Co-Sleeping Controversy, And Tips For Making Bedsharing Safer

bedshareBy Sarah Kerrigan
Guest Contributor

Over the last week, my post on co-sleeping and public policy has generated a huge, passionate response.

Comments ranged from heartfelt, personal stories of family bedsharing to adamant opposition to the practice, from questions about terminology to pleas for more information about safe bedsharing.

Riobound wrote: “I like the idea of ‘educate’ but don’t ‘dictate.’ The State should inform not impose.”

And PilgrimOnTheJames posted that “we shared our bed with each of our seven babies…for the first several months of their post-partum lives…because it allowed my wife to breast-feed them without her having to greatly disturb her much needed rest, and also, because the little tikes smelled so good and were so cute to watch sleeping. We moved them into a separate bed in our room once they were able to consistently sleep through the night. The bonds that were begun then have only grown and strengthened over the past 30+ years of family life. I thank God that we ignored the advice of many well-meaning, but totally scandalized family members and friends.”

Amelia Oliver commented, “Thank goodness the scientific community is finally considering moving away from trying to scare people out of bed-sharing and co-sleeping. The comparison with the policy of advocating abstinence instead of sex-ed is strikingly appropriate since almost everyone does it but we are all afraid to talk about it, let’s start teaching the safe way to do it.”

Molly pointed out “This article…conflates the issues of cosleeping in bed sharing, which are not the same thing. Cosleeping is risk free, end of story. Bed sharing does have risks if not done carefully and correctly.”

So in an effort to shed more light on the topic, I’ll try here to clarify the terms, explain why the research linking SIDS to bedsharing is inherently flawed, and provide some tips to make sleep as safe as possible for all babies.

1. Terminology

In the scientific community, “co-sleeping” is a general term for a child sleeping in close proximity to a caregiver, within sensory range.  “Room-sharing” is when a child sleeps in the same room as her caregiver.  Under this definition are two sub-categories: “separate-surface cosleeping,” in which the child has his own bed, and “same-surface cosleeping,” also known as bedsharing.   “Bedsharing” is the term that describes what most Americans think of when they hear “co-sleeping:” a child sleeping in an adult bed with his caregivers.  This sort of close proximity is natural to the human species.

2.  ’Shaky Evidence’ And A Shift In Thinking

The AAP, a highly influential professional group of pediatricians, opposes bedsharing and has led the charge to promote the idea that sleeping in the same bed as your infant is dangerous. “The American Academy of Pediatrics (AAP) does not recommend any specific bed-sharing situations as safe,” the organization says in its latest statement on the matter, which then goes on to list what it characterizes as particularly unsafe bed sharing practices to be avoided “at all times,” including, “when the infant is younger than 3 months,” or with a smoker. The AAP also says bed sharing should be avoided “with someone who is excessively tired,” which makes us wonder if any of them have ever actually been parents.

But many researchers, medical professionals and worldwide organizations question the AAP’s position on bedsharing, in large part due to ‘shaky evidence’ as the basis of the academy’s position, and also given the benefits of the practice. Dr. Abraham Bergman, a prominent SIDS researcher and pediatrician said in an email that “the evidence linking bed sharing per se to the increased risk for infant death is shaky, and certainly insufficient to condemn a widespread cultural practice that has its own benefits.”  The WHO, UNICEF, La Leche League International, the Breast Feeding section of the AAP, and Academy of Breast Feeding Medicine all disagree with a sweeping recommendation to avoid bedsharing.

In an editorial published earlier this month in JAMA Pediatrics called “Bedsharing per se Is Not Dangerous” Bergman wrote: it is becoming clear to many doctors and researchers that “non-uniform and unverifiable information on the causes of death” in SIDS studies led to conclusions about bedsharing that are not supported.

Death reports are recorded by county officials, and in the United States there are over 3000 counties. Each county has a different form and methods of collecting death information. There is no standardization, and cultural and personal biases can play a role in death reports. The major concern is with over 3000 officials using their own judgment to decide cause of death, rather than a standardized reporting system that looks at all SIDS risk factors. So when an infant dies in an adult bed it would be common for the bed itself and the sharing of space with an adult to be cited as the cause of death. In many cases, the death of a baby while sleeping with an adult on a couch or lounge chair (both dangerous sleep situations with a high risk of entrapment and suffocation) would be classified as a death due to bedsharing as well: this adds to the supposed “data” against bedsharing.

A UNICEF statement on bedsharing concurs: “There is robust evidence that sleeping with a baby on a sofa or armchair dramatically increases the risk of Sudden Infant Death Syndrome (SIDS), as does sleeping with a baby when under the influence of alcohol or drugs or when parents smoke. However, there is little evidence or expert consensus as to whether there is any risk to bed-sharing in the absence of known risk factors.”

