Bedsharing in the US is rather common. 25% of mothers report bedsharing with their breastfed babies.

Unsafe practices related to bed sharing/co-sleeping:

  • Environmental smoke exposure and maternal smoking
  • Sharing sofas, couches, or daybeds with infants
  • Sharing waterbeds or the use of soft bedding materials
  • Sharing beds with adjacent spaces that could trap an infant
  • Placement of the infant in the adult bed in the prone or side position
  • Use of alcohol or mind-altering drugs by the adult(s) who is bed sharing
  • Infants bed sharing with other children
  • Bed sharing with younger babies

Safe sleep environments for bedsharing with their infants:

  • Place babies in the supine position for sleep.
  • Use a firm, flat surface; avoid waterbeds, couches, sofas, pillows, soft materials, or loose bedding
  • Avoid duvets, comforters, pillows, and stuffed animals in the infant’s sleep environment.
  • If blankets are used, they should be tucked in around the mattress so that the infant’s head is less likely to be covered.
  • Ensure that the head will not be covered.
  • In a cold room the infant could be kept in an infant sleeper to maintain warmth.
  • Never put an infant down to sleep on a pillow or adjacent to a pillow.
  • Never leave an infant alone on an adult bed.
  • Ensure that there are no spaces between the mattress and headboard, walls, and other surfaces, which may entrap the infant and lead to suffocation.
  • Placement of firm mattress directly on the floor away from walls.
  • Another alternative to sharing an adult bed is using infant bed that attaches to side of adult bed.

Some circumstances in which co-sleeping with your baby can be very dangerous:

  • Either you or your partner smokes (even if you do not smoke in the bedroom)
  • Either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy)
  • You are extremely tired
  • Your baby was born premature (37 weeks or less)
  • Your baby was born at a low weight (2.5kg or 5½ lbs or less)
  • Never sleep on a sofa or armchair with your baby, this can increase the risk of SIDS by 50 times

American Academy of Pediatrics (AAP) issued recommendations advise against all bedsharing for sleep.

These recommendations overemphasize the risks of bedsharing, and this overemphasis has serious unintended consequences. It may result in increased deaths on sofas as tired parents try to avoid feeding their infants in bed.

SIDS risk increased 16 to 100 times greater for babies who bed share with a mother or other adult who smokes. This pertains to both prenatal exposure—i.e., babies whose mothers smoked during pregnancy—and to postnatal exposure to household smoke

Current evidence shows that other risks are far more potent, such as smoking, shared sleep on sofas, sleeping next to impaired caregivers, and formula feeding. The emphasis on separate sleep is diverting resources away from addressing these critical risk factors. (Bartik, BF Med)

Recommendations to avoid bedsharing may also interfere with breastfeeding.

Bartik concludes that the only evidence-based universal advice to date is that sofas are hazardous places for adults to sleep with infants. that exposure to smoke, both prenatal and postnatal, increases the risk of death. that sleeping next to an impaired caregiver increases the risk of death.

No sleep environment is completely safe.

Public health efforts must address the reality that tired parents must feed their infants at night somewhere and that sofas are highly risky places for parents to fall asleep with their infants, especially if parents are smokers or under the influence of alcohol or drugs.

Among WIC mothers (Dallas, New Haven, Atlanta, Savannah) Approximately one-third of mothers and infants bedshare despite increased risk of sudden infant death syndrome (SIDS). The factors associated with bedsharing are also associated with SIDS likely rendering infants with these characteristics at high risk for SIDS. (Moon, J Pediatr) 

New AAP Policy SIDS Policy 2016: The AAP is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report.

The recommendations are published in the accompanying “Policy Statement—Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment,” which is included in this issue ( peds.2011-2220). Pediatrics 2011;128:e1341–e1367

BF and SIDS Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analyses RESULTS: A total of 2267 SIDS cases and 6837 control infants were included. In multivariable pooled analysis, breastfeeding for <2 months was not protective (adjusted odds ratio [aOR]: 0.91, 95% confidence interval [CI]: 0.68–1.22). Any breastfeeding ≥2 months was protective, with greater protection seen with increased duration (2–4 months: aOR: 0.60, 95% CI: 0.44–0.82; 4–6 months: aOR: 0.40, 95% CI: 0.26–0.63; and >6 months: aOR: 0.36, 95% CI: 0.22–0.61). Although exclusive breastfeeding for <2 months was not protective (aOR: 0.82, 95% CI: 0.59–1.14), longer periods were protective (2–4 months: aOR: 0.61, 95% CI: 0.42–0.87; 4–6 months: aOR: 0.46, 95% CI: 0.29–0.74). (Moon, Pediatr 2017.)

Recommendations to prevent SIDS (AAP 2016 policy) include:

  • Supine positioning (“back-to-sleep) for every sleep, every caregiver
  • Use of a firm sleep surface, crib, bassinet, portable crib, or play yard in parents’ room, close to parents’ bed, on a separate sleep surface
  • Babies should not sleep routinely in car seats, strollers, swings, or carriers
  • Breastfeeding for at least 4 months, BF < 2 months not protective, 2-4 months somewhat protective
  • Room-sharing without bed-sharing
  • Routine immunizations, (vaccinations have a protective effect)
  • Consideration of a pacifier when putting baby down to sleep, nap time & bedtime
  • Avoidance of soft bedding, soft objects, loose covers, bumper pads
  • Avoidance of overheating,
  • Avoid exposure to tobacco smoke, prenatally and post-partum,
  • Avoid alcohol, & illicit drugs during pregnancy and after birth.
  • Swaddling is not a strategy to reduce risk of SIDS

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