If there is one topic that makes parents go quiet in my exam room, it is this one. Where is your baby actually sleeping? Not where you planned for them to sleep. Not what you told your mother-in-law. Where are they really sleeping at 2am when you are exhausted and just need everyone to rest? I brought Dr. Michael Milobsky on the show because he is one of the few pediatricians willing to have this conversation out loud. Twenty-seven years in practice, father of seven, grandfather of five, and someone who has been in every corner of pediatric medicine. We sat down and got honest about bedsharing in a way that I wish every parent could hear from their own doctor.

Here is what I want you to know before you hit play. I used to be the doctor who said independent sleep space and moved on. No room for nuance, no real conversation. And what I have come to understand over the last several years is that when parents feel judged, they stop telling us the truth. And when that happens, we lose the chance to actually keep babies safe. This episode is not about telling you what to do. It is about giving you the information you deserve so you can make the most informed choice for your family.

What We Talk About

• Why so many parents are not being honest with their pediatrician about where their baby sleeps, and why that silence is the bigger safety problem

• What the AAP guidelines are actually designed to do, and where they fall short in a real clinical conversation

• The specific risk factors that make bedsharing significantly more dangerous, including smoking, alcohol, sedating medications, soft bedding, prematurity, and very young infants

• The Safe Sleep Seven, what it covers, what its limitations are, and why it is still a useful harm reduction tool

• How bedsharing is practiced in other countries and why the surface and setup matter as much as the decision itself

• Why breastfeeding changes the biology of bedsharing and shifts the risk picture in meaningful ways

• What both of us did with our own kids, because real talk requires real transparency

• Room sharing versus bedsharing, and what the updated AAP recommendations actually say

• Why most pediatricians default to the hard line, and why it is usually about time in the system, not ignorance of the nuance

• What to do if your pediatrician will not have this conversation with you

Connect with Dr. Michael Milobsky on Instagram @drmichaelmilobsky and visit his site ⁠linktr.ee/milobsky⁠ .

00:00 – Pediatric Sleep Guidance: The Nuance of Bed Sharing
04:15 – Meet Dr. Michael Milobsky: From the ER to Raising 7 Kids
08:30 – Why Strict AAP Safe Sleep Guidelines Fail Exhausted Parents
13:10 – Co-Sleeping Around the World vs. Mainstream US Pediatrics
17:45 – Understanding Risk Stratification in the Marriage Bed
21:20 – Navigating Survival Mode and Chronic Sleep Deprivation
25:55 – Infant Temperaments: Evaluating Your Baby’s “Cuddle Quota”
30:15 – High-Risk Factors: Alcohol, Sedating Medications, and Sobriety
34:40 – The Biology of Breastfeeding Proximity vs. Formula Feeding
38:10 – Breaking Down the Safe Sleep Seven Framework
42:50 – The Hidden Dangers of Couches, Armchairs, and Recliners
46:15 – Systemic Issues: Why Pediatricians Lack Time for Nuanced Advice
50:30 – How to Safely Discuss Your Sleep Choices with Your Doctor
53:20 – Outro: Shifting to Supportive, Non-Judgmental Pediatric Guidance

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00;00;00;06 – 00;00;25;25

Dr. Michael Milobsky

It’s sometimes not possible to function. And you are given this very, very hard view of risk. And where I think the conversation and the part in the app version, it and combined with the fact that but the knowledge that this is done around the world, you know there are we missing the mark in the nuanced conversation about the risk stratification here?

 

00;00;25;25 – 00;00;36;07

Dr. Michael Milobsky

Because it is clearly very different than just a single hard view that’s presented.

 

00;00;36;09 – 00;00;55;22

Dr. Mona

Welcome to the PedsDocTalk. Do you know that we are a top 30 parenting podcast in the United States? Thanks to you. And we also have a new look on YouTube. So take a look at it. Our intros, I think, are so much more engaging and I cannot wait for you to take a look. So if you are a YouTube fan and love watching instead of listening, take a look there.

 

00;00;55;25 – 00;01;15;21

Dr. Mona

And as a reminder, I’m Doctor Mona and today we are talking about something that comes up in my office more than almost any other topic, and that is sleep specifically, we’re talking about bed sharing, and this episode was honestly inspired by my own learning. The more I listened, read, and paid attention, the more I noticed something I could not ignore.

 

00;01;15;28 – 00;01;36;29

Dr. Mona

Bed sharing is the norm in most of the world, whether by choice or by need. Because of space, families globally sleep together and have for generations. So why is mainstream pediatrics in the US still not having real conversations about risk reduction and education around it? Why is the answer is still just don’t do it with nothing else to offer.

 

00;01;37;02 – 00;02;01;24

Dr. Mona

When parents feel judged, they stop being honest with us. And when that happens, we lose the chance to actually keep babies safer. Parents are going to make their own choices, but they deserve real information. And not just too hard. No. So I sat down with Doctor Michael Milobsky a pediatrician with 27 plus years of experience, father, seven and grandfather of five, who has practiced across pediatric, emergency hospital medicine and private practice.

 

00;02;01;27 – 00;02;22;22

Dr. Mona

What I love about Doctor Michael is that raising seven kids gave him something you cannot learn in a textbook, and also his experience for 27 years. He knows what it feels like to be the exhausted parent in the room at 2 a.m. making impossible decisions. He, like myself, also knows that there is no one size fits all and that lived experience shapes every conversation we have.

 

00;02;22;24 – 00;02;42;13

Dr. Mona

We talk about where the data on bed sharing is strong, where it is honestly not clear what the safe sleep. Seven actually is, and not the situations where bed sharing is a hard no and why. The way we talk to families about sleep needs to change. This is one of the most honest conversations I’ve had on this topic.

 

00;02;42;16 – 00;03;05;18

Dr. Mona

Subscribe. Download this episode and share it with someone who needs to hear it. Check out our new intro and look on YouTube and tag us at PedsDocTalk at the PedsDocTalk podcast, and at Doctor Michael McCloskey Mitchell Lab’s Kai. Now let’s get into this very important conversation.

 

00;03;05;20 – 00;03;09;00

Dr. Mona

Thank you so much for joining me. I’m so excited to have you on the show.

 

00;03;09;03 – 00;03;12;15

Dr. Michael Milobsky

I’m excited to be here as a as a long time admirer of your work.

 

00;03;12;16 – 00;03;17;14

Dr. Mona

Thank you. Sam. You know, I when did you start your social platform, by the way, and tell everyone your handle.

 

00;03;17;16 – 00;03;46;20

Dr. Michael Milobsky

Oh, so Instagram is app, doctor Michael Malesky. TikTok is doctor Mike. But that’s mostly for street cred. Yeah. Or the youth for the Gen Zers. Yeah. Or square. And, and YouTube is, Doctor Michael Malesky and, I started social media 4 or 5 years ago, mostly because, you know, I transitioned from being, you know, employed as a pediatric emergency hospital doctor to owning a a practice.

 

00;03;46;20 – 00;04;09;25

Dr. Michael Milobsky

And it was just one of those things where if you’re practice, probably a good idea, you own a business to stop you on social media. And it’s just something that’s evolved over the last really year or two to be a much more central part of what I do, because I’m reaching way more people, and it’s such a great way to, to be more, effective and to, you know, to, to be able to help more people, you know, on scale.

 

00;04;09;25 – 00;04;12;07

Dr. Michael Milobsky

So that’s where that’s where I’ve been spending a lot more time.

 

00;04;12;14 – 00;04;42;13

Dr. Mona

I know it’s a lot of work to do. Social. As you can imagine, I’m in that same boat with you, and I always appreciate we were chatting about this before we started recording, the perspectives. Right. Like for me as a, doctor who’s been practicing for 11 years, I have two small children to be able to learn from you who is a father of, you know, seven, grandfather of five who’s been in this career longer, but more importantly, why I was just so excited to have you is I do feel like sometimes we can be very polarizing in the guidance that we give.

 

00;04;42;13 – 00;05;03;07

Dr. Mona

And I saw a video you did about, you know, bed sharing. And I said, oh my gosh, I want to talk to you because I feel like we’ve gotten so much in this sort of dichotomy of like, you either do this or don’t do this, that bed sharing all of it is bad. And my recent revelation to understanding more about bed sharing came over the last 5 to 6 years.

