The Co-Sleeping Controversy

By Jan Tedder, BSN, FNP, IBCLC; President of HUG Your BabySee Roadmap to Breastfeeding Success Online Course

One problem with this controversy is that the terms “bed-sharing” and “co-sleeping” are often interchanged. “Co-sleeping” means that the baby sleeps in close proximity to the mother—and either on the same surface, or not. “Bed-sharing” means that the baby sleeps on the same surface, and in the same bed, as the parent.

A 2013 study concluded that “infants who share a bed with their parents during the first three months of life increase their risk of SIDS by five times – even if the parents don’t smoke, don’t use alcohol, and are exclusively breastfeeding” (Carpenter et al., 2013). The American Academy of Pediatrics recommends “room-sharing” (AAP, 2011), as does the Canadian Public Health Agency (Public Health Agency of Canada, 2012). Both these professional groups conclude that it is safe for a mother to feed the baby in her bed and then return the baby to the baby’s bed for sleeping.

However, given the fact that the release of oxytocin increases relaxation and promotes sleepiness in a breastfeeding mother, it is not surprising that studies show that 45% (AAP, 2011) to 80% (Rigda et al., 2000) of mothers report falling asleep with their babies at some point. Another study confirms that mothers are hesitant to tell their health care provider that they do, in fact, choose to sleep with their baby, or that they sometimes fall asleep with their baby at night (Kendall-Tackett et al., 2010).

Given the complexity of the data on bed-sharing, co-sleeping and room sharing, it is not surprising that other leaders in lactation and pediatrics draw different conclusions from the SIDS and sleep-related death literature, and from the literature on breastfeeding and infant sleep.

Dr. William Sears (Sears, n.d.), Dr. Nils Bergman (Morgan, et al., 2011), Professor Helen Ball of the Parent-Infant Sleep Lab (Ball, 2011), the UK’s National Childbirth Trust (NCT, n.d.), the Australian Breastfeeding Association (ABA, n.d.), and Dr. James McKenna of the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratories (McKenna, 2014) all conclude that there are important benefits of co-sleeping and that parents should make their own decision based on all available facts.

These professionals believe that close proximity to the mother is critical to the early growth and development of babies and that this closeness boosts a baby’s immune system, helps a baby regulate her temperature, and promotes both ease of arousing to breastfeed and breastfeeding duration. In addition, these leaders cite studies that suggest mothers and babies sleep better together. Because they agree that breastfeeding offers protection against SIDS, they do not recommend co-sleeping for formula-fed babies. They also join the American Academy of Pediatrics in discouraging co-sleeping (AAP, 2011) . . .

   if the baby is exposed to smoking in the home;
   if the mother smoked prenatally;
   if the adult has consumed alcohol, illicit drugs, or sleep-inducing drugs;
   if the adult is experiencing extreme fatigue;
   if the adult is obese;
   if the bed is excessively soft, or contains pillows or loose blankets;
   if there is a possibility that the baby might over-heat;
   if the bed is also shared by a sibling or pet.
In addition, UNICEF discourages co-sleeping for babies born prematurely (UNICEF, n.d.).

Breastfeeding advocates may wish that expert guidelines were clearer and simpler. It would help us all if the sleep literature reached firm, universal conclusions that BOTH enhance breastfeeding initiation and duration, AND promote safe sleep. However, because the literature and recommendations are ambiguous and highly qualified, and vary from state to state and country to country (Blair, 2008), those who promote breastfeeding must stay aware of this controversial issue and provide a range of up-to-date resources to parents who are considering where their baby will sleep (UNICEF, n.d; NC Healthy Start Foundation, May, 2014; ABA, n.d).

AAP Task Force on SIDS. (2011). SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics. 128(5), e1341-1367.

Ball, H. (2011). Bed-sharing and co-sleeping: Research overview. Retrieved from

Blair, P. (2008). Putting co-sleeping into perspective. Journal de Pediatria. 84(2).

Carpenter, R., McGarvey, C., Mitchell, E., Tappin, D., Vennemann, M., Smuk, M. & Carpenter, J. (2013). Bed sharing when parents do not smoke: Is there a risk of SIDS? An individual level analysis of five major case-control studies. British Medical Journal 3(5).

Kendall-Tackett, K., Cong, Z. & Hale, T. (2010). Mother-infant sleep locations and nighttime feeding behavior. Clinical Lactation 1, 27-31.

Morgan, E., Horn, A. & Bergman, N. (2011). Should neonates sleep alone? Biological Psychiatry. 70(9), 817-825.

NC Healthy Start Foundation. (May, 2014). Infant Safe Sleep/SIDS. Retrieved from

NCT. (n.d.). Co-sleeping and bed-sharing. Retrieved from

Public Health Agency of Canada. (2012). Preventing sudden infant deaths in Canada. Retrieved from

Rigda, R., McMillen, I. & Buckley, P. (2000). Bed-sharing patterns in a cohort of Australian infants during the first six months after birth. Journal of Paediatric Child Health 36, 117-121.

UNICEF. (n.d.). Caring for your baby at night: A guide for parents. Retrieved from

By Jan Tedder, BSN, FNP, IBCLC 
©HUG Your Baby 2015