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by Danielle DiMarco

Chapter 5- The First Two Years: Biosocial Development, page 138

"...many experts seek ways to safeguard the practice of bed-sharing (Ball & Volpe, 2013). Their advice includes never sleeping beside a baby if the parent has been drinking, and never using a soft comforter, pillow, or mattress near a sleeping infant."

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This article goes in depth about the pro's and con's of co-sleeping with your baby. It lists safety guidelines for co-sleeping and includes SIDS statistics due to co-sleeping. The article also touches briefly on the psychological effects of co-sleeping.

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What is co-sleeping?

Co-sleeping essentially means sleeping in close proximity to your child. It may be in the same bed or just in the same room. Some ways of co-sleeping that different families use are:

Bed-sharing/Family Bed:
Parent(s) sleep in the same bed with the child.

Sidecar arrangement:
Securely attach a crib to one side of the parents' bed, next to the mother. Three sides of the baby's crib are left intact, but the side next to the parents' bed is lowered or removed so that mother and baby have easy access to one another. Commercial cosleeper/sidecar cribs are also available.

Different beds in the same room:
This might include having baby's bassinet or crib within arm reach of the parents (easier at night) or just in the same room; or preparing a pallet or bed for an older child on the floor next to, or at the foot of, the parents' bed.

Child welcomed into parents' bed as needed:
The baby/child has her own bedroom, but is welcomed into the parents' bed at any time. In many families, children start their overnight hours in a separate bed or room, but are welcomed into the parents' bed after a night waking.

Advantages of co-sleeping

Co-sleeping is not the best fit for every family, but it can have many advantages:

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Parents often get more sleep.

Babies often get more sleep. Baby stirs and almost wakes up when she needs to nurse, but since she is right beside mom, mom can breastfeed or soothe her back to sleep before she fully wakes up.

Breastfeeding during the night is easier when baby is nearby.

Breastfeeding at night helps to maintain your milk supply.

Sleeping in the same room as your baby reduces the risk of SIDS by as much as 50% [AAP].

Night nursing also tends to prolong the child-spacing effects of breastfeeding.

No nighttime separation anxiety.

Fewer bedtime hassles.

It's lovely to wake up next to a smiling baby!

Creating a safe sleep area for your baby

Any sleep surface that baby uses (including cribs, nap surfaces, or adult beds) should be made safe for baby:

Baby should be placed on his back to sleep.

The sleep surface should be firm. Do not put a baby on a waterbed mattress, pillow, beanbag, sheepskin or any other soft surface to sleep.

Bedding should be tight fitting to the mattress.

The mattress should be tight fitting to the headboard and footboard (or sides of the crib).

There should not be any loose pillows, stuffed animals, or soft blankets near the baby's face.

There should not be any space between the bed and adjoining wall where the baby could roll and become trapped.

Babies (with or without an adult) should never sleep on a sofa, couch, futon, recliner, or other surface where baby can slip into a crevice or become wedged against the back of the chair/sofa/etc.

Bed-sharing Safety

Bed-sharing is just one of the ways that a family might co-sleep, but it is frequently practiced by breastfeeding mothers. One of the biggest issues when it comes to bed-sharing is safety. Some sources publicize bed-sharing as an unsafe practice, no matter how it's done, but there are ways to sleep safely while bed-sharing if you follow guidelines for safe sleep surfaces and safe sleep sharing.

According to the Academy of Breastfeeding Medicine, in their Clinical Protocol #6: Guideline on Co-Sleeping and Breastfeeding:

There is currently not enough evidence to support routine recommendations against co-sleeping. Parents should be educated about risks and benefits of co-sleeping and unsafe co-sleeping practices and should be allowed to make their own informed decision.

The ISIS Infant Sleep Information Source website notes:

The most recent studies have shown that most bed-sharing deaths happen when an adult sleeping with a baby has been smoking, drinking alcohol, or taking drugs (illegal or over-the-counter medicines) that make them sleep deeply.