 

00;05;03;07 – 00;05;23;06

Dr. Mona

I would say I was one of those doctors that came out of residency, very much like you must do safe sleep, which means independent sleep space back ups, you know, back to sleep. Bed sharing is risky. And as I started having friends, family, my patients tell me that. Listen, I don’t want to do it, or, you know, this is what’s working.

 

00;05;23;06 – 00;05;44;11

Dr. Mona

I opened my mind a little bit more, and I was like, I want to talk to a fellow doc like yourself about where we’re missing the mark on safe sleep education. And so that first question I have for you is, we know that the American Academy of Pediatrics recommends safe sleep, but there’s very little on co-sleeping, risk reduction when co-sleeping is very common around the world.

 

00;05;44;13 – 00;05;57;23

Dr. Mona

And I’m going to I’m going to talk more about this bed sharing is the terminology. So people understand that we’re sharing a bed. And that is surprising to me. Right. Because I was talking to a pediatrician in India and he’s like, you know, we all but a lot of us bed share. And that’s what it is. And I’m like, then what are we doing here?

 

00;05;58;00 – 00;06;07;28

Dr. Mona

So where do you see the biggest gap between the app recommendations and real life? And just explain to us what we can do with that information to actually meet families where they are.

 

00;06;08;03 – 00;06;43;01

Dr. Michael Milobsky

Yeah. So I like you was, coming out of training. I actually had three children between the end of medical school and the end of my residency and fellowship. And so I was trained and, you know, socialized basically into that, that app sort of very hard view. And that’s where it changed for me, because I saw when you are in this place as a parent, it’s sometimes not possible to function and you are given this very, very hard view of risk.

 

00;06;43;04 – 00;07;07;11

Dr. Michael Milobsky

And where I think the conversation and the part in the app version, it and combined with the fact that but the knowledge that this is done around the world. Yeah. Where are we missing the mark in the nuanced conversation about the risk stratification here? Because it is clearly very different than just a single heart view that’s presented in the app version.

 

00;07;07;11 – 00;07;16;23

Dr. Michael Milobsky

And and when we were in this really hard phase of three kids under the age of four, which I don’t recommend, but we were like, yeah.

 

00;07;16;25 – 00;07;20;02

Dr. Mona

What happened? And they’re wonderful children and now adults.

 

00;07;20;04 – 00;07;40;02

Dr. Michael Milobsky

That we and as someone who experiences this talking to families all the time, hey, this is what I too am. I made this decision and I, and then afraid to talk about it or don’t want to talk about it because all they they assume that, oh, hey, he’s just you being who is this? And then we’re not.

 

00;07;40;04 – 00;07;50;13

Dr. Michael Milobsky

And he’s just going to scold me or tell me that I’m going to kill my child. And there is a large gray area in the middle of understanding risk stratification, how to talk about it in a more nuanced way.

 

00;07;50;13 – 00;08;10;26

Dr. Mona

And I think you had mentioned we were talking about where the data is missing the mark. And so when we talk about that, you know, what I’ve seen, and I would love to hear your opinion. The strongest data we have shows that bed sharing is much more dangerous when certain risks are present, right? Like smoking, alcohol use, sedating medications, couches, soft bedding, prematurity, low birth weight, very young infants.

 

00;08;11;00 – 00;08;38;22

Dr. Mona

However, the research is less clear in you know, where the exact risk of planned lower risk bed sharing, right? We don’t have the best data on low risk bed sharing. And what are the outcomes with that. And so, you know, lower mis lower risk does not mean no risk. However, I think it’s important to understand that the data that’s always often presented, and I spoke about this on another podcast doesn’t account for if we can reduce that risk and I don’t know.

 

00;08;38;25 – 00;09;18;06

Dr. Michael Milobsky

Have more together. And that’s where they came up with this very hard, all or nothing approach. And. Yeah. And, and the truth of the matter is every place where there’s been some attempt to stratify this, as you pointed out, the full term baby who’s being breastfed, there’s no tobacco or exposure pre or postnatal, and a healthy mom who isn’t sedated or medicated and who is taking steps around the in the sleep environment as far as the surface and the surrounding, you know, bedding, pillows, when you take those away, there is a significant change in what the risk really looks like, although it’s not been explored specifically and large enough.

 

00;09;18;08 – 00;09;40;29

Dr. Michael Milobsky

But it is it is clearly different. It is. Those are not the same things that they’re talking about when it comes to risk. And and the risk really seems to be extremely low. And like you said, nothing is zero risk. But, neither is putting your kid in the car to go to the store, and you can so on, you know, nothing is zero risk.

 

00;09;40;29 – 00;10;01;10

Dr. Michael Milobsky

It’s all about risk benefit. And I, I can tell you as a parent who’s been there and you’ve been there, and so many of my, my, moms who come to us, they, they meet all these criteria. They’re exhausted. They need to get some measure of sleep. They pull their two month old who’s full term and healthy and is fully breastfed, nurse them, and everyone falls asleep.

 

00;10;01;10 – 00;10;19;23

Dr. Michael Milobsky

And everyone’s usually fine because they’re taking the right steps and they’re, they’re they’re reducing all of those issues and they don’t want to talk about it because they’re afraid of the response and they’re afraid that, that they’re doing it wrong. And then there’s a lot of guilt and shame, but I’m still going to do it anyway. And we need that’s what we need to correct.

 

00;10;19;28 – 00;10;22;20

Dr. Michael Milobsky

Yeah.

 

00;10;22;23 – 00;10;42;01

Dr. Mona

Now let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh yeah. And we will get into again for everyone to listen, because it’s important for us as two pediatricians who are talking about this, to discuss, like our approach in terms of reducing risk as much as possible in a very clear, clear way.

 

00;10;42;01 – 00;10;57;16

Dr. Mona

But I want to get into more of like, why this conversation is important. And you brought it up at the beginning that so many parents aren’t truthful when it comes to where their child is sleeping due to the fear of judgment, right? Due to that sort of hard line. And I’ve heard it and I’ve been there. I’ve been that person.

 

00;10;57;16 – 00;11;17;10

Dr. Mona

Right. And I’m taking, ownership of that. And I’ve changed my ways because I’m like, that’s not serving anybody. So how can we as pediatricians, knowing what you just mentioned, right, that there’s a lot of nuance that the AP takes a hard line in order to make sure that they’re creating a broad recommendation and then leaving it to the clinicians, hopefully to have these conversations.

 

00;11;17;12 – 00;11;29;05

Dr. Mona

How can we open up the conversations around sleep choice with safety and no judgment in mind so that we protect babies, keep them safe, but also support families if they decide that co-sleeping is worse for them.

 

00;11;29;10 – 00;11;56;21

Dr. Michael Milobsky

I mean, I think first off is is is leading with empathy and leading with, the nuance that, you know, I, I know as a parent, I’ve done it and I know that so many parents struggle with this, these middle of the night decisions about, if you’re nursing and where and where your baby’s sleeping. So I, I would love to know what you guys are doing so we can just talk about the best ways to approach it.

 

00;11;56;24 – 00;12;19;08

Dr. Michael Milobsky

And if leading with that instead of, you know, how dare you not follow guidelines and put it up? And once again, I think that comes from experience. I think that you have to be a parent on some level to be able to put your be in that place with them. You know, people ask me, do you have to be a parent to be a good pediatrician?

 

00;12;19;08 – 00;12;49;15

Dr. Michael Milobsky

No, you don’t have to. But do you need running shoes to run normally? It certainly helps. So it’s one of those situations where I think meeting parents where they are. But, but, but accessing your own experience to understand why that place and what that’s like in those months and months of 2 a.m. decisions of in total exhaustion and just needing a solution is the place to be, and the place to open those conversations in an empathetic, nuanced way.

 

00;12;49;20 – 00;12;58;25

Dr. Mona

Yeah. And I would love to add in a little personal, experience. So, you know, with your own kids, right? I know it’s your your youngest, I believe, is 16.

 

00;12;58;25 – 00;13;00;23

Dr. Michael Milobsky

My seventh child is 16 years old.

 

00;13;00;23 – 00;13;03;25

Dr. Mona

Yeah. Okay. How old’s the oldest?

