Ask the Experts: Is Co-sleeping Safe?

Co-sleeping is one of the most controversial topics of parenting, these days. Despite all the questions surrounding the practice, a 2015 study[1] reports that 24% of parents in the U.S. co-sleep “often or regularly,” and another 37% report sharing their bed “sometimes or rarely.” This means over 50% of parents are co-sleeping at least some of the time.

Unfortunately, the same 2015 co-sleeping study revealed that almost 50% of caregivers received either incorrect advice on safe sleep practices from their healthcare provider—or no advice at all.

According to the American Academy Pediatrics (AAP), it is not safe to bed-share with a infant less than 6 months old, although room-sharing is considered a good option. What is co-sleeping?

But just like every child is different, every family is different — what works for one family may not work for another. After 6 months, although room-sharing is the recommended practice from experts, you might decide that co-sleeping is a viable option for your familyRegardless of the decision you choose to make with your family when it comes to co-sleeping, it’s important to understand the facts and educate yourself on reducing risk with safe sleep practices.

What is co-sleeping?

Co-sleeping is when you “sleep close enough to your baby that you can see, hear, touch, or smell each other.[2]” Although “co-sleeping” and “bed-sharing” are used interchangeably, bed-sharing is when the parent(s) and the baby are sleeping together in the same bed. “Room-sharing” refers to having the baby sleeping in the same room as the parents, but not in the same bed. Bed-sharing and room-sharing are both different forms of co-sleeping.

Co-sleeping Sleeping in the same room or in the same bed/sleeping surface as your baby. Bed-sharing Sleeping in the same room and bed as your baby. Room-sharing Sleeping in the same room, but on a different surface than your baby. Your baby’s sleep surface (like a crib or bassinet) can be close to or next to your bed.

For the remainder of this article, the term co-sleeping will reference bed-sharing, as they are most commonly used interchangeably.

Why is co-sleeping controversial?

Despite the growing spotlight on co-sleeping in recent years, it’s not a new practice. According to anthropologists, bed-sharing has been practiced for more than 200,000 years. In some cultures, such as Japan, co-sleeping is the norm. In western culture, however, co-sleeping is advised against by various organizations and experts such as the American Academy of Pediatrics (AAP).

Those against co-sleeping argue that it’s dangerous for the infant and can lead to potentially deadly situations, while advocates of co-sleeping, including some prominent doctors and anthropologists, insist that the bonding, convenience and other benefits that accompany co-sleeping outweigh the risks. This controversy leaves most parents wondering what the right choice is.

Most doctors recognize that the stigma around co-sleeping only makes for more dangerous situations because parents are less inclined to share their decision with their doctor. “For some families,” says Toronto pediatrician Daniel Flanders, it is virtually impossible to make it through the night without bringing baby into bed,” Fearing judgement, they often hide this from their doctor, which means professionals miss out on the chance to educate families on how to reduce risk.

From the experts “We make the statement for the first time that health care providers should first and foremost have open and nonjudgmental conversations with families about their individual preferences, sleep patterns, sleep environment and be able to have a dialogue about doing the best they can do," - Lori Feldman-Winter, MD, MPH, Co-author of AAP’s Safe Sleep Recommendations

When announcing the 2016 recommendations for safe infant sleep, Lori Feldman-Winter, co-author of the guidelines and professor of pediatrics at Cooper University Health Care, expressed that the AAP would rather parents be honest about their practices, and encouraged pediatricians to have an open and judgment-free dialogue with their patients about co-sleeping.

Co-sleeping facts you should know[Infographic]

Co-sleeping and safety

Co-sleeping with a newborn

Newborns (babies under 4 months old) are considered “high-risk” even if they were born at a normal weight and in perfect health, which means co-sleeping is not the ideal scenario. If your baby was born pre-term or with a low birth weight and is under 4 months old, co-sleeping is highly discouraged.Co-sleeping & SIDS

Co-sleeping & SIDS

The link between Sudden Infant Death Syndrome (SIDS) and co-sleeping has been thoroughly studied over the years to determine the safety of the practice. SIDS is defined as an unexpected, unexplained death of an infant under 1-year-old that occurs during sleep. SIDS is a type of Sudden and Unexpected Infant Deaths (SUID), which also includes cases of accidental suffocation or strangulation in bed and any other unknown cause.

More than 3,500 infants under 1 year old die each year in the U.S. from sleep-related causes. While co-sleeping is not the sole cause of all SIDS or SUID cases, sleep environments do play a major role. Investigations of SIDS cases by Child Fatality Review Teams have shown that the majority of infants who die of SIDS or asphyxiation (suffocation) are found in an unsafe sleep position or environment. A safe guide to co-sleeping from the University of Notre Dame can be found here.

