Across the world mothers have always slept close to their babies at night, historically, there would have been no other way to keep babies breastfed, safe, warm and contented. By sleeping close to her baby, a mother can check on him regularly and respond quickly when he wakes—breastfeeding him back to sleep before either of them become wide awake. Sleeping close or “co-sleeping” can include both a baby sleeping in his own cot close to his mother in the same room (room-sharing), or when mother and baby share a sleep surface (bed-sharing).
- Room-sharing day and night with baby sleeping in their own cot close to a parent, is thought to be protective against Sudden Infant Death Syndrome (SIDS) 12.
- Bed-sharing with baby is a little more complicated because modern thick duvets, soft pillows, mattresses and high beds have potential safety issues surrounding them such as overheating, suffocation risk or falls from the bed. In addition, bed-sharing when a baby isn’t breastfed, could introduce changes to a baby’s physiology, health and behaviour 3. Despite these safety issues, bed-sharing remains popular because a baby wants to be close to his mother and often can’t sleep well without her. And mothers like to be close to their babies to check on them:
Video studies in sleep labs and parental homes have shown that mothers frequently touch their babies, even when they are only half awake, monitoring the baby’s temperature and relationship to the bedding. Furthermore, mothers who usually sleep with their babies may be more likely to notice if their baby is unwell because of their proximity.
This article shares the recommendations for making your sleeping area as safe as possible if you are considering bringing your baby into your bed at nap-time or bed-time. By increasing awareness of the risks and benefits of bed-sharing and of unsafe co-sleeping practices parents can make their own informed choice about where their baby will sleep (ABM, 2008).
Bed-sharing with baby
Research reveals three quarters of breastfed babies sleep with their mother or parents some of the time in the early months 4. Many of these parents did not plan to bed-share but found their baby settled better there and breastfeeding was easier. It is therefore important that all parents know the safety issues and how to bed-share safely, even if they don’t initially plan to take their baby into bed.
Make your bed and bedding materials as safe as possible
- Avoid very soft bedding materials which are a suffocation risk (ABM, 2008); keep soft pillows and soft toys away from your baby in the bed, do not put your baby to sleep on a soft pillow
- Use light blankets—an adult duvet on your baby could cause him to get too hot
- Don’t overwrap your baby or block air movement across your baby’s face 5.
- Consider the height of your bed and whether your baby could fall, see James McKenna’s Safe Co-sleeping Guidelines for a drawing of a safe arrangement
- Fill any spaces beside the bed that could trap a baby
- Tie back a parent’s long hair to prevent baby getting tangled in hair
#1 Do not smoke and bed-share
There is a strong association between SIDS and smoking exposure. Smoking around a baby has been shown to increase the risk of Sudden Infant Death Syndrome (unexplained deaths) when using both cots and bed-sharing arrangements. Bed-sharing is not advisable if either parent is a smoker, even if they never smoke in the bedroom 6.
With regard to room-sharing with a parent who smokes, the authors of Sweet Sleep, 2014 say:
Even if you or your partner smokes, most research and health organisations still suggest keeping your baby in your room at night for at least the first half-year. But you can minimise your baby’s nighttime exposure to smoke by keeping his bed away from yours, by bringing him into your bed only for feeds, and by staying between him and a partner who smokes.
James J. McKenna is Director of the Mother-Baby Sleep Laboratory, University of Notre Dame. His list of Safe Co-sleeping Guidelines explains that safe sleep starts with a smoke free pregnancy and continues with breastfeeding your baby and a continual smoke free atmosphere.
#2 Do not sleep with your baby on a sofa, armchair or waterbed
A sofa, settee, or armchair are not safe spaces as a baby can get trapped in them. It is not recommended to bed-share on a waterbed either (ABM, 2008).
Couch or sofa cosleeping is […] intrinsically dangerous as babies can and do all too easily get pushed against the back of the couch by the adult, or flipped face down in the pillows, to suffocate.
#3 Do not bed-share if you have taken alcohol or drugs
These substances, including some general medications, could change your awareness when you are asleep (ABM, 2008).
#4 Do not bed-share with your baby while bed-sharing with other children
Babies less than 12 months old should not sleep with other small siblings. A responsible adult should be present at all times and a baby should not be left alone on an adult bed 7.
Be aware that
- It is recommended that babies are placed on their backs to sleep not on their side or tummy (ABM, 2008). Nils Bergman has an interesting theory as to why this is protective 89.
- Bed-sharing with younger babies 8–14 weeks of age may be more strongly associated with SIDS (ABM, 2008).
- A premature or low birthweight baby has an increased risk of SIDS 10.
- An extremely obese parent may not be aware of their baby’s position in the bed 11.
