Baby Co-Sleeping Safety

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Whether to co-sleep with your baby or not is a personal choice. However, before deciding as to whether to co-sleep with your baby, it is essential to understand baby co-sleeping safety.

Baby Co-Sleeping with Dad

As I said, co-sleeping is very much a personal choice. I did not co-sleep with my son; he slept in his cot in his room from the 1st day we bought him home. My sister, on the other hand, co-slept with all 3 of her children.

When we think about co-sleeping, we think of a baby sleeping in a bed with one or both of their parents, but this is not accurate. A baby sleeping in the same bed is what is known as bed-sharing, which is one form of co-sleeping.

Co-sleeping can take 1 of 2 forms:

  • Bed-sharing – where a baby sleeps in the same bed as their parents.
  • Room-sharing – where a baby sleeps in the same room as their parents but in their cot or bassinet.

One of the challenges for parents when it comes to deciding whether to bed-share is the enormous amount of information. Then deciphering the information to understand baby co-sleeping safety, the risks, benefits, do’s and don’ts.

Even the experts cannot agree.

The Statistics

In the US alone, 3500 babies die each year from sleep-related infant deaths, including Sudden Infant Death Syndrome (SIDS) and accidental suffocation in bed.

Most parents naturally want to sleep protectively near their babies. According to data co-sleeping in some form is on the increase. More than half of parents admit to bed-sharing with their baby, although not always intentionally. Many parents admit that they had not planned to bedshare with their baby but ended up doing so for several reasons, ease of breastfeeding, tiredness etc.

Data compiled by NPR (National Public Radio) suggests that a newborn has a 1 in 46 000 chance of death while sleeping in a crib in the parent's room. The same baby's risk increases to 1 in 16 400 when sleeping in a parent's bed.

Therefore, understanding baby co-sleeping safety is critical.

Co Sleeping Risk Chart

SIDS risk is calculated for a 2-month-old, female baby of European ancestry. The low-risk baby is of average birth weight and has a 30-year-old mother who does not smoke or drink. The high-risk baby is of low birth weight and has parents who smoke and a 21-year-old mother who has more than two alcoholic drinks regularly.

Cristina Spanò for NPR./Sources for statistics: BMJ Study On Bed-Sharing (SIDS); NOAA (lightning); CDC (drowning and car accident); NIH (peanut allergy)

Source: NPR

What Do The Experts Say?

American Academy of Pediatrics

The AAP recommends room-sharing without bed-sharing. However, they acknowledge that there are times when parents may fall asleep with their babies in bed. Therefore, to provide parents with bed-sharing safety guidelines they updated their Recommendations for a Safe Infant Sleeping Environment concerning co-sleeping in 2016.

In summary, they recommend:

  • Room-sharing without bed-sharing for at least for the first six months, ideally up to 12 months.
  • The use of a firm sleep surface, preferably a mattress placed in a safety-approved cot. Cover the mattress with a fitted sheet only. There should be no bedding, soft objects such as pillows or soft toys to reduce the risk of SIDS and suffocation.
  • Babies should always be put to sleep on their back for every sleep until the age of 1 year old.
  • Avoid smoke exposure and smoking during pregnancy and after birth. When a baby bed-shares with an adult that smokes even if they do not smoke in bed, the risk of SIDS is particularly high.
  • Avoid alcohol and illicit drug use during pregnancy and after birth. Parental alcohol or illegal drug use in combination with bed-sharing places babies at an increased risk of SIDS.  

The AAP recommendations to reduce the risk of SIDS and other sleep-related infant deaths, together with the full guidelines for bed-sharing, can be read on their website.

Professor James J. McKenna

The recommendations of the AAP contrasts with Professor James J. McKenna, who is the world's leading authority on mother-infant co-sleeping in relation to breastfeeding and SIDS. He believes that for breastfeeding mothers, bed-sharing makes breastfeeding much easier to manage. This increases the number of breastfeeding sessions whilst allowing mothers and infants to get more sleep.

He believes that bed-sharing can be made either safe or unsafe; however, couch or sofa co-sleeping is dangerous. When adults fall asleep on a couch or armchair with their baby, the baby can be pushed against the back of the sofa by the parent or end up face down in the pillows and suffocate. 

Professor James believes that bed-sharing will not be eradicated because it is biologically appropriate to sleep next to your baby. 

Professor Mckenna is not alone in his thinking with several organisations supporting bed-sharing. These organisations are The Academy of Breast Feeding Medicine, the USA Breast Feeding Committee, the Breast Feeding section of the American Academy of Pediatrics, La Leche League International, UNICEF and WHO.

Professor James McKenna has a book entitled Safe Infant Sleep: Expert Answers to Your Co-sleeping Questions

The book offers a range of options and safety tips for co-sleeping arrangements including variations of room-sharing and bed-sharing.

Professor James McKenna has written several articles on the subject of co-sleeping which you can read here.

Bed-sharing Safety

The reality is there is no scientific consensus on the potential benefits or risks of bed-sharing. There is, however, consensus on baby co-sleeping safety.

What experts do agree is there are certain factors and circumstances which increase the chances of SIDS or suffocation when bed-sharing either from someone in the bed or from the bedroom furniture itself.

DO NOT’s

  • Do not bedshare with your infant if you are inebriated or desensitised by drugs.
  • Do not bedshare with your infant if you are overly exhausted (this is a challenging one as a new mum is often exhausted). However, if you are too exhausted, you will not stir or wake as quickly putting your baby at increased risk.
  • Do not have other toddlers or children in the same bed as your infant.
  • Do not bedshare if you smoked during pregnancy or if you or your partner smoke even if you do not smoke in the bedroom. If you do smoke, place your infant alongside you on a different surface (bassinet or bedside sleeper) but not in the same bed.  
  • Do not place your infant on their stomach (prone position). 
  • Do not cover your infants head with a blanket or place them near or on top of pillows.
  • Do not bedshare with preterm infants (even full-term, normal-weight babies under four months of age are at increased risk of SIDS when bed-sharing).
  • Do not let your baby sleep next to the edge of the bed as they may fall off the bed and sustain injuries. 
  • Do not place pillows or any soft objects next to your baby to prevent them from falling off the bed. 
  • Do not go to sleep with your infant on a couch or armchair and never place your sleeping infant on a sofa to sleep alone. Armrests, cushions and softbacks can all-cause suffocation if your baby becomes entrapped or flips onto their face. 

DO’s

  • Use light blanketing in the bed and make sure that your baby is away from all bedding. 
  • Ensure that there are no spaces in the bedroom furniture where the baby can become wedged. If your bed is currently against a wall, it is best to move the bed into the middle of the room or place the mattress on the floor. 
  • If you fall asleep while feeding your infant, place them on their back immediately after you wake up.
  • Do make sure the mattress is firm.
  • Do make sure that bedding (pillows, blankets, etc.) do not cover your baby's face or your baby cannot become entangled in them.
  • Do only place your baby on the mattress directly. Do not place soft items such as a pillow underneath them.
  • Do place your baby to sleep beside you and not in between and your partner.
  • Do use an infant sleeping bag and not adult bedding.
  • Do remove teething necklaces before sleep.

Benefits and Risks of Co-sleeping (both bed-sharing and room-sharing)

Benefits of Co-sleeping 

  • Bed-sharing makes breastfeeding much easier to manage, which increases the number of breastfeeding sessions.
  • Parents often get more sleep.
  • Babies often get more sleep. When a baby needs to nurse in the night, and the Mum is right next to them, they can nurse and then soothe back to sleep before fully waking up.
  • Infants respond to maternal smells, movement and touch, which reduces infant crying, regulates infant breathing, body temperature and immune system, which appears to make babies happier. These infant responses are achieved, whether bed-sharing or room-sharing.
  • Co-sleeping can give parents more time with their babies, especially if they haven't seen them much during the day.
  • Sleeping in the same room (room-sharing not bed-sharing) reduces the risk of SIDS by as much as 50% [AAP].
  • No nighttime separation anxiety.
  • Fewer bedtime hassles.

Risks of Co-sleeping

  • Bed-sharing increases the risk of SIDS, and there are many benefits from room-sharing, which is considered entirely safe.
  • Bed-sharing can result in less sleep for parents. The critics' site that parents will not sleep as well with their baby sleeping right next to them, especially if they are concerned about rolling onto them. Also, babies are very noisy sleepers, and their constant noises may wake parents.
  • Bed-sharing can result in less sleep for babies. Supporters of bed-sharing say bed-sharing babies get more sleep; however, babies are light sleepers, and as they move through their sleep cycles they can cry out although they are not awake. The natural inclination for parents is to check on and comfort their baby, which could inadvertently wake them up.
  • Babies who bed-share may struggle to transition to a crib later on and will also have a more challenging time learning how to fall asleep independently and stay asleep.
  • Babies who sleep in their parents' bed may have more trouble transitioning to a crib and learning to fall asleep by themselves.
  • Less intimacy for parents. 

As I said at the beginning of this post, the decision to co-sleep (either bed-sharing or room-sharing) is very personal. The decision needs to be the one that is right for you, your baby and family.

Regardless of your final decision whether to bed-share, room-share or place your baby in their bedroom, preparation, understanding baby co-sleeping safety, the potential risks and implementing the safety recommendations is critical.

When I watch my baby sleep, my world is at peace

– Unknown

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