Co-sleeping is more common than you think.
Find out how to do it safely and get more sleep yourself.
Co-sleeping is a term that refers to a mother and/or her partner (or any other person) being asleep on the same sleep surface as a baby.
If your baby ends up in your bed during the night, you're not alone. Many parents find that bringing their baby into their bed is easier. It helps them to care for their baby at night and everyone gets more sleep. Australian research has found that around 75% of babies spend at least some time co-sleeping in the first 3 to 6 months of life.
It is recommended that babies sleep in their own safe sleeping space next to the parent's bed for the first 6 to 12 months of life. However, many parents choose to, or have no option but to, share a sleep surface with their baby.
It’s not bed-sharing alone that is dangerous, but other factors which may interact in bed-sharing and shared sleep environments to increase the risk of a sudden unexpected death in infancy (SUDI).
Breastfeeding has a protective effect against SIDS
There are several theories as to why breastfeeding protects against sudden unexpected deaths in infancy:
Breastfed babies are more easily woken up than formula-fed babies at 2 to 3 months of age, which is within the 2-to-4-month age when SIDS occurs most.
Breastfeeding provides babies with important immune factors (e.g. antibodies and white blood cells) which may help to protect babies from SIDS.
Some babies whose deaths are sudden and unexpected have had a minor infection in the days before that wasn’t considered sufficient alone to have caused death. Breastfed babies suffer fewer infections than formula-fed babies.
Breastfeeding and co-sleeping
Babies need to be fed during the night and many new mums fall asleep while feeding their baby. Co-sleeping helps to minimise disruption to sleep for both mum and baby.
Breastfeeding and co-sleeping mutually support each other. Co-sleeping is convenient for night feeding so that’s why parents choose to do it. Mums who bed-share with their baby tend to breastfeed longer and keep exclusively breastfeeding for longer than those who do not co-sleep.
You may be concerned about co-sleeping with your baby. However, it has been found that when a breastfeeding mum co-sleeps, she usually lies in a position that helps her keep close physical contact and care of her baby.
She usually forms a protective "C'' shape around her baby. She keeps her baby at the level of her breast with an arm between her baby’s head and the pillow.
She instinctively bends her legs making the protective space around the baby. It's impossible for another person to roll onto the baby without first touching her legs.
A breastfeeding mum who co-sleeps with her baby also tends to be highly responsive to her baby’s needs. As long as she hasn’t drunk alcohol, taken illegal or sleep-inducing drugs and isn’t extremely tired.
Mums and babies who co-sleep tend to wake more during the night and this may protect against sudden unexpected infant deaths. The mum checks her baby and breastfeeds them more frequently when co-sleeping than when room-sharing.
Risk factors for SUDI when co-sleeping
Under certain circumstances, some studies have reported an increased risk of SUDI in co-sleeping babies. The following risk factors have been identified:
A baby exposed to cigarette smoke (e.g. if the mother or father smokes, or the mother smoked during pregnancy) increases the risk of SIDS, no matter where the baby sleeps. Smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby.
Parents who smoke are encouraged to room-share as long as the room the baby sleeps in is kept smoke-free. Their babies have an increased risk of sudden infant death and therefore require more checking.
Babies are at increased risk of a fatal sleeping accident if they co-sleep with someone who has consumed alcohol or illegal or sleep-inducing drugs or who is extremely tired. If this is you, don’t co-sleep with your baby.
Babies are at increased risk of death if they co-sleep with more persons than their parents (e.g. other siblings) or with a pet. Co-sleeping with a sibling raises the risk. Babies should not co-sleep if there is anyone other than the parents in the bed.
Dr James McKenna recommends that formula-fed babies room-share with their parents rather than co-sleep, because mothers who formula feed their babies do not show the same responsive night-time parenting practices as breastfeeding mothers.
Sleeping a baby on a sofa, couch, beanbag or armchair increases the risk of a fatal sleeping accident. Caregivers should never co-sleep with a baby on a sofa, couch or armchair. Babies can suffocate against cushions or become wedged between the seat and the back of the sofa whether or not a sleeping adult is present.
It’s possible there is a higher risk of death in a young baby who co-sleeps with a parent if the baby overheats or if the baby’s head becomes covered. Some studies have reported a higher risk of death when a young baby (i.e. under the age of 12 weeks) shares a bed with a parent. These studies did not however consider all known risk factors such as alcohol or drug use, or multiple bed-sharers. In addition, the peak age for SIDS has always been within this range no matter where the baby sleeps.
Leaving a baby unattended on an adult bed increases the risk of a fatal sleeping accident.
Do not wrap baby if sharing a sleep surface as this restricts arm and leg movement.
Room-sharing is safer than sleeping alone
There is a lower risk of SIDS when a baby room-shares with parents as compared to a baby sleeping alone in another room. Sleeping in a room with other children has no protective effect.
As long as you don’t smoke and haven’t been drinking...
The main risks of co-sleeping are overheating and head covering. If you want to co-sleep:
Put your baby to sleep on their back.
Don’t swaddle or wrap your baby.
Don’t use electric blankets.
Keep your baby away from pillows, doonas, blankets or sheets.
Keep your baby’s head clear.
Use a firm, flat mattress.
Make sure your baby cannot become trapped against a wall or another bed between the sides of the bed and the mattress.
Summary
Most SUDI deaths occur when a baby is sleeping alone outside the supervision of a committed adult.
Parents who co-sleep need to be aware of the risks and arrange the sleeping space to minimise these risks.
Co-sleeping with a parent who smokes increases the risk of SUDI including SIDS. Smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby.
Parents affected by alcohol, drugs or extreme fatigue should not co-sleep with their baby while under the influence of those conditions.
A sofa is not a safe sleeping place for a baby with or without a parent present as it increases the risk of infant death.
Co-sleeping has the potential to benefit babies in that it supports breastfeeding and therefore a baby’s health.
Co-sleeping helps parents get more sleep.
The challenge is to lower infant death rates without compromising breastfeeding.
It is unlikely that bed-sharing in itself is a risk factor for SUDI. It’s more likely to be the particular circumstances in which co-sleeping occurs.
For further information
The UNICEF leaflet Caring for Your Baby at Night is an excellent resource as it covers more issues and includes formula feeding
Dr James’s McKenna’s website
Red nose guideline Co-sleeping with your baby
Download ABA's information leaflets about breastfeeding and co-sleeping
Six ways to reduce the risk of sudden unexpected death in infancy and sleep baby safely (from Red Nose)
1. Sleep baby on the back from birth, not on the tummy or side
2. Sleep baby with head and face uncovered
3. Keep baby smoke free before birth and after
4. Provide a safe sleeping environment night and day
5. Sleep baby in their own safe sleeping place in the same room as an adult care-giver for the first six to twelve months
6. Breastfeed baby
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