Co-Sleeping and Bed-Sharing Safely

Four words that get used interchangeably

The Lullaby Trust separates them, and the distinction runs through everything below.

• Room sharing: the baby sleeps in the same room as their parent or carer, in their own separate sleep space such as a cot or Moses basket.
• Bed sharing: the baby shares the bed with an adult for most of the night including for sleep, not just to be comforted or fed.
• Sofa sharing: a parent or carer sleeps on a sofa or armchair with a baby.
• Co-sleeping: the umbrella term — parents or carers sleeping with a baby on a bed, sofa or chair.

Room sharing is recommended everywhere for at least six months. Bed sharing is where the guidance splits. Sofa sharing is where nobody splits at all.

The American position

The AAP is unambiguous, and its wording leaves no room for a safer version: "Based on the evidence, the AAP doesn't recommend bed sharing with your baby under any circumstances. This includes twins and other multiples." Its instruction if you bring your baby into bed is to put them in their own sleep space before you go to sleep, and it recommends room sharing instead, which it says "can decrease the risk of SIDS by as much as 50%".

It also publishes the relative risks that inform that position. Sleep-related infant death risk is "more than 10 times higher for babies who bed share with someone who is fatigued or has taken medications that make it harder for them to wake up or has used substances such as alcohol or drugs". It is "5 to 10 times higher when your baby is younger than 4 months", and "2 to 5 times higher when your baby was born preterm or with low birth weight".

The UK and Irish position

UK guidance does not tell parents never to bed-share. It sets out safer practice and then names the circumstances in which it should not happen at all. NICE's postnatal care guideline NG194 puts this in two numbered recommendations. Recommendation 1.3.14 asks clinicians to "discuss with parents safer practices for bed sharing", including making sure the baby sleeps on a firm, flat mattress lying face up rather than face down or on their side; not sleeping on a sofa or chair with the baby; not having pillows or duvets near the baby; and not having other children or pets in the bed.

Recommendation 1.3.15 sets the exclusions: "Strongly advise parents not to share a bed with their baby if their baby was low birth weight or if either parent has had 2 or more units of alcohol, smokes, has taken medicine that causes drowsiness, or has used recreational drugs."

The Lullaby Trust takes the same approach and explains the reasoning behind it: the safest place is a separate sleep space, "but many parents find themselves co-sleeping whether they mean to or they fall asleep together unintentionally", and so "wherever you're planning for your baby to sleep, we recommend making your bed as safe as possible for your baby." UNICEF UK's Baby Friendly Initiative publishes the parent leaflet that carries this approach into practice, Caring for Your Baby at Night and When Sleeping, which is endorsed by the Lullaby Trust, the Baby Sleep Info Source, the Royal College of Midwives and the Institute of Health Visiting.

And Australia

Red Nose Australia lands between the two: "The safest place for a baby is in their own safe sleep space. Red Nose does not recommend co-sleeping. However, if you do co-sleep, it is important for you to know the safest way to do it."

When bed-sharing is never safe

Here the guidance converges almost word for word. The Lullaby Trust says co-sleeping is "very dangerous if":

• "You or anyone in the bed has recently drunk any alcohol." NICE sets the threshold at 2 or more units.
• "You or anyone in the bed smokes or the baby was exposed to smoking in pregnancy." Red Nose adds: even if you do not smoke in the bedroom.
• "You or anyone in the bed has taken any drugs or medication that make you feel sleepy."
• "Your baby was born prematurely (before 37 weeks of pregnancy) or weighed under 2.5kg or 5.5 pounds when they were born."

Red Nose adds two more circumstances: when you are overly tired or unwell. In any of these, the Lullaby Trust's instruction is to use a separate sleep space, and it offers the practical fix — keeping the cot or Moses basket next to your bed makes that easier at 3am.

The one thing nobody disagrees about

Sofas and armchairs. The Lullaby Trust: "Never fall asleep on a sofa or armchair with your baby as it significantly increases their risk of SIDS." The AAP quantifies it at up to 67 times higher. NICE lists it in its safer-practices recommendation. Red Nose calls it "extremely dangerous and not recommended under any circumstances", and extends it to chest-sleeping: falling asleep lying down or semi-reclined with your baby on your chest "places baby face down, which is the same as sleeping them on their tummy".

This is why the UK risk-minimisation approach exists. A parent who is determined not to bed-share and ends up asleep on the sofa at 4am has moved to the more dangerous option, not the safer one.

If you do bed-share, what makes it safer

The Lullaby Trust's list, with Red Nose's additions where they go further. Baby on their back on a firm, flat mattress. Keep pillows and adult bedding away from your baby, along with belts and cords — the Lullaby Trust notes that many babies who die of SIDS are found with their head covered by loose bedding. Keep adult bedding