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Barry ES, D'Souza L. Maternal depressive symptoms and mother-infant cosleeping (including room sharing and bedsharing): a systematic review. J Clin Sleep Med 2024; 20:1517-1533. [PMID: 38648117 PMCID: PMC11367717 DOI: 10.5664/jcsm.11164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
STUDY OBJECTIVES Maternal depressive symptoms (MDS) affect most women during the first year postpartum. Mothers provide most of the nighttime care for infants, so studying the relationship between MDS and infant sleep location (ISL) is highly relevant to understanding maternal mental health over the first year of life and beyond. Infant sleep is studied by anthropologists, health care providers, and psychologists, with very little communication across disciplines. This review aimed to determine whether there is a predictive relationship between MDS and ISL. METHODS This systematic review searched 6 databases with terms related to maternal mood and ISL. Final analysis included 14 published studies, analyzed with narrative synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies directly compared ISL and MDS. RESULTS Five studies showed no relationship between ISL and MDS, and 1 study found bedsharing reduced MDS. Five studies found cosleeping was related to higher MDS although directionality is mixed or missing, and 3 studies found an association at some ages or for some populations only. Examining studies according to type of infant sleep assessment, study design, age of infant, or breastfeeding status failed to detect consistent patterns. CONCLUSIONS A variety of study designs, types and definitions of variable measures, sample recruitment, and study outcomes prevent detection of a consistent relationship between MDS and ISL. We explore reasons for the elusive nature of a relationship and make recommendations for future research in MDS and ISL, including crossdisciplinary collaborations. CITATION Barry ES, D'Souza L. Maternal depressive symptoms and mother-infant cosleeping (including room sharing and bedsharing): a systematic review. J Clin Sleep Med. 2024;20(9):1517-1533.
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Affiliation(s)
- Elaine S Barry
- Human Development and Family Studies, The Pennsylvania State University, Fayette, Lemont Furnace, Pennsylvania
| | - Levita D'Souza
- Faculty of Education, Monash University, Clayton, Victoria, Australia
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Schindler-Ruwisch J, Dubar RT, Casale R, Watkins NK, Rubenstein V. Sleeping Like a Baby: An Investigation of Bed-Sharing, Co-Sleeping, and Breastfeeding Among Pregnant Adults During the COVID-19 Pandemic. Breastfeed Med 2023; 18:678-687. [PMID: 37638807 DOI: 10.1089/bfm.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Introduction: Given the lack of clarity in the literature related to the impact of breastfeeding intentions on sleeping practices, the current research aimed to investigate the relationship between co-sleeping or bed-sharing and breastfeeding intentions among a sample of pregnant adults, during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Pregnant adults from a large nationally representative sample, responded to a one-time, online Qualtrics survey between October and November 2020. Pregnant adults (n = 544) were asked closed and open-ended questions about their family characteristics, sociodemographic factors, sleeping and breastfeeding habits, and intentions. This protocol was approved by the Wesleyan University Institutional Review Board. Results: Bed-sharing (odds ratio [OR] = 2.47) and co-sleeping (OR = 3.52) intentions doubled and tripled, respectively, intentions to breastfeed at 3 months. Additionally, income at some higher levels (i.e., $150,000+/year) significantly increased breastfeeding intentions at 3 months compared with the lowest income category (OR = 5.74, p = 0.011). There was also a significant relationship between intentions to bed-share (OR = 2.96, p = 0.012) and co-sleep (OR = 3.62, p < 0.001) with breastfeeding at 6 months. Prior breastfeeding experience was significantly associated with breastfeeding intention at 6 months (OR = 1.88, p = 0.035). Based on the qualitative findings, breastfeeding ease was by far the most common motivation for co-sleeping or bed-sharing, followed by security/safety, closeness, and past experience. Conclusion: Plans to bed-share and co-sleep, significantly increased the odds of breastfeeding intentions up to 6 months postpartum. Supporting breastfeeding should include conversations about parent-infant sleeping modality, style, and preference. Future research is necessary to understand the directional impacts of these decisions and the predictive role of prenatal intentions on postpartum behaviors in this context.