We now know that a baby in a crib in a room alone is actually at higher risk of SIDS than a baby sleeping in the same room as a caregiver. Since proximity is a protective factor against SIDS, I would argue that bedsharing, when practiced absent of other risk factors, can be a very safe sleep environment for many babies.

I am not attempting to encourage families to share a bed with their infants. But I believe that each family has the intrinsic right to be informed of their choices, and to arrange the safest possible sleep situations for their babies. While the AAP advises against bedsharing, it does recommend room-sharing for all babies under the age of one.

3. Safe Sleep for Babies

A healthy gestation is the first step in reducing the risk of SIDS. Exposure to smoke while in utero, being born prematurely or at a low birth weight, and lack of prenatal care are all established risk factors.

(Image courtesy of Dr. James McKenna)

(Image courtesy of Dr. James McKenna)

•Breastfeeding significantly reduces the risk of SIDS for all babies

•Babies should be dressed lightly for sleep, and their heads should not be covered.

•It is not safe for infants to sleep on sheepskins, bean bag mattresses, water beds, couches or sofas. The risk of smothering or entrapment is high in such situations.

4. More Tips For Safer Bedsharing

•Consider using an attached co-sleeper bassinette as an extension of your bed surface. This is an excellent option that provides the closeness of bedsharing but also meets the AAP’s recommendation for a separate sleep surface for your baby.

•Infants under age one should not bedshare with older children. If there is more than one adult in the bed, both should share responsibility for the baby’s safety and well-being at night.

•Never sleep with your baby on a couch or waterbed. The risk of entrapment and suffocation is very high in these situations.

•If an adult is using any prescription medication that may increase drowsiness, or using drugs or alcohol, bedsharing is not a safe choice.

•Babies should always be placed to sleep on their backs, on a firm, clean sleep surface, with no pillows, blankets or stuffed animals nearby.

•To reduce the chance of entrapment or falls, the adult mattress should be placed on the floor, away from walls where a baby could become wedged

5. Added Benefits

•Babies who sleep close to their parents have better temperature regulation, breathing patterns and heart rhythms than babies who sleep alone.

•Proximity during sleep promotes breastfeeding and reduces the risk of SIDS.

•Babies who bedshare startle less during the night, and can spend less time crying.

•Some studies show long-term emotional health benefits to bedsharing

Readers, parents, have we missed anything here? Let us know.

Sarah Kerrigan, M.A. is a Child Development Specialist, trained pediatric sleep consultant, and the mother of two young children.

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  • Grace

    Please lets not also give parents of infants yet one more thing to feel guilty about and make the mistake of assuming one sleeping position is better than another for a baby. Each baby has its preferred sleeping position and it is almost impossible once a baby is able to move at all on her/his own to keep them in whatever position is currently seen as best. My son, now 29 years old, was a back sleeper but at the time of his infancy parents were told to sleep babies on their tummys. Now I learn that he WAS actually safer, maybe, sleeping on his back, yet I had to worry about that a lot at the time…..From my reading of the research, it seems clear that the key factor that poses a danger to bed sharing infants is whether parents are under the influence of a substance that will make them sleep more soundly than usual. Otherwise, babies are, and have been throughout human history, perfectly safe bed sharing. It is also true that where a baby sleeps is a parent choice, and there are ways to help a difficult sleeper sleep alone in a crib throughout the night, if that’s a parent’s choice. Babies are adaptable and can be helped to sleep wherever parents feel best about.

  • Jen

    So is sleeping on your back no longer a part of “safe sleep”? I note that you say breastfeeding is protective, but my understanding was that back-sleeping was the one of the best things to do to avoid SIDS. Interesting it isn’t in your list of safer practices. I hope you are being responsible in conveying information.

    • Sarah Kerrigan

      Thank you for pointing this out Jen! The “Back to Sleep” campaign has been instrumental at lowering SIDS rates. It was an error that this point was edited out. It has been corrected. All babies should be placed on their backs to sleep.

  • M

    I have no doubt that my son is a more confident, secure second grader today because he slept next to us for many months in his early life. I’m tired of “experts” who actually aren’t! Glad I made my own choice.

  • Cat

    “However, there is little evidence or expert consensus as to whether
    there is any risk to bed-sharing in the absence of known risk factors.” So…they don’t know if there are risks other than the ones they know about. That’s pretty much true of everything and not terribly comforting.

    I did not bed share with my son because I am a very deep and active sleeper. I roll around, I pull blankets, I kick. Even if we had known to (and been able to) put our mattress directly on the floor, I am sure that our son would have ended up on the floor. Others who are better sleepers than I may have more luck sleeping peacefully with their child in their bed. We considered trying a co-sleeper, but he went straight from “won’t sleep unless directly on a person’s skin” to “sleeps through the night independently.” We kept him in our room until about 4 months, when he was easily able to roll and lift his head.