 

00;13;03;27 – 00;13;06;00

Dr. Michael Milobsky

I’m oldest is 30 and has four children.

 

00;13;06;06 – 00;13;18;07

Dr. Mona

Oh my gosh. So there we go. Right. We have a huge ring. And, as at the time of this recording, I have a six year old and a three year old at the time of this recording with your own kids. Right. You talked about how you were in residency and training when you had a few of your children.

 

00;13;18;07 – 00;13;33;26

Dr. Mona

And then outside of that, how did you approach sleep with your own children? Like to be transparent. Like, did you follow the sort of, you know, back to sleep? Was there was there bed sharing happening? And I’m also going to offer my perspective personally. But how that, you know, I just like to I’m just very curious about that.

 

00;13;33;29 – 00;14;00;15

Dr. Michael Milobsky

We tried, because I was also like very dogmatic. And my wife was, you know, okay. And, and, it broke down really fast. Yeah, fast with me, you know, chronically sleep deprived and on my wife, you know, juggling three kids under four and newborn after newborn after newborn. Honestly, it didn’t last long. And we entered survival mode for a very long time.

 

00;14;00;17 – 00;14;10;00

Dr. Michael Milobsky

And that often meant the baby was just there because nursing happened, and then everyone fell asleep and nursing happened again. And then you don’t want to wake up the toddlers.

 

00;14;10;02 – 00;14;10;23

Dr. Mona

Yeah.

 

00;14;10;25 – 00;14;24;04

Dr. Michael Milobsky

So that that’s where it. We tried, but it didn’t last long. We were in survival mode. Took over and I know so many of us and so many of my families, that’s where you are. Because all of us at two in the morning, at six weeks in.

 

00;14;24;10 – 00;14;41;13

Dr. Mona

I, I relate to this, and I love hearing your perspective because I have two children. And, you know, again, we talk about the circumstances that may make you where you are. Right? So in my circumstances, I had two children, one of which was formula fed. The first one, I had a very traumatic delivery. Breastfeeding was my plan.

 

00;14;41;13 – 00;14;59;22

Dr. Mona

It didn’t happen. I was I’m very happy with how things turned out. My second, I exclusively pumped, and I just know how I am as a sleeper. That I know that if someone’s in the bed like a baby, I didn’t feel comfortable with the baby being in the bed. Like for me, for me. And that’s only for me.

 

00;14;59;22 – 00;15;18;01

Dr. Mona

It doesn’t mean another person doing it. It’s like, how could you? And so and my husband as well, we were like, he’s like, I’m actually afraid of rolling over on my baby. And I’m like, okay, sweetie. Like, let’s, let’s do independent sleep space. My son took took to an independent sleep space. Very well. Like the first child, my daughter was like a stage five clinger.

 

00;15;18;01 – 00;15;40;08

Dr. Mona

You know, I love that. I love that about her. She’s a cuddle bug. She’s such a cuddle bug. And so to transfer her to an independent sleep space took a lot more work. And that work can be very exhausting, as you know. Right? That takes time to teach and to teach a newborn how to be an independent sleep space, because to the point of people who co-sleep, it is comforting to be near someone as a baby.

 

00;15;40;08 – 00;15;46;23

Dr. Mona

Like I’m never going to deny that that like it’s cozy. It’s warm. Like, of course, that’s why it happens a lot of the times, right?

 

00;15;46;23 – 00;15;48;15

Dr. Michael Milobsky

It’s kind of walk away.

 

00;15;48;18 – 00;16;04;08

Dr. Mona

Yeah, exactly. I don’t look at it as the easy way out. I look at it as like, that makes sense. No wonder the baby doesn’t want to transfer because they’re cuddle bugs. And I describe something called a cuddle quota. Every baby has a different cuddle quota because of their temperament, right? My son did not have a high cuddle quota.

 

00;16;04;16 – 00;16;13;23

Dr. Mona

And my daughter, it’s a very high cuddle quota. Interestingly enough, my husband has a very high cuddle quota. I do not have a very high cuddle quota. It’s very interesting.

 

00;16;13;27 – 00;16;16;08

Dr. Michael Milobsky

It’s like no. Yeah, yeah.

 

00;16;16;14 – 00;16;42;20

Dr. Mona

And so then I say that because the, the approach had to be different in getting them to the independent place. But maybe, just maybe it’s why a lot of families go to co-sleeping for that fam, for that baby that they’re trying to get them into that independent space, like you said, they’re breastfeeding or maybe even formula feeding, but if they’re breastfeeding, I also know because I nursed and pumped my for my daughter, there’s a smell and there’s an extra comfort that happens with the breastfeeding journey, right?

 

00;16;42;20 – 00;16;59;14

Dr. Mona

Like I even though my daughter was in an independence space and we got her into an independence space the moment I walked into the room because we were room sharing, she would wake up because I swear to God, she probably smelled my boobs like. And it’s. And I bring that up for all of our breastfeeding moms who are doing the bed sharing that.

 

00;16;59;14 – 00;17;17;09

Dr. Mona

I get that like, yes, we were able to do it. It took a lot of work, but I also had the capability because I had help. I had someone to like, I had a night nurse to help with the transfers, but I don’t know what would have happened had I not had that help, that we would have probably been in the same bed.

 

00;17;17;12 – 00;17;28;15

Dr. Mona

And I think about all my friends who are doctors, all my friends who know the risk, but still did it because we are thinking, and I’m going to talk about this reduce risk bed sharing, which I think is not often talked about.

 

00;17;28;18 – 00;17;39;01

Dr. Michael Milobsky

Not enough, not enough. And it does it it’s not brought into the conversation to know that there’s lots of ways and factors that that have to do with changing the bed, sharing conversation.

 

00;17;39;01 – 00;17;59;11

Dr. Mona

Yeah. And a lot of the reason why I wanted to have this is that I’ve been on social for about six years. And, you know, let’s say seven years now. And I’m curious what you think, because you’ve been on for a little less than me. Do you feel like sleep guidance is actually as divided as it looks like online, or do you feel like social media extremes are amplifying that?

 

00;17;59;11 – 00;18;14;29

Dr. Mona

Like, I’m just curious, like from what you’re seeing on social, or maybe you haven’t been down the rabbit holes of what people are saying about sleep stuff. How does that yeah, how does that compare? Maybe you don’t know. And I can kind of speak to that to just have a healthy conversation about what’s actually happening in offices versus what people are seeing on the line.

 

00;18;14;29 – 00;18;41;05

Dr. Michael Milobsky

So so the social media space is just an amplifier, and so it can take something that may be part of the conversation, but is nothing more than a part but make it seem so big, because controversy and conflict drive views, which is what ends. And that’s what drives social media things. People want to want attention that drives attention.

 

00;18;41;07 – 00;19;03;04

Dr. Michael Milobsky

In the office, for sure. It’s it’s it’s not that as far as how often I have the conversations. So once or twice a week, if you do want. Certainly. And I and I see I have 30 newborns a month in my office. And so my office is way overrepresented with tumor boards for my board six month olds.

 

00;19;03;04 – 00;19;07;11

Dr. Mona

I love it, I love it, I know, I love that, I love starting their journey with that. Right.

 

00;19;07;13 – 00;19;33;03

Dr. Michael Milobsky

There’s a lot and and there for sure. Some families just don’t tell me that’s not true. When I bring it up, some families admit, you know, I don’t. I I’ve been afraid to talk about it, so I don’t I don’t think it’s as big as you would think because of how it’s overrepresented in social media, because it it drives a lot of clicks and views, but it’s totally consistent and persistent and, I, I do talk about it.

 

00;19;33;03 – 00;19;52;20

Dr. Michael Milobsky

Sleep incessantly. And this has been part of the conversation more and more as people are understanding that risk and assessing risk is a nuanced thing, and it’s different than the way it’s been presented in the standard AARP driven version. Yeah.

 

00;19;52;23 – 00;20;09;10

Dr. Mona

Yeah. And I, I’m again, I’m happy that we’re going to chat about that. And we already kind of talked about some of the where that research kind of is, is at fault, in my opinion. When we talked about like how it doesn’t look at reduce risk bed sharing as much as it could. And maybe other countries can do that for us maybe.

