There are many stressful things about becoming a parent, but safe sleep is often cited as the most stressful of them all. Even before your baby is born, books and medical professionals will detail the importance of babies sleeping on their backs, running you through the important details of how to reduce the risk of Sudden Infant Death Syndrome (SIDS).
For first-time parents, the questions about safe sleep can feel endless: How much sleep do babies need? Will they sleep more soundly with a white noise machine? How do we safely swaddle? What exactly is co-sleeping?
When it comes to the basics of safe sleep, the American Academy of Pediatrics (AAP) has some basic rules:
- Always put your baby on their back to sleep.
- Have your baby sleep in their own space.
- Use a firm, flat mattress and a fitted sheet.
- Don’t let baby sleep on the couch, in a swing, or in a car seat.
- Don't put loose items like blankets, toys, or pillows in the sleep space.
While this is a good place to start, parents may still have many questions even after reading these guidelines or discussing safe sleep with their pediatrician. So, we have taken all of your questions — including the ones you are secretly wondering about but are too afraid to ask — and asked the sleep specialists to answer them. So keep reading for the basics of co-sleeping and safe sleep with babies from newborns through infancy.
What is co-sleeping, and is it safe?
Co-sleeping is a hot topic, and can raise concerns, depending on who you’re speaking with.
The first question you may have about co-sleeping is: What does co-sleeping mean? “Co-sleeping means sleeping in close proximity to your baby,” says Heather Turgeon, marriage and family therapist, psychotherapist, and co-author of “The Happy Sleeper.” The AAP defines co-sleeping as sharing a room with your infant but lying on different sleep surfaces. You are still close to your infant, but parent and baby sleep in different beds.
Turgeon calls this practice of sharing a room, but sleeping in different sleep spaces, the safest option for small babies. Because some people can conflate co-sleeping with bed-sharing, the terms can become confusing, so some experts refer to co-sleeping as room-sharing to differentiate it from the more dangerous practice of bed-sharing. “We call [co-sleeping] room-sharing for clarity. Co-sleeping with a baby in a bassinet or crib on a separate surface but in the same room is a good idea, and it’s the safest option when babies are very little,” Turgeon emphasizes.
Dr. Antoinette T. Burns, Pediatric Sleep Medicine Physician at Children’s Hospital Colorado, prefers to use the term “room-sharing” to decrease confusion for parents and pediatricians alike. “When you room-share, keep your baby on their own safe sleep surface while they sleep in the same room as their parent.”
Burns says that the AAP recommends room-sharing for the first six to 12 months of your baby’s life, to decrease risk of SIDS. After 12 months, you can move them to their room. Other than the AAP guidelines above, she also states that parents should not use an inclined sleeper, in-bed sleeper, lounger, nursing, pillow, swing, bouncer, or positioning device for sleep “if it does not meet the federal safety standards for infant sleep.”
What is the difference between co-sleeping and bed-sharing?
There is a lot of understandable confusion regarding all of these different terms surrounding infant sleep, especially since some of them are incorrectly used interchangeably. However, they do not mean the same thing. There is a distinct difference between a parent who chooses to co-sleep with their child and a parent who bed-shares.
“Co-sleeping and bed-sharing are not synonymous terms,” says Dr. Denise Scott, a pediatrician and pediatric endocrinologist who works with JustAnswer. “Bed-sharing implies just that — a parent shares the same bed or sleeping surface with a child.” This practice is not advisable, and can create risk of suffocation, smothering, or other injuries for a baby. “There is no question that the safest arrangement is not to sleep in the same bed or sleeping surface,” Scott says. “The AAP warns that bed-sharing increases the risk of Sudden Unexpected Infant Death (SUID), in which SIDS is included.”
How to know if co-sleeping is right for you
“The pros of room-sharing are that you are close to your baby for frequent feeds in the early months,” says Natalie Barnett VP of Clinical Research at Nanit. “Plus, some parents can feel less anxiety when their baby is close.”
Meanwhile, Scott says that other co-sleeping benefits include “more bonding time for parents, especially working parents.” She also says that, along with making it easier for mothers to offer breastfeeding during the night, “some studies have shown that mothers may breastfeed longer” if a child is co-sleeping. Plus, “bedtime is easier on both parents and children,” Scott says. Some studies have shown that babies sleep better when they can hear a parent’s breathing, or smell a parent nearby, and it offers peace of mind for parents, too.
