Is Co-Sleeping Healthy for a Child?

Dear Dr. Johnson: What is co-sleeping, and when it is it healthy or unhealthy for a child and the parent-child bond?

Dear Reader: Co-sleeping is the term most commonly used when an infant or child is sleeping in the same bed with parents. This also is referred to as bed-sharing or the family bed.

Since there are numerous products on the market also called “co-sleepers” that either function in the parents’ bed or next to the parents’ bed, I will use the term bed-sharing to avoid confusion. When parents ask me about bed-sharing, they are usually referring to their infants, so I will focus on this age.

The American Academy of Pediatrics published a policy statement in October 2011 on recommendations for a safe infant sleep environment. Since the prior policy statement, there has been a dramatic decrease in deaths attributed to Sudden Infant Death Syndrome (SIDS), but there has been an increase in other sleep-related deaths such as suffocation, asphysia and entrapment. The purpose of the updated policy statement was to address the environmental risk factors for all types of infant sleep-related deaths.

Since the introduction of the “Back to Sleep” campaign in 1992, most are aware that an infant should always be put on their back to sleep. It is also important to place an infant to sleep on a firm, flat surface with a snug-fitting sheet. No heavy blankets, stuffed animals, pillows or positioning wedges should be in the infant’s sleep environment.

Room-sharing, where the infant sleeps in the same room as his parents, is recommended. But bed-sharing is not.

While bed-sharing is promoted by many to increase the parent-child bond, studies have not shown that bed-sharing is protective against SIDS or suffocation. The American Academy of Pediatrics notes that it “does not recommend any specific bed-sharing situations as safe.”

The adult bed has many of the things we avoid in the infant bed: soft mattress, loose sheets, blankets and pillows. Infants are at risk for entrapment between the mattress and walls or furniture or even under sleep-deprived parents.

There also are other specific situations that can substantially increase the risk of SIDS or suffocation: bed-sharing with an infant less than 3 months old, bed-sharing with a current smoker, bed-sharing with someone who is excessively tired or is using medications or substances (i.e. alcohol) that could impair alertness, bed-sharing with someone who is not a parent (i.e. another child), or bed-sharing on a soft surface (i.e couch, chair, old mattress, waterbed).

The co-sleepers designed to go in the parents’ bed are not recommended by the American Academy of Pediatrics. The co-sleepers that go next to the bed are similar to bassinets but attach adjacent to the bed. This allows the infant to have their own safe environment while being close to parents. As long as they meet the above guidelines for SIDS reduction, these can be a good option.

Other things to reduce sleep-related deaths include regular prenatal care, breastfeeding, infant use of pacifier at naptime and bedtime, avoiding overheating, and avoiding smoke exposure during pregnancy and after birth.

Article featured in the Wisconsin State Journal on September 20, 2012

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