Is it safe to sleep with my baby? Many parents (whether breastfeeding or not) end up sleeping with their child at some stage. What is co-sleeping? Is it sharing the same bed? Sharing a sofa (a very big NO NO!) or just sleeping in close proximity but not on the same sleep surface? All of these constitute co-sleeping but how do we co-sleep safely?
Differing Opinions
We all have the right to our own opinion. When we were researching this topic we found so many of us had different views. My husband and I didn’t bed share with our children because during this time we had the fear of God put into us. I was also in and out of hospital with Jacob. If I could go back now I would have tried to share a sleep surface with my babies.
One of my colleagues who shared a sleep surface with her daughter found that her daughter slept so much better when her baby was next to her in bed. She found that in the first few weeks, the whole family slept so much better because they were close. My colleague’s view was that her baby was so used to being inside of her close to her that it makes sense that sleeping beside her would help her sleep better.
Safety Considerations
If you have or are considering sharing a sleep space with your baby you need to ensure that you do so safely. This is so you can make an informed decision about the arrangement you choose for you, your baby and your family. We will explore sharing a sleep surface versus sharing a sleep space so that you can explore both sleeping arrangements!
Co-Sleeping defined
There is much debate about the practice of bed-sharing and co-sleeping but also what's defined as bed-sharing and co-sleeping. The issue of bed-sharing is very complex. For the purpose of this blog, co-sleeping includes the terms “sharing a sleep surface” or “bed sharing”. Bed-sharing refers to bringing the baby onto a sleep surface where co-sleeping is possible, whether intended or not. Co-sleeping also includes “room sharing” where the parent and the baby sleep in the same room on a separate sleep surface. These are all different forms of co-sleeping.
Professor James J. McKenna works at the Mother-Baby Behavioural Sleep Laboratory at the University of Notre Dame in Indiana. Professor McKenna studies how sleeping environments reflect and respond to family needs. In particular how they affect mothers, breastfeeding and a baby's physiological and psychological well-being and development. "Separate surface co-sleeping is always safe - more like room sharing. It makes the baby healthier and safer for its night’s sleep...it’s proactive” according to Professor McKenna
Red Nose Recommendations
Red Nose (formerly SIDs & Kids) also shares Professor McKenna's view.
“The safest place to sleep a baby is in their own safe sleeping place in the same room as an adult care-giver for the first 6 to 12 months of life. This has been shown to lower the risk of Sudden Unexpected Death in Infants (SUDI)”.
Red Nose explains that “sharing a sleep surface with a baby can increase the risk of SUDI, including Sudden Infant Death Syndrome (SIDS) and fatal sleep accidents”. It is possible that other factors contributed to the deaths, but for the fact that they were bed-sharing . Professor McKenna also points out that “we don’t often hear all the factors that contributed to the baby’s death, in addition to the fact that they were co-sleeping (bed sharing/sharing a sleep surface). Perhaps there was a history of smoking, or a sibling climbed into the bed? Was the baby sleeping prone (ie on their stomach)?”.
Bed sharing risk factors
Red Nose believes the risks of bed sharing below.
- Sharing a sleep surface with a baby can increase the risk of SUDI. A considerable proportion of SUDI occur on a shared sleeping surface. Babies most at risk of SUDI when sharing a sleep surface are those less than 3 months postnatal age, babies who were born preterm or small for gestational age.
- The risks are always much greater if parents smoke or are under the influence of alcohol or drugs (prescription or illegal) that cause sedation and impair their ability to respond to their baby.
- There is a very high risk of infant death, including deaths attributed to fatal sleeping accidents, when a baby shares a sofa or couch with an adult during sleep.
- There is no increased risk of SUDI whilst sharing a sleep surface with a baby during feeding, cuddling and playing, provided the baby is returned to a cot or their own safe sleeping surface before the parent goes to sleep.
- Sharing a sleep surface with a baby is a complex issue that encompasses many factors. Strategies can be used to reduce the risk in circumstances where parents share a sleep surface with a baby due to parenting preferences, cultural beliefs or unavoidable living circumstances, including instances where a parent may unintentionally fall asleep.
Sleeping baby on the parent’s chest
Sleeping baby on their tummy on the parent’s chest, often skin to skin, is an excellent way to settle a baby and help them self-regulate. BUT ONLY IF the baby and their airway are being observed (either by the nursing parent or another adult care-giver). If a parent falls asleep with a baby on their tummy on the parent’s chest and unobserved it can significantly increase the risk of SUDI. Sleeping a baby on their tummy reduces baby’s arousal mechanisms that protects baby’s airway. Baby’s nose and/or mouth may become covered by clothing, or the parent’s body or breast; or an unobserved baby may become positioned with their chin to chest, which will also obstruct baby’s airway
Mother-Baby Behavioural Sleep Laboratory
The Mother-Baby Behavioural Sleep Laboratory found that breastfeeding is closely linked to room sharing with baby. A mother who breastfeeds will often keep her baby nearby for ease of feeding but also for very important physiological reasons such as bonding and security. Breastfeeding can significantly help to protect infants from death including deaths from SIDS/SUDI and from secondary disease and/or congenital conditions. Babies who are near their parent when asleep maintain higher oxygen levels and will be more easily aroused from sleep if they need to feed which is a positive thing. These babies also maintain a better body temperature.
