Co-Sleeping Guide

Co-sleeping is a huge topic in the world of parenting. Most new parents are desperate for a sleep arrangement that will allow everyone to get the most sleep but that is also safe. This article aims to provide accurate information on the different types of co-sleeping so that you can make a more informed decision on what will work best for your family. 

What is Co-Sleeping?

When many people hear the term co-sleeping, they think of bed-sharing. The terms are often used interchangeably, but they’re not actually the same. 

  • Co-sleeping refers to sleeping in close proximity to your baby so that each can sense the presence of the other. Bed-sharing and room-sharing are each types of co-sleeping.
  • Bed-sharing is when one or both parents sleep in the same bed with their baby.
  • Room-sharing is when babies sleep in the same room with their parents, but on a separate sleep surface, like a bassinet, crib or bedside sleeper.

Bed-sharing is common in other countries and has become increasingly popular in the United States. However, the American Academy of Pediatrics (AAP) has raised safety concerns about the practice. We’ll go into these and how to decrease the risks associated with bed-sharing later in this article.

The AAP recommends room sharing for your baby’s first six months and ideally for a full year.

History

Mothers and babies have slept close to one another for thousands of years, probably since our species first evolved. A recent article states that it’s still common in about 40 percent of documented cultures. Bed-sharing began to wane in popularity in Western culture as early as the 10th century, but really fell out of favor in the late 1800s. Even co-sleeping was discouraged in Europe as a means to prevent the spread of disease. It also became a way for wealthier families to distinguish themselves from those of lower economic status because they simply had the money for separate rooms and beds.

Bed-sharing, specifically, has recently become more popular in Western culture. One recent study found that 24 percent of parents report bed-sharing all or most of the time, up from just 6 percent in 1993. Though there are a variety of factors at play, including demographics and cultural norms, wider acceptance of bed-sharing in the West is related to increasing popularity of a philosophy known as attachment parenting. The approach focuses on promoting a secure, nurturing attachment between parents and babies through responding to babies’ needs immediately. It’s highly dependent on nearly constant physical contact.

Is Co-Sleeping Safe?

Safety is a top concern for most new parents, and there’s a wealth of information out there related to sleep safety. In this section, we’ll explore the safety of different types of co-sleeping, including bed-sharing and room-sharing.

What do Doctors Say about Co-Sleeping?

While a variety of factors may influence the way your family chooses to sleep, the AAP’s official stance is that babies should sleep in the same room with their parents—but not the same bed—for at least six months, if not a full year. Most pediatricians tell new parents that room sharing comes with a variety of benefits, including close proximity for breastfeeding and the ability to quickly respond to a baby’s needs. Pediatricians in Canada, the United Kingdom, the Netherlands, New Zealand and Australia provide similar recommendations.

Bed-sharing remains common in much of the rest of the world, but the AAP sites a variety of risks associated with the practice, including suffocation, overheating and entanglement. Because these risks are much greater if you fall asleep with your baby in a chair or on a couch, the AAP recommends moving to your bed if you’re feeding your baby and fear you might fall asleep.

Risk of SIDS

Sudden Infant Death Syndrome (SIDS) is a major concern for most new parents. SIDS is the sudden, unexplained death of an infant younger than twelve months, and because it often happens during sleep, sleep arrangements are thought to play a role. Co-sleeping is thought to reduce the risk of SIDS when babies sleep in their own bassinet or crib, which is why the AAP recommends room-sharing.

When it comes to bed-sharing, safety becomes more complicated and is highly dependent on a variety of risk factors. While many advocate that bed-sharing can be done safely, there are risks, including suffocation, strangulation, entrapment and SIDS.

These risks are greatly influenced by other factors. One study looked at 400 SIDS infants and found that 36 percent were bed-sharing with their parents. However, the risk was much higher for infants who were co-sleeping on a sofa or next to a parent who had been drinking or smoking. Another study found that while bed-sharing alone increases the risk of SIDS, the risk is much higher when paired with other factors, like smoking and alcohol use.