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Affiliation(s)
- Jennifer Schindler-Ruwisch
- Egan School of Nursing and Health Studies, Public Health, Fairfield University, Fairfield, Connecticut, USA
| | - Royette T Dubar
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Rosa Casale
- Egan School of Nursing and Health Studies, Public Health, Fairfield University, Fairfield, Connecticut, USA
| | - Nicole K Watkins
- Department of Psychology, Wesleyan University, Middletown, Connecticut, USA
| | - Vanessa Rubenstein
- Department of Public Health, Sacred Heart University, Fairfield, Connecticut, USA
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Abstract
Objective: Studies have shown that mothers sleeping with their babies have longer breastfeeding duration. Bedsharing (BS) is thought to be a risk factor for Sudden Infant Death Syndrome. The aim was to investigate the frequency of BS and roomsharing (RS) and the effect of those on breastfeeding during the first 2 years of life. Also to evaluate risk-bearing situations regarding sleep environment. Methods and Study Design: This is a cross-sectional study, with retrospective cohort features for the evaluation of some data. The setting was a Well-Child Clinic at Bakırköy Research and Training Hospital. The children were followed from the first month until survey. Feeding history was collected retrospectively from child health records. Parents were surveyed concerning sleeping location and sleeping arrangements with a questionnaire. The study encompassed 351 children and their families. Results: The rate of exclusive breastfeeding was found to be 50.2% for the first 6 months of life and BS increased in exclusively breastfed infants. When breastfeeding continued after 6 months, the trend of increased BS through months was observed. RS, BS, and breastsleeping rates were 80.6%, 22.8%, 56.1%, respectively, in the whole cohort. Working mothers and mothers >35 years of age were significantly more likely to bedshare. Cigarette smoking in BS parents was identified as a child health risk. Unsafe sleep environment was found in 72.4% of the group. Conclusions: BS increases breastfeeding for the first 6 months. Families need guidance on safe sleeping practices and should be advised regarding avoidable risks and unsafe situations in BS. Parents should be counseled to make informed decisions.
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Affiliation(s)
- Bahar Kural
- Department of Pediatrics, Bakırköy Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey
| | - Gülbin Gökçay
- Department of Social Pediatrics, Istanbul University Institute of Child Health, İstanbul, Turkey
- Department of Pediatrics, Istanbul University Istanbul Medical School, İstanbul, Turkey
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Abstract
BACKGROUND There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy. OBJECTIVES To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS. SELECTION CRITERIA We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence. MAIN RESULTS Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded. AUTHORS' CONCLUSIONS We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
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Affiliation(s)
- Rashmi R Das
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Mari Jeeva Sankar
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
| | - Ramesh Agarwal
- Newborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of Pediatrics, All India Institute of Medical Sciences, Delhi, India
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Dennis CL, Brown HK, Brennenstuhl S, Haddad S, Marini FC, Stremler R. Prevalence and Predictors of Postpartum Maternal and Infant Bed-Sharing Among Chinese-Canadian Women. Behav Sleep Med 2020; 18:120-130. [PMID: 30585091 DOI: 10.1080/15402002.2018.1546179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective/Background: Our primary objective was to describe and identify predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum among Chinese-Canadian mothers. Participants: We conducted a longitudinal study of 570 Chinese immigrant and Canadian-born women in Toronto, Ontario. Methods: Any bed-sharing, defined as sharing a bed or mattress for any part of the night on any night in the previous week, and predominant bed-sharing, defined as sharing a bed or mattress for most of the night, on more than half the nights of the previous week, were evaluated at 4 and 12 weeks postpartum. Predictors of bed-sharing, evaluated in multivariable logistic regression models, were background (age, parity, education, household size, delivery mode, social support), cultural (immigrant status, acculturative stress, acculturation, postpartum ritual uptake), and postpartum variables (mental health, breastfeeding problems, fatigue, sleep knowledge, plans for bed-sharing, perceptions of infant sleep problems, cognitions about infant sleep). Results: One in five women (20.7%) reported bed-sharing as the predominant sleep location for their infant at 4 weeks postpartum, with nearly half (45.6%) reporting any bed-sharing at this time. The prevalence of any bed-sharing remained relatively stable at 12 weeks postpartum (46.5%), while predominant bed-sharing increased to 30.1%. The most consistent predictors of any and predominant bed-sharing at 4 and 12 weeks postpartum were lower education level, greater acculturative stress, and predelivery plans to bed-share. Conclusions: These findings have implications for the development of clinical recommendations given to expectant and new parents to promote infant sleep practices that are consistent with American Academy of Pediatrics recommendations.
