Safe Co-Sleeping, Safe Cribs

Widespread advice is to have your baby sleep in a bassinet or a crib and to never sleep with your baby. If you have your baby in a hospital, you are nearly guaranteed to leave for home armed with information on safe sleep. Unfortunately, this information nearly always fails to cover safe co-sleeping principles and simply states that you should never sleep with your baby. This is considered a public health measure because infant deaths while sharing sleep do occur. But in my opinion, the fact that these babies are dying highlights the need for better sleep safety education – education that includes how and when co-sleeping can be made safe and when it can’t. With accurate co-sleeping information, you will be able to know if, when, and how co-sleeping is a safe option in your family.

Sleep safety is non-negotiable. I’m 100% on board with that. But I also confidently believe that co-sleeping is often a safe option. Studies say that over 40% of American families co-sleep. This includes families who co-sleep intentionally throughout the night and families who spend part of the night in bed together or sleeping on the couch or in easy chairs. There are safety concerns for both solitary and shared sleep. I recommend that you must follow safe sleep guidelines 100% of the time. This article will cover how to do that for both solitary and shared sleep.

What is co-sleeping? Why would or wouldn’t you do it?

Co-sleeping is sharing a sleeping surface with your baby. A quick internet search will reveal in a moment that co-sleeping is a hot topic with very sensationalized views on both sides of the debate. Proponents will claim that co-sleeping regulates a baby’s biophysical homeostasis and that a baby needs this closeness in order to feel secure in the world. They may say that sleeping on their own impairs a baby’s ability to develop intimate relationships as an adult. Opponents of co-sleeping are very concerned about safety and the potential of suffocation in an adult bed. They also may believe that sleeping with your baby will create unhealthy dependency that will make them whiny, spoiled, and unable to confidently explore their independence. Both sides sometimes claim that the alternative sleep arrangement is a precursor to adult sleep conditions which are becoming epidemic in our society. And both sides assure parents that their preferred arrangement is best for the family! Co-sleepers see the family bed as a place of closeness for the entire family. They encourage parents to find creative and exciting alternative options for having sex. Opponents emphasize the parents relationship as the most important foundation of the family and value preserving the parental bed as a convenient space for sex.

Baby research hints at a basis for some of these beliefs, but both sides have carried the claims way too far. Here are some research-based findings about healthy full-term babies that are used as defense for sleep arrangement arguments. The first three findings are actually used in support of both sides! You will also note that some of the findings used in support of co-sleeping are not sleep-related, and therefore are an extrapolation. (Not all findings apply to sick or early babies.)

  • Babies sleep lighter when they sleep within arms reach, or closer, of a parent. They wake more frequently and spend less time in the brain wave pattern that is associated with deeper sleep. This lighter sleep state is protective against SIDS (Sudden Infant Death Syndrome), though the mechanism for the protective factor is unknown.
  • Having babies sleep on their back reduces SIDS.
  • The breathing rate, heart rate, temperature, and blood sugar levels of a newborn baby are more consistent when skin-to-skin with their parent.
  • Breastfeeding mother/baby pairs who co-sleep share sleep cycles, entering lighter and deeper sleep phases, and REM sleep, in sync.
  • Breastfeeding mothers who co-sleep report less fatigue than breastfeeding mothers who do not and formula feeding mothers, though they wake more frequently to interact with their babies.
  • Attachment is an important early developmental accomplishment and is facilitated by consistently responding to a baby’s cues such as crying, smiles and rooting.

Deciding on a Sleep Arrangement. So what is a parent to do?

Well, it’s not entirely up to you! Some babies come into the world with a strong drive towards one sleeping arrangement or the other. You can teach your baby to sleep on their own or to co-sleep, regardless of their instinctual preference, but the path to mastery is very different from one baby to another.

Some babies adjust to alternative sleep arrangements relatively easily, while other parents can spend a year or more fighting their baby’s sleep patterns/preferences, all-the-while getting very little sleep themselves. It is a recipe for disaster. Parents simply must be able to sleep in order to be healthy, which is so important for your family.

Determining the best sleeping arrangement for your family given your values, schedules, what is safe for you, and your baby’s temperament is a family-specific process. No one else can tell you, without getting to know you, how to sleep or approach sleep training. That being said, a good sleep consultant can be worth their weight in gold. They will first come to understand your current patterns and needs and then will also learn your baby’s temperament. Working with you, they will help you determine what arrangement is likely to be both safe and feasible for your family and then will teach you how to get there. They will also help with questions about how long to follow one sleep arrangement and at what age to transition to other arrangements. Advising on sleep decisions and training is beyond the scope of this article.

Co-Sleeping: Is is safe for our family?

Regardless of your choice – or your baby’s – there are a few things you must know. Co-sleeping body-to-body is not safe for every family, so it may not be an option. However, there are aids that make co-sleeping accessible to nearly every family. Statistically the safest arrangement for all families is room sharing, with baby and the parents each on their own surface, together in the same room. (“All families” refers to families without specific exceptions such as medical conditions, prematurity, or psycho-social complications.)

Do NOT co-sleep body-to-body:

  • If you are heavy enough to make an indentation in the bed that the baby can roll into, or if your body extends beyond your awareness. This is typically the case with a BMI > 30.
  • If you have a sleep disorder or know that you are an unusually deep sleeper.
  • If you sleepwalk.
  • If you are under the influence of any drugs (prescription, over-the-counter, or illicit) or alcohol.
  • If you smoke or are regularly exposed to second hand smoke.
  • If you are extremely exhausted. (Special note: if you are “resorting” to co-sleeping because it is the only way your baby will sleep and you have barely slept for days, stop now and call for help. Someone must come and hold the baby for you while you sleep a solid 10-12 hours (waking to breastfeed as necessary). Once you have caught up on some sleep you can establish safe co-sleeping.
  • If you are not breastfeeding.
  • If you are not the baby’s mother.

