As she had done so many times before, Kakuna Smith placed her 11-week-old daughter, Kamilah, beside her on the bed and went to sleep.
Kamilah was fussy. Smith knew she would wake up in the middle of the night to feed.
"I had a headache. I just wasn't feeling too well," said Smith, 34, of South suburban Dolton, recollecting that fateful night six years ago. "I woke up like 4 in the morning to feed her. I reached over, and that's when I touched her. She was cold."
The medical examiner's autopsy was inconclusive and Kamilah's death was ruled a possible case of Sudden Infant Death Syndrome, or SIDS.
There was no evidence that Smith, who was taking anti-depressants at the time, rolled over Kamilah in her sleep. Yet, to this day, the 34-year-old can't help but wonder whether her daughter's death was her fault.
"I still think that I did it, when I was assured that I didn't," said Smith, who has become an advocate for educating parents about the dangers of co-sleeping.
Illinois' leading agency charged with the protection of children warns that sleeping in the same bed with your baby can be akin to a death sentence for the child, and urges parents to place babies in cribs instead.
Yet, some experts say mothers sleeping alongside their infants is a practice that has been going on for centuries with positive benefits and is not as dangerous as public health officials portray.
The issue made headlines earlier this month in Utah with the Court of Appeals refusing to dismiss charges of child abuse, homicide and reckless endangerment against a couple accused of killing their 3-month-old baby in 2006 by sleeping with him. The couple's first child also died in bed with them, according to an Associated Press report.
Cases of infants dying unexpectedly in their parents' beds due to accidental smothering or possible suffocation from bedding are becoming more common, according to the Illinois Department of Children and Family Services.
In the wake of a few recent unexpected baby deaths, including one involving a 3-month-old in Hoffman Estates, the state agency and child protection advocates are trying to educate parents to end the habit of bed sharing or co-sleeping.
"Sleeping with your child is the most natural thing in the world," DCFS spokesman Kendall Marlowe said. "As a cultural practice, the whole family sleeping in one bed is the common practice. When they are little infants, people don't realize how fragile breathing is. This kind of safe sleeping issue is probably a greater threat."
DCFS has distributed brochures urging safe sleeping practices to licensed foster homes, day cares, doctor's offices, and WIC (Women, Infants and children) program clinics statewide. Meanwhile, state law enacted Jan. 1, 2011, also requires hospitals to discharge new mothers with such information.
The characterization of bed sharing as a deadly practice is a relatively recent phenomenon in human history, said James McKenna, a cultural anthropologist and director of the Mother-Baby Behavioral Sleep Laboratory at University of Notre Dame in Indiana.
"In Western industrialized society, we have 100 years of cultural history that has maintained that sleeping with your baby is harmful," said McKenna, who has written and published numerous articles on co-sleeping/bed sharing in professional journals.
McKenna said that perception initially arose from the fear that children would become overly dependent and lack confidence if they didn't sleep separately by themselves.
"What has proved to be the case is completely the opposite now," he said. "If it's a good, healthy, loving and affirmative relationship during the day, that relationship is brought to bed during the night. We got that wrong from the beginning. We simply gave rise to this ideology."
McKenna said co-sleeping is prevalent in many Asian countries that also have the lowest infant mortality rates.
"Co-sleeping is completely protective of babies," he said. "Babies are so neurologically immature, their bodies are regulated by contact and proximity of the parent (through) touch, smells, movement, sounds, exchange of heat, exchange of carbon dioxide. They grow faster. They breathe more stably. There are less cortisol stress levels in their bodies."
McKenna added that there are numerous forms of co-sleeping, and some can be dangerous.
"Couch co-sleeping is very dangerous," he said. "It probably is good to avoid bed sharing when the mother is not breast-feeding."
Illinois Child Death Review teams started looking into deaths involving unsafe sleeping conditions in 2008. But it became cumbersome as the state's nine teams already had a heavy caseload, said Sherry Barr, Illinois Child Death Review coordinator.