The inverse is also true: Barnett warns that room-sharing can make you hyper-aware of your baby’s noises, causing lighter, more disrupted sleep, though this lighter sleep could be the reason for fewer instances of SIDS among babies that room-share. Additionally, parents who are craving reconnection after the ordeal of pregnancy and childbirth will experience “less one-on-one time and privacy for the parents,” Scott adds.
How to co-sleep safely
If you decide co-sleeping is the best course of action for you and your family, follow these guidelines to keep your baby safe.
- Babies should never be placed on their tummies for sleep. Instead, they should always be placed on their backs to sleep.
- Your baby’s bed should be a firm, flat surface with a tight-fitting sheet. You should not use memory foam, sheepskin, or a waterbed.
- Keep blankets, pillows, toys, and crib bumpers out of your baby’s sleep area.
- Once your baby starts to roll, this is a sign to take them out of swaddles and weighted sleep suits.
- Make sure there are no gaps between the mattress and the crib rails (or headboard and footboard).
- The room should be kept cool, between 65 and 70 degrees. Your infant should be dressed in a sleeved sleeper or a footed sleeper.
- Use a pacifier when your baby is sleeping, as it can help decrease the risk of SIDS.
- Do not use inclined sleepers, in-bed sleepers, loungers, nursing pillows, swings, bouncers, or positioning devices for sleep.
When should co-sleeping start?
When discussing your family’s sleep needs with your partner and your pediatrician, it’s essential to distinguish between room-sharing (or co-sleeping) and bed-sharing, as each has different guidelines from the AAP.
In general terms, you can begin room-sharing from day one, says Burns. Most hospitals and birthing centers in the U.S. encourage room-sharing by placing the baby next to you in a bassinet shortly after birth.
“Room-sharing is recommended for the first six to 12 months of age,” says Burns. “When you room-share with your infant, the infant must have their own safe sleep surface because there is no safe time to bed-share with an infant under 12 months of age.”
Turgeon agrees, stating that “the best place for a newborn baby is in a bassinet or crib in the parent’s room.”
This is even more crucial if a mom is breastfeeding, since “this is also the best arrangement to promote feeding on demand, which is the healthiest approach for newborn babies,” says Turgeon. Additionally, she recommends that parents of newborns have a plan for who will soothe and feed the baby at night — before bringing the baby home. “Having support if possible is a good idea,” she says. “It’s best to switch caregivers, so that parents don’t resort to bringing the baby into bed or sleeping together in a chair or other space, which is dangerous.”
Make a plan with your partner to allow the baby to sleep in the room with you right away — and that you have to trade night duties so that neither of you becomes overtired and makes compromises when it comes to safe sleep.
Though bed-sharing promotes breastfeeding, it is not recommended before 12 months due to the increased risk of death or injury to infants who share a bed with a parent. “The AAP does not recommend bed-sharing for any babies,” says Dr. Liza Natale, a general pediatrician at Pediatric Associates of NYC and a Nanit Medical and Scientific Advisory Board Member. “There is always a risk when safe sleep practices aren’t followed.”
Is there a risk of SIDS with co-seeping?
The answer to this question largely depends on whether parents use the term co-sleeping to mean room-sharing or bed-sharing. “The risk of SIDS significantly decreases when parents follow safe sleep recommendations with their baby,” says Emily Osborne, a Lamaze-certified childbirth educator, certified lactation counselor, and a parenting expert at Owlet. “If parents choose to bed-share, the risk of SIDS does increase.”
However, Osborne wants to make it clear that there are many other factors that contribute to an increased risk of SIDS. She notes that a recent study on bed-sharing published by the British Medical Journal states that approximately 1 in 46,000 low-risk babies will die while sleeping in a crib in a parent’s room, whereas 1 in 16,400 low-risk babies will die while sleeping in a parent’s bed. But, despite this statistic, babies who sleep in bed with an adult who smokes, uses alcohol or drugs, or has obesity are at an increased risk of SIDS compared to those who bed-share with parents who don’t do any of these things. Additionally, infants born preterm or with low birth weight are at a higher risk of SIDS. “Those infants should stay out of a parent’s bed,” says Scott.
While doing your research, it’s important to keep in mind the difference between SIDS — an undefined death — and a sleep-related infant death. A sleep-related infant death can include suffocation, strangulation, or entrapment when bed-sharing. The CDC estimates that sleep-related deaths in infants account for over 28% of SUID.