    I think any sleeping arrangement for an infant will draw judgement from someone. I know this article stated it’s not trying to convince anyone, but it reads like an advertisement brochure for bed sharing. While I’m sure education will make bed sharing safer, I doubt my 8-month-old is in danger just because we all sleep better when he gets his own room. As with so many things, we say “let’s educate people and give them a choice” but at the same time we push “but YOUR choice has these dangers, our choice is better for the baby!” It’s the same with breastfeeding/forumla, c-section/vaginal delivery, epidural/natural birth. And probably any other choice someone can make about caring for their baby.

    • Sarah Kerrigan

      People also often think that the “breast is best “message is out to shame formula feeding mothers, but that is not the case. Sharing information about what science tells us about best practice is a way to counteract decades of incorrect information. I don’t think you will see the American culture trying to shame you for having your baby sleep in the crib in his own room. That is accepted practice. By sharing this information I am hoping that the families who feel shame or secrecy around their bed sharing practice can feel less so.

      • Cat

        I have heard from plenty of mothers who feel shamed for giving their babies any formula at all, regardless of the reason they choose to do so.

        It’s not so much about the intent — I’m sure your intent truly is to educate everyone about their options, and in particular about how to implement this option in the safest possible way. But these messages are often perceived differently by stressed out new mothers trying to do the “best” and being told that a baby in a crib in their own room is more likely to die of SIDS. These things are very scary and emotional for us. This is panic-attack inducing for me, and probably for many other new moms who keep getting different information.

        • Sarah Kerrigan

          The recommendation to room share with babies comes straight from the AAP! My hope for all families is that they have the information they need to make their sleeping arrangement of choice as safe as possible. It sounds like you have found the best way for your family to sleep, Cat, and that is great! Every parent should have the opportunity to feel informed, and proud of their choices.

          • TL

            This would be wonderful – *IF* you were giving parents good information. But you’re not. You’re simply parroting the McKenna party line and completely ignoring that the OVERWHELMING science indicates bedsharing is dangerous, especially for young infants.

          • Sarah Kerrigan

            I wonder if you read section 2 of this article? There are many prominent researchers and reputable international organizations who disagree with the statement you are making.

        • milemily

          There is stating opinion and there is stating fact. The fact here is that SIDS rates are higher for infants that sleep in their own rooms. How you respond to that fact is your responsibility, not the author’s. And since you mentioned formula, the facts are that formula fed babies are more likely to die from SIDS than breastfed babies. There is no judgement or directive in that statement, only fact. The reason behind why you decide to do something doesn’t make the facts any less true.

          • Cat

            milemily, I understand that these correlations are factual. I have not read the research, and I’m not clear on how strongly they have been determined as causal vs correlated. Very few things in this world are as simple as “well, it’s a fact.” There are often many different variables and relationships to tease apart. I too have heard that research shows breastfed babies are less likely to die from SIDS, and I am glad I have been able to breastfeed my baby so far, but there are women out there who physically cannot. And some of the approaches to educating women are so heavy-handed that people in this situation have an extremely negative experience. If the goal is to educate and help people, those approaches are obviously not working for everyone.

            Sarah, thank you for helping to get information out. It does sound like you are taking a very inclusive approach to how you spread the word, and I appreciate that.

  • Carol M.

    Thank you Sarah for this follow-up post to your “Is it time to rethink
    co-sleeping?”. I too found your analogy of advocating abstinence instead of
    sex-ed strikingly appropriate. We are bedsharing with our 7 month
    old breastfeeding son, as we did with our daughter. I look to the AAP for advice
    and/or recommendations on many issues, so found myself feeling stressed and
    somewhat irresponsible when I read a recent article in Parents (Nov 2013). It
    started out discussing SIDS and the back to sleep campaign but then moved
    onto Sudden Unexpected Infant Death (SUID) – “..despite ample evidence about the
    dangers, many parents share their bed with a young infant” and “..sleeping with
    an infant under 3 months of age triples her risk of suffocation death” (no
    reference was provided for this data). There were also moving stories from
    parents who experience tragedy or near tragedy when bedsharing. While we are
    still bedsharing with our son, this article really gave me pause and made me think about our approach to sleeping. I would really appreciate guidelines from the AAP on
    bedsharing rather than a blanket statement of ‘don’t do it’.

    • AnnMc

      After trying everything we knew of and listening to too much distress, my husband and I have chosen not to use a car seat with our 2 week old. We know he is much more comforted and secure being in arms and breastfed rather than away from us in the back seat,

      Knowing it’s better for babies to be held, why wouldn’t they issue recommendations on how to make it safer rather than a blanket prohibition?