 

00;20;09;10 – 00;20;24;02

Dr. Mona

Or who’s going to do it? I have no idea. Just to kind of show like, hey, if we take those steps that it can reduce risk. And I often also my experience as I’ve gone through being a pediatrician has also come from the stories I hear, the families I hear of, the deaths that happen due to SIDs. Right.

 

00;20;24;02 – 00;20;39;03

Dr. Mona

And a lot of it is I mean, I’m going to be quite honest, is unsafe sleep practices, which includes falling asleep in a rock or falling asleep on a couch. And again, this is no judgment to the parents. They. But what I what I fear is that did they just not get that education. And that’s why it happened.

 

00;20;39;06 – 00;20;48;09

Dr. Michael Milobsky

I just told, well, we can’t do this because, so so they go to the in my practice. The most recent one was a recliner was off.

 

00;20;48;09 – 00;20;48;27

Dr. Mona

Yeah, I.

 

00;20;48;27 – 00;21;12;03

Dr. Michael Milobsky

Know the couch. Those are I mean by many orders of magnitude way more dangerous. But they don’t get that’s not as clear when the entire message is around. Bed sharing is off limits. So. Right. Austin parents are stumbling into their living room to try and soothe their baby. And then. And then they.

 

00;21;12;03 – 00;21;12;18

Dr. Mona

Fall asleep.

 

00;21;12;21 – 00;21;13;25

Dr. Michael Milobsky

And.

 

00;21;13;27 – 00;21;34;03

Dr. Mona

Yeah. And I mean, we’ll get into the, the when what we’re going to get into is what are your kind of strategies on like risk reduction and what are hard nosed which we’ll get into which I think is going to be super helpful. And then before we get into that, you know, this, this experience on social media, you know, I, I am very pro sleep training in that if a family wants to do it, I love it.

 

00;21;34;03 – 00;21;41;01

Dr. Mona

But when you when someone is pro sleep training it, people automatically think that they’re anti bed sharing. Right. Like that.

 

00;21;41;08 – 00;21;43;18

Dr. Michael Milobsky

That’s where you might be a monster or that.

 

00;21;43;18 – 00;21;44;10

Dr. Mona

I’m a monster.

 

00;21;44;10 – 00;21;45;09

Dr. Michael Milobsky

Organization.

 

00;21;45;12 – 00;22;10;06

Dr. Mona

And listen, I there’s a few things recently I did get attacked because I did share our, our sleep training journey. That is very different than what the recommendations may be. Going back to the A guidance, we did sleep trainer sun much earlier than the AP recommendation, and there’s much nuance to why like there I don’t need to explain it to people who don’t know me, but there’s much nuance and my son is a beautiful attached child, all that stuff.

 

00;22;10;11 – 00;22;26;21

Dr. Mona

But of course the the and I don’t want to use the term anti, but it is the people who are against sleep training. Let’s just use that term, you know came out and we’re like not really happy. And I and I said I’m like you know the reality is like I can’t explain myself to you because you don’t know the nuance conversations that I’m having about that.

 

00;22;26;21 – 00;22;46;06

Dr. Mona

This is not recommended for all babies. Nor do I recommend certain methods for all babies. Right. So my and I think social can kind of create this sort of it’s us versus them. Your pediatrician doesn’t know sleep. They’re not an expert in sleep. But I am. And over the last 6 or 7 years of being online, what I’m defending is not co-sleeping.

 

00;22;46;06 – 00;23;04;25

Dr. Mona

What I’m defending is different methods of approaching sleep, you know, is that we are looking at the family unit. We are looking at how the lack of sleep or sleep is affecting the entire family. And then we’re making decisions with discussions. And that’s what’s actually happening in my office. Right. That it’s not you’re going to do this because I said so.

 

00;23;04;25 – 00;23;21;03

Dr. Mona

It’s hey, how I sleep going for you. Do you have any questions about sleep? So my question to you is, what is that first question? You asked the family to not be judgmental, like when you’re meeting a new family, rather than saying like, you know, are you bed sharing? Or, you know, are you, you know, independent sleep?

 

00;23;21;07 – 00;23;36;23

Dr. Mona

What is that first question that you feel really makes the biggest impact to drop the judgment? So maybe they’ll open up to you. Now, let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. Oh.

 

00;23;36;25 – 00;23;43;08

Dr. Michael Milobsky

I, I, I try to be as open ended as possible and just say, how is sleep going in your home?

 

00;23;43;12 – 00;23;44;09

Dr. Mona

Yes, that’s what I do.

 

00;23;44;09 – 00;24;13;13

Dr. Michael Milobsky

Yeah. And and that gives a lot of space to well it’s, it’s going great and here’s why. Or it’s a disaster and, and I can say well let’s talk about what parts of that and then and, and to your point with your personal journey and that you kind of reference it earlier, deeply enmeshed in that was you also knew the temperament of your child and naturally different children.

 

00;24;13;13 – 00;24;35;26

Dr. Michael Milobsky

Each kid is a Rubik’s Cube to solve as well. So probably my favorite, you know, psychology person is fond of saying your child is born with over 400 personality traits that unfold as they age. You have nothing to do with you. It is just who they are. And and this is I remember hearing this in residency, but having no idea what they were talking about to they until I had a kid.

 

00;24;35;28 – 00;24;56;00

Dr. Michael Milobsky

And even when I had my first kid, it was really, really hard to to articulate and tune into what those things were. It got a lot easier as I had, you know, we we were parents further then, much quicker to go. I know what kind of kid I have. I have a kid who’s transitions easy, is laid back, doesn’t get up over stuff, but it just who they are.

 

00;24;56;03 – 00;25;16;04

Dr. Michael Milobsky

And then the other kid who was, like, highly needy, really reactive, needs a lot of touch and attachment for regulation. Those were not words I had in my vocabulary and I could not understand. Well, even with the first two kids, it took me a while. So. But you know, you all have the benefit of being, I think, more experienced at the time.

 

00;25;16;04 – 00;25;36;24

Dr. Michael Milobsky

Your kids like, yes, you could tune in to that. So it was that that your decision and how you dealt with sleep was also deeply entwined in understanding your child too, and that that needs to all be part of the conversation. Because you’re right, sleep training is highly individual. Yeah, it’s something that works for one family in a child sort of match and couple.

 

00;25;36;25 – 00;25;43;20

Dr. Michael Milobsky

It does not work for the other. And it has to. You have to include both those conversations. So that’s what I try to do and explore.

 

00;25;43;23 – 00;25;44;09

Dr. Mona

I love.

 

00;25;44;09 – 00;25;45;20

Dr. Michael Milobsky

That. So

 

00;25;45;23 – 00;26;04;21

Dr. Mona

Yeah. Yeah, I love that, you know, how is sleep going in your home and do you, do you feel like you need any support in that area? It’s kind of the added question because sometimes they’re like, nope, I’m good. And then I, you know, if the family is, bed sharing or co-sleeping by that point, that family has usually made a, made a, you know, reduced risk decision.

 

00;26;04;21 – 00;26;30;26

Dr. Mona

And then I just remind them of the safety risks, which we’ll go over not to, like, judge them, but to say, hey, love that. Just make sure if you’re drinking or anyone’s a deep sleeper or if it’s another member of the family who’s not used to being with the baby. But we’ll get into that. But you know, already, I really appreciate this conversation because I think what I want people to understand is that myself, you we may be anomalies, like, I’m being honest with you, and I think you may know that, that there is still a lot of pediatricians out there that do take the hard stance.

 

00;26;30;26 – 00;26;58;07

Dr. Mona

And can we convince everybody? No. But can we maybe give them the resources with this conversation to bring it to their pediatrician and say, you know what, this is what’s working for our family. I listened to this episode by two pediatricians. I would love to just have a conversation with you about it. And at the end of the day, I think you and I both know that if a family feels like a strong value set is not being heard by their pediatrician, it’s okay to go find another pediatrician if you have that opportunity, right.

 

00;26;58;07 – 00;27;14;28

Dr. Mona

I understand not everyone lives in an area that has that, but I think what’s often done is like, you know, when I was in that very hard stance phase, like not shaming, I wouldn’t shame, but I would just say, hey, just a reminder, we need to, you know, independent sleep space. I wouldn’t even entertain the bed sharing.