Protective sleep position
Several studies have found that breastfeeding reduces the risk of SIDS (ABM, 2008). In addition, breastfeeding mothers all tend to adopt the same protective position around their nursling when they bed-share. The authors of Sweet Sleep call this the “cuddle curl” and describe it as follows:
During sleep you’ll automatically go into the same position as breastfeeding mothers all over the world and throughout time. It’s called a cuddle curl, and it’s nature’s way of protecting a baby during sleep. Your knees come up and your arm tucks under your head or pillow, or curls around your baby, creating a protected space. There’s no way for you to roll towards your baby because your bent legs won’t let you. And no one else can roll into the space because your knees and elbows are in the way.
What if I don’t breastfeed?
James McKenna recommends that babies who are bottle-fed should sleep on a separate surface close to their mother rather than in the bed (McKenna, 2016). In the following video by Fox News, McKenna explains why not breastfeeding is a concern when bed-sharing, due to changes in a baby’s arousal patterns and their sleep position in the bed. McKenna goes on to explain why he thinks breastfeeding is a prerequisite for bed sharing (watch from 6:15).
Absence of cuddle curl
Bed-sharing may be less safe for non-breastfeeders as they do not adopt the same protective cuddle curl position. BASIS—Baby Sleep Info Source explains:
One small study showed that mothers who did not breastfeed often placed their babies high in the bed, at parents’ face-height, positioned between, or on top of pillows. They did not consistently face the baby or adopt the “protective” sleep position. This suggests that bed-sharing may be less safe for non-breastfeeders, unless the above behaviour can be learned, which is unknown. A three-sided ‘bedside’, or ‘side-car’, crib which attaches to your bed may be a suitable option if you want to be close to your baby, but you have concerns about bed-sharing safety.
Absence of breastsleeping
More recently McKenna and Gettler 12 have coined the term ‘breastsleeping’ to acknowledge the ways a breastfeeding mother and baby differ from a bottle-fed baby during sleep:
- Normal infant sleep can’t be measured without breastsleeping because it is a highly balanced system between mother, baby and breast. The sensory exchanges between mother and baby, the arousal patterns, feeding frequency, and breastmilk itself—which influences infant metabolism—are all important protective factors.
- The breastsleeping mother and baby show very different behavioural and physiological characteristics compared to the bottle or formula feeding mother and baby who bed-share.
For further help with evidence based information about safe sleeping arrangements for you and your breastfed baby see:
#1 Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family, LLLI, 2014 (book)
A comprehensive, research based sleep book. Includes the Safe Sleep Seven—a checklist for safe sleeping for the breastfeeding mother, and how to make your bed as ‘SIDS-safe as a cot’. See my Sweet Sleep Book Review for further information.
Safe Sleep Seven
- No smoking for mother [or father]
- Sober parents. No alcohol. No drowsy meds
- Breastfeeding mother day and night
- Healthy baby full term [born after 37 weeks]
- Baby on back
- No sweat no swaddle
- Safe surface. No super-soft mattress, no extra pillows, no toys, no heavy covers. Clear of string and cords. Fill the gaps: use rolled towels or baby blankets. Cover the baby not the head.
#2 Sleeping With Your Baby, James McKenna, 2007 (book)
James J. McKennna is an author and director of the Mother-Baby Sleep Laboratory, University of Notre Dame. His work includes Sleeping with Your Baby: A Parent’s Guide to Cosleeping, and many articles such as those referred to above and in further reading.
#3 BASIS—Baby Sleep Info Source (website)
A comprehensive website established by Helen Ball, a Professor of Anthropology at the Durham Infancy and Sleep Centre at Durham University. BASIS explains how babies sleep, what is normal, parents’ expectations, safety concerns and how to avoid dangerous situations. The site is supported by breastfeeding advocates Lactation Consultants of Great Britain, La Leche League GB, National Childbirth Trust, Breastfeeding Network and UNICEF and has a number of excellent information sheets which are freely downloadable.
The importance of safe sleep conversations
As more is learned, organisations who previously dismissed bed-sharing as dangerous are now recognising that parents need balanced information on safe co-sleeping arrangements including bed-sharing.
Remember, shocking messages that imply that all/any co-sleeping leads to death are not helpful. They do not reflect the evidence, and they frighten parents and staff, induce guilt and close down honest conversations.
Evidence suggests that it is less hazardous to fall asleep with the infant in the adult bed than on a sofa or armchair, should the parent fall asleep.
Babies frequently wake at night to feed or to seek contact with their mothers and this is normal baby behaviour. Many babies will not settle in a cot away from their mother leading families to consider bed-sharing to get enough sleep. Modern high beds and soft bedding can pose a safety risk but there are ways to make a sleeping environment safer. If you are thinking of having your breastfed baby in your bed for all or part of the night, or only think you might, informing yourself of all the safety aspects of bed-sharing will enable you to make your sleeping space safe in advance.
Remember breastfeeding protects your baby against Sudden Infant Death Syndrome (SIDS) and the more you breastfeed the greater the protection. Babies need to feed during the night so talk to your midwife or health visitor about feeding positions which help you rest and minimise risk to your baby.