Marilyn Heins A doubter on co-sleeping

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The death of a 3-week-old Tucson infant in his home Thursday morning shows the dangers of a controversial yet popular practice called co-sleeping.

Co-sleeping — a parent and an infant sharing a bed — was a contributing factor in the death and in two other infant deaths here this year.

Thursday's is the 11th such case Sgt. Carlos Valdez, a detective in the Tucson Police Department's dependent-child unit, has handled since he began his job in July 2005.

"It's heart-wrenching when a mom asks me 'How did my baby die?' and we have to say 'It's possible it was from sharing the bed with your baby,' " Valdez said.

Co-sleeping is debated in medical and parental circles.

On one side there's the added bonding that mom and dad can have with a baby who is sharing a bed with them. For moms who are breast-feeding, it's convenient. There are cultural and economic reasons adults and infants share beds, too.

"There are in effect two groups for whom co-sleeping is common practice," said Dr. Stephen Metz, a Tucson pediatric pulmonologist. "The very poor, and moderately poor, where there may not be another place for the baby; and then there are the much more wealthy, sophisticated — mothers or families usually who are very interested in trying to do things as naturally as possible — who also practice co-sleeping.

"The cultural overlay of this has made it very difficult to condemn a practice that is either unavoidable or would seem the natural way to do things," Metz said. "By the natural way to do things, I mean that every other animal co-sleeps with its young, so that would seem to be the most natural way to do things."

Indeed, James J. McKenna, author of the recent book "Sleeping With Your Baby: A Parent's Guide to Co-sleeping," says that sleeping alone is not biologically correct. The University of Notre Dame professor says babies need the warmth, stimulation and monitoring that comes with sleeping next to a caregiver. He estimates about 95 percent of parents in the world sleep with their babies.

But co-sleeping in the United States is somewhat different than it is for animals and for people in many other countries, some experts note. An American preference for soft bedding and abundant covers and pillows puts infants in more danger than if they were on a firm, less comfortable surface.

Sleep environment was the most common factor contributing to unexpected infant deaths in Arizona in 2005, the most recent data from the Arizona Child Fatality Review Program.

That year, unsafe bedding contributed to 44 infant deaths statewide, while co-sleeping was a factor in 41 infant deaths, which worked out to 46 percent of all the unexpected infant deaths, the program says.

"We live in a very complex society. We don't sleep on the floor of a hut where there are no soft pillows," said Dr. Marilyn Heins, a Tucson pediatrician.

"The nature argument bugs me a little," she continued. "Thinking of pregnancy and childbirth and raising children as a natural function of human beings is very accurate, but I don't think anyone is going to go off in the woods and have their baby and use a pointed stick to cut the cord. Parents used to sleep with their children, but that was before $3,000 pillow-top mattresses."

Probably the worst bed in which to put a baby would be a waterbed covered with more soft bedding, shared with two sleeping parents who are impaired, whether by drugs, alcohol or smoking, Metz said.

Another precarious situation is sleeping with an infant on a couch, said Sgt. Valdez, since there's not a lot of room to spread out.

Valdez was so alarmed by handling eight co-sleeping deaths of infants in his first 17 months on the job that he teamed up with Tucson Medical Center to produce a tip card titled "Safe Sleeping for your Baby." Nearly 5,000 have been handed out since January.

Valdez advocates bonding with infants, even resting with them, but when it's time to sleep for the night, he urges parents to put the child in a crib or bassinet near the bed. If the family can't afford one, he suggests using a drawer from a nightstand or a dresser and putting a flat mat and a tight-fitting sheet in it.

The U.S. Consumer Product Safety Commission warned in 1999 that babies placed on adult beds risk suffocation from hidden hazards.

And the American Academy of Pediatrics' Task Force on Infant Sleep Position and SIDS suggested in 2005 that parents use a safety-approved crib, bassinet or cradle.

Yet many families continue to find advantages in co-sleeping.

Beatriz Oshaben said she and her husband never intended to co-sleep with her daughter, who is now 4.

"It's just what worked best. I was breast-feeding. We had tried having a playpen adjacent to the bed, but sometimes we just fell asleep," said Oshaben, 40, a resident of Sahuarita.

"It felt so comfortable and easy. She's very attached, especially to her mom. I'm from a Hispanic background and I think it's more common for us to be closer-knit like that. I was talking to someone else about this and she had a baby sister when she was 13 whom she shared a bed with. They were in a big, Hispanic family."

Oshaben, whose daughter often still shares her parents' bed, said she can see the dangers. But she stressed that she's not a heavy sleeper, nor is she physically a big person.

Experts emphasize that co-sleeping deaths are rare.

Still, there are no reliable statistics available on co-sleeping and infant deaths nationwide because the people collecting the data can't agree with one another, said Dr. Michael Durfee, chief consultant for the California-based ICAN National Center on Child Fatality Review.

"There are some classified as sudden infant death syndrome (SIDS)," Durfee said.

SIDS is the sudden and unexplained death of a child younger than 1 year, usually a seemingly healthy infant. Most SIDS deaths are associated with sleep, and the infants typically show no signs of suffering.

"There are deaths where a cop might say it's an accident and the coroner might call it a homicide," Durfee said. "You are looking for something that's subtle and problematic."

In February 2003, Tucsonan Shawn Dallas Ramon and his girlfriend, Stephanie Molina, were charged with manslaughter and child abuse after their 7-month-old son, Shawn Dallas Ramon Jr., died in their bed.

An autopsy report said the infant died of "probable suffocation due to overlying by adults while in bed."

Though the Pima County medical examiner ruled the death accidental, the couple were criminally charged. They admitted to being intoxicated the night their son died. Both later pleaded guilty to endangerment and in 2005 were sentenced to probation.

In a pre-sentence report prepared for the court, Molina told a probation officer that she believed her son died of SIDS. She said that although she'd consumed more than a six-pack of beer the previous evening, it had been light beer. She also denied knowing how her infant got into her bed.

The most recent co-sleeping death in Tucson could end up being a SIDS case, Valdez said.

According to Metz, the incidence of SIDS, also called crib death, is about two per 1,000 across the country. "Perhaps 20 to 40 percent, I'm just guessing, might be associated with co-sleeping," Metz said.

Though she didn't co-sleep with her son when he was newborn, Gina Burdick says she can see both sides of the debate. Burdick is president of the MOMS Club of Sahuarita.

"I'm sure that moms who do co-sleep have good reasons to," she wrote in an e-mail. "They may have sick infants or it may be the only way to get their baby to sleep.

"Face it, if the baby doesn't sleep, the mommy doesn't sleep. And it's hard enough to take care of a baby with the kind of rest one can get from the short intervals of time the baby actually provides between feedings."