An article published in USA Today has added fuel to an already-raging fire — the debate over co-sleeping. The article references a study which found that while the number of SIDS-related deaths has dropped by over 50% in the past two decades (since the introduction of the “Back to Sleep” campaign in 1994 began discouraging tummy sleeping), the drop has plateaued recently. What’s more, the number of SIDS-related deaths as a result of co-sleeping is actually on the rise.
There’s no doubt that co-sleeping is a controversial topic, with parents offering strong and emotional opinions on both sides. Reports like the one in USA Today seem to indicate that co-sleeping is dangerous, but co-sleeping advocates point to research showing that it’s safe. So what do we make of this? Is co-sleeping actually dangerous? Should you and your baby co-sleep?
Defining Our Terms: Co-Sleeping vs. Room Sharing vs. Bed-Sharing
First, let’s get our terms straight. Co-sleeping simply means that a child shares a sleeping space with a parent. With that in mind, co-sleeping can mean a baby sleeping in the same bed as his parents; however, it can also mean a baby in a bassinet next to the bed. The American Academy of Pediatrics (AAP) calls that kind of sleeping arrangement “room-sharing”. Room-sharing is considered completely safe, as long as baby’s sleeping area follows safety guidelines (no loose bedding, firm mattress that’s flush with the sides of the bassinet, tight-fitting bottom sheet, etc.) Bed-sharing refers to the practice of parents and children sharing the same bed. Bed-sharing (specifically when infants are involved) carries far more risks than other forms of co-sleeping.
Can Co-Sleeping Be Dangerous?
Room-sharing is safe; bed-sharing, however, is inherently risky, specifically when it involves young infants. As rates of bed-sharing continue to rise in the United States, so do the rates of infant deaths related to bed-sharing. The most obvious danger related to bed-sharing is suffocation. An adult (or an older child) can roll on top of a baby, or the baby can be smothered by the large pillows and heavy blankets that most adults use in bed. Some less obvious dangers include a baby falling from the mattress to the floor, or a baby becoming wedged between the mattress and the headboard/footboard or wall. The mattress itself can also be a threat; if it’s overly soft, a baby can sink too low and suffocate.
As a growing number of babies die due to bed-sharing, health organizations are stepping up their efforts to warn parents. The AAP, along with the Consumer Product Safety Commission (CPSC), has issued precautions against bed-sharing, warning parents that it puts babies at a much higher risk of suffocation. And warnings like these aren’t just happening on a national scale; they’re happening at the local level, too. Bed-sharing was blamed for causing increasing rates of infant death in Milwaukee, WI, so the city’s health department responded by releasing a highly controversial ad depicting a baby curled up (in an adult bed) next to a large butcher knife. When critics attacked the ad as extreme (and it is), Milwaukee’s Commissioner of Health replied, “…what is even more shocking and provocative is that 30 developed and underdeveloped countries have better [infant death] rates than Milwaukee.”
Can Co-Sleeping Be Safe?
Again, room-sharing arrangements are considered very safe. In fact, the AAP recommends room-sharing as the best sleeping arrangement for infants, since it’s been shown to produce lower rates of SIDS than a solitary sleeping arrangement (which places baby in a room by herself.) And while bed-sharing is statistically less safe, advocates of bed-sharing point out that research studies (like the one cited in the USA Today article) fail to account for a variety of factors and ultimately make bed-sharing seem more dangerous than it actually is.
For example, researchers refer to bed-sharing as a baby and an adult sharing an “adult bed.” But an adult bed doesn’t necessarily mean an actual bed — in these studies, it can also mean a couch, or a recliner, or a waterbed (all surfaces that bed-sharing advocates would never recommend using). Research studies also fail to account for safety factors like smoking, or drug and alcohol abuse (parents who smoke or use drugs or alcohol should never bed-share.) Even factors like obesity, which advocates say should be considered (since obese parents are advised not to bed-share), aren’t considered in research studies.
Supporters of bed-sharing claim that when these factors are considered, research shows that safe bed-sharing practices make putting a baby to sleep in an adult bed just as harmless as putting a baby to sleep in a crib. In fact, a 2006 study indicates that when researchers controlled for these kinds of safety factors, rates of infant death related to safe bed-sharing proved to be very low.
A study published in 2013 reveals that any kind of bed-sharing, even safe bed-sharing, increases an infant’s risk of SIDS five-fold. The study’s researchers found that even in the safest of settings, bed-sharing presents a dramatic increase in the risk of SIDS. This stands in direct opposition to the earlier study which found that safe bed-sharing produces low rates of infant death.
