James J. McKenna - Safe Infant Sleep: Expert Answers to Your Cosleeping Questions

DR. JAMES J. MCKENNA founded and directed the revolutionary Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame and taught in the Anthropology Department there for 22 years. He received his undergraduate degree in anthropology from the University of California, Berkeley, his Masters Degree from San Diego State University, and his Ph.D. in biological anthropology from the University of Oregon, Eugene.

He pioneered the worlds first studies of the physiology and behavior of cosleeping mothers and infants, and has published over 165 scientific articles in medical and anthropological journals on the topics of cosleeping, breastfeeding, evolutionary medicine, and SIDS. He has also authored several books, including Ancestral Landscapes in Human Evolution, Evolutionary Medicine (two volumes, 1999 and 2008), Sleeping with Your Baby, and Researching the Sudden Infant Death Syndrome: The Role of Ideology in Biomedical Science. Dr. McKenna is a sought-after speaker at medical, parenting, and policy conferences around the world and remains a chief spokesperson to the U.S. media on breastfeeding, SIDS, and bedsharing issues.

He recently retired from the University of Notre Dame, having received before his departure the highest honor the University can bestow, the Presidential Award, for sustained exceptional contributions. He will remain (in abstentia) an Emeritus Professor there, continuing to direct the sleep lab he created as an information and resource center. Having accepted a special Endowed Professorship at Santa Clara University in California, he will continue his teaching, research, lecturing, and writing activities. He resides in San Francisco with his wife, Joanne, both of whom just became grandparents to their sons first child. Dr. McKenna can be reached at

When it comes to infant sleep arrangements, parents and professionals alike use different phrases interchangeably and confuse related terminology. Here is a glossary of the most common terms so everyone can begin to have conversations using the same language.

Note: Because these terms are inter-related, these definitions build upon one another. For this reason, this glossary is not ordered alphabetically.

Cosleeping: The general term for sleeping within range of detecting the signals from another person, regardless of age. Encompasses roomsharing, separate-surface cosleeping, use of a cosleeping device, same-surface cosleeping, bedsharing, cobedding, and breastsleeping.

Roomsharing: Sleeping in the same room as another person, regardless of age, but on a separate surface. Includes a baby sleeping in a crib or bassinet next to the parents bed, or in a cosleeping device. Also known as separate-surface cosleeping.

Separate-Surface Cosleeping: Sleeping in the same room as another person, regardless of age, within sensory range of each other, but on a separate surface. Includes a baby sleeping in a crib or bassinet next to the parents bed or in a cosleeping device. Also known as roomsharing.

Cosleeping Device: A product that allows a baby to sleep in close proximity to his or her parents without being on the same surface. It may attach to or rest beside the bed, or sit on top of the bed. Use of a cosleeping device can be considered roomsharing or separate-surface cosleeping.

Same-Surface Cosleeping: Sleeping on the same surface as another person, regardless of age. Includes sleeping on a bed, on a couch (which is dangerous), or on any other surface. Encompasses cobedding, bedsharing, and breastsleeping.

Cobedding: Two bodies of the same size sleeping on the same surface, such as twins sharing a single crib.

Bedsharing: Sleeping in the same bed as another person, regardless of age. Includes breastsleeping.

Breastsleeping: A primarily breastfed baby sleeping in the same bed as his or her mother in order to facilitate breastfeeding, with the infant lying face-up, in an environment free from all hazardous risk factors.

Hazardous Risk Factors: Circumstances that increase the risk of SUID when combined with bedsharing or by themselvesthese include sleeping next to an adult who is impaired by alcohol or drugs, smoke exposure, sleeping face-down, sleeping on a sofa with an adult, preterm birth, formula-feeding, and soft bedding (definition from Peter S. Blair, et al., in press).

Epidemiology: The study of the distribution, causes, and risk factors of diseases or other health and safety issues within a specified population (definition adapted from Principles of Epidemiology in Public Health Practice, 3rd Edition).

Sudden Unexpected Infant Death (SUID) or Sudden Unexpected Death in Infancy (SUDI): The sudden and unexpected death of a baby less than one year old in which the cause was not obvious before investigation. Encompasses both SIDS and SASS.

SUID/SUDI are also broadly defined in the International Classification of Diseases, 10th Revision (ICD-10), as a compilation of classifications that include SIDS, ASSB, and unspecified deaths lacking evidence to be called SIDS.

Sudden Infant Death Syndrome (SIDS): The sudden and unexplained death of a baby younger than one year of age, without a known cause even after a complete investigation (definition from the National Institute of Child Health and Human Development). See page 67 to explore the difference between SIDS and SASS in the context of bedsharing.

Sleep Associated Suffocation and Strangulation (SASS) or Accidental Suffocation or Strangulation in Bed (ASSB): The accidental sleep-related death of a baby by suffocation or strangulation, often due to unsafe cosleeping environments.

SASS (term proposed by Melissa Bartick and Linda J. Smith) is more commonly referred to as ASSB, which is how it appears in the International Classification of Diseases, 10th Revision (ICD-10). Confusingly, Accidental Suffocation or Strangulation in Bed does not have to occur in an actual bed, and may also occur when using a crib, couch, or armchair. This is why I prefer using the term SASS.

Chaotic Bedsharing: Sharing a bed or other sleep surface with an infant due to necessity rather than as an intentional parenting choice. Multiple hazardous risk factors are often present, such as other children or pets in the bed, parents being impaired by alcohol, drugs, or extreme exhaustion, one or more parent being a smoker, or a general lack of proactive sleep safety measures.

Elective Bedsharing: Sharing a bed with an infant as an intentional parenting and lifestyle choice, most often to facilitate breastfeeding or gain more sleep. Characterized by knowledge and avoidance of risk factors, and the parents active and continuous commitment to the babys safety.

Mixed-Feeding: Providing a baby with a combination of formula and breastmilk. Can include feeding the infant expressed breastmilk from a bottle, breastmilk directly from the breast, donor milk, and any variation of formula, cows milk, or other milk substitute.

Families who feel they are unable to maintain a safe bedsharing environment may use various products to create a separate-surface cosleeping arrangement that works for their unique family. Many parents may not be aware of what products are available and where they can find these devices, so the following is a list of suggested products designed to facilitate cosleeping. I am not recieving compensation for including any of these products in the book.

Arms Reach Versatile Co-Sleeper Bedside Bassinet