|On September 29, 1999
the Consumer Product Safety Commission (CPSC) issued a
recommendation against co-sleeping. The CPSC cited research that
indicates an increased risk for SIDS, for suffocation and for
strangulation associated with cosleeping. This research, published
by D.A. Drago and A.L. Dannenberg in Pediatrics (103:5:e59,1999),
has been sharply criticized in a follow-up letter to that journal
by James J. McKenna, PhD, director of the Mother-Baby Behavioral
Sleep Laboratory at the University of Notre Dame and Lawrence M.
Gartner, MD, co-author of the American Academy of Pediatrics (AAP)
1997 statement on breastfeeding.
On September 30, 1999, La Leche
League International, the worlds foremost authority on
breastfeeding, issued a statement citing studies that show that
"cosleeping with a breastfeeding infant promotes bonding,
regulates the mother and baby sleep patterns, and helps the mother
become more responsive to her baby's cues."
And in an opinion piece in the New
York Times on October 1, 1999, Penelope Leach, London
psychologist and author of Your Baby and Child, says,
"Three other studies, in the United States, New Zealand and
Britain reported no direct risks to babies from sleeping in
Unfortunately, the American
Academy of Pediatrics (AAP) is publishing a new book in December, Guide
to Your Child's Sleep, that extols the dangers of the family
bed. Fortunately, I know better, but I grieve for the new parents
who will be sorely confused by this nonsense.
Over the years, I've observed a
progression in the life cycle of new ideas. They are first
ignored, then ridiculed, next attacked and, finally, assimilated.
This process of social change can take decades. Does the fact that
the AAP finds it necessary to attack the family bed mean that it
is being taken seriously by our culture? Does the advice in their
book indicate that pediatricians, unfamiliar with the family bed
themselves, don't know how to advise the parents who have
legitimate questions about it? Could it possibly mean that the AAP
is afraid of some future liability should they appear to condone
the family bed in the present? Or, does it simply mean that now we
will have something new to lie to our doctors about?
The family bed is not a medical
issue. It is a personal, social, and familial issue. It is a
"mother management" issue. It is nobody's business but
our own. I suppose that someone can dredge up obscure research
showing that some drunk or drugged parents have actually rolled
over and squished their infants while sleeping with them. I, for
one, am tired of recommendations based on the worst case scenario.
I will not have my perfectly
innocent, healthy maternal instincts co-opted by medical
associations who focus on deviations at the expense of normalcy.
And, I refuse to base my parenting philosophy on fear.
I am not a doctor. I am, however,
the mother of four contented family bed veterans. I have also been
the editor and publisher of a magazine for parents for 20 years.
Never once have I heard a story of any real parent who slept with
a child, rolled over and hurt that child. Nor have I heard of any
child being emotionally hurt by sleeping in the family bed.
What I have heard, however, are
the moans of parents whose awareness is so heightened by the
presence of their baby in the bed that they cannot sleep. I have
heard from parents who don't know how to manage the family bed
when their baby squirms, kicks and moves about. I have heard the
frustrations of parents who wonder how to keep their sexual
relationship alive with a family bed. And, I have heard from
parents who fear they will never get their child out of their bed
once they have experienced nighttime nurturing. All of these
situations have creative solutions that experienced family bed
parents can share with new parents.
I'm practical enough, however, to
want to know more than anecdotes. I want to know more about what
other countries do, what other generations in our own country have
done. That's why I was glad to find the book The Family Bed
when I was a new parent 25 years ago. And, more recently, Meredith
Small's book, Our Babies, Ourselves, reminds us that,
"In almost all cultures around the globe, babies sleep with
an adult." Small says that it is only in industrialized
Western countries such as the US, Canada, and some countries in
Europe that sleep has become a private affair. In fact, the US is
unique from the rest of humanity in the way we treat our children
In her book, Small notes one study
of 186 non-industrial societies that shows that in 67 percent of
these cultures, children sleep in the company of others. And in
none of these 186 cultures do babies sleep in a separate place
before they are at least one year old. In another study of 172
societies, all infants in all cultures do some cosleeping at
night. As Small says, "The US consistently stands out as the
only society in which babies are routinely placed in their own
beds and in their own rooms."
In officially being cautious and
fearful about the family bed, the AAP not only ignores the
practices of hundreds of other societies in the world but also the
research of other scientists. The research of James McKenna, PhD,
for example, shows a synchronicity between the breathing of the
mother and the newborn suggesting that, for some babies,
especially for those at risk for SIDS, cosleeping may be life
When did we agree to let medical
authorities into our bedrooms? What gives medical associations the
right to terrorize us with so-called "recommendations"
that only undermine our authority as parents? Why are we parents
so often made to feel that our doctors are our adversaries rather
than our advocates? Such "universal recommendations"
that take neither individual circumstances nor personal
preferences into account are a one-size-fits-all pediatrics-
insulting at best and hurtful at worst.
However, as parents, we do want
the leadership of the AAP regarding medical matters. Just
what is its track record in this regard? Let's take, as examples,
the association's recommendations regarding breastfeeding,
circumcision, and vaccinations. In 1997, the AAP came out with an
historic statement in support of breastfeeding, which encouraged
women to breastfeed their babies for at least one year and advised
physicians to become educated about and supportive of
breastfeeding. I know that the authors of this statement worked
for years to reach consensus among the academy, and while I
applaud the AAP for this statement, it was hardly new information.
