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

Written by James J. McKenna, PhD   
Sunday, 01 June 2008 00:00
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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.

“ 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.