My second baby slept in bed with me, all night, every night, from the time we took her home from the hospital until she was 3 months old. At first, I was almost too terrified to fall asleep, for fear that I would roll over and suffocate her.
After all, nearly all major medical organizations warn against bedsharing, on the grounds that it increases the chances of Sudden Infant Death Syndrome (SIDS).
“The safest place for your baby to sleep is in the room where you sleep, but not in your bed. Place the baby’s crib or bassinet near your bed (within arm’s reach). This makes it easier to breastfeed and to bond with your baby,” according the The American Academy of Pediatrics.
Statements like these sound definitive. But, in fact, considerable scientific controversy surrounds the role of bedsharing in SIDS.
Prominent researchers like James McKenna, for example, advocate bedsharing as a way to make breastfeeding easier on mothers. McKenna claims that bedsharing in the absence of other hazards, a practice he terms “breastsleeping”, does not increase the risk of SIDS, and makes it easier for women to maintain their milk supply and to practice extended breastfeeding.
No one disputes that bedsharing is unsafe under the following circumstances:
- if the mother smokes, drinks heavily, or abuses other drugs
- if the baby was born with a low birth weight or prematurely
- if the baby is co-sleeping with someone on a chair or couch, or with a sibling
- if the baby is bottle-fed instead of breastfed
Instead, the debate boils down to two questions:
- Whether bedsharing is always unsafe, or only unsafe when other risk factors for SIDS–like alcohol or drug abuse, smoking, and bottle feeding–are present.
- Whether bedsharing is unsafe on normal sleep surfaces, like a mattress, or only on other surfaces, like sofas and rocking chairs.
Here’s my take on the evidence, and why I ultimately felt comfortable sharing my bed with my daughter.
1. When no other major risk factors for SIDs are present, the absolute risk while bedsharing is very low.
In 2006, a large review of SIDS research found that bedsharing was clearly dangerous if the baby’s mother smoked, drank excessively, or abused drugs; whether bedsharing raised the risk of SIDs when these other factors were not present was unclear. It seemed possible that bedsharing might be risky for very young infants, under 8 weeks of age.
Following up on this review, in 2013, Robert Carpenter of the London School of Medical Statistics led a meta-analysis of 5 case-control studies.
(Because randomized controlled trials are infeasible for something like SIDS, researchers must rely on observational and case-control studies. Case-control studies typically interview parents to compare the circumstances and characteristics of infants who died from SIDS (cases) with those of similar infants who did not die from SIDS (controls). Factors found more often, statistically, among cases than controls are assumed to influence the risk of SIDS)
Carpenter’s goal was to assess the independent risk associated with bedsharing–whether bedsharing increased the chances of SIDS even under “ideal” circumstances: a baby sleeping next to only a breastfeeding mother who does not smoke, drink, or abuse drugs.
For infants under 3 months of age, Carpenter found a 5-fold increase in relative risk for bedsharing, even under “ideal” circumstances, when compared to sharing only a room. Despite the increase in relative risk, the absolute risk of SIDS for this population remained very low: roughly 2 out of 10,000, a rate substantially lower than the 9 out of a 10,000 for the US as a whole.
2. But for infants 3 months and older, case-control studies find no increased risk of SIDS, in the absence of other risk factors. Carpenter found no evidence that bedsharing alone raised the risk of SIDS after the age of 3 months. An additional 2014 meta-analysis of 2 case-control studies, led by Peter Blair, actually found a reduced risk of SIDS for infants older than 3 months who shared a bed with their mothers.
Why was Blair’s meta-analysis one of the few to find a significantly reduced risk for older infants? Perhaps because his was one of the few studies to carefully distinguish co-sleeping on a mattress from co-sleeping a sofa or chair. This matters because co-sleeping on sofas and chairs is a large and undisputed risk factor for SIDS. Co-sleeping on a couch or chair raised the odds of SIDs 18-fold, in Blair’s research.
(Blair also found no statistical increase in risk for infants younger than 3 months. But, the there was a trend towards a higher risk, which approached statistical significance. Considering this fact, and that numerous studies find that bedsharing with very young infants, especially before 8 weeks, slightly increases the risk of SIDS, I am inclined to chalk up this null finding to inadequate statistical power.)
3. Bedsharing, on its own, has far less of an impact than other risk factors for SIDS. Surprising, isn’t it? Considering that not bedsharing, along with putting your baby to sleep on its back, is the focus of so much SIDS advice given to parents. But bedsharing on its own is in fact far less risky than stomach sleeping or having the misfortune of being the third child, and only slightly more risky than having your baby sleep in a separate room. And how often are we parents warned against having our babies sleep in a separate room?
But let me stress again that bedsharing significantly heighten the risk of SIDS when other dangers are present, like maternal smoking, alcohol or drug abuse, prematurity or low birth weight, and bottle feeding. Bedsharing with a mom who smokes is far worse than just the combined risk of having a mom who smokes and having a mom who bedshares. Bedsharing makes having a mom who smokes or abuses drugs many times more risky than it would be otherwise.
This makes sense. Sleeping next to an impaired adult who could easily roll over on a baby is extremely dangerous. No one who smokes, abuses drugs or alcohol, or who does not breastfeed should ever share a bed with a baby.
Some Concluding Thoughts…
Bedsharing worked for me, but is clearly not for everyone. Not everyone can sleep comfortably with their baby, and, as many mothers report, infants who share a bed may wake up more often than infants who sleep in a crib.
For me, the decision came down to a potential slight increase in the risk of SIDS in the early months versus the collateral risks of severe sleep deprivation.
When my first child, a boy, was a newborn, I did not bedshare. During those early months, I could barely perform even the most routine tasks, like going to the grocery store or holding up my end of a casual conversation. Every time I drove a car, I felt like I was putting my life–and the lives of everyone else on the road–at risk.