In addition to environmental factors, when it comes to SIDS, biology also plays a role. Premature babies and others with low birth weight are at a higher risk for SIDS, especially if they bed-share. Babies with brain defects also have a higher risk as do those whose parents smoke. The risk for SIDS decreases as babies get older, with 90 percent of cases occurring before six months of age.

Source: BMJ

Bed-Sharing and Your Mattress

One of the reasons bed-sharing can be hazardous is that an adult bed is not an ideal surface for a baby for a variety of reasons:

  • Mattress is too soft: The AAP recommends babies sleep on firm mattresses, which is why crib and bassinet mattresses are designed that way. Adult mattresses are simply too soft, which can cause a baby to accidentally roll from back to stomach, where the mattress can potentially block the baby’s airway.
  • Soft bedding: Most of us sleep with plush pillows and comforters, but these pose suffocation hazards for infants. That’s why the AAP recommends placing nothing in a baby’s sleep environment except a fitted sheet.
  • Crevices: In a bed that’s against a wall, it’s possible for a baby to get stuck between the wall and the bed. Headboards and footboards with cutouts can also pose a risk if your baby gets his or her head stuck in the openings.

Different Ways to Practice Co-Sleeping with Your Child

There are a variety of ways to practice co-sleeping with your child. We’ve summarized the most common:

  • Room-sharing: It’s a great idea to share a room with your infant for at least six months, if not a year, and many parents continue the practice for longer. For younger infants, bassinets are a good option, because they’re small and can fit close to your bed. As your child grows, you’ll probably want to move them into a crib or travel crib. A mini crib is an excellent option if you have limited space.
  • Bedside sleeper: If you’d like to have your child within arm’s reach, a bedside sleeper, or sidecar, is a good option. Bedside sleepers can either attach to your bed or be pulled up right next to it. Most have railings on three sides, with the side adjacent next to the bed left open for easy access. For many parents, a bedside sleeper offers the best of both worlds: your baby is right next to you but remains safely on his or her own sleep surface.
  • Bed-sharing: Bed-sharing doesn’t require you to purchase anything for your baby to sleep in as he or she sleeps in your bed with you. Be aware of the risks discussed above.

When is it Time to Transition Out of Co-Sleeping?

Every family’s approach to co-sleeping is different. The AAP recommends room-sharing for at least six months and ideally one year. After that, babies can be moved to a crib in their own room. For a variety of reasons, some parents choose to make the move earlier or later, and there is some research to show that babies (and probably parents) sleep better when babies are in their own rooms after nine months. Especially if you want your child to sleep in his or her own room, and bed, long-term, it can be a good idea to start the move earlier rather than later.

The difficulty of making this transition will depend a lot on your current sleeping situation, with bed-sharing infants having a harder time transitioning to sleeping in their own bed. Be sure to ease into the change gradually. Consider moving your child into his or her own bed in your room for a few nights, or sleeping on a cot in his or her room until your child gets used to the new setup.

Is Co-Sleeping Healthy?

Benefits

Co-sleeping comes with a variety of benefits.

  • Bonding: Especially if your baby is in a bedside sleeper or otherwise within your reach, co-sleeping can offer a unique opportunity for mother and baby to bond during the night. If your baby fusses, you can easily reach out and stroke your baby’s head or rock her. Bed-sharing advocates highlight this as a benefit because they’re able to be in physical contact with their babies all night.
  • Better sleep: Babies, especially newborns, wake often during the night to feed or for comfort. Having your baby close allows you to minimize the amount of time you’re awake. Babies also tend to sleep better when they can sense their parents are near.
  • Easier breastfeeding: For breastfeeding mothers, nighttime can be exhausting, especially if they have to get up and go into the nursery every time their babies have to eat. Co-sleeping allows mothers to breastfeed in their own room, and perhaps even their own bed, before placing their babies back in their own bed and falling right back to sleep.