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Affiliation(s)
- Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Hilary K Brown
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Interdisciplinary Center for Health & Society, University of Toronto Scarborough, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Summer Haddad
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Flavia C Marini
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Das RR, Sankar MJ, Agarwal R. Bed sharing versus no bed sharing for healthy term neonates. Cochrane Database Syst Rev 2017; 2017:CD012866. [PMCID: PMC6486321 DOI: 10.1002/14651858.cd012866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effect of bed sharing started during the neonatal period on breast feeding status (exclusive and total duration of breast feeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long‐term neurodevelopmental outcomes.
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Affiliation(s)
- Rashmi R Das
- All India Institute of Medical Sciences (AIIMS)Department of PediatricsSijuaBhubaneswarIndia751019
| | - Mari Jeeva Sankar
- All India Institute of Medical SciencesNewborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of PediatricsDelhiIndia
| | - Ramesh Agarwal
- All India Institute of Medical SciencesNewborn Health Knowledge Centre, WHO Collaborating Centre for Training and Research in Newborn Care, Department of PediatricsDelhiIndia
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Parker MGK, Colson ER, Provini L, Rybin DV, Kerr SM, Heeren T, Corwin MJ. Variation in Safe Sleep and Breastfeeding Practices Among Non-Hispanic Black Mothers in the United States According to Birth Country. Acad Pediatr 2017; 17:887-892. [PMID: 28729127 DOI: 10.1016/j.acap.2017.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine variation in safe sleep and breastfeeding practices among US non-Hispanic black (NHB) mothers according to birth country. METHODS We analyzed NHB mothers who were surveyed regarding safe sleep and breastfeeding practices when their infants were 2 to 6 months of age in 2011 to 2014, as part of a larger national study. We examined prevalences of safe sleep and breastfeeding practices according to birth country and examined odds of adherence to American Academy of Pediatrics recommended safe sleep and breastfeeding practices in foreign-born NHB mothers, compared with US-born NHB mothers. Our multivariate models included adjustment for maternal age, education, income, and US geographic region, and infant age at the time of the survey. RESULTS Among 828 NHB mothers, 690 (83%) were US-born, 42 (5%) were African-born, 47 (6%) were Haitian-born, 24 (3%) were Jamaican-born, and 25 (3%) were born elsewhere. In the analysis of 803 US, African-, Haitian-, and Jamaican-born mothers, we found that Jamaican-born mothers had a lower rate of supine sleep compared with US-born mothers (40% vs 66%; adjusted odds ratio, 0.34; 95% confidence interval, 0.18-0.63). African-born mothers had lower rates of bedsharing compared with US-born mothers (11% vs 25% adjusted odds ratio, 0.22; 95% confidence interval, 0.11-0.46). Foreign-born mothers had higher rates of any and exclusive breastfeeding, compared with US-born mothers (85% and 40% vs 23% and 13%, respectively). CONCLUSIONS Safe sleep and breastfeeding practices vary among US NHB mothers according to birth country. These data illustrate the importance of recognizing heterogeneity of safe sleep and breastfeeding practices within racial/ethnic groups.
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Affiliation(s)
- Margaret G K Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Mass.