Sometimes people fall asleep with their babies accidentally or without meaning to. This can be very dangerous, especially if it happens on a couch/sofa where a baby can get wedged or trapped between the adult and the cushions.

James J. McKenna, Ph.D., a world-recognized infant sleep authority, notes:

In sum, overwhelmingly, bedsharing deaths are associated with at least one independent risk factor associated with an infant dying. These include an infant being placed prone (on its stomach) and placed in an adult bed without supervision, or no breastfeeding, or other children in the bed, or infants being placed in an adult bed on top of a pillow, or who bedshare even though their mothers smoked during the pregnancy therein compromising potentially the infants ability to arouse (to terminate too little oxygen, or to terminate an apnea). Drug use and alcohol have historically been associated with poor outcomes for bedsharing babies so if drugs and/or alcohol are present, please don't bedshare.

General Safety Guidelines for Bed-sharing

If baby is sharing sleep with another person:

Very small premature or low birth-weight babies appear to be at greater risk when bed-sharing, but benefit greatly from co-sleeping nearby but on a separate surface (more).

Do not sleep with baby if you are currently a smoker or if you smoked during pregnancy - this greatly increases SIDS risk (more)

Do not sleep on the same surface as your baby if you are overly tired or have ingested alcohol/sedatives/drugs (or any substance that makes you less aware) (more).

Baby appears to be safest when sleeping beside his/her breastfeeding mother. (More info here for non-breastfeeding parents)

Older siblings or other children should not sleep with babies under a year old.

Do not swaddle your baby when bed-sharing. Baby may overheat (which is a risk factor for SIDS) and a swaddled baby is not able to effectively move covers from the face or use arms and legs to alert an adult who is too close (more).

Other potential hazards: very long hair should be tied up so that it does not become wrapped around baby's neck; a parent who is an exceptionally deep sleeper or an extremely obese parent who has a problem feeling exactly how close baby is should consider having baby sleep nearby, but on a separate sleep surface (more).

Some authorities specifically recommend co-sleeping without bed-sharing, since they feel that not bed-sharing is the easiest way to eliminate any risks of bed-sharing. For example, the American Academy of Pediatrics says, "Room-sharing without bedsharing is recommended- There is evidence that this arrangement decreases the risk of SIDS by as much as 50%."

Night nursing and ear infections?

You might hear that breastfeeding your baby in a lying down position will cause ear infections. Research indicates that this is . Also, keep in mind that with most nursing positions, baby is lying down while nursing anyway - whether mom is or not!

Can co-sleeping cause psychological problems in my child?

People who are uncomfortable with the idea of co-sleeping often suggest that co-sleeping is "less healthy" than the child sleeping alone and will cause psychological damage to the child, cause baby to become too dependent on the parents, etc. Dr. James McKenna counters these suggestions:

In part, this view represents a personal and arbitrary judgment that anyone is entitled to make as long as it is not passed on as scientific fact. Such judgments are based on Western values favoring the perception of how individualism and infant autonomy are best promoted and obtained. No study has shown, however, that the goals for separateness and independence (or happiness, for that matter) are obtained in the individual by, among other things, separate sleeping arrangements for parents and children, nor do any studies demonstrate negative consequences for children or parents who choose to cosleep for ideological or emotional purposes, except when cosleeping is part of a larger psychologically disordered set of family relationships or when cosleeping occurs under dangerous social or physical circumstances. The only studies of the psychological or social effects of cosleeping reveal not negative but positive consequences. One study among military families revealed that cosleeping children receive higher evaluations of their comportment from their teachers than do solitary sleeping children and are under-represented among psychiatric populations, when compared with children who do not cosleep [Forbes JF, Weiss DS: The cosleeping habits of military children. Mil Med 1992; 157:196-200]. Lewis and Janda found that college-age students who coslept as children were better adjusted and more satisfied with their sexual identities and behavior than college-age students who did not cosleep [Lewis RJ, Janda H: The relationship between adult sexual adjustment and childhood experience regarding exposure to nudity, sleeping in the parental bed, and parental attitudes towards sexuality. Arch Sex Behav 1988; 17:349-363] . Clearly, we need to change our conceptualization concerning what constitutes a normal or healthy childhood sleep pattern!