La Leche League has been saying the same thing for over forty
years. The World Health Organization (WHO) goes further than the
AAP by recommending breastfeeding for at least two years. And, a
study of women in the US who allow their children to wean
themselves showed the average age of weaning to be between two and
a half and three years of age.
In the case of breastfeeding, the
AAP has not been a leader, but a follower. In recent years, the
AAP has also been a follower, as well, in regards to its
contradictory statements on circumcision. Instead of taking the
role of leadership that medical associations around the world have
taken, the AAP chose vacillation. In 1971, the AAP first publicly
opposed circumcision, a procedure performed almost universally in
the US at that time. In 1975, the AAP reinforced this position,
issuing a statement that "there is no absolute medical
indication for routine circumcision of the newborn." And in
1983, both the AAP and the American College of Obstetrics and
Gynecology reiterated their opposition to circumcision, and
circumcision rates dropped from over 90 percent to just over 50
However, in 1989, the AAP did an
about face, issuing a statement that "newborn circumcision
has potential medical benefits and advantages as well as
disadvantages and risks." And, to add to the confusion, in
1999, the AAP said, "the benefits [of circumcision] are not
significant enough for the AAP to recommend circumcision as a
routine procedure." However, they did not actually recommend
against it. They left it up to the parents.
The physicians of other countries,
however, have been more straightforward in condemning
circumcision. The medical associations of Canada, Australia, and
Great Britain all have strongly worded position statements
opposing circumcision. The Australian College of Pediatrics, for
example, says, "Neonatal male circumcision has no medical
indication. It is a traumatic procedure performed without
More recently, the vacillation of
the AAP has had tragic effects. In November, 1998, the AAP
recommended that RotaShield, the vaccine for Rotavirus, a common
childhood virus causing diarrhea and other problems, be given to
infants at two, four, and six months of age, with doses no less
than three weeks apart. This three-dose series cost parents $240.
The vaccine was first recommended by the Centers for Disease
Control and Prevention's (CDC) Advisory Committee on Immunization
Less than a year after this
vaccine was recommended by the AAP, and after approximately 1.5
million doses were administered to infants, they changed their
minds. On July 15, 1999, the CDC postponed the use of RotaShield
because of 15 reported cases of bowel obstruction allegedly
associated with the vaccine. The AAP followed suit. What makes
this "postponement" of the rotavirus vaccine all the
more ominous is that a statistically significant rate of bowel
obstruction was reported in the vaccine trials that occurred
before it was licensed for use. Despite these complications in
prelicensure trials, RotaShield was approved and recommended, and
neither parents nor physicians were warned to watch for symptoms
of bowel obstruction. As a result, some eight infants have
required surgery because of a recommended vaccine for an illness
that is highly treatable with rehydration therapy in the US and
which does not cause widespread death among US children.
Clearly, the AAP is not an
infallible organization. While the organization has issued some
important statements on the effects of television and violence on
children, it has also been dead wrong a number of times. And, it
has let us down. Where we expect the organization to be proactive,
it has been reactive. Medical recommendations regarding pregnancy,
childbirth, and parenthood, for example, are notoriously rift with
fears of liability and the concerns for special interest groups.
Following standard medical procedures often contradicts even the
most current medical research.
Pregnant women are told not to
gain too much weight even though low-birth weight is the number
one cause of infant mortality in the US. Women are often left
alone during labor even though continuous emotional and physical
support by another woman has been shown to reduce cesarean births
by 50 percent, the labor length by 25 percent, and drug use and
other interventions by 20 to 40 percent. Women often take drugs
during labor even though studies show that drug use by the mother
during labor imprints the baby for drug use and addiction as an
As if this isn't discouraging and
contradictory enough, since 1991, the AAP and CDC have recommended
the hepatitis B vaccine for all infants at birth. Hepatitis B,
however, is most often a sexually transmitted disease and there
are five times more reactions to the vaccine as there are
incidences of the disease. The AAP and the CDC no longer recommend
this vaccine for non-risk infants at birth. They changed their
minds this past summer after congressional hearings on the
complications of the hepatitis B vaccine.
How could we have been so naive?
We expected the medical establishment to lead the way, to be aware
of the latest research, to be broad-based. Gosh, we even expected
them to inspire us, to support the validity of our own experience.
Instead, what they do is to systematically break down our parental
instincts so that we no longer know what we know and must rely on
experts for the rest of our lives. Maybe that's why they call it
So I say to the AAP, "Mind
your own business." I want your courageous leadership
concerning medical matters, but not your interference regarding
personal matters. The unique dyad that I have with my child is
incredibly and inherently wise. I may not know you, my doctor, in
twenty years, but I will know my child. Only my child and I will
have to live with the decisions that I make. Do not make them for
me. Do not imply that you know better than I do what is best for
my child. Do not give me a one-size-fits-all prescription for my
totally authentic and original child.
How long I nurse my baby, whether
or not I share my bed with my child, or how many times I have sex
with my husband is no business of yours. Please, dear doctors,
find us a cure for autism; acknowledge our legitimate questions
about vaccinations; give us something other than drugs for our
"hyperactive" children; explain to us why there's an
increase in chronic disease among youth; support our efforts to
raise our children in a clean environment free of pesticides and
genetically engineered food.
But do not tell us what to do in
our own bedrooms. It's hard enough to figure this parenting thing
out. Please, doctors, help us. Don't scare us. Please, doctors, do