 

00;27;14;28 – 00;27;32;18

Dr. Mona

Right? I wouldn’t even talk about it. I’m sure there were families leaving thinking, well, this doctor just didn’t even discuss something important to me. And now I look at that as, oh, I lost a huge opportunity, like you said, right? I lost an opportunity to help a family reduce risk and understand that, you know what? This is happening in other places, too.

 

00;27;32;20 – 00;27;43;05

Dr. Mona

And so now I want to go into like this risk reduction, which is the meat. So people, you know, I hope they’re staying here because this is where we need to, like, understand, how to reduce. Now there’s something called the safe Sleep seven. Are you familiar with that?

 

00;27;43;08 – 00;27;44;00

Dr. Michael Milobsky

Absolutely.

 

00;27;44;03 – 00;28;00;10

Dr. Mona

Okay. So first of all, we can, before we get into safe sleep, seven, because I think it’s an important thing. What are your thoughts about it in general? What would you like people to know about it when they’re approaching it and when they hear non-medical experts, speak about safe sleep? Seven I have my own thoughts.

 

00;28;00;12 – 00;28;07;04

Dr. Michael Milobsky

I mean, so, I, I have to say, like, we’re all seven right now off the top of my head, but I think it has to do, like, you know.

 

00;28;07;06 – 00;28;09;16

Dr. Mona

Full time. I have all of them seven, two because I had. Yes.

 

00;28;09;17 – 00;28;34;16

Dr. Michael Milobsky

Yeah. That that it is. It is a great way to frame an understanding of risk and harm reduction. And that that is a valid way for every anybody. And as a parent, you know, it’s a valid way to look at, okay, if I’m if I, if I want to make these choices and I want to do these, this is a great way to understand.

 

00;28;34;19 – 00;28;47;17

Dr. Michael Milobsky

Hey, checking all seven of these boxes really does make a big difference when it comes to my understanding of risk and risk reduction harm to my child when, we’re making this choice around sleep. Yeah.

 

00;28;47;20 – 00;29;09;27

Dr. Mona

And I, you know, so I obviously started looking more into it because it’s very common in the co-sleeping educator space, right, with the bed sharing space. And not a lot of pediatricians talk about it because of this whole nuanced discussion. Well, that goes against the AP guidelines. And the first conversation I want to say is that if you actually go on the AP Healthy Children website, they do take their stance that is more blanketed of like, you know, independently.

 

00;29;09;27 – 00;29;19;27

Dr. Mona

Space is what we know, but there is a section on their website that if you do bed share, here are some reduced risk practices. So it’s almost it’s been a newer thing I’ve seen in the last seven years. And I want to say like.

 

00;29;19;29 – 00;29;22;11

Dr. Michael Milobsky

You got to go down to go down. Yes.

 

00;29;22;17 – 00;29;39;12

Dr. Mona

But now we’re bringing it to the top of this conversation. But I bring that up because I, I, I appreciate them in a way that is that I’m not trying to support it. And maybe we can in later, we’ll talk about why we feel like the AP is just not saying what we want to say. Like, just say this, say that we can reduce risk.

 

00;29;39;15 – 00;30;01;05

Dr. Mona

But I want to say that if anyone’s listening, they’re like, this is going against evidence based guidelines, that there’s not a lot of good evidence for what we’re describing. And I want to reiterate that in that we don’t know the evidence surrounding produce for speech sharing, but that means that it doesn’t mean it’s harmful. Like, I want to be clear now, the safe sleep seven what I want to also be clear about is that it’s not a validated, evidence based guideline.

 

00;30;01;05 – 00;30;16;16

Dr. Mona

So if you are an evidence based person, you might be arguing with us and we recognize that. But that doesn’t mean it’s not a good way to reduce harm. So I wrote it all down because I also didn’t want to forget them, because I have them, because it ends up coming out and all the things we talk about yours.

 

00;30;16;19 – 00;30;27;16

Dr. Mona

Okay. So everyone and I and I’m sure you’ll, you’ll agree with all of this. So nonsmoking household, not just a nonsmoking parent, but a household that’s a nonsmoking household. Because smoke can linger.

 

00;30;27;18 – 00;30;29;03

Dr. Michael Milobsky

To and postnatal like either.

 

00;30;29;03 – 00;30;34;02

Dr. Mona

Yes. Okay. And maybe we can go through these and then we’ll maybe explain why that’s a risk.

 

00;30;34;02 – 00;31;04;29

Dr. Michael Milobsky

Yeah. Because the tobacco smoke has a significant impact on your child’s. It’s even prenatal exposure, the development of your respiratory center. And those kids certainly, clearly have differences in how they, their respiratory drive and arousal and all those things. Tobacco directly inhibits that. And it’s highly dangerous, to, to to that issue. So any, any alternative sleep choice is going to be impacted risk wise by tobacco exposure either before or after pregnancy.

 

00;31;05;00 – 00;31;14;12

Dr. Mona

Love it. Agree. The next one we kind of talked about, which was a sober no alcohol or sedating medications. I don’t think we need to explain that, but maybe do it. I would love just for people understand.

 

00;31;14;12 – 00;31;33;28

Dr. Michael Milobsky

Yeah, exactly. I mean, if if the if a parent is impaired, their own arousal system is going to be impaired and they’re not going to respond to their baby, movement sound. In the same way, if you are drinking or have to take opioid medication for pain or things like so, any either of those are going to be impaired, which is dangerous.

 

00;31;34;03 – 00;31;47;29

Dr. Mona

Yes. Okay. So that was two. The next one was a breastfeeding parent, which you talked about like having a breastfeeding parent. But why can that reduce the risk of SIDs. Why that? Why may that be something that someone may do and approach but sharing.

 

00;31;48;01 – 00;32;11;19

Dr. Michael Milobsky

So we do know that breastfeeding moms are deeply tuned into cues from their kids. Unconsciously, kids who are babies were breastfed are aroused more, you know, in proximity to the mom, which is itself an independent, protective, mechanism around SIDs and suffocation. And moms who are breastfeeding instinctually kind of create a safe space around their baby.

 

00;32;11;22 – 00;32;32;19

Dr. Michael Milobsky

And this has been shown across multiple cultures and places in breastfeeding moms who are sleeping with their kid that they they create this sort of C sort of shape because, you know, when you’re lying in breastfeeding your baby, you kind of instinctually do that. And then I always get the question about what about formula fed kids and what you just it’s just not the same, you know, duplicate it the same way.

 

00;32;32;24 – 00;32;47;00

Dr. Michael Milobsky

Not that it can’t be safe, but we’re we’re talking about the the seven checklist. Breastfeed breastfeeding is on it for that reason. They arouse differently breastfed babies and moms respond differently because of that breastfeeding relationship.

 

00;32;47;00 – 00;33;05;18

Dr. Mona

And you know as as I I’m an I be silky also. So like I you know I know the breastfeeding mechanisms the hormones. And having done one child who had formula and one child who had breast feeding, albeit it was, more pumped feeding that we did with my daughter, but still there there is there is a difference, right?

 

00;33;05;23 – 00;33;25;01

Dr. Mona

It doesn’t mean that there won’t be a family listening that may but share with their formula fed baby just because they they think that that’s something they want to do. And then as long as you’re following all the other things, I think that’s, that’s reasonable. But it’s so happens that I do feel I don’t hear a lot of my formula fed babies bed sharing.

 

00;33;25;01 – 00;33;36;28

Dr. Mona

Like I hear more from my breastfeeding parents, like, I, I don’t know if that’s your experience too, I just don’t it’s not something that I’m hearing of. I don’t think I can remember the last patient I’ve had who’s formula feeding and also bed sharing or.

 

00;33;36;28 – 00;34;04;01

Dr. Michael Milobsky

What happens once again, we also had multiple kids with some were breastfed, a few were not. Yeah. In the not let’s just take the the formula situation. There’s the option of the partner getting up and then allowing the mom to rest. Like that’s at least that’s an option and that’s exercised frequently. In an exclusively breastfed baby. That’s simply just it’s if you’re if you’re making that choice, that’s not an option.

