short.

—Franklin A. Holman
fholman@allied360.com