Co-Sleeping: Is it Safe?

Co-sleeping, or sleeping in the same bed with your child, is a practice that has been used by humans since prehistoric times. Today, co-sleeping is still the norm in most countries around the world. Even in the U.S. (where co-sleeping is the exception to the rule), millions of families share beds with their infants: 13% of infants routinely co-sleep, and nearly 50% co-sleep for at least part of the night.

Yet recently, co-sleeping has come under fire as a potentially dangerous practice. The controversy stems from a debate on whether or not co-sleeping is safe for babies. In October of 2005, as part of new safe-sleeping guidelines issued by the American Academy of Pediatrics (AAP) to help reduce the incidence of SIDS (Sudden Infant Death Syndrome), the AAP issued a recommendation that parents not co-sleep with their infants. The AAP cites numerous studies to support their position that co-sleeping increases the risk of infant death due to suffocation, entrapment, or SIDS.

However, many pediatricians and pediatric organizations maintain that co-sleeping can be safe and healthy for infants, children, and their parents, provided a few sensible guidelines are followed (see below). Some of these organizations maintain that co-sleeping is actually safer than crib sleeping.

According to Attachment Parenting International (API), "The research has shown that co-sleeping does not increase the risk of SIDS, if practiced following guidelines that create a safe sleeping environment for the child. Further, some research has clearly identified how co-sleeping may reduce infants' risk of SIDS due to the lighter sleep and synchronized parent-infant sleeping patterns associated with this practice."

Dr. William Sears, M.D., a renowned pediatrician, author of numerous best-selling books on baby and child care, and creator of the AskDrSears.com website, holds the same opinion. After reviewing numerous studies, Sears states that "infants who sleep in a crib are twice as likely to suffer a sleep-related fatality (including SIDS) as infants who sleep in bed with their parents." According to Sears, "The answer is not to tell parents they shouldn't sleep with their baby, but rather to educate them on how to sleep with their infants safely."

Here are some of the recommendations that API and Dr. Sears make to support safe co-sleeping:

• Put up a mesh guardrail to prevent baby from rolling out of bed, or push mattress tightly against the wall.
• Take every precaution to ensure that there are no crevices into which your baby could fall or become trapped.
• Place baby between mother and the edge of the bed (wall or guardrail), not between mother and father. Mothers are generally more aware of their baby's presence than fathers-especially for the first few months.
• Follow the "back to sleep" rule, always placing baby on her back to sleep.
• Dress warmly and use lightweight blankets.
• Get a big-enough bed for the three of you, and make sure it is firm-a bed that is too soft could increase the risk of suffocation due to the padding.

Sears emphasizes that although co-sleeping can be safe in most circumstances if the proper guidelines are followed, there are some conditions that make co-sleeping unsafe. Families should NOT co-sleep if one or both of the parents are:

• Under the influence of drugs or alcohol. This could include sleep medication, cold medicine, or even a couple of beers.
• Extremely obese. The large size of the parent poses a physical risk of smothering, and people who are obese often suffer from sleep apnea-a condition that reduces alertness.
• Overly exhausted. Sleep deprivation is commonly a factor in most postpartum households. If you feel you might not be in a condition to wake for your baby, then a bassinet next to your bed might be a safer option.

Never co-sleep on a waterbed or a couch, and watch out for strangulation hazards, like curtain cords, clothing ties, long strands of jewelry, or excess bedding. Don't over-bundle your baby and never let a newborn and an older child share a bed.

While some experts maintain that babies are better off sleeping alone in a crib, other research suggests that the reverse is true. Provided certain guidelines are followed, co-sleeping can actually be a beneficial practice.

A 1997 Pediatrics article outlined a study that observed night-time breastfeeding behavior in mother-infant pairs. The study found that co-sleeping led to increased breastfeeding. Because breastfeeding has been shown to have a protective effect against SIDS, then co-sleeping, which facilitates breastfeeding, might be protective against SIDS₁.

Another article published in Pediatrics suggests that co-sleeping has protective effects against SIDS because of an increase in the infant's arousals and the mother's responsiveness when the pair is co-sleeping₂.

Some other potential benefits of co-sleeping include:

• Increased total sleep time (for all parties involved). It is normal for babies to wake frequently throughout the night, but when mom's right there, it is easier to fall right back asleep. And for mom, rather than waking up at 3 a.m. and feeling your way down the hall to feed your baby, just rouse yourself enough to roll over, latch on, and drift off as your baby nurses.
• More stimulation. Lots of extra touch and sound stimulation helps baby to develop intellectually and socially.
• More time for bonding. Especially when parents are away for work all day, co-sleeping gives the family a chance to reconnect at night.
• Depressed ovulation. With 'round the clock, on-demand nursing, most women won't experience a return of their menstrual cycle until baby is well into the solid food stage₁.
• Peace of mind. Because you're right there, you'll know and be able to respond immediately if something is wrong.

If you want to share in many of these benefits, but are nervous about bed sharing, a co-sleeper bassinet might be a better option for your family. These are enclosed on three sides, are the same height and the adult bed, and attach securely to the bed-affording you the comfort of sleeping in close proximity to your child, while still providing baby a separate sleeping surface.

With so much conflicting information on the subject, the decision about whether or not to co-sleep can be a confusing one for parents and should be discussed with the child's pediatrician. Co-sleeping isn't for everyone; it is not essential for building a healthy relationship with your child, nor is it a guarantee against SIDS. But many families who try it end up loving it so much that they can't imagine it any other way.

Sources:
(1) McKenna JJ, Mosko SS, Richard CA. Bedsharing promotes breastfeeding. Pediatrics. 1997;100:214-219

(2) Mosko S, Richard C, McKenna J. Infant arousals during mother-infant bed sharing: implications for infant sleep and sudden infant death syndrome research. Pediatrics. 1997;100:841-849

About The Author

Liza Barnes Liza received her bachelor's degree in health promotion and education from the University of Cincinnati and is pursuing a master's degree in nurse midwifery. She is the proud mother of one daughter.