Co-sleeping and bed-sharing

 Should I take my  baby into bed with me?

The safest place for a baby to sleep is as close to his or her parents as possible but in a separate bed. This is co-sleeping. Bed-sharing means the baby is in bed with one or more adult. Many large organizations oppose bed-sharing because of concerns about sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) but mothers continue to do it. It has some advantages, reducing stress in the baby, and making breastfeeding easier at night, but there are dangers. Parents should not bed-share if the  baby may become trapped, such as between the  mattress and a wall, if the sleep surface is very soft, or if there is more than one parent or a pet in the same bed. Bed-sharing is a bad idea if the parent is a smoker, drinks alcohol, has a substance abuse disorder, or takes medication that can make them sleepy. It can be dangerous if the parent is a deep sleeper, excessively heavy, or has very large breasts.

A) Describing co-sleeping and bed-sharing

Co-sleeping means having the baby in the same room as the parents. Compared with having babies in a different room, co-sleeping is safer and has been reported to have long-term benefits (Beijers 2018).

Bed-sharing  means having the baby in bed with a parent.

Until the 20th century, humans slept right next to their babies. Today, bed-sharing rates have been reported to vary greatly around the world (Bombard 2018; Gilmour 2019; Hirai 2019; Mileva-Seitz 2017; Mindell 2010):

  • 5% in New Zealand
  • 10% in Australia, Germany, the Ukraine
  • 33% in Canada
  • 65% in the USA
  • 83% in Vietnam
  • 100% in Kenya, Mozambique, and Mongolia

Higher income countries generally have lower rates of bed-sharing than lower-income countries. Conditions also vary greatly, from sleeping on the floor on a mat to sleeping in a soft bed with cushions and covers. 

There is much debate about bed-sharing. Because of concerns about sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS), some doctors and medical organizations have argued against it (Moon  2016),  but mothers continue to do it (Batra  2016; Kellam 2018; Paul 2017) while worrying that it is wrong or dangerous (Crowell 1987). Other organizations have a more holistic approach.

B) Risks of bed-sharing

The risks of bed-sharing include suffocation of the baby and SIDS (Byard 1998; Carpenter 2013; Colvin 2014; Vennemann 2012). However, the quality of the evidence has been described as low and it may be that it is the conditions in which bed-sharing occurs that are dangerous and not bed-sharing itself (Bartick 2018; Das 2021). Examples of dangerous conditions include bed-sharing when parents are smokers or bed-sharing on an unsafe sleeping surface such as a sofa.  

Parents who bed-share are sometimes blamed for causing sleep problems in their children. In some cases, however, parents start bed-sharing to help a child who already has problems sleeping (Quine 2001). Culture has a large impact on whether parents bed-share, how they do it, and how they view their child’s sleep (Mileva-Seitz 2017).

There have been reports that some mothers who bed-share are more likely to be depressed, experience more family stress, and have poor sleep (Galler 2006; Mileva-Seitz 2017; Teti 2016; Volkovich 2015).

There is little information on the experiences of partners who bed-share with mothers and babies but this too is common in various areas around the world (Crittenden 2018). 

There have been concerns that bed-sharing increases the risk of spreading disease to the baby, but the research is not conclusive (Mileva-Seitz 2017).

Bed-sharing does not seem to result in abnormal sexual or psychological development (Okami 2002).

C) Advantages of bed-sharing

Bed-sharing has been practiced throughout human development and can provide both physical and psychological benefits for babies (McKenna 2007a). In this way it is similar to skin-to-skin care.

Bed-sharing may (Baddock 2018):

  • Prevent attachment disorders (Mileva-Seitz 2016).
  • Prevent abnormal stress responses and anxiety (Carrillo-Díaz 2021; Tollenaar 2012).
  • Increase the baby's ability to self-regulate (Lerner 2020).
  • Allow the baby to develop better sleep-wake cycles (Burnham 2007).
  • Keep the baby from being cold (Baddock 2019; Mileva-Seitz 2016).
  • Keep the baby’s heart rate from being too slow (Richard 2004).
  • Increase the baby’s waking and decrease the amount of time the baby spends in deep sleep thereby possibly protecting against SIDS (Baddock 2019; Mosko 1996).
  • Increase how long a baby breastfeeds (Blair 2010; Bovbjerg 2018; Huang 2013). 
  • Result in babies breastfeeding more often and having longer feeds (Baddock 2006; Ball 2003; Gettler 2011; McKenna 1997; Pollard 1999).
  • Increase the mother’s sleep (Quillin 2004).

Humans are born very immature and most of our brain maturation happens after birth. As they grow, babies need extensive contact with their caregivers. Mothers who bed-share watch and touch their babies more (Baddock 2006). This encourages attachment (Ward 2015).

As with all primate babies, human babies become stressed when separated from their parents (Nishida  2012).  They often  cry when put down. Many babies sleep best in bed with their parents (Ward 2015). When bed-sharing, the parent is close by and can quickly attend an upset baby, minimizing the baby’s stress.

Bed-sharing makes monitoring babies easier. Parents who bed-share are more likely to check on their babies and more able to respond to life-threatening events (Baddock 2007; McKenna 2017b).

Bed-sharing  makes breastfeeding easier, since the mother does not have to get up to get the baby, and babies settle more quickly after feeds. 

D) Why parents choose to bed-share

Parents may choose to bed-share:

  • To make breastfeeding easier.
  • Because of personal beliefs or experiences.
  • For traditional or cultural reasons.
  • To have more sleep.
  • Out of concerns about the baby’s safety.
  • Because of a limited number of beds or space in the household.

They may also bed-share because the baby:

  • Cries less when bed-sharing.
  • Is sick.
  • Sleeps better when bed-sharing.

Even parents who do not intend to bed-share may end up doing so occasionally (Hauck 2015).

E) When bed-sharing is not safe

If you are thinking of keeping  the  baby in bed with you, you need to make sure you can provide a safe sleeping area for  the  baby. Even healthy babies may not be able to protect themselves from suffocation (Rosenblith 1974). You should not bed-share if (Moon 2016):

  • You and the baby will be sleeping together on a sofa, armchair, rocker, recliner, waterbed, or other soft surface.
  • The  baby may  become trapped, such as between the  mattress and a headboard or wall. 
  • There is loose bedding. 
  • A partner, the baby’s sibling, or a pet is also in the bed. 
  • You consume alcohol, medication that can cause sleepiness, or have a substance use disorder (Carpenter 2013). 
  • Anyone in the household smokes (Carpenter 2013).
  • The baby’s mother smoked during pregnancy.
  • You are a heavy sleeper. 
  • You are excessively heavy.
  • You are a mother whose breasts are very large and may  cover the baby’s mouth and nose. 
  • The baby has any  of the risk factors for SIDS or SUIDs, including not being breastfed (Ball 2006).
  • The baby was born premature or with a low birth weight.
  • The baby frequently ends up sleeping on the stomach instead of the back.
  • You have any concerns about the baby’s safety in your bed.

Every baby and family is different.  You need to make an informed decision that works for all of  you.

 Please speak with your health-care  providers  for more information. Unfortunately some mothers and partners may not tell their health-care providers that they are bed-sharing out of concerns about being judged (Caraballo 2016). 

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