Supporters of co-sleeping also point to the fact that co-sleeping in all its forms (including bed-sharing) has been the norm for human infants since the dawn of time, while putting babies in cribs, in their own rooms, alone, is a practice that’s less than 200 years old. Anthropologist Dr. James McKenna, an outspoken advocate of co-sleeping, points to these facts as proof that mothers and babies are biologically designed to sleep together, and he asserts that co-sleeping is the best sleeping arrangement for families.
Finally, bed-sharing advocates emphasize that while co-sleeping is no longer standard practice in most Western cultures, it remains the norm in many, many countries around the world. These advocates are quick to point out that if it works for families around the globe, it can work for families in the West.
An important note, though, about comparing bed-sharing in Western countries to bed-sharing around the world: the comparison isn’t always a fair one. Western-style beds (with their soft, elevated mattresses as shown above, and their abundance of pillows and blankets) make bed-sharing more dangerous than do other types of beds found around the world. What’s more, health-habits vary worldwide, making the bed-sharing comparison a tricky one. Western mothers are more likely to smoke than are Japanese mothers, for example; this may partly explain why Japan has an extremely low rate of deaths related to bed-sharing. It’s best to take cultural differences like this into account when looking at bed-sharing from an international perspective.
Should You Co-Sleep Or Not?
Putting a baby to bed is a bit like stepping into a car. There are risks associated with driving, and traveling in a car can certainly kill you. But there are many steps you can take to make driving safe, like wearing a seat belt, obeying traffic signs, and taking proper care of your vehicle. Baby sleep can work the same way. There are risks associated with any sleeping arrangement, but parents can take steps to make their baby’s sleep environment as safe as possible. Parents who educate themselves and practice safe co-sleeping shouldn’t be made to feel guilty about their decision. And of course, neither should parents who choose not to co-sleep; after all, it won’t work for everyone! That was certainly the case with Nicole — during the short time she co-slept, she found herself so worried about harming her son that she hardly slept at all.
A final word: while many forms of co-sleeping are safe, bed-sharing is inherently risky. There are ways to bed-share safely, but the list of precautions is long, and some of the precautions themselves border on extreme. For example, it’s recommended that you remove pillows and blankets from the bed, and even that you put your mattress directly on the floor. It’s also safest if the only people in bed are mom and baby, meaning that if dad is around, he needs to find somewhere else to sleep! What’s more, safety guidelines specify that some people shouldn’t bed-share, including those who smoke and use drugs/alcohol, those who are obese, and those who are “overly exhausted.” That last one is bound to exclude many readers of this blog! If you’re considering bed-sharing, remember to review the list of precautions carefully, and then commit to following them. Otherwise, we recommend that you consider a different method of co-sleeping.
What do you think? Room-sharing? Bed-sharing? No-sharing? Tell us your thoughts on co-sleeping!
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Emily DeJeu says
@ Jennifer — thanks for sharing your opinion! Sounds like bed-sharing was a solution that made nursing at night much easier for you. That’s definitely one of the advantages to that sleeping arrangement 🙂
Jennifer says
It is apparent the posters here questioning whether parents can actually get any sleep while bed sharing decided it was not for them. This was the best way for me and my family and the best way for me to get sleep. My son was a night waker (and still wakes on occasion even now that he is 3). My husband was deployed for 7 months and co-sleeping was the only way I could get any sleep at night without him!
Also I think the missing link here is that bed sharing can allow a breastfeeding mother to get more sleep because all she needs to do is lift her shirt. My daughter was a solid sleeper until she turned 8 months. For the last four months we have been bed sharing and it works for us. She can nurse at night quickly and easily when she needs to which means more sleep for me. I just turn over and go to sleep and so does she.
Rather than guess at what is best for everyone else we should all focus on what is best for our own families. Parenting is hard enough these days without people ragging one another that what they do isn’t the “right” way.
Emily DeJeu says
@ Katarina — thanks so much for sharing your experience! You bring a good balance to the conversation, as someone who’s bed-shared and had it work well. Glad to hear this sleeping arrangement is working well for your family 🙂
Katarina says
I’m a new mom with a 9 month old. In the beginning I did not bed-share with our daughter. frankly speaking she just looked too fragile and with the crazy sleep schedule I didn’t feel safe. I bought one of those co-sleeping bassinets and had her in it near my bed. Also she had a short stint in the NICU so I couldn’t sleep unless I knew she was on the sleep monitor. But at 4-5 months something happened. I started letting her sleep next to me when she was having a rough nigh with sleep. Sometimes my husband would sleep next to us but often he chose to take the floor.