Both room-sharing and bed-sharing parents experience these benefits, though bed-sharing parents will likely assert that they’re more pronounced in a bed-sharing situation. For example, if a baby and mother share a bed, the baby can breastfeed throughout the night even without waking the mother. Some also believe that bed-sharing allows mothers and babies to fall into a similar sleep rhythm, and it can be comforting to be so close. As we’ve discussed, the benefits of bed-sharing also come with risks.

Risks

Co-sleeping, and specifically bed-sharing, does have associated risks.

  • Safety: Safety risks include a higher risk of SIDS, though this is greatly impacted by other factors, like the infant’s health, age, birth weight, whether the parents drink or smoke and the sleep surface. Other risks include suffocation, strangulation and entrapment.
  • Sleep dependency: Babies who bed-share get used to sleeping next to a warm body and the comfort of having their parents close-by. If you’d like to transition your child to his or her own bed later, bed-sharing can make this more difficult. It may take your child some time to be able to fall asleep on his or her own. For this reason, you might bed-share longer than you’d like.

Co-Sleeping and Sex

While you may not be interested in being intimate with your partner right after your child is born, chances are you’ll want to rekindle this part of your relationship sooner or later. It can be difficult to do so if your baby is sharing your room, and might feel next to impossible if you’re all in the same bed.

Co-sleeping advocates stress that intimacy can, and should, be maintained. It often requires being more creative and strategic. Look for other ways to be intimate and consider sneaking off to other parts of the house while your baby is sleeping. Also remember that everything is temporary. Once your child moves into his or her own room, your sex life can return to normal.

General Safety Guidelines to Follow for Co-Sleeping

A safe sleep environment is important for any baby, and it’s especially vital that you take precautions if you do decide to bed-share. Here are a few guidelines to keep in mind:

  • Back is best: Always place your baby on his or her back to go to sleep. This minimizes the risk of both SIDS and suffocation. In fact, since the introduction of the Back to Sleep campaign in 1994 by the National Institute of Child Health and Human Development, SIDS rates in the U.S. have dropped by almost 50 percent.
  • Use a firm surface: Babies should always sleep on a firm surface to minimize the risk of rolling onto their stomach and blocking their airways. While adult mattresses are generally considered too plush, it’s especially important not to lay your baby on pillows or comforters.
  • No stuffed animals or pillows: Babies should ideally sleep in a crib or bassinet with nothing but a wearable blanket and fitted sheet. If you do decide to bed share, make sure no pillows or blankets are close to your baby’s head.
  • Parents are aware of bed-sharing: If you do choose to bed share, make sure both parents are comfortable with the decision. Also ensure that both parents are aware the baby is in bed with them every time you bed-share.
  • No bed-sharing after substance use: You should never share a bed with your baby if you’ve been drinking or have taken anything, prescription or otherwise, that could make you sleep too deeply or not rouse easily. Smokers should also never bed-share.
  • Remove strangulation risks: If you are bedsharing, remove anything that poses a strangulation risk, including nearby curtains or cords for blinds. Mothers with very long hair should tie it back.
  • No couches or chairs: Never fall asleep with your baby in a couch or chair. You could easily drop your baby, or he or she could become trapped against the back of the couch.
  • No siblings or pets: For bed-sharing parents, remember that babies under one year old shouldn’t share the bed with older siblings or pets.

Conclusion

Families need to decide what works for them when it comes to sleeping arrangements, and our role is to provide quality information so they can better understand the subject. Co-sleeping, when it involves babies sleeping in their parents rooms but in their own cribs, is the preferred sleeping arrangement of the AAP for at least the first six months. While bed-sharing works well for many families, it is important to remember the increased risk of SIDS, which is most likely when paired with other risk factors. Whatever you decide to do, be sure to do your research and consult your pediatrician.

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