Safe Co-Sleeping With Infants

As you make your own decision about where and how your infant should sleep, here are some of the issues to be concerned with.

What constitutes a “safe sleep environment”?

Regardless of where an infant sleeps, safe infant sleep begins with the presence of an informed, breastfeeding, committed mother, or an informed and committed father. Infants should sleep on their backs, on clean, firm surfaces, in the absence of smoke, with light, comfortable blanketing. Their heads should never be covered. The bed should not have any stuffed animals or pillows around the infant. An infant should never be placed to sleep on top of a pillow.

Sheepskins or other fluffy material, and especially bean-bag mattresses, should never be used. Water beds can be dangerous, too. Mattresses should always tightly intersect the bed frame. Infants should never sleep on couches or sofas, with or without adults, because they can slip down (face first) into the crevice or get wedged against the back of a couch.

In regard to bed-sharing, it is important to be aware that adult beds were not designed to assure infants’ safety.

Bottle-feeding babies should always sleep alongside the mother on a separate surface rather than in the bed.

If bed-sharing, ideally, both parents should agree and feel comfortable with the decision. Each bed-sharer should agree that he or she is equally responsible for the infant and acknowledge that the infant is present. My feeling is that both parents should think of themselves as primary caregivers.

Infants a year or less should not sleep with other siblings, but always with a person who can take responsibility for the infant’s presence.

Persons on sedatives, medications or drugs, who are intoxicated or excessively unable to arouse, should not co-sleep on the same surface with the infant.

Excessively long hair on the mother should be tied up to prevent infant entanglement around the infant’s neck. (Yes, that has really happened.)

Extremely obese persons, who may not feel where or how close their infant is, exactly, may wish to have the infant sleep alongside but on a different surface.

It is important to realize that the physical and social conditions under which infant-parent co-sleeping occur, in all its diverse forms, can and will determine the risks or benefits of this behavior. What goes on in bed is what matters.

It may be important to consider a worst-case scenario. Just as babies can die from SIDS in a risk-free, solitary sleep environment, it remains possible for a baby to die in a risk-free co-sleeping/bed-sharing environment. Make sure, as much as possible, that if this happened, you would not assume that either you or your spouse would think that bed-sharing contributed to the death, or that one of you accidentally suffocated the infant.

Aside from never letting an infant sleep outside the presence of a committed adult—i.e., separate-surface co-sleeping, which is safe for all infants—I do not recommend to any parents any particular type of sleeping arrangement since I do not know the circumstances within which particular parents live. What I do recommend is to consider all of the possible choices and to become as informed as is possible, matching what you learn with what you think will work the best for you and your family.

—James J. McKenna, Ph.D.