 

00;34;04;01 – 00;34;26;12

Dr. Michael Milobsky

And yes. And so the breastfeeding mom is, you know, getting up every three hours, sometimes two hours. And the exhaustion kind of gets to be overwhelming after about a few weeks. And so just that choice of bringing the baby next to you to feed and sleep is was way more just feels way more to live in a natural because you don’t have the option of the partner managing.

 

00;34;26;14 – 00;34;33;18

Dr. Mona

Yeah, the next one we talked about as well is healthy full term baby. So the risk of having like a pre-term baby and bed.

 

00;34;33;20 – 00;35;02;02

Dr. Michael Milobsky

Preterm babies have also different arousal when when babies are premature. Their other neurodevelopmental cues are also behind. And they’re also smaller and weaker. And they have less reserve especially respiratory reserve. So there’s there’s lots of physiologic reasons why a preemie and in terms of what you call preemie, at what level, I don’t know that that’s not really outlined is 37 weeks to premature is 36 weeks or 35 weeks.

 

00;35;02;04 – 00;35;15;00

Dr. Michael Milobsky

The cutoff is not clear. I guess you have to be transparent about that. But let you know I generally use myself if you’re if you’re under 38 weeks, I’m gonna at least advise you on that. There’s a slightly elevated risk.

 

00;35;15;00 – 00;35;36;17

Dr. Mona

I love this already because you are exactly saying what we do and do not know. And and that was the point of this conversation, like you said there, because the AP does not have a hard line, right? Because we don’t know the data of what is that week. And also the babies can be different, right? We know that even between and within, preterm babies, there’s so much variation within what was the reason for their preterm delivery.

 

00;35;36;21 – 00;35;53;27

Dr. Mona

So I love also did the healthy, you know, when we talk about healthiness like the you know, what’s going on with the baby? This is one of those conversations where I wish pediatricians would be able to be more open about this entire conversation, that we’re having to guide a family and say, hey, look, I think that I understand that you want to do bed sharing.

 

00;35;53;27 – 00;36;11;11

Dr. Mona

I think at this point, you know, I’m not shaming you, but let’s just make sure that we’re doing the independent because of X, Y, and Z. We don’t have all the data and this is why I recommend it. So it doesn’t feel like they’re not being listened to. They feel like, okay, the doctor understands that this is something I wanted to do, but because of my kid’s age, we’re not going to do it.

 

00;36;11;11 – 00;36;25;07

Dr. Mona

And it’s for the it’s just to protect the baby as much as possible. So I love that one. We have three more to go. We did four, so babies sleeping on their back, and then we’ll talk about where they’re sleeping but on their back and not on their belly in the shared sleep space.

 

00;36;25;10 – 00;36;44;26

Dr. Michael Milobsky

Exactly. So you know that we did this and I’ll the, the parents who I talked to you pull the baby and you feed them, but then you just sort of booth on their back in that safe, protected space, you know, near the mom as opposed to, you know, resting on their side or on the. Yes, there is there’s definitely a risk reduction.

 

00;36;44;26 – 00;36;47;01

Dr. Michael Milobsky

They’re choosing to do it on their back.

 

00;36;47;01 – 00;36;52;07

Dr. Mona

And I think I’m going to jump to the number seven. I mean, you can do this in any order, but they’re not like a, you know, that.

 

00;36;52;07 – 00;36;53;12

Dr. Michael Milobsky

Is but.

 

00;36;53;15 – 00;37;10;16

Dr. Mona

But this kind of goes into like when the baby starts to roll on their side, the baby starts to roll over in a in a bed sharing space. That number seven was a safe sleep surface, which is a firm mattress, no pillows or loose bedding near the baby. And that would also help when they start rolling to their side as well.

 

00;37;10;18 – 00;37;42;07

Dr. Michael Milobsky

Correct. And I think that when, when that also plays very much into the question around what other countries do it. Yes, we see it, other cultures. And listen, I’m not going to pretend that I am a international traveler. But what I’ve looked into it and seen what they mean when other cultures are doing it. They are doing it on form flat surfaces that they don’t have 17 pillows like we tend to have in America, and a duvet and a comforter.

 

00;37;42;10 – 00;37;53;19

Dr. Michael Milobsky

Yeah, they don’t have that. None of that stuff is there. So changing your sleep space to reflect what that looks like, in Japan, in India makes a difference.

 

00;37;53;25 – 00;38;19;11

Dr. Mona

Yeah. I a lot of my information about this came from doctor Imran Patel. I have to call him out. He’s a pediatrician in India. Huge following, because obviously India has billions of people. But but yes, he said the same thing. And I, you know, I’ve seen it when I’ve traveled, I’ve seen the, the floor beds. A lot of the families have beds on the floor and it’s, you know, a firm mattress, like you said, the baby, which was number six that we jumped over, has minimal clothing on, so there’s no overheating.

 

00;38;19;11 – 00;38;38;15

Dr. Mona

It’s not like they’re in like 7000 bottles. And interestingly, we know that they don’t need a lot of the bottles because they’re closer to the parent. Right. Like meaning the reason why swaddling exists is that it sort of mimics, mimics what a baby may want from bed. Sharing in an independent sleep space is what I believe is why we do this.

 

00;38;38;17 – 00;39;06;25

Dr. Michael Milobsky

Yes. I mean, listen, this the swaddling is to provide that binding comfort, to recreate, you know, closeness with the parent and or the womb. I mean, I think Doctor Karp has made quite a fortune on his new product. Yeah, yeah, yeah, on that thing. Who? So, therefore, you know, I think that that is very astute, that it’s just recreating what you’re giving when you are providing the physical closeness.

 

00;39;07;01 – 00;39;22;26

Dr. Mona

And then in terms of newborns, because I know there’s like some, you know, we talk about how the SIDs rate is, you know, higher in the first 3 to 6 months. Is your approach the same for newborns? Like what what we’re talking about here, like all of the the sleep seven, or would you take a little bit more nuance within the safe sleep seven.

 

00;39;22;26 – 00;39;35;21

Dr. Michael Milobsky

For a full term, busy, active newborn who’s waking up on their own and and is that’s a very different discussion. I think it’s baby. The baby. Yeah. When it comes to the newborn.

 

00;39;35;23 – 00;39;53;04

Dr. Mona

I, I love this this is so great. And thank you again for like, adding in all that. You know, I wanted us to have this discussion so you could add, we could add in all the whys and the explanation and where the, where the nuance is still existing. And so that families can make that best decision for their family with that reduced risk in mind.

 

00;39;53;06 – 00;40;09;14

Dr. Mona

And so just to reiterate the situations we do not love, you already said smoking, alcohol, drug use, sedating medications, prematurity speaking to the clinician. And then we we we talked about this in earlier, which is the couch recliner or.

 

00;40;09;14 – 00;40;11;12

Dr. Michael Milobsky

Soft I.

 

00;40;11;14 – 00;40;25;16

Dr. Mona

Want to talk about that is like if I actually I wish they would break it down, I don’t know, I have to look into it. And if I do find the data on like how much of it is in a couch recliner, soft surface, I’m going to include it at the beginning of this conversation as an intro, but to me, that’s where I’m seeing the most of it.

 

00;40;25;17 – 00;40;26;11

Dr. Mona

Like that is.

 

00;40;26;15 – 00;40;26;25

Dr. Michael Milobsky

In my.

 

00;40;26;26 – 00;40;27;26

Dr. Mona

Research.

 

00;40;27;28 – 00;40;36;11

Dr. Michael Milobsky

Where it’s happened, tragically, has always been in one of those specific cases.

 

00;40;36;14 – 00;40;54;07

Dr. Mona

Now, let’s take a quick break to hear from our sponsors who support helps us keep bringing you this show. So let’s talk about the couch and recliner. I think soft surface. We already understand that. It’s because obviously it’s a suffocation hazard if they’re putting their face into a soft blanket or soft pillow. But the couch or recliner.

 

00;40;54;07 – 00;41;23;12

Dr. Michael Milobsky

So the couch recliner is that those spaces on the side and and a and a baby, especially in the newborn phase, they can roll and get trapped you if you’re exhausted and it can happen sort of suddenly and your baby ends up wedged into the in between you and the ball and the arm of the recliner, or the arm of the couch, or with the space between the cushion and the side of either kind of couch in that.

