By: A.M., IANtB Science Editor
Another government cosleeping policy FAIL…This time, in Indiana.
Tippecanoe County, Indiana Coroner Donna Avolt, despite having no medical or science degrees, has taken it upon herself to make recommendations to the public regarding cosleeping (we assume the journalists covering this story are referring to bed sharing) in the wake of a bed sharing-related death of a four month-old infant in the Tippecanoe city of Lafayette.
Whenever you hear about a bed sharing-related death, it is important to make sure you have all the information first. Avolt failed to share important details about the circumstances surrounding the infant’s death, such as parental lifestyle habits such as drinking or drug use, or the characteristics of the cosleeping environment in which the infant was found. Interestingly, the Lafayette Journal and Courier reports that the results of a police search of the home where the infant died led investigators to request permission from a judge to go back to the house and do a broader search for drug paraphernalia and other supplies that could be used to manage a drug-dealing operation. Drugs and alcohol are known risk factors for overlay and infant suffocation. Socio-economic status and mode of feeding are also important factors in sleep-related infant deaths. This coroner is drawing conclusions about this infant’s death before the investigation is finished, and before toxicology results are back. Very scientific.
It is further apparent that Avolt failed to conduct even a marginal amount of research. If she had, she’d have noticed that one of the world’s leading infant sleep researchers, James McKenna, has a laboratory in the next county over. McKenna, Rev. Edmund P. Joyce, C.S.C. Endowed Chair in Anthropology at the University of Notre Dame and AAAS fellow, has been researching infant sleep architecture and mother-infant cosleeping for over 30 years. In a 2008 article, he explicitly states,
Indeed, no legitimate SIDS researcher nor forensic pathologist should render a judgment that a baby was suffocated without an extensive toxiological report and death scene investigation including information from the mother concerning what her thoughts are on what might or could have happened.
Unfortunately, Indiana has a terrible track record regarding its public policy on cosleeping. Past anti-cosleeping campaigns in Indiana have featured shock-value dramatics and broad-sweeping commands to “Never sleep with your baby” and to “Put your baby to sleep alone.” The Indiana Department of Child Services inaccurately tells parents that bed sharing increases risk of SIDS, when it is known that most SIDS deaths occur in relation to solitary, completely unsupervised sleep. Even it’s state-funded Indiana Perinatal Network, which supports breastfeeding coalitions at the local level, has a long-running relationship with the First Candle organization, which is adamantly against bedsharing and shows no interest in educating parents about how to bedshare safely.
This news comes on the heels of this weekend’s meeting of the Academy of Breastfeeding Medicine, where experts discussed new recommendations for safe sleep for infants, including new AAP recommendations that are in the works. These new recommendations are based on research findings indicating that current approaches are not effective, and are arguably making the situation worse. Having been told not to fall asleep in bed with their infants, parents are now attempting — and failing — to “not fall asleep” in chairs and on couches. Researchers like physician Fern Hauck of the University of Virginia School of Medicine are now saying that recommending parents not fall asleep with their infants on a couch or chair is more effective than recommending they not bedshare.
As a person of science, I try to avoid expressing opinions. But a thorough understanding of human evolution and the physiological needs of infants makes it unequivocally apparent: human infants evolved a deep-seated drive to be close to their parents 24-7, and they will find a way to get there. Adaptations like that don’t happen in a vaccuum. The work of scientists like James McKenna and Helen Ball seem to suggest that physical proximity to the mother, particularly within the context of a breastfeeding relationship, is protective against SIDS, also serving the purpose of aiding in growth and development. And assuming safe practices are used, the risk of suffocation is no different than on any other sleep surface.
However, many state governments in the U.S. think that parents aren’t smart enough to follow these rules. We disagree. The Le Leche League came up with seven rules that are simple enough to put on a pamphlet or poster. They call it the “Safe Sleep Seven”:
The mother should be
1. A non-smoker
Baby should be
4. Healthy (full-term)
5. Put to sleep on his back
6. Lightly dressed and unswaddled
7. share a safe surface (firm mattress, no cushy duvets or pillows near baby’s face)
It is my opinion that, if we truly wish to reduce sleep-related infant deaths, we need to do three things:
- Aknowledge the complexity of a human behavior such as sleep, and develop comprehensive recommendations that acknowledge these complexities.
- Treat parents with respect and trust them to follow recommendations that go beyond “Just don’t do it. Because we said so.”
- Acknowledge and address the fact that certain socioeconomic groups are disproportionately affected by sleep-related infant deaths, and work with these communities to increase awareness and education, and support them in providing safe sleep surfaces for their babies. 
For more scientific information on safe cosleeping, please refer to this informative website constructed specially for parents by the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory.
 UPDATE April 2015: Apparently, IPN has updated their guidelines, noting “Doctors agree that the safest place for your baby to sleep is in your room,” and leaving the exact location of where baby sleeps up to the parent’s interpretation. Interesting strategy! I can’t really fault an organization for being uncomfortable directly addressing a controversial issue. We applaud this effort!
 Fern Hauck, MD. “Breastfeeding and Safe Sleep: Is it Possible to Have Both?” Presented on November 15, 2014 at the meeting of the Academy of Breastfeeding Medicine, held at the Cleveland at the InterContinental Cleveland Conference Center, Cleveland, OH.
 Check out the graph of breastfeeding and SIDS rates by race on page 147 of this article. Also see this study on SIDS rates by race.
 In accordance with the standard scientific language, IANtB makes a distinction between “cosleeping” and “bedsharing.” Cosleeping refers to any sleep arrangement where the baby is within sensory range of the parent. Thus, putting a baby to sleep in a bassinet in your bedroom is a form of cosleeping. Bedsharing is a form of cosleeping wherein the baby shares the same sleep surface with the parent. This happens in many different forms in different cultures — from floors, to futons, to hammocks.