From the experts The rates of SIDS and other sleep-related deaths, particularly those occurring in bed-sharing situations, are highest in the first 6 months.” - Bed sharing when parents do not smoke: is there a risk of SIDS?

A healthy, normal weight infant can be brought into the parent’s bed to be fed or for comfort. But since this age range is more vulnerable, parents should try their best not to fall asleep with the baby in their bed, and consider using a bedside bassinet or co-sleeper instead.

Factors that increase the risk of SIDS Overheating Soft or plush sleeping surfaces Loose bedding, pillows(may use co sleeping pillow post consulting the doctor), and blankets Placing your baby on their side or stomach to sleep Co-sleeping typically exposes babies to one or more of these SIDS risk factors.

A 2015 study that examined over 1,000 SIDS cases and monitored close to 5,000 families’ sleeping practices revealed that bed sharing does increase the risk of SIDS, even when the infant is “low risk,” meaning the parents of that infant are not smokers and do not take any drugs or alcohol.

From the experts Bed sharing for sleeping when the parents do not smoke or take alcohol or drugs increases the SIDS risk. Risks associated with bed sharing are greatly increased when combined with parental smoking, maternal alcohol consumption and/or drug use. A substantial reduction of SIDS rates could be achieved if parents avoided bed sharing. - Bed sharing when parents do not smoke: is there a risk of SIDS?

 A 2008 Canadian study that survey co-sleeping families reported that 13% of respondents remember rolling onto or part way into their baby while co-sleeping at least once. The same study showed that mothers who slept in the same bed at their infant woke up 30% more than moms who sleep in a separate space, suggesting that co-sleeping can negatively effect the parent’s sleep.

Co-sleeping around the world

Across the globe, Japan has one of the lowest SIDS rates in the world and one of the highest rates of co-sleeping. More than 60% of parents in Japan practice co-sleeping. Despite this, Japan has half as many SIDS deaths as the U.S.

However, the typical Japanese family bed doesn’t look like most Western beds:

• Futons are commonly used, which are much firmer than regular mattresses
• Beds/futons are usually placed on the floor, which removes the risk of falling off the bed

Reports show that as co-sleeping and breastfeeding rates increase in Japan, SIDS rates have decreased, which suggests that the way co-sleeping is practiced might be more dangerous than co-sleeping in general.

Benefits of co-sleeping

While there are inherent risks involved in co-sleeping, there are also benefits. Some studies have linked co-sleeping to:

• Prolonged breastfeeding
• Better bonding between parent and child
• Improved emotional health, such as less anxiety and higher self esteem

Most importantly, co-sleeping is convenient for most families. Instead of getting out of bed to check on or feed your baby every few hours, they're already in the parents' bed with you. This can lead to easier bedtimes and longer, sounder sleep for all.

Co-sleeping with a toddler: A few pros and cons

The desire for closeness. Exhaustion from the drama of struggling with a fussy toddler at bedtime. There are many reasons parents may choose to bed-share with a toddler. Bed sharing can cut down on the time, energy, and effort it takes to get a little one to nod off. And parents have to pick their battles.Co-sleeping with a newborn

However, there are a few downsides to co-sleeping with your toddler or child—even when safety is not the red flag it was when your baby was an infant. Here are just a few drawbacks to keep in mind:

• Poor quality sleep: Many toddlers are active sleepers; they change positions frequently and little legs and arms ted to flail around, making it difficult for you to get a good night's rest. (In fact, co-sleeping means neither of you will sleep as well as you would alone.)
• Loss of parental control: Letting toddlers call the shots about where they want to sleep can make sleep training more difficult in the long run.
• Loss of private time with your partner: There are a few downsides to co-sleeping with your toddler or child—even when safety is not the red flag it was when your baby was an infant.

You should never practice co-sleeping…

• On a sofa, waterbed, armchair, etc. as this increases the SIDS risk by more than 60%. Co-sleeping in your bed is advised over other furniture options.
• If you or your partner are current smokers, even if neither of you smoke in bed or in the room.
• If you or your partner is impaired due to medications or substances that may effect your ability to arouse from sleep, such as pain medications, antidepressants, sedatives, drugs, alcohol, etc.
• If you are not the infant’s parent or primary caregiver and especially if the parent or caregiver has not given explicit permission.
• If your baby has any health concerns that might increase the risk of death while sleeping.