As out of it as I was, I constantly worried that I would trip and fall while carrying my son, or fall asleep while holding him on a sofa or chair–a huge risk factor for SIDS.
So, with my second child, a girl, I bedshared from the day I brought her home from the hospital. Bedsharing while she was a newborn kept me sane and comparatively–very low expectations here–well-rested.
When my newborn daughter woke up in the middle of the night for the umpteenth time, I just rolled over, latched her on, and fell back asleep. This was so much easier than having to wake up fully, stand up, pick her up from her crib, struggle stay awake until she was done breastfeeding, and then put her back down in her crib–assuming that all this movement did not startle her back awake.
By planning to bedshare–as opposed to bedsharing haphazardly, sometimes unintentionally, and frequently out of sheer desperation–I was able to follow the best guidelines on making our sleep environment as safe as possible. I removed all blankets and extra pillows, and had no one but me with my daughter in the bed.
Given the evidence, do I think I slightly increased my daughter’s chances of SIDS? Perhaps. But sometimes when we try to reduce the risk of a rare but horrible outcome like SIDS to zero, we unintentionally raise the risk of others, such as severe sleep deprivation, postpartum depression, and car accidents.
After all, life is risky. Crossing the street is risky. Riding a bike is risky. Getting in a car is risky. Yet, I plan on my children doing every one of those things, often.
As parents, we have to weigh the risks and benefits of every decision. This is why, as parents, we need to understand the actual risks involved in the choices we make for our children.
“I removed all blankets and extra pillows, and had no one but me with my daughter in the bed.”
So does having both parents in the bed increase the risk of SIDS?
Yes, it is better for only a breastfeeding mother to sleep next to her baby. Breastfeeding seems to make women more attuned to their baby’s position. Breastfeeding women also appear to wake up more easily.
Practical question.. We had poo explosions so often overnight! No brand of nappies seemed to make a difference.. In those early days we included a nappy change with the middle of the night feeds.. Which makes co-sleeping a lot less attractive haha.. let alone the fact I didn’t sleep better the few times we did co-sleep.. Was that ever a problem for you?
Oh yes, blowouts are the worst! I double diapered my daughter, with a nighttime diaper inside and another bigger size nighttime diaper on the outside, and would change only if having a wet or dirty diaper would wake her up. I coated her entire bottom with diaper cream before bedtime so her bottom would not get irritated. Poo would wake her up, so she was not sitting in it, but pee would not.
Curious if there is any research around the whole “back is best” movement? Our son only slept on his tummy so I finally gave in. But I always wondered if sids was a risk. (When all other risk factors like blankets were removed)
There is a lot of research on the back is best movement. Stomach sleeping is linked with a 13-20 fold higher risk of SIDS in studies, and since the widespread recommendation to place babies to sleep only on their backs, SIDS rates have declined by more than 50%.
As with co-sleeping, separating that the risk of back sleeping from other risk factors is very hard–many SIDS deaths have multiple risk factors, and we cannot do the kind of careful randomized trials needed to really tease out the effects of a single risk factor.
That said, I totally understand how difficult it can be to force your child to sleep in one position once they can roll over. My daughter insisted on rolling over to her tummy by 3 months. Initially I was very worried, because she could not yet roll from tummy to back, and I would wake up multiple times a night to check on her. But she was fine, and everything I’ve read says that once they can roll over, you do not need to force them to back sleep.
My husband and I co-slept with all three of our children from birth until close to two years of age. We began with the first out of desperation because he kept waking up when we tried to transfer him to the crib after I nursed him. We quickly discovered that he slept better and I slept better co-sleeping. I slept without a pillow and slept with my face next to my baby. My husband and I trained ourselves to never have any bedding pulled up past our waists. I often woke up enough to breastfeed without even being aware that I was doing it and often my baby would only begin to rouse before I started nursing him. He only cried when he had a dirty diaper. It worked very well and we were more than satisfied with the arrangement as we all got much better restorative sleep. As my mother pointed out when we mentioned what we were doing, babies have been sleeping with their parents in the family bed for thousands of years. We did have a crib, so when my husband and I wanted to be intimate, I nursed the baby, waited for him to fall asleep and then waited until he slept through the “pick up his arm and drop it” test before transferring him; then when he next roused I put him back in our bed. I don’t know how I would have survived parenting an infant, a two-year-old and a four-year-old without co-sleeping.
I mean curious what exclusively breastfeeding on demand does to the sids risk? I’m also curious what you think of the McKenna research regarding the oxygen/carbon dioxide feedback loop that he therorizes keeps babies breathing and from dying of SIDS? Thnx for your informative blog!
Thank you for this detailed, thoughtful response. I just wanted to note that I did not solely rely on McKenna’s research for this post. Instead I looked at the recent meta analyses of SIDS case control studies. These show either a small increase in risk for bedsharing during the first three months only or no increase in risk. Whether cosleeping helps you breastfeed is no doubt highly personal. It helped me. It may not help everyone.
Co sleeping does not increase the risk of SIDS. Please do more research. SIDS is “sudden infant death syndrome” it is NOT suffocation by person or object! Yes, there is increased risks associated with co sleeping for parents who bottle feed or drink alcohol, that is, there is increased risk of being less aware and not easily awoken and therefore rolling over on your baby. Suffocating your baby is not a baby dying of SIDS it is a baby dying of suffocation under a parent.
Hi Liz, This depends on the coroner. Some coroners record all unexpected cosleeping deaths as SIDS, others distinguish suffocation from true SIDS. And some will record any shared sleeping surface death as suffocation. Since the true causes of SIDS are unknown, it’s hard to say whether some of these are misclassified.