The practice of cosleeping, or parents sharing a bed with their infant, is controversial in the United States. Supporters of cosleeping believe that a parent's bed is just where an infant belongs. But is it safe?

Why Do Some People Choose to Cosleep?

Cosleeping supporters believe — and some studies support their beliefs — that cosleeping:

• encourages breastfeeding by making nighttime breastfeeding more convenient
• makes it easier for a nursing mother to get her sleep cycle in sync with her baby's
• helps babies fall asleep more easily, especially during their first few months and when they wake up in the middle of the night
• helps babies get more nighttime sleep (because they awaken more frequently with shorter duration of feeds, which can add up to a greater amount of sleep throughout the night)
• helps parents who are separated from their babies during the day regain the closeness with their infant that they feel they missed

But do the risks of cosleeping outweigh the benefits?

Is Cosleeping Safe?

Despite the possible pros, the U.S. Consumer Product Safety Commission (CPSC) warns parents not to place their infants to sleep in adult beds, stating that the practice puts babies at risk of suffocation and strangulation. The American Academy of Pediatrics (AAP) recommends the practice of room-sharing with parents without bed-sharing. The practice of room-sharing according to the AAP is a way to reduce the risk of sudden infant death syndrome (SIDS).

Cosleeping is a widespread practice in many non-Western cultures. However, differences in mattresses, bedding, and other cultural practices may account for the lower risk in these countries as compared with the United States.

According to the CPSC, at least 515 deaths were linked to infants and toddlers under 2 years of age sleeping in adult beds from January 1990 to December 1997:

• 121 of the deaths were attributed to a parent, caregiver, or sibling rolling on top of or against a baby while sleeping
• more than 75% of the deaths involved infants younger than 3 months old

Cosleeping advocates say it isn't inherently dangerous and that the CPSC went too far in recommending that parents never sleep with children under 2 years of age. Supporters of cosleeping feel that parents won't roll over onto a baby because they're conscious of the baby's presence — even during sleep.

Those who should not cosleep with an infant, however, include:

• other children — particularly toddlers — because they might not be aware of the baby's presence
• parents who are under the influence of alcohol or any drug because that could diminish their awareness of the baby
• parents who smoke because the risk of SIDS is greater

What About SIDS?

But can cosleeping cause SIDS? The connection between cosleeping and SIDS is unclear and research is ongoing. Some cosleeping researchers have suggested that it can reduce the risk of SIDS because cosleeping parents and babies tend to wake up more often throughout the night.

However, the AAP reports that some studies suggest that, under certain conditions, cosleeping may increase the risk of SIDS, especially cosleeping environments involving mothers who smoke.

CPSC also reported more than 100 infant deaths between January 1999 and December 2001 attributable to hidden hazards for babies on adult beds, including:

• suffocation when an infant gets trapped or wedged between a mattress and headboard, wall, or other object
• suffocation resulting from a baby being face-down on a waterbed, a regular mattress, or on soft bedding such as pillows, blankets, or quilts
• strangulation in a bed frame that allows part of an infant's body to pass through an area while trapping the baby's head

In addition to the potential safety risks, sharing a bed with a baby can sometimes prevent parents from getting a good night's sleep. And infants who cosleep can learn to associate sleep with being close to a parent in the parent's bed, which may become a problem at naptime or when the infant needs to go to sleep before the parent is ready.

Making Cosleeping as Safe as Possible

If you do choose to share your bed with your baby, make sure to follow these precautions:

• Always place your baby on his or her back to sleep to reduce the risk of SIDS.
  
• Always leave your child's head uncovered while sleeping.
• Make sure your bed's headboard and footboard don't have openings or cutouts that could trap your baby's head.
  
• Make sure your mattress fits snugly in the bed frame so that your baby won't become trapped in between the frame and the mattress.
  
• Don't place a baby to sleep in an adult bed alone.
  
• Do not place a baby on a soft surface to sleep such as a soft mattress, sofa, or waterbed.
  
• Don't use pillows, comforters, quilts, and other soft or plush items on the bed. Consider using a sleeper instead of blankets.
  
• Don't drink alcohol or use medications or drugs that could keep you from waking or might cause you to roll over onto, and therefore suffocate, your baby.
  
• Don't place your bed near draperies or blinds where your child could be strangled by cords.

Transitioning Out of the Parent's Bed

Most medical experts say the safest place to put an infant to sleep is in a crib that meets current standards and has no soft bedding.

If you've been cosleeping with your little one and would like to stop, talk to your doctor about making a plan for when your baby will sleep in a crib. Transitioning to the crib by 6 months is usually easier — for both parents and baby — before the cosleeping habit is ingrained and other developmental issues (such as separation anxiety) come into play.

Eventually, though, the cosleeping routine will be broken at some point, either naturally because the child wants to or by the parents' choice.

You can still keep your little one close by, just not in your bed. You could:

• Put a bassinet, play yard, or crib next to your bed. This can help you maintain that desired closeness, which can be especially important if you're breastfeeding. And the AAP says that having an infant sleep in a separate crib, bassinet, or play yard in the same room as the mother reduces the risk of SIDS.
• Buy a device that looks like a bassinet or play yard minus one side, which attaches to your bed to allow you to be next to each other while eliminating the possibility of rolling over onto your infant.

Of course, where your child sleeps — whether it's in your bed or a crib — is a personal decision. As you're weighing the pros and cons, talk to your child's doctor about the risks, possible personal benefits, and your family's preferred arrangements.

Reviewed by: Yamini Durani, MD
Date reviewed: October 2011