How to practice co-sleeping as safely as possible

Even though it's not as safe as sleeping separately, there are steps you can take to reduce risk while practicing co-sleeping. If you choose to co-sleep once your baby is 6 months or older, you can reduce risk by making sure to:

• Place your baby on their back to sleep to reduce the risk of SIDS
• Keep the room at a comfortable temperature and don’t overdress your baby for sleep
• Use a headboard and/or foot-board that doesn’t have any openings or rails wide enough to trap your baby. Or remove headboards, foot boards, and bed frames altogether.
• Limit the use of blankets and pillows as much as possible in your adult bed and remove any other plush objects or toys.
• Keep your baby uncovered by any blankets or sheets that are being used on your bed.
• Remove any pillows
• Avoid co-sleeping with multiple children and don’t allow an infant and older child to co-sleep unsupervised.
• Remove any blinds, cords, or anything else that could wrap around your baby is near the bed.
• Try not to fall asleep with your baby on your chest (always place them on their back)
• Put your baby between two parents to reduce the risk of rolling off the adult bed
• Consider placing a barrier between you, your baby, and your partner (but remember the CPSC does not endorse any product claiming to reduce risk while co-sleeping)

The verdict

Co-sleeping isn’t recommended by most professionals, but it’s the reality for many parents. Babies are safer sleeping on a separate sleep surface than in their parents bed, and you should always give room-sharing a try before resorting to co-sleeping or bed-sharing, as studies show that bed-sharing does increase your baby’s risk of SIDS.

However, if co-sleeping is what works best for your family, do your research. And be sure to talk about your choice with your pediatrician, so you can take every precaution to make sure you’re sleeping with baby as safely as possible. 

Discuss your thoughts on safe infant sleep and co-sleeping in the comments of Touchy subjects: co-sleeping pros & cons.

Common questions about safe co-sleeping

• Is co-sleeping bad?

  Co-sleeping can be harmful to your baby, especially if they are newborns. This is because it can increase the risk of sudden infant death syndrome. However, as your baby gets older, the negative effects of co-sleeping are reduced and it may be safe to do so.

• Is safe co-sleeping possible at a certain age?

  The American Academy of Pediatrics (AAP) strongly warns against bed sharing with babies less than one year of age, because bed sharing can increase the risk of SIDS. (In fact, the AAP warns that bed-sharing with your baby is never safe). On the other hand, they do advocate for room-sharing for the first 6 months of a child’s life, as this can actually reduce the risk of SIDS. Safe co-sleeping involves having your baby sleep in your room in their own crib or bassinet. Co-sleeping is generally considered to be safe from the age of 1 year however, it is still recommended that you try to let your baby sleep on their own. The older your child gets, the less risky co-sleeping becomes.

• When should I stop co-sleeping with my baby?

  The AAP defines safe co-sleeping as room-sharing (as opposed to bed sharing). After six months or more, experts recommend that infants sleep in their own rooms. Studies have found that infants who slept in their own rooms after this age actually slept longer.

• How do I ensure safe co-sleeping with a newborn?

  According to the American Academy of Pediatrics (AAP) , safe newborn infant sleep can only be accomplished through room-sharing—never bed-sharing. This is a particularly important warning for parents with newborns under four months old, since bed-sharing can increase the risk of SIDS. For safe room-sharing, make sure that there are no pillows, loose bedding or any other items that could obstruct your baby’s breathing or cause overheating.

• Should I swaddle my baby when we’re co-sleeping?

  According to the American Academy of Pediatrics (AAP) , safe co-sleeping is only possible if you and your baby are room-sharing, not sharing bed. You can certainly swaddle your newborn before placing them in their crib or bassinet. Just follow the guidelines for safe swaddling.

• Is it safe to co-sleep with my 1 year old?

  Experts agree that co-sleeping after 12 months is generally safe. This is because as children get older, they’re more able to move, roll over, and free themselves from restraint. Safe co-sleeping with an infant under 12 months of age, on the other hand, is only advisable if infant and parents are room-sharing—never bed-sharing.

• When is SIDS no longer a risk?

  The risk of SIDS decrease after about d 6 months of age. The older your child gets, the more the risk decreases.

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Some helpful resources

¹Vital signs: trend and disparities in infant safe sleep practices via CDC’s Morbidity and Mortality Weekly Report

²Bedsharing – March of Dimes

SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment – AAP Task Force on SIDS

Mother-Baby Behavioral Sleep Laboratory – University of Notre Dame

Is co-sleeping really unsafe? – The Scientific Parent

Bed sharing when parents do not smoke: is there a risk of SIDS? Via BMJ Open Medical Journal

Bed-sharing – Kidshealth.org

New guidelines acknowledge the reality: babies do sleep in mom’s bed via NPR

Co-sleeping around the world – James J. McKenna, Ph.D.

Ambivalence: new research on co-sleeping in the United States via National Council on Family Relations 

Is sleeping with your baby as dangerous as doctors say? Via NPR