 

00;41;23;17 – 00;41;41;15

Dr. Michael Milobsky

And your baby can get stuck there, and it does not take long, and they can’t. And it’s they can’t. They’re silent. Unfortunately, they’re not going to be able to, you know, people think, oh, I hear them cry. No, you want if they’re especially if they’re small enough and they’re in there and they’re newborn enough, they are just going to suffocate there.

 

00;41;41;18 – 00;41;46;24

Dr. Mona

It’s and and also in many of those situations, the parent is also sleeping and like.

 

00;41;47;00 – 00;41;50;17

Dr. Michael Milobsky

So like that’s right. And they’re totally asleep. And then and.

 

00;41;50;17 – 00;42;05;11

Dr. Mona

Then you’re if you’re in a deep sleep and you don’t hear that, then of course there’s tragedy and I, I it can be so scary to talk about these conversations, but I hope people feel educated and empowered to say, you know what, I’m going to do my best. I’m going to do all the things to reduce that risk.

 

00;42;05;15 – 00;42;25;19

Dr. Mona

And I love this because this is how we do it, right? This is how we educate our families to say, yeah, this is what I wanted to do. It feels the most natural to me to bed. Sure. And now I have some tools that understand how to how to reduce that risk. And then of course, the, you know, we talk about the, the couch in the, like the recliner.

 

00;42;25;21 – 00;42;38;29

Dr. Mona

Yeah, the couch ones are the ones that are hardest, and we talked about that earlier, that well-meaning families who maybe don’t want to say don’t want to do bed sharing. One of the partners takes the family, takes the baby out of the room so the other partner can sleep with us.

 

00;42;38;29 – 00;42;40;02

Dr. Michael Milobsky

Right. And then you.

 

00;42;40;04 – 00;42;50;17

Dr. Mona

Bring a scenario, and then they fall asleep on the couch, and the baby is like, neck flopped or neck or, you know, face into the parents chest the entire night or into the pillow on the couch.

 

00;42;50;17 – 00;43;04;12

Dr. Michael Milobsky

And or or they slide. Yeah. Is without knowing it. Those were the unfortunate ones in my office that we’ve had most of that, thankfully. Not for a while, but that was the last one is exactly. Yeah.

 

00;43;04;14 – 00;43;21;11

Dr. Mona

Yeah. And I think, what we said earlier, you know, that data that we look at obviously is looking at the riskiest, forms, of, of bed sharing. And so it’s really important, to know that. Right. The apps I think the most recent safe sleep guidance guidelines came out in 2022.

 

00;43;21;13 – 00;43;22;12

Dr. Michael Milobsky

I believe that.

 

00;43;22;17 – 00;43;30;19

Dr. Mona

And it’s yeah. And it’s like the most recent updated was, you know, the room sharing for six months, which was a new recommendation. Not bed.

 

00;43;30;22 – 00;43;50;13

Dr. Michael Milobsky

I mean, the room sharing was 12 months. And honestly that was seem so many. I had so many discussions with parents who are like, we need that went to that discussion about what we need. We really need to see a baby. And yeah, that’s whole they have to stay here till 12 months. Like that was patently ridiculous in my opinion.

 

00;43;50;20 – 00;43;51;10

Dr. Michael Milobsky

I.

 

00;43;51;12 – 00;44;13;28

Dr. Mona

So funny because that was my next question because I, you know, although we’re talking about bed sharing, I just want to have this conversation is also just about the sex in general. And that is the the room sharing wreck. I moved, but I moved my daughter, my son out at two months, but I, I move my son out at two months of age, but I shared the room with him and not my husband because it was Covid time and he needed to get sleep as an ER doctor.

 

00;44;13;28 – 00;44;31;12

Dr. Mona

And I was still on Matt leave. And then at four months I went back into the room with my husband. But then I still went back into my husband’s room because of, we didn’t know what Covid was, right. I didn’t want to share room with him and get Covid and bring it back to my son. With my daughter, we were like, hey, like, when are we ready to go out?

 

00;44;31;12 – 00;44;38;10

Dr. Mona

But the room setup we have, we didn’t have a room for her and a crib for her to go into, so that’s why she shared a room with us.

 

00;44;38;10 – 00;44;39;12

Dr. Michael Milobsky

But you.

 

00;44;39;14 – 00;45;00;13

Dr. Mona

You mentioned like the recommendations came out for room sharing. Again, we’re talking about room sharing for six months. And that was including, you know, not bed sharing. That was the app rack. And so many of my families, like you said, or like, I can’t do this, I’m going to wake up more. And to your point, exactly what we said as long as there was no as long as it’s a nonsmoking household, I was okay with it.

 

00;45;00;13 – 00;45;09;25

Dr. Mona

As long as they weren’t premature, I was okay with them going into their other space. Was there any reasons that you would not be okay with someone separating their baby out into a separate room?

 

00;45;09;27 – 00;45;43;28

Dr. Michael Milobsky

What’s the conditions for a healthy kid? Yeah. We also know that all babies are going to arouse more just because of the proximity to mom. And if you if you are trying to make your do that calculus about. I’m exhausted. I have to go back to work. I need to at least explore a sleep training option. The first thing is the to move your baby to a separate sleep space, because a lot of babies will just sleep longer because they’re not in that proximity to mom, which does generally arouse the more just.

 

00;45;43;28 – 00;45;44;27

Dr. Michael Milobsky

Yeah.

 

00;45;44;29 – 00;46;05;21

Dr. Mona

On that topic of arousal, because I there’s been a lot of discussion in the people who are against sleep training or independent sleep space. Like people were like, it’s not safe. I want to I want to be clear. So when we talk about arousal, of course, yes, being close proximity is going to arouse them. But that’s different than like the baby is still arousing in an independent sleep space, meaning they’re still breathing.

 

00;46;05;21 – 00;46;18;07

Dr. Mona

Because what I think is happening, what I think is happening is people are creating, people are creating that they arouse. And you need that arousal to survive. But babies are independent. Sleep spaces are still breathing and arousing, just not as frequent.

 

00;46;18;10 – 00;46;45;16

Dr. Michael Milobsky

Yeah, there’s definitely a factor of maternal proximity that just stimulates more of it. Yes, yes. So you get a little bit more space, slightly longer sleep windows in in a lot of kids. And once again, every kid is different and no two kids are going to respond exactly the same. But that can be just a simple measure. In a kid who’s you’ve already you’ve you’ve reached that point, of development.

 

00;46;45;16 – 00;47;07;24

Dr. Michael Milobsky

And, you know, for most kids, that’s after six months where they, you, they have at least some of the developmental resources to self-soothe and to self-regulate more where separation makes sense. If you want to go that route because you need to at least initiate the process because of your, going back to work on all the factors that the, the discussion that, that are all there that have to that are different for every family.

 

00;47;07;27 – 00;47;12;20

Dr. Michael Milobsky

But your needs were different. And so but that is a good first step that I often start with.

 

00;47;12;20 – 00;47;30;06

Dr. Mona

This is such a great conversation. I knew it would be, I am just so grateful that we can have all of this out here as a resource for our communities, you know, for the families that are looking for it, because there is a gap in the education and for us to be able to just dive deep into it and just get into it was just so beneficial.

 

00;47;30;08 – 00;47;47;09

Dr. Mona

I loved it. Again, I love learning from you. A lot of the stuff I already knew and have been doing already, but just took from a fellow pediatrician to tell me, yeah, okay. As a newbie doctor, meaning 11 years compared to your your experience to be like, okay, this is what I was saying to my families. I feel justified and understanding that, you know, safe sleep.

 

00;47;47;09 – 00;48;10;26

Dr. Mona

Seven although it may not be an evidence based resource, it’s still is really accurate in saying, you know, the things that we know that can reduce the risk. In your opinion, what is your biggest goal with families when it comes to sleep guidance and support. And that just includes whether they sleep, train, whatever method they choose. Bed sharing what is something that you just wish every family could get from their pediatrician as well?