Ultimately, what parents need to know is that room-sharing has been shown to have a lesser risk of SIDS while bed-sharing in western countries has an increased risk, says Natale.
How to transition kids out of co-sleeping
The AAP recommends that room-sharing with infants continues for the first six to 12 months of age, but after that, “an infant can be transitioned to their own room,” says Burns.
When considering making this change during the second half of your baby’s first year, Turgeon recommends that parents speak with their pediatrician about the health aspects of their choice. “From a sleep perspective, once a baby’s awareness begins to grow, a parent’s presence often becomes more activating at night than soothing.” This can lead to much tiptoeing and disruption to the parents’ evening routine.
However, Scott emphasizes that the transition from room-sharing to a baby sleeping in their room is ultimately a family decision. “Typically, the ‘right’ time is usually when the parents decide they want their private space back,” she says. It is unlikely that the child will initiate this transition since babies tend to like to stick to a routine, but you can rely on your pediatrician or a sleep coach to smooth the transition.
Another factor to consider when considering the right time to transition out of room-sharing is whether you and your child are getting good sleep, says Osborne. “Trust your instincts regarding the right time to transition your child to a new sleep environment,” she says. “If you or your child are not getting consistent, quality sleep, it will impact your daytime energy levels, mood, and your child’s behaviors.”
Osborne recommends easing this transition by “keeping certain aspects of your bedtime routine the same while changing the location of where your child is sleeping.”
Have a loud sleeper or especially grunty baby? Barnett says that it is also okay for parents to move babies to their own room before the six-month mark. What is most important is a well-rested, happy parent that can take good care of their child instead of being overly tired.
Is it okay to bed-share with older kids?
“Many parents do choose to bed-share, and many cultures have done so for centuries,” says Scott. “The decision may be for a variety of reasons, but a parent does need to be aware of the risks.” The good news is that the older the child, the less risky bed-sharing becomes. However, she does warn that children can be “very restless sleepers,” which can lead to a poor night’s sleep for the parent.
Burns agrees, adding that “bed-sharing with a toddler or older children is not generally recommended because it can lead to poor sleep for both adults and children.” Additionally, many children roll, requiring bed rails.
Though bed-sharing can promote closeness and sometimes avoid bedtime battles, Barnett says that “kids who are independent sleepers have better and longer sleep than kids who need a parent to sleep with them.” The same goes for parents, who also tend to sleep better and longer on average than when a toddler is sleeping in their bed — “as any parent who has had a foot in their face can attest!”
Some parents may instead bring their child’s mattress into their room and put it on the floor next to their bed. “This can allow everyone to sleep in close proximity while also having separate sleep spaces to allow for better quality sleep for all,” she says.
If you have tried many different sleep methods and are still struggling, Burns says, “please discuss specific recommendations with your pediatrician or pediatric sleep physician, psychologist, nurse practitioner, or physician assistant.”
Is there a “safe” way to practice bed-sharing?
“As educators, it is our responsibility to provide new parents with the best information to help them make well-informed decisions,” Osborne continues. “We know that there are specific ways to practice safe sleep, which is why we typically provide the AAP’s recommendations for safe sleep to all new parents.” However, she acknowledges that parents in the U.S. and other countries may still choose to bring their baby into their adult bed. “We must also provide good information to parents who make that choice, even if that choice goes against the AAP.”
When in doubt, La Leche League provides a “safe sleep seven” for parents who proactively choose to bed-share, which includes a bed-sharing song to the tune of “Row Row Row Your Boat.”
No smoke, sober mom
Baby at your breast
Healthy baby on his back
Keep him lightly dressed.
Not too soft a bed
Watch the cords and gaps
Keep the covers off his head
For your nights and naps.
Despite these resources, pediatricians like Scott still “cannot endorse any form of bed-sharing with an infant that would be considered safe,” although she also acknowledges that many parents choose this option. Instead, she recommends an alternate solution to get a bedside sleeper that attaches to the bed or a bassinet that sits next to the bed. “This keeps the infant off the parents’ mattress and gives the infant their own sleeping surface and is the safest arrangement.”
At the end of the day, though, Burns says that one thing is most important when it comes to your baby’s safe sleep: “Please be sure that the sleep surface you provide for your infant meets the standards set by the Consumer Product Safety Commission.”