- From: Stein MT, et al. Cosleeping (Bedsharing) Among Infants and Toddlers. Pediatrics 2001 Apr; 107(4); 873-877

Dr. McKenna also notes that

It has never been proven, nor shown, nor is it even probable, that sleeping with your baby has any kind of negative long-term effects when the relationships between those involved are healthy. Instead, experts are finding that cosleeping can help develop positive qualities, such as more comfort with physical affection, more confidence in one's own sexual gender identity, a more positive and optimistic attitude about life, or more innovativeness as a toddler and an increased ability to be alone.

See also: What are the long term effects on my baby of sharing a bed? by James McKenna, PhD.

More information

Co-sleeping safety

Where Babies Sleep from the ISIS Infant Sleep Information Source

Guidelines to Sleeping Safe with Infants by James J. McKenna, Ph.D.

Safe Sleep 7: Is it safe to bedshare? is a free handout for parents, produced by La Leche League International

Infant Health Research: Bed Sharing, Infant Sleep and SIDS from the UNICEF UK Baby Friendly Initiative
Attachment Parenting International - Infant Sleep Safety
Babies sharing their mothers' beds while in hospital: a sample policy from the UNICEF UK Baby Friendly Initiative

Guideline on Co-Sleeping and Breastfeeding, Clinical Protocol Number 6 from the Academy for Breastfeeding Medicine

AAP Policy Statement: SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment (Oct. 17, 2011)

Logistics: Making co-sleeping work for your family

Rooming-in at the Hospital: Assessing the Practical Considerations by Martin Ward-Platt and Helen L. Ball, from Mothering, Issue 114 September/October 2002.

Excerpts from the book Good Nights - The Happy Parents' Guide to the Family Bed (and a Peaceful Night's Sleep!)

How to make sleep sharing work from BabyCenter.com, with input from James McKenna, PhD

Co-sleeping: Yes, No, Sometimes? by William Sears, MD

Collections of co-sleeping articles

Sleep & Family Bed articles from Mothering.com

Sleep & Family Bed Articles at The Natural Child Project

Making & defending the decision to co-sleep - Research and opinion articles on co-sleeping

Responding to criticism @ is written about breastfeeding, but can be applied to any other parenting choice that draws criticism from others. Some of the links included are directly geared toward co-sleeping.

Safe Sleep & the Breastfed Baby from La Leche League Great Britain

What Every Health Professional Should Know About Sleeping with Baby by James J. McKenna, Ph.D.

Does Bedsharing Increase the Risk of Death for Younger Infants? by Tracy Cassels BA, MA, PhD, at Evolutionary Parenting, discusses this article: Colvin JD, Collie-Ackers V, Schunn C, Moon RY. Sleep environment risks for younger and older infants. Pediatrics 2014; doi:10.1542/peds.2014-0401.

Interview with James J. McKenna, Ph.D. from the Huffington Post

Should the AAP Sleep Alone? by Melissa Bartick, MD, MSc, from the Academy of Breastfeeding Medicine blog, April 2014

Somebody's been sleeping in my bed! by Amy Spangler, from Amy Spangler's Feeding Times, December 2004.

Ten Reasons to Sleep Next to Your Child at Night by Jan Hunt at The Natural Child Project

Sleep With Me: A Trans-Cultural Look at the Power - and Protection - of Sharing a Bed by Meredith F. Small

Go Ahead - Sleep With Your Kids by Robert Wright

Annals of Parenthood: Sleeping with the Baby - Which Side of the Bed Are You On? The Author and His Wife Defied the Experts by John Seabrook. This article is reprinted from an article first published in the Nov. 8, 1999 issue of the New Yorker Magazine, and includes the interview with Dr. Richard Ferber where he said

"...There's plenty of examples of co-sleeping where it works out just fine. My feeling now is that children can sleep with or without their parents. What's really important is that the parents work out what they want to do."

