Co-sleeping is about as controversial as vaccination online. And that is saying something. But I think that is important to review the evidence about the safety of this topic in infancy. Paying careful attention to your child’s sleeping venue and position can avoid tragedy in the first year of life.
First off, let’s put together some definitions:
- Co-sleeping is a relatively slippery term. It basically means sleeping with your child. I’d like to use two more precise terms.
- Bed-sharing means sleeping with your infant or child in the same bed as you.
- Room-sharing means having your infant or child sleep in your room but not in your bed. This may be in a crib, bassinet, bed, or “co-sleeper” adjacent (or even attached) to your bed.
The reason this matters is because bed sharing in infancy is associated with risk of infant death, usually via suffocation. There was a very important article published last April in the American Journal of Public Health by a group that looked at over 3000 sudden unexpected infant deaths. This includes all cases in 9 states over a several year period Note that this group of infants include infants who meet the criteria for Sudden Infant Death Syndrome (SIDS) and those who met the criteria for Sudden Unexpected Infant Death (SUID); this second group were composed of infants died of SIDS as well as infants with a clearly identified cause of death, most commonly suffocation. In this study, over 3,000 infant deaths were studied. Seventy percent of these infants were on a sleep surface not recommended for infants; 64% were sharing a sleeping surface with someone. The authors make special note of the fact that sharing a sleeping surface like a chair, recliner, or couch seem especially dangerous.
The American Academy of Pediatrics issued a policy statement in 2011 on safe sleeping practices for infants . A more detailed accounting of the research used to make this statement is available in the accompanying Technical Report. Recommendations include:
- Sleeping on the back is the only safe sleep position.
- Avoidance of bed sharing with other sleepers, especially other children or non parental adults.
- Avoidance of any soft pillows, blankets, covers, etc. This includes stuffed animals and crib bumper.
- Use of a pacifier after breast-feeding is established through age six months may reduce SIDS risk.
- Room sharing with parents may reduce SIDS risk.
- Special risk factors for SIDS include prematurity, tobacco exposures, a history of maternal smoking in pregnancy, and bed-sharing with an intoxicated adult.
- Avoidance of overheating of the baby, with ambient temperatures in the room below 70 degrees. The baby should not feel hot to the touch or be sweating.
- Practicing tummy time when awake is important.
I also want to make two additional points.
- Infant sleep positioners, both in and out of the parental bed, are NOT SAFE and were associated with 13 infant deaths since 1997.
- Use of infant monitors, either medical grade or commercial products (such as the Angel Care monitor), have NOT been associated to reduce the risk of SIDS.
- It is fine to bring the infant into bed to nurse but he or she should be returned to a safe sleeping surface afterwards.
- Sleep deprived parents sleep very deeply. If you feel like you are falling asleep with your infant, ESPECIALLY on a couch or chair, you need to get up and put the baby somewhere safe.
So what does a safe infant sleep environment look like? I like this illustration from the Nebraska Department of Health and Human Services.
I want to reinforce that I am not trying to make people feel guilty if they bed-shared with their child during infancy. If you had a great experience, that is fine. However, for parents considering bed-sharing with infants, you need to be aware of the proven risks.
Recommended reading:
- Seattle Mama Doc has a great article and video summarizing risk factors for SIDS.
- KC Kids Doc has a powerful article on trying to resuscitate an infant who died from SIDS which also summarize safe sleep recommendations.
I did co-sleep with my kids before I knew the risks, and I have residual guilt over it to this day (and this was only in 2007!). We’re lucky. I will say that even though I was incredibly sleep-deprived, I never slept “deeply” as mentioned above–I felt like I was always half-awake, probably because I was breastfeeding (the reason why we co-slept in the first place) However, my husband did, in fact, sleep very deeply. So there’s that.
Maya. Please don’t feel guilty. We know more now than we did in 2007 and your children are healthy.
Excellent summary! Definitely posting this on my office web site. Thanks Dr. Canapari!
Thank you Dr. Hoberman nee Marder!
This is one of the best articles I’ve read that summarizes infant safe sleep practices. I posted it on the CAUSE Facebook page – the Coalition Against Unsafe Sleep Environments.
Hello! I know this article is almost a year old, but I am hoping you can give me some info OB why couches/recliners are even more dangerous than beds. My 8 week old suddenly hates his bassinet. He fusses and cries constantly and we are not getting any sleep. Frequently my husband or I will sit with him on the couch in the middle of the night and often we drift off. So now I am very concerned.
Sorry for the typos! Stupid auto-correct!
There are many documented cases of infants becoming wedged in between cushions, or between parents and cushions. Hang in there. It is not easy but it is important to be safe.