[Note: This article is being published in draft form for use in an active research study. Its contents may be adjusted as we receive feedback from collaborating health care professionals.]
Co-sleeping is a commonly used term with variable definitions.1 It can be used to refer to sleeping in close proximity to an infant, such as sharing a room, or as sharing a sleeping surface with an infant. The American Academy of Pediatrics (AAP) recommends against the use of this term due to its lack of clarity and instead prefers to use the terms room sharing and surface sharing.
According to the AAP, surface sharing with infants is not recommended under any circumstances.1 They advise that the safest place for a baby to sleep is on a separate sleep surface designed for infants. There is insufficient to make a recommendation regarding the use of devices advertised as making bed sharing safer.
Bed sharing increases the risk of sleep-related infant death from causes such as suffocation, strangulation, and entrapment as well as increasing the risk for Sudden Infant Death Syndrome (SIDS), with further increased risk for the following situations:1
- Bed sharing with someone who uses sedating medications or substances such as certain antidepressants, pain medications, alcohol, or illicit drugs
- Bed sharing with a current smoker, even if the smoker does not smoke in bed, or if the pregnant parent smoked during pregnancy
- Bed sharing on a soft surface such as a water bed, old mattress, sofa, couch, or armchair
- Bed sharing with infants <4 months old
- Bed sharing with anyone who is not the infant’s parent, including nonparental caregivers and other children
- Bed sharing with infants who were preterm or had a low birth weight
- Bed sharing with soft bedding accessories such as pillows or blankets
While some evidence exists that bed sharing can offer a few benefits, namely increasing breastfeeding frequency and duration2,3 and enhanced bonding,4 these benefits do not outweigh the substantial increase in risk to the infant’s life.
While bed sharing is discouraged, room sharing is recommended by the AAP, especially in the first six months when the rates of sleep-related deaths are highest.1 Room sharing without bed sharing can be protective for the first year of life. Having the infant’s sleeping surface close to the parents’ bed can facilitate feeding, comforting, and monitoring as well as giving parents peace of mind.
Sleep-Related Infant Death
Bed sharing has been shown to significantly increase the risk of SIDS. A 2013 meta-analysis of case-control studies including 1,472 SIDS cases and 4,679 across the UK, Europe, and Australasia found that bed sharing increases the risk of SIDS regardless of smoking status, alcohol consumption, or drug use.5 Among cases, 22.2% were bed sharing compared to 9.6% of controls (Odds Ratio [OR] 2.7, 95% Confidence Interval [CI] [1.4-5.3]). When neither parent smoked, the baby was <3 months old, breastfed, and had no other risk factors, the absolute risk for room sharing infants was 0.08 per 1,000 live-births compared to 0.23 per 1,000 live-births for bed sharing infants (OR 5.1, 95% CI [2.3-11.4]).
Another case-control study in the UK of 400 SIDS infants and 1,386 controls between 1993-1996 had similar findings.6 Among cases, 36.3% were found bed sharing with an adult at the time of death compared to 15.4% of controls (OR 3.9, 95% CI [2.7-5.6]). The risk of SIDS was increased among parents who had consumed alcohol (7.3% of cases vs 0.9% of controls, OR 18.29, 95% CI [7.68-43.54], p<0.001) or smoked (14.8% of cases vs 4.5% of controls, OR 4.04, 95% CI [2.41-6.75], p<0.001) as well as for those sharing a sofa or chair as a sleeping surface (8.3% of cases vs 0.5% of controls, OR 18.34, 95% CI [7.10-47.35], p<0.0001).
In addition to SIDS, bed sharing also increases the risk of accidental suffocation and strangulation. A 2009 analysis of infant mortality data from the Centers for Disease Control and Prevention (CDC) found that bed sharing was reported among 51.2% of suffocations and strangulations in bed from 1984-2004.7 In comparison, 6.3% of cases did not share a bed (the remaining 42.6% of cases had unknown bed sharing status or were pending determination at the time of the study).
References
- Moon RY, Carlin RF, Hand I. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. Jul 1 2022;150(1)doi:10.1542/peds.2022-057990
- Huang Y, Hauck FR, Signore C, et al. Influence of bedsharing activity on breastfeeding duration among US mothers. JAMA Pediatr. Nov 2013;167(11):1038-44. doi:10.1001/jamapediatrics.2013.2632
- Bovbjerg ML, Hill JA, Uphoff AE, Rosenberg KD. Women Who Bedshare More Frequently at 14 Weeks Postpartum Subsequently Report Longer Durations of Breastfeeding. J Midwifery Womens Health. Jul 2018;63(4):418-424. doi:10.1111/jmwh.12753
- Ball H. Reasons to bed-share: why parents sleep with their infants. Journal of Reproductive and Infant Psychology. 2002;20(4):207-221. doi:10.1080/0264683021000033147
- Carpenter R, McGarvey C, Mitchell EA, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. BMJ Open. May 28 2013;3(5)doi:10.1136/bmjopen-2012-002299
- Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-sharing in the absence of hazardous circumstances: is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. PLoS One. 2014;9(9):e107799. doi:10.1371/journal.pone.0107799
- Shapiro-Mendoza CK, Kimball M, Tomashek KM, Anderson RN, Blanding S. US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: are rates increasing? Pediatrics. Feb 2009;123(2):533-9. doi:10.1542/peds.2007-3746