Australian Breastfeeding Association's Position
The Australian Breastfeeding Association’s position statement states that “co-sleeping can benefit babies by supporting breastfeeding and therefore a baby’s health. The challenge is to lower infant death rates without compromising breastfeeding. Therefore avoiding exposing the baby to the nutritional, immunological and developmental risks of not breastfeeding, including an increased risk of SIDS. It is unlikely that co-sleeping per se is a risk factor for SUDI but rather the particular circumstances in which co-sleeping occurs”.
The Australian Breastfeeding Association does NOT recommend co-sleeping under the following circumstances where:
- any parent is a smoker or if the mother smoked during pregnancy
- a parent has consumed any alcohol or taken illegal or sleep-inducing drugs including prescription medication
- on a sofa/couch/armchair/beanbag or similar (i.e. furniture not designed for sleeping on)
- in the first few months if their baby was born very small or prematurely
- the parent is obese
- a parent is likely to have temporary losses of consciousness (eg is an insulin dependent diabetic or epileptic)
- persons other than the parents are present eg a sibling(s)
- a pet(s) is present
- the baby is formula fed
It is also not safe to leave a baby unattended on an adult bed. Adult beds are NOT designed for babies like cots and bassinets are.
Sharing the same sleep surface recommendations
Parents who decide to sleep on the same sleep surface as their baby should always adhere to the following:
- Keep pillows away from their baby.
- Ensure that their baby cannot fall out of the bed or become trapped between the mattress and the wall or bedside tables.
- Make sure baby’s face and head does not become covered.
- Place the baby on their back to sleep.
- Use a firm, flat mattress (waterbeds are not safe nor are sofas).
- Do not wrap or swaddle a baby if co-sleeping as it can contribute to over-heating and also restricts a baby’s ability to move.
- Ensure that each parent is aware that the baby is in the bed.
Safe Sleep in any environment These same safe sleep guidelines should be followed, whether a baby sleeps
- on the same surface as his or her parents,
- on a same-surface co-sleeper,
- in a bassinet or in a separate cot, in the same room as their parents; or
- in a bassinet or separate cot in a separate room, a baby should follow these same guidelines:
Always
- place baby on their back,
- on firm clean surfaces,
- without exposure to secondhand smoke,
- under light comfortable bedding, and
- with their head uncovered.
Do NOT use the following:
- Pillows
- Cot bumpers
- Stuffed animals
- Soft bedding
- Sheepskins
- Beanbag mattresses
- Waterbeds
- Babies should never sleep on couches, sofas or arm chairs with or without adults. They can slip down into the crevice or get wedged against the back of a couch where they may suffocate.
Dressing baby for bed
What baby wears to bed and the bedding can contribute significantly to the safety of the sleep space. Younger babies can be swaddled or wear a baby sleeping bag designed specifically for their weight and height. Swaddling can help to stop a baby rolling onto their tummy accidentally at a young age. Babies sharing the same sleep surface as an adult should not be swaddled.
Once a baby can roll over, a baby sleeping bag is a very safe way to keep baby sleeping comfortably. A safe sleeping bag has a fitted neck and armholes and no hood and is the correct size for baby.
Bubbaroo Joey Swag Baby Sleeping bags help to keep baby’s temperature at a consistent level whilst asleep and reduce the risk of bed clothes covering the face.
Final Points
Some final very sound points to remember from Professor James McKenna: It is important to realise that the physical and social conditions under which infant-parent co-sleeping occur. In all its diverse forms, can and will determine the risks or benefits of this behaviour. What goes on in bed is what matters.
Bottle Fed Babies
- Bottle fed babies should always sleep alongside the mother on a separate surface rather than in the bed.
Parental Responsibility
- If bed sharing, ideally, both parents should agree and feel comfortable with the decision.
- Each bed-sharer should agree that he or she is equally responsible for the infant. Acknowledging before they're asleep that they are aware that the infant is present in the bed space.
- Do not place a baby in bed with a sleeping adult who isn't aware that baby is in bed with them. My feeling is that both parents should think of themselves as primary caregivers.
Siblings
- Infants a year or less should not sleep with other/older child siblings -- but always with a person who can take responsibility for the baby being in the bed.
Alcohol & Drugs
- Persons taking sedatives, medications or drugs, or intoxicated from alcohol or other substances, or otherwise excessively unable to arouse easily from sleep should not co-sleep on the same surface with the infant.
Physical Characteristics
- Excessively long hair should be tied up to prevent infant entanglement around the infant's neck (yes, this has very unfortunately happened).
- Extremely obese persons or others who may have difficulty feeling where exactly or how close their infant is in relation to their own body, may wish to have the infant sleep alongside but on a different surface, such as a co-sleeper attachment.
Reflect & Consider
- It may be important to consider or reflect on whether you would think that you suffocated your baby if, under the most unlikely scenario, your baby died from SIDS whilst in your bed. Just as babies can die from SIDS in a risk-free solitary sleep environment, it remains possible for a baby to die in a risk-free cosleeping/bedsharing environment. Just make sure, as much as this is possible, that you would not assume that if your baby died, that either you or your spouse would think that bed-sharing contributed to the death. Or that one of you by accident suffocated your baby. This is an unpleasant and uncomfortable topic, it's one worth thinking about before you make the choice to co-sleep with your infant.
You may wish to view further information from Professor McKenna here
Conclusion
It’s hard to make good decisions when you’re so tired and exhausted. Especially during the night so it’s always better to have the discussion ahead of time with your partner or family. Then try to enforce your agreed decision at the time the choice arises.
Be informed, so you can make the right decision for your family and your own personal circumstances! We do not recommend any particular type of sleep situation. We simply remind parents to research all information available on co-sleeping to make an empowered decision as to what best suits your baby and family situation.