In these situations, you may be able to co-sleep with the use of a side-car co-sleeper that safely attaches to the side of the adult bed, or by creating a side car arrangement on the floor with a baby-safe mattress pad that can be secured to the side of your mattress, also placed on the floor. The baby sleeps on the side-car surface, always safely away from your body. Any crack between the side car and the adult bed must be stuffed so there is no surface your baby can roll into.

Another option is a nest with raised sides which can be placed in the adult bed at head level and away from all pillows.

If co-sleeping is safe for your family, either body-to-body or with the use of a side car or nest, you must also be sure the environment is safe for your baby.

A Safe Co-Sleeping Environment

It's important to think about what factors create a safe co-sleeping environment.
It’s important to think about what factors create a safe co-sleeping environment.
  • Never sleep with your baby on a couch or in an easy chair. There are too many surfaces where the baby can become trapped between you and the sofa, or fall to the floor. You can lose awareness of your baby during sleep. Always sleep on a flat firm surface where you baby will be safe if they roll.
  • No extra pillows, blankets, stuffed animals or anything soft or fluffy. Blankets in use should be cotton and not used near the baby. If you are lying beside your baby, wear warm clothes and keep blankets away from you and the baby. It is okay to have a pillow under your head but not near the baby.
  • Pillow-top mattress pads and water beds are too soft for your baby. Your sleeping surface should be firm.
  • Be sure there are no strings within reach of the baby. Common strings are: the cords on mini-blinds, cords to lamps or alarm clocks, ties longer than 6 inches on mother’s night shirt, and long hair that is not secured in a braid.
  • All cracks must be stuffed so there is nowhere a baby could roll between two surfaces. Common places for cracks are between the bed and the wall or a safety rail, between the mattress and headboard or footboard, and between side car co-sleepers and the adult bed. Babies 0-3 months old are at the highest risk for entrapment.
  • Baby must not be able to roll out of bed. Place your bed next to a wall or use a safety rail along the side of the bed. Headboards and foot boards must not have gaps greater than 2 inches between rails.
  • Keep it cool. Room temperature should be 65-70 degrees F. Your baby can be dressed in a simple sleeper with an arms free sleep sack rather than a blanket. Some professionals recommend not swaddling the arms when baby’s co-sleep.

Positioning for Safe Co-Sleeping

  • Baby may be at arms reach in a side car co-sleeper, or within a nest with side rails placed at head level. In these arrangements,  baby may be between two parents or by either parent. Other children and pets may not be in the bed.
  • Baby should sleep on their back. Side and belly sleeping is not advised.
  • Body-to-body sleeping is only safe for breastfeeding mothers and babies. Baby should be placed between the mother and the side of the bed, not between parents. When cuddling close, baby is usually placed in a protective place between mothers arm and bent knees while mother is lying on her side.

Safety for Solitary Sleep

  • Babies should sleep in their parents room until they are 6 months old. Room sharing further reduces the rate of SIDS.
  • Anytime babies are sleeping alone they should be in a safety approved bassinet or crib. Approved items will indicate age and weight requirements that protect against falls, and will be free of gaps where the baby could become entrapped.
  • All additional tips for a safe co-sleeping environment must be followed as well, such as no soft things in the bed and no strings near the baby.

More Information Please. Let me See the Science

I am well aware that the sleep safety advice I have shared in this article is different than the advice shared in many doctor’s offices and hospitals. The American Academy of Pediatrics is a great place to read more about sleep safety research. This is a good study to start with. You can also find information from university researchers such as James McKenna at the Mother-Baby Sleep Laboratory at the University of Notre Dame, and on government sites such as the National Institute of Child Health and Human Development. Check sources carefully and avoid sites sponsored by the American Crib Association or popular media sources. Fears around sleep safety are often exploited and inaccurate information is widespread.

Why not just stick with the simple advice such as “never sleep with your baby”?

This section is mostly for the health professionals out there who are uncomfortable with this article.

I believe we need a safe co-sleeping campaign. I envision posters and brochures that share “safety when they sleep alone / safety when they sleep with you” information for all parents. We need to acknowledge that over 40% of families are co-sleeping. Some of them are co-sleeping because of its benefits, and many of those families have independently researched safe co-sleeping. However, many co-sleeping families do it because there comes a day when no one has slept well for weeks and they are just exhausted. Their baby cries all night unless they are held. Eventually, they talk to a friend or relative who tells them that they slept with their baby. They feel torn between safety and real needs for sleep, and when they learn that other families they respect gave up on the safety measure too, they “give in.”

I believe that if these families were empowered with information about who can co-sleep and who can’t and how to do it safely, they may be able to recognize when that friendly advice is safe for their family too, and when it isn’t. We also may be able to prevent the wide spread unsafe practice of sleeping on couches and easy chairs. Many parents do this because they are too afraid to bring their baby to bed, thinking it is unsafe. They reason that on the couch at least they aren’t “sleeping with the baby.” We could also prevent accidents that happen when people sleep with the baby only when they are too exhausted.

Black and white blanket statements like, “never sleep with your baby,” are similar to preaching abstinence over safe-sex. It just doesn’t work. There are also very real benefits to co-sleeping, such as the benefits of room sharing and increased breastfeeding rates and duration.

I understand that there are a lot of details to safe sleep, and sleep safety is impacted by many social and socioeconomic factors. I understand that simple health messages are often best for public health campaigns, but in the case of sleep safety they are falling short. We may not be able to stop the terrible situations we witness where drug abuse and poverty endanger babies, but I believe we can further reduce SIDS and other accidental sleep-related death with a new and better campaign.

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