Now at 9 months, she is still in our room and mainly sleeps in a crib in our room, but sometimes still sleeps between us. She’s always been exceptionally strong. She was born lifting her head, always hated tummy time, and never crawled. Even at 2 months she seemed to always want to work on being upright. She was cruising at 6.5 months and walking on her own by 8 months. She will nap in her room during the day but at night she screams bloody murder, so we let her sleep in ours. She’s perfectly capable of sleeping om her own. We don’t believe in crying it out, but we will let her cry a bit to burn off some energy if she’s struggling to go down. Normally if she needs it, a good 5 minute sleepy cry and 2 minutes of rocking will get her to sleep. My little one sleeps about 11-12 hours from 10 to 9. I am a remote consultant so I work from home, so we let her sleep later so I don’t have to get up so early.
We try to make the bed safe – no excess pillows or blankets, etc. If she sleeps between us, we carve out a section for her so she doesn’t get rolled on. We also have barriers so she doesnt go rolling off the bed. We’re both light sleepers. Im also still breastfeeding, so it is nice to be able to nurse before she sleeps and again in the morning before we get up.
I ultimately feel that some creative research interpretation and overly cautious public guidance has resulted in vilifying bed-sharing. Like all things – common sense prevails. If you smoke, if you are over weight, if you are a heavy sleeper, if your bed is too small, if your bed is too soft, if you aren’t hyper attentive, if you have been drinking, if you are on drugs /medications, if your floors are hard, if your beds too high…..maybe bed sharing isn’t for you.
Emily DeJeu says
@ Lindsay — thanks for sharing your story! What a good reminder to parents who bed-share; it’s so, so important to understand all the precautions that need to be taken to bed-share safely, and it’s important to actually follow them! It’s recommended that mom be the only person to bed-share with an infant, and your example certainly shows why that’s the case.
Lindsay says
I second the rule of daddy sleeping somewhere else for at least the first year. I almost lost my daughter twice due to his incompetent sleeping practices. I had to dig her head out from under him once and her lower half another time. It was truly frightening. I held her for two weeks through the night following each incident. He’s also overweight, which may not have helped the situation much. She now has an attached crib to the bed (sorta like a cosleeper) and is 15 months old. It works for now since at no point can she be alone. She’s very social, to the point of it being a need to be near someone at all times.
My 11 year old was the same way as my daughter but he wouldn’t tolerate anything other than sleeping on my chest for the first 6 months of life. At about 6 months he switched and had no issues sleeping in his crib most nights. I am a very aware sleeper and can even get a good nights sleep on a 2by4 (without falling off). A little exaggerated, but I’ve slept in some situations where anyone else would have fallen or crushed something.
My 15 year old probably would have been great in a crib if I could afford one. He’s never minded being left to himself and actually prefers it. He slept with just me for the first year and a half and moved to a full size western style bed at 18 months without a cry or a care. He was an ideal baby in that way. He just hated to be held so cuddling wasn’t an option until he was over a year. Not very ideal in that way. But all babies are different.
I feel bed sharing is completely safe for someone like me and completely unsafe for the first 6 months at least for someone like my daughters dad. So, I’m not a blind advocate, but I am an advocate of the rules.
Emily DeJeu says
@ Shari — thanks for sharing your thoughts! Your are right about socioeconomic status and income level making a difference; deaths related to bed-sharing are more common in families who live below the poverty line. I didn’t emphasize that fact in the article, though, simply because some of the factors that make bed-sharing dangerous apply to people of all income levels, so it’s important that we don’t write off bed-sharing death as something that can only happen to people who are poor.
@ Alix — I generally agree. It’s fantastic to remain open-minded, and to be willing to learn from other people and cultures (as well as from the past.) But I do think people sometimes tend to glorify the past, as well as other cultures’ methods, without accounting for some of the less glamorous realities (like disease, etc.)
@ Nadina — Excellent, excellent advice! Parents really do know their own children and their own situations better than anyone else, so the decision on when/where/how to sleep should be left entirely to them 🙂 Thanks for sharing your experience!
@ Katia — you make an excellent distinction here, and it’s one that lit up message boards after this article was published. SIDS, and death due to actual suffocation, are two different things. This article played a little fast and loose with the terms SIDS, I thought. The truth is that bed-sharing deaths are almost always due to actual suffocation, whereas SIDS deaths don’t have any obvious or apparent cause. Thanks for pointing out the need for clarification!