On April 5, 2012 Vanessa Clark was found guilty of child endangerment in the death of her 2-month-old son Tristan in July 2010.  What did she do?  She co-slept with him.  The problem is that in 2009, she lost another child, presumably to SIDS but who was also co-sleeping.  At the time of her first child’s death, Child Protective Services (CPS) warned Ms. Clark about the dangers of co-sleeping.  This warning, and this warning alone, served as the basis for the child endangerment charge she would be found guilty of.  There are multiple things wrong with this though and we need to look at all them to understand how flawed this outcome and entire situation is.

Xanax and Hydrocodone

It is absolutely essential that I mention that at the time of her son’s death in 2010, a blood test revealed that Ms. Clark had heightened levels of both Xanax and Hydrocodone, both of which had been prescribed by a doctor.  The problem here is that if you look at the side effects of these drugs, they include “drowsiness”, “decreased alertness and concentration”, “confusion”, and “depersonalization”[1][2].  As long as she didn’t stop taking the medications or undergo hydrocodone detox, co-sleeping should never have been even considered. Nothing is known about the 2009 case, but at the very least, Ms. Clark should not have been co-sleeping while taking these drugs.  However, the warnings that were given to her by CPS (as reported in the news which is all I can speak to as I wasn’t at the trial) spoke to the idea that children get caught in bedding or pillows and can suffocate that way.  It is plausible that Ms. Clark took those precautions to heart when co-sleeping with her next child – removing pillows or any fluffy blankets before bringing her son to sleep.  And let’s face it, when a doctor prescribes us drugs, we assume they’re safe.  When they speak of sleepiness, we know not to operate heavy machinery, but many people don’t think about the effects of getting into bed with a small infant.  Why not?  Because the anti-co-sleeping movement has made the education of safe co-sleeping all but impossible in the mainstream, and so we face cases like this.

Genetic Factors

I have no idea if Ms. Clark had any genetic factors that would put her infants at risk of SIDS, but the fact remains that several genetic features have been identified as possible etiologies for SIDS[3].  While genetics do not seem to account for all cases of SIDS – nothing close to that – there are several genetic pathways that would put multiple children in the same family at risk.  In a review on the research into the genetic pathways, five distinct genes are implicated for which there is enough research to suggest that the genetic link cannot be ignored[3].  Even if co-sleeping were undertaken completely safely (which, unfortunately was not the case here, though not necessarily due to the fault of the mother, moreso perhaps her ignorance), it is not impossible that she carries particular genes that would make her children more susceptible to SIDS regardless of where they slept.

The Double Standard

What most people will probably be incensed by, and rightfully so, is that if both her children had died in cots, there would be no charges.  And I would bet there would be no charges even if she had bumpers or pillows or stuffed animals in the crib.  Why?  Because our society has decided that cribs = safety.  People forget that SIDS used to be known as “cot death” because it was so much more prominent for children in cribs to die.  Nowadays, we treat cribs like they actually serve to keep infants alive when the numbers for SIDS don’t suggest that at all.  Most people who argue that cribs are safer try to argue that co-sleeping is so uncommon that the rates of SIDS deaths from co-sleeping reflect the greater risk.  While many parents report not co-sleeping because their child starts the night in their own crib, when questions are more specific (e.g., does your child come into bed with you at all during the night?), the numbers are far higher.  For example, in the 1990s, one review found that approximately 50% of US families co-slept at least part of the time[4].  While I have yet to find a longitudinal study in the US looking at SIDS rates for cot versus bedsharing rates (studies looking at just 1 or 2 years tend to be flawed because of the short time span that can be highly affected by other factors), there is such a study from the UK.  In this study, SIDS deaths from 1984 to 2003 were examined and in 96% of cases, the sleeping environment in which the infant was found was recorded[5].  Seventy-four percent were found in cots or cot-like environments (e.g., moses baskets) while 19% were found in the parental bed.  In the UK, nearly half of parents report co-sleeping at least part time[6], thus the risk-ratio would seem to be in favour of co-sleeping, despite the warnings given by those in charge.  This is supported in the research when risk factors are controlled for (see Bedsharing and SIDS).  And yet, a number of negligent actions can take place in a crib and no one suffers any type of legal consequence as a result.

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What do we take from this?  Quite obviously Ms. Clark should not have been co-sleeping with her second child, but the way I see it, the anti-co-sleeping people are actually putting more babies at risk than they are saving them with their one-size-fits-all approach based on fear.  Why do I say this?  First, individuals who do put their children in a cot do not eliminate the risk of SIDS at all, especially if the cot contains any risk factors as well.  Second, and more importantly, by ignoring the fact that many families will co-sleep regardless of any public statement telling them not to (primarily because it’s easy, convenient when breastfeeding, and most mothers have a biological urge to keep their infants as close as possible to keep them safe), these individuals squash any attempt to teach families what the real risk factors are and how to safely co-sleep.  This means more families fall into the bad pattern of bringing their babies to sleep in their bed when they’re tired and it’s the middle of the night.  When this happens, safety precautions that make co-sleeping safe are typically ignored—pillows and duvets are there, the mattress may be soft, etc.—and that puts babies at a much greater risk.  I think Dr. Helen Ball is right when she says our policy makers are looking for a quick fix, but damning co-sleeping is not that quick fix.  There are too many biological imperatives that will make mothers bring their babies to bed with them.  What we need is education about how to co-sleep safely so no family has to suffer the pain of losing an infant and being blamed for that death when all they did was one of the most natural things a parent can do.

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For further information, you can view the UNICEF Baby-Friendly Initiative Leaflet here or our very own EP Safe Co-Sleeping Pamphlet here (which is still in progress, but the information holds).

 


[1] http://www.alprazolamsideeffects.com/

[2] http://www.drugs.com/sfx/hydrocodone-side-effects.html

[3] Weese-Mayer DE, Ackerman MJ, Marazita ML, Berry-Kravis EM. Sudden infant death syndrome: Review of implicated genetic factors.  American Journal of Medical Genetics 2007; 143A: 771-788.

[4] Willinger M, Ko CW, Hoffman HJ, Kessler RC, Crowin MJ. Trends in infant bed sharing in the United States, 1993-2000: The national infant sleep position study. Archives of Pediatrics and Adolescent Medicine 2003; 157: 43-49.

[5] Blair PS, Ward Platt MP, Smith I, Fleming PJ.  Major changes in the epidemiology of Sudden Infant Death Syndrome: a 20-year population based study of all unexplained deaths in infancy.  Lancet 2006; 367: 314-9.

[6] Blair PS, Ball HL.  The prevalence and characteristics associated with parent-infant bed-sharing in England.  Arch Dis Child 2004; 89: 1106-10.