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Ask the Experts: Co-sleeping

To co-sleep or not to co-sleep: now that’s the question. It’s perhaps the most controversial practice 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.” Which 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.

mom and baby co-sleeping

Just like every child is different, every family is different — what works for one family may not work for another. Regardless 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 sleep 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/sleep 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 sleep surface than your baby. Your baby’s sleep surface (like a crib or bassinet) can be next to or close to your own 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.

parents don't know if they should co-sleep or not

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 safe sleep recommendations, 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.

Is co-sleeping safe?

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.

Factors that increase the risk of SIDS

  • Overheating
  • Soft or plush sleep surfaces
  • Loose bedding, pillows, 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 sleep when the parents do not smoke or take alcohol or drugs increases the risk of SIDS. 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 sleeping 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, he or she is already right in bed with you. This can lead to easier bedtimes and longer, sounder sleep for all.

mom and baby co-sleeping with the Zen Sack

Is there such a thing as “safe co-sleeping”?

Although room-sharing is the recommended practice from experts, you might still be considering co-sleeping as a viable option for your family. While co-sleeping is not technically safer than sleeping separately, there are steps you can take to reduce risk while practicing co-sleeping.

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.

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.

You should never co-sleep…

  • On a sofa, waterbed, armchair, etc. as this increases the risk of SIDS by more than 60%. Co-sleeping in your bed is advised over other furniture options.
  • If you or your partners 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.
  • If your baby is underweight or was born premature.

How to co-sleep as safely as possible

The AAP recognizes that there haven’t been any studies evaluating claims of products promoted to “make co-sleeping safe.” Since there are no standards set by the Consumer Products Safety Commission (CPSC) for in-bed sleepers or co-sleepers, it’s impossible to say whether or not a certain product reduces the risks of co-sleeping.

However, if you choose to co-sleep once your baby is 4 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 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.
  • Avoid falling 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 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 from their parents, 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 co-sleeping as safely as possible.  

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

 

 

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