 

00;48;10;28 – 00;48;32;09

Dr. Michael Milobsky

First thing and I know is that as someone who’s fully involved in a in a practice that I own, that’s insurance based is time. The clock is and I think one of the reasons that pediatricians tend to default to just the dogmatic app view is simply we do lack the time to have the meaningful, nuanced conversations that these topics deserve.

 

00;48;32;09 – 00;48;58;29

Dr. Michael Milobsky

Sleep being but eating an ADT, all of them. We are not afforded the time by the system because of how it all works. And the economics of this are complicated. And this is not the time to talk about it, but just know that insurance creates a system that makes it almost impossible to give a topic like this the time that it deserves to flesh out the nuance individually, which every family deserves and needs.

 

00;48;58;29 – 00;49;30;24

Dr. Michael Milobsky

It’s just not possible. It’s way easier to go to your doctor sleep app says go got three people waiting. That’s that’s the problem. And I wish that what families got was the time because most pediatricians know this. It’s not it’s really not something that that most physicians are ignorant of. They all understand it. It’s the ability to dive into it in a way that gives parents what they need, is they lack the time.

 

00;49;30;24 – 00;49;48;12

Dr. Mona

And that is why you started your platform. That is why I started mine. By the way, I don’t think you know my origin story, but I was working at a big box, corporate medicine practice, seeing patients every ten minutes, and I just felt so burnt out because I didn’t have the time to explain all this middle ground, like all this sort of.

 

00;49;48;17 – 00;50;07;24

Dr. Mona

Hey. And so then what it end up being is an outlet for me. I didn’t imagine it would become what it is now, an outlet to be like. You know what, I want you if you can please. Here’s the here’s the Tldr or teal did you know didn’t listen. Please go read this article or please go watch this Instagram reel or iGTV that I made back in the day when that was the what happened?

 

00;50;07;26 – 00;50;19;07

Dr. Mona

Because I do feel like people need this and we’ve for the last 48, 50 minutes, we’re able to give people that. And I’m just so grateful for you, for your time. What would be your final uplifting message for everyone tuning in today?

 

00;50;19;10 – 00;50;43;06

Dr. Michael Milobsky

I think that being empowered to know yourself and know your children and know how those intersect with your needs is valid and it’s okay. And, and and you need to be able to talk about it. And all of it has a place and and there’s so much nuance and space to do things right. And what’s right in your house doesn’t feel like someone else’s house.

 

00;50;43;09 – 00;50;55;17

Dr. Michael Milobsky

Yeah. And that’s okay, too. And this whole I think parents feel over judged, feel over scrutinized because of the world we live in and social media. So that’s my message that I try to leave everybody with on all of these topics, not just.

 

00;50;55;22 – 00;50;56;27

Dr. Mona

My little snap fingers as.

 

00;50;57;01 – 00;50;57;28

Dr. Michael Milobsky

Well. I really.

 

00;50;57;28 – 00;51;04;23

Dr. Mona

Appreciate it. And, the final, final question is out of left field, but what’s what’s making you happy right now in your life?

 

00;51;04;24 – 00;51;32;07

Dr. Michael Milobsky

Being able to actually spend the time and reach more people than I’m afforded to in the traditional system, and to have a platform that’s big enough, is bringing me an enormous amount of joy and fulfillment and filling your bucket, my bucket, because I can actually deploy all of this knowledge and things I’ve accumulated in a way that in a in a time frame that isn’t limited by things that I can’t and families can’t control.

 

00;51;32;07 – 00;51;47;26

Dr. Michael Milobsky

And that’s what I really love. That’s what I love about the platform that we made, the raising well, platform and yes, channel is that’s that’s the reason why it’s there is because that’s the need I’m trying to feel. The need I feel is lacking every day in, in a traditional office system.

 

00;51;47;27 – 00;51;56;21

Dr. Mona

And I’m thankful for you doing it. Tell people where they can stay connected, including the raising platform. And so that they can get more information, a little, little info about that as well.

 

00;51;56;24 – 00;52;16;10

Dr. Michael Milobsky

Yeah. Sorry. So the Instagram channel, and we really try to, to answer questions and as much as we can at, at doctor Micro Key, and that’s where you can find the information about raising. Well which is our parent platform, which is designed to give parents the time and space to explore deep and nuanced topics in a way that they don’t often have the time to.

 

00;52;16;16 – 00;52;39;24

Dr. Michael Milobsky

So there’s a library of content on all these topics to live calls a week, and a live open question answer stream that we manage that allows us to touch more, do more, be more present, be more available for these topics from someone who has that to offer. 30 years of being a pediatrician and a parent. And and so that’s those where both of them exist.

 

00;52;39;24 – 00;52;58;16

Dr. Mona

I will be adding this to our shownotes. And what an awesome conversation. I know we’ve connected even before this. You know, I, I love chatting with fellow pediatricians who are doing this hard work, not only seeing patients, but also, you know, online. I know it’s it’s it it requires us to show up in unique ways. And I’m happy that I get to do this job with you.

 

00;52;58;18 – 00;53;10;04

Dr. Mona

Like, thank you for being a colleague in all the work that you do online and in real life. And I know this is not going to be the last time we’re on the show together, and I think maybe we need to start our own show together. Me and Doctor Michael.

 

00;53;10;07 – 00;53;15;00

Dr. Michael Milobsky

Separate and let me talk. I think I know, yeah.

 

00;53;15;02 – 00;53;17;15

Dr. Mona

Well, listen, I, where are you based again?

 

00;53;17;17 – 00;53;18;22

Dr. Michael Milobsky

I’m in Denver, Colorado.

 

00;53;18;24 – 00;53;39;29

Dr. Mona

Denver? I now know that when I do, I’m. I’m writing a book. So I now know that when I coming to Denver, you are going to be my co-host on that conversation. We are going to talk about this. You are going to be my you’re going to interview me and we’re going to chat all about it. I haven’t announced to my my community what the book is and when it’s coming out, but just know you are my person now because we have to have more conversations, my friends.

 

00;53;40;04 – 00;53;43;23

Dr. Michael Milobsky

To come to Colorado because you could experience a snow storm on May 6th.

 

00;53;43;26 – 00;53;45;03

Dr. Mona

Oh wow.

 

00;53;45;05 – 00;53;54;10

Dr. Michael Milobsky

That was a school once and tomorrow it will. You will not be able to know it’s there because it will be 75 degrees. That’s all.

 

00;53;54;12 – 00;53;57;03

Dr. Mona

Okay. Yeah, maybe I’ll come when it’s not.

 

00;53;57;06 – 00;54;00;02

Dr. Michael Milobsky

Oh my gosh.

 

00;54;00;04 – 00;54;21;21

Dr. Mona

What stayed with me the most from this conversation is something so simple but so important. Doctor Michael’s first question to every family is how is sleep going in your home? Not where is the baby sleeping? Not are you following the guidelines? No shame. Just how is it going? That open door changes everything. Because when parents feel safe enough to be honest, that is when we can actually help.

 

00;54;21;23 – 00;54;43;05

Dr. Mona

And I want to be clear about something we’re not saying everyone should share. That is not the point of this conversation. What we are saying is that families deserve real education around risk reduction, because right now, without that conversation, parents are falling asleep on couches, recliners, swings, armchairs and soft surfaces with their babies. And that is where the data is clear and the risk is higher.

 

00;54;43;08 – 00;55;05;00

Dr. Mona

Those are the situations we want to prevent. A planned, intentional conversation about safer practices is always going to be better than silence that leads to an unsafe one. And if this episode resonated with you, or if you learned something, please share it. Me and Doctor Michael really want to be balanced in this discussion, and part of that balance is understanding that people approach sleep differently, that they have different desires.

 

00;55;05;00 – 00;55;28;26

Dr. Mona

So how are we going to reduce risk in all of those situations? Tag us at PedsDocTalk. And the PedsDocTalk podcast and Doctor Michael at Doctor Dr. Mona Download it. So we know this kind of conversation matters to you. And again, it helps the show grow. And if you want to go deeper on sleep parenting and all the real life nuance in between, check out Doctor Michael’s Raising Wall platform.

 

00;55;29;03 – 00;55;41;19

Dr. Mona

Link is in the show notes. Thank you for joining me for learning, for always continuing to be the most incredible community here on the PedsDocTalk podcast, and I cannot wait to chat with another guest next time on the show.