| | - Eve R Colson
- Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Lauren Provini
- Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Denis V Rybin
- Department of Biostatistics, Boston University School of Public Health, Mass
| | | | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Mass
| | - Michael J Corwin
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Mass; Slone Epidemiology Center, Boston University, Mass
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8
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Defining Behavior Patterns Towards Exclusive Breastfeeding Using Latent Class Analysis. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.10575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mother-child bed-sharing trajectories and psychiatric disorders at the age of 6 years. J Affect Disord 2017; 208:163-169. [PMID: 27788379 PMCID: PMC5159994 DOI: 10.1016/j.jad.2016.08.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 08/27/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about the effect of bed-sharing with the mother over the child mental health. METHODS Population-based birth cohort conducted in Pelotas, Brazil. Children were enrolled at birth (n=4231) and followed-up at 3 months and at 1, 2, 4, and 6 years of age. Bed-sharing was defined as "habitual sharing of the bed between the child and the mother, for sleeping, for part of the night or the whole night". Trajectories of bed sharing between 3 months and 6 years of age were calculated. Mental health was assessed at the age of 6 years using the Development and Well-Being Assessment instrument that generates psychiatric diagnosis according to ICD-10 and DSM-IV criteria. Odds ratios (OR) with 95% confidence intervals were obtained by multivariate logistic regression. RESULTS 3583 children were analyzed. Four trajectories were identified: non bed-sharers (44.4%), early-only (36.2%), late-onset (12.0%), and persistent bed-sharers (7.4%). In the adjusted analyses persistent bed-sharers were at increased odds of presenting any psychiatric disorder (OR=1.7; 1.2-2.5) and internalizing problems (OR=2.1; 1.4-3.1), as compared to non bed-sharers. Among the early-only bed-sharers OR for any psychiatric disorder was 1.4 (1.1-1.8) and for internalizing problems 1.6 (1.2-2.1). LIMITATIONS Although the effect of bed-sharing was adjusted for several covariates including the family socio-economic status, maternal mental health and excessive crying, there was no information on maternal personal reasons for bed-sharing. Mothers that bed-share intentionally and those that bed-share in reaction to a child sleep problem may have a different interpretation of their children behavior that may bias the study results. CONCLUSION Bed-sharing is a common practice in our setting and is associated with impaired child mental health at the age of six years.
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Smith LA, Geller NL, Kellams AL, Colson ER, Rybin DV, Heeren T, Corwin MJ. Infant Sleep Location and Breastfeeding Practices in the United States, 2011-2014. Acad Pediatr 2016; 16:540-9. [PMID: 26851615 PMCID: PMC6202582 DOI: 10.1016/j.acap.2016.01.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 01/23/2016] [Accepted: 01/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To describe the prevalence of breastfeeding and sleep location practices among US mothers and the factors associated with these behaviors, including advice received regarding these practices. METHODS A nationally representative sample of 3218 mothers who spoke English or Spanish were enrolled at a sample of 32 US birth hospitals between January 2011 and March 2014. RESULTS Exclusive breastfeeding was reported by 30.5% of mothers, while an additional 29.5% reported partial breastfeeding. The majority of mothers, 65.5%, reported usually room sharing without bed sharing, while 20.7% reported bed sharing. Compared to mothers who room shared without bed sharing, mothers who bed shared were more likely to report exclusive breastfeeding (adjusted odds ratio 2.46, 95% confidence interval 1.76, 3.45) or partial breastfeeding (adjusted odds ratio 1.75, 95% confidence interval 1.33, 2.31). The majority of mothers reported usually room sharing without bed sharing regardless of feeding practices, including 58.2% of exclusively breastfeeding mothers and 70.0% of nonbreastfeeding mothers. Receiving advice regarding sleep location or breastfeeding increased adherence to recommendations in a dose response manner (the adjusted odds of room sharing without bed sharing and exclusive breastfeeding increased as the relevant advice score increased); however, receiving advice regarding sleep location did not affect feeding practices. CONCLUSIONS Many mothers have not adopted the recommended infant sleep location or feeding practices. Receiving advice from multiple sources appears to promote adherence in a dose response manner. Many women are able to both breastfeed and room share without bed sharing, and advice to adhere to both of these recommendations did not decrease breastfeeding rates.
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Affiliation(s)
| | - Nicole L Geller
- Slone Epidemiology Center at Boston University, Boston, Mass
| | - Ann L Kellams
- Well Newborn and Breastfeeding Medicine Services, University of Virginia, Charlottesville, Va
| | - Eve R Colson
- Department of Pediatrics, Yale University, Yale School of Medicine, New Haven, Conn
| | - Denis V Rybin
- Data Coordinating Center, Boston University School of Public Health, Boston, Mass
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Mass
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Parent-child bed-sharing: The good, the bad, and the burden of evidence. Sleep Med Rev 2016; 32:4-27. [PMID: 27107752 DOI: 10.1016/j.smrv.2016.03.003] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 12/30/2022]
Abstract
The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - anthropology, psychology/psychiatry, and pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.
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