The department reviews the deaths of all children in the state under 18 years old. It is required to investigate infant deaths that meet five criteria: if the child is a ward of the state; if DCFS has a pending investigation at the time of death; if DCFS has an open case at the time of death; if DCFS flagged the case during its investigation; and if there has been an investigation within a year of the child's death.
In 2008, Illinois Child Death Review teams investigated 165 cases of infant deaths involving children under a year old and found 90 of those infants died while bed sharing. In 2009, the teams investigated 106 cases and found 69 deaths involved infants who were bed sharing. In 2010, of the 49 cases reviewed, 31 deaths involved infants who were bed sharing.
Barr said measuring the true extent of the problem is difficult because medical examiner and coroner reports often are inconclusive, making it harder to determine whether a child's death was due to rollover or suffocation.
Keeping baby safe
State authorities launched a campaign in 2008 against co-sleeping but stepped aside once private advocacy groups such as Lisle-based SIDS (Sudden Infant Death Services) of Illinois took the lead on the issue.
SIDS of Illinois -- formerly the Northern Illinois SIDS Foundation, which started out as a bereavement group in the late 1960s -- has been hammering against co-sleeping through a provocative advertising campaign.
The group has plastered billboards statewide with ads showing an infant casket in the back of a hearse, and another of a double bed with a tombstone that reads, "For some babies, this is their final resting place."
The campaign was meant to shock people, said Nancy Maruyama, the group's executive director.
"Adult beds are a death trap," she said. "What we are saying is room share, not bed share. It is really tough because it does feel like it's the natural maternal instinct to have your baby close to you."
Maruyama, a registered nurse from Crystal Lake, said health officials are just beginning to understand the dangers posed by co-sleeping.
"Many of these accidental suffocation, rollover, entrapment deaths that occur when a baby is sleeping in an unsafe situation were called SIDS when they weren't really truly SIDS," she said.
Maruyama says an increase in crib deaths due to entrapment and subsequent product recalls have convinced parents that bringing babies into their beds is the safer option.
"But actually the crib is the safest place for the baby to be," she said.
Adding to the danger
Maruyama said while bed sharing may be an age-old practice, modern beds are far more dangerous than parents realize.
"Mattresses were much different than (what) we have today," she said. "You didn't have memory foam, pillow toppers, sleep number beds. ... We've had a number of deaths that way."
The American Academy of Pediatrics recommends babies be put to sleep on their backs, on a firm, flat surface without any soft bedding.
Babies under 11 weeks old are most at risk of suffocation by soft bedding because they can't push things away from their faces, Maruyama added.
Experts say other risk factors in infant deaths are the parents themselves who may be overtired, sleep-deprived, on medication, impaired because of drugs, smoking or alcohol, or have a chronic illness.
"The problem comes in when the parent or parents turn their back on the infant. There is no awareness (of the baby) and that's when we can run into trouble," Maruyama said. Yet, with increasing counterpressure on women to breast-feed, mothers are encouraged by advocacy groups and even doctors to sleep alongside their infants to increase bonding.
Barbara Kopec with the La Leche League of Des Plaines said while bed sharing is not something the group promotes, the practice has been beneficial to breast-feeding mothers.
Kopec said her now grown children were also breast-fed while sharing the family bed.
"This has been around forever," Kopec said. "It has worked for countless families. It can be very helpful for mothers who are getting up constantly throughout the night for breast-feeding. It really puts you and the baby in the same sleep cycle. It's so regulated that you can almost read each other."
But Kopec agrees precautions should be taken when co-sleeping with infants such as making sure there are no spaces between the mattress and bed frame where children could get stuck.
"Generally, cushy mattresses or water beds are not recommended," Kopec said.
She recommends using co-sleepers -- a mini-crib walled on three sides with the fourth side meeting up with the parents' bed.
Maruyama said despite the pressures on breast-feeding moms, the best time for bonding is when both the mother and infant are awake.
"Certainly, many babies have survived sleeping with their parents," she said. "The problem is we don't know which ones are going to die. It can be a fatal outcome and you don't get a second chance."