Understanding the Risks of Bed Sharing: A Doctor's Perspective

Bed sharing between parents and their newborns is a topic that has long sparked debate among healthcare professionals, researchers, and parents. Advocates argue that it fosters bonding, facilitates breastfeeding, and improves sleep for both the baby and the parent. However, opponents emphasize the risks, particularly Sudden Infant Death Syndrome (SIDS), suffocation, and other hazards. So, is bed sharing with a baby safe?

Understanding Bed Sharing: What It Means

Bed sharing, also known as co-sleeping, refers to parents and their infant sleeping together on the same sleep surface, typically a bed. This practice can be intentional or unintentional, and it can occur in different ways. For instance, some parents place their child in bed every night, while others may fall asleep with their child during breastfeeding or comforting.

There’s a distinct difference between bed sharing and room sharing, which is often confused. Room sharing involves the baby sleeping in the same room as the parents but on a separate sleep surface, such as a crib or bassinet. Room sharing is recommended by many health organizations, as it has been shown to reduce the risk of SIDS without the risks associated with bed sharing.

Cultural Perspectives on Bed Sharing

Globally, bed sharing is a common practice in many cultures, particularly in parts of Asia, Africa, and Latin America. Historically, families would sleep together in one bed or room, and the practice continues to this day in several non-Western societies. Proponents of bed sharing argue that it supports emotional security, enhances bonding, and makes nighttime care more convenient, particularly for breastfeeding mothers.

In Western cultures, especially in the United States and parts of Europe, the idea of bed sharing has traditionally been discouraged by many health authorities. Here, parents are typically encouraged to place babies in separate sleep spaces designed for infants, like cribs. Nonetheless, a significant number of Western families still practice bed sharing, whether intentionally or due to circumstances such as night feeding or soothing.

The Science: Risks of Bed Sharing

The conversation surrounding bed sharing cannot be separated from the risks it poses, particularly to infants under 12 months of age. The most significant risk associated with bed sharing is Sudden Infant Death Syndrome (SIDS), a sudden, unexplained death of an otherwise healthy baby under one year of age, often during sleep.

Sudden Infant Death Syndrome (SIDS)

SIDS is a leading cause of death in infants between 1 month and 12 months of age. While the exact cause of SIDS is not fully understood, research indicates that certain sleep environments can significantly increase the risk, and bed sharing is one of them. A study published in The Journal of Pediatrics indicated that bed sharing was associated with a five-fold increase in the risk of SIDS, particularly in babies younger than 4 months.

Factors That Increase SIDS Risk with Bed Sharing:

1. Soft Bedding: Parents’ beds are typically not designed to be safe for infants. Soft mattresses, pillows, blankets, and comforters can increase the risk of suffocation or entrapment.
2. Overheating: Babies are at higher risk of overheating while bed sharing due to sharing body heat, particularly if they are covered with heavy blankets.
3. Parental Factors: Bed sharing is particularly dangerous when one or both parents smoke, drink alcohol, or take sedating medications, all of which can impair the parent’s ability to wake up if something goes wrong.
4. Premature or Low Birth Weight Infants: Babies who are born prematurely or with low birth weight are at a greater risk of SIDS, and bed sharing can exacerbate this risk.

Suffocation and Entrapment

Beyond SIDS, bed sharing increases the risk of accidental suffocation and entrapment. A baby can become trapped between the mattress and the bed frame or wall, or under pillows and blankets. Babies can also roll into positions where their airways are blocked. Even parents rolling over onto their baby, though rare, is a known risk.

The U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) have both issued strong warnings against bed sharing due to these risks.

The American Academy of Pediatrics’ Safe Sleep Guidelines

The AAP recommends that babies should sleep in the same room as their parents, but on a separate sleep surface for at least the first six months of life, and ideally for the first year. This practice, known as room sharing, has been shown to reduce the risk of SIDS by up to 50% while eliminating many of the risks associated with bed sharing.

The AAP’s safe sleep recommendations include:

• Placing babies on their backs to sleep.
• Using a firm sleep surface, such as a crib mattress covered with a fitted sheet.
• Keeping the sleep area free from soft objects, including pillows, blankets, and stuffed animals.
• Avoiding overheating or covering the baby’s head during sleep.

The Case for Bed Sharing: Why Some Parents Choose It

Despite the well-publicized risks, many parents choose to bed share with their infants, either intentionally or due to circumstances. Research has found that up to 60% of parents have shared a bed with their baby at some point, and around 24% do so regularly.

Bonding and Emotional Security

One of the most common reasons parents choose to bed share is the emotional closeness it provides. The ability to bond closely with their baby during the night can be comforting for both parents and the baby. Bed sharing allows for more physical contact, which can promote emotional attachment and a sense of security for the infant.

Breastfeeding Benefits

Mothers who breastfeed are more likely to bed share, and for good reason. Bed sharing can make nighttime breastfeeding more convenient, allowing mothers to nurse their baby without getting out of bed. Breastfeeding itself is associated with a reduced risk of SIDS, and some research suggests that frequent breastfeeding facilitated by bed sharing may help regulate a baby’s breathing patterns, heart rate, and body temperature.

Sleep and Convenience

Parents often find bed sharing makes nighttime care easier, especially for newborns who wake frequently. Rather than having to get up and go to another room or sleep space, parents can attend to their baby’s needs more quickly, which can result in more rest for both the baby and the parents.

Safe Bed Sharing: Is It Possible?

Given the risks, many health professionals outright discourage bed sharing, but some parents feel the benefits outweigh the risks. For families who choose to bed share, there are guidelines that can help reduce — though not eliminate — the risks.

Guidelines for Safer Bed Sharing:

1. Choose a firm mattress: The bed should be free of soft bedding, pillows, or other items that could cause suffocation.
2. Keep the baby on their back: Always place the baby on their back to sleep, which is the safest position for reducing SIDS risk.
3. Use a large, safe sleep space: Ensure the baby has enough room to move and avoid entrapment between the mattress and bed frame or wall.
4. Do not share a bed with smokers: Parents who smoke, even outside of the bedroom, should not bed share, as exposure to second-hand smoke increases the risk of SIDS.
5. Avoid alcohol and sedatives: Parents should not bed share if they have consumed alcohol or medications that make them less aware of their baby’s presence.
6. Breastfeed safely: If bed sharing to facilitate breastfeeding, ensure that the baby is in a safe sleeping position afterward.

Alternative Options: Bedside Sleepers

For parents who want the convenience of bed sharing without the risks, bedside sleepers offer a safe alternative. These devices attach to the side of the bed, allowing the baby to be close to the parents but on a separate sleep surface.

Conclusion: Is Bed Sharing Safe?

The safety of bed sharing depends on many factors, including the baby’s age, the sleep environment, and the behavior of the parents. While bed sharing can promote bonding and breastfeeding, it also comes with significant risks, particularly the increased chance of SIDS, suffocation, and entrapment. The consensus among leading health organizations like the American Academy of Pediatrics is that bed sharing should be avoided, especially in the first year of life.

For parents who choose to bed share, following safe sleep guidelines can reduce, though not eliminate, the risks. However, the safest option is room sharing, where the baby sleeps in the same room as the parents but on a separate sleep surface.

Ultimately, the decision to bed share is a personal one, but it should be informed by a thorough understanding of the risks and benefits.