Research and discussion of research

Mother-and-Baby Behavioural Sleep Laboratory Professor James J. McKenna's area at the University of Notre Dame website. Dr. McKenna is best known for his pioneering studies of the differences between the physiology and behavior of solitary and co-sleeping mothers an infants-and the connection these data might have in addressing SIDS risks. He is a Professor at the University of Notre Dame and runs the University of Notre Dame Mother-Baby Behavioral Sleep Laboratory.

Parent-Infant Sleep Lab, Department of Anthropology, University of Durham, UK. The Parent-Infant Sleep Lab is the home for a team of researchers led by Dr Helen L. Ball who are examining various aspects of infant sleep and night-time parenting. Their website includes research papers, project descriptions, presentations and other resources.

Bovbjerg ML, Hill JA, Uphoff AE, Rosenberg KD. Women Who Bedshare More Frequently at 14 Weeks Postpartum Subsequently Report Longer Durations of Breastfeeding Journal of Midwifery and Women's Health. May 2018.

Why the Conflicting Results on Bedsharing Risk? by Tracy Cassels BA, MA, PhD, at Evolutionary Parenting

Thompson J, Tanabe K, et al. Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics. November 2017, volume 140 / issue 5.

Fleming P, Blair P, Mckenna J. New knowledge, new insights, and new recommendations: Scientific controversy and media hype in unexpected infant deaths. Arch Dis Child. 2006;91(10):799-801.

McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev. 2005 Jun;6(2):134-52.

Okami P, Weisner T, Olmstead R. Outcome correlates of parent-child bedsharing: an eighteen-year longitudinal study. J Dev Behav Pediatr. 2002 Aug;23(4):244-53.

Baby bedsharing fears dismissed. Discussion of the above Okami study from BBC News.

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Co-sleeping and Bed-sharing * KellyMom.com

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Co-sleeping essentially means sleeping in close proximity to your child. It may be in the same bed or just in the same room. Some ways of co-sleeping that different families use are: Bed-sharing/Family Bed : Parent(s) sleep in the same bed with the child.

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Context: "SIDS risk is calculated for a 2-month-old, female baby of European ancestry. The low-risk baby is of average birth weight and has a 30-year-old mother who does not smoke or drink. The high-risk baby is of low birth weight and has parents who smoke and a 21-year-old mother who has more than two alcoholic drinks regularly."

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This picture is a safe co-sleeping example of a baby sleeping in their parents bed in a baby nest. This is one of a few ways parents can co-sleep with their baby safely.

"Walls of the nest separate baby from parents. That prevents parents from rolling into the nest. Your baby will sleep next to you, in your bed, but much safer.

Snuggle nests are a great solution for shared beds, but they are suitable only for the first six months of baby’s life."

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Digestive system and baby sleep position

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Digestive system and baby sleep position

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DO's

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DONT's

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This video outlines the "do's" and "don't's" on how to co-sleep with your baby. They highlight that it is dangerous to share a bed with your baby if you have recently drank any alcohol, if you smoke, if you have taken any medication that makes you drowsy, and if your baby was born prematurely or was born underweight. They also suggest safe alternative options for co-sleeping.

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https://www.youtube.com/watch?v=YFNTGXY8fCA

https://www.npr.org/sections/goatsandsoda/2018/05/21/601289695/is-sleeping-with-your-baby-as-dangerous-as-doctors-say

https://kellymom.com/parenting/nighttime/cosleeping/

https://babyslittleplace.com/benefits-of-co-sleeping-with-baby/

https://rednose.org.au/article/will-baby-choke-if-he-she-vomits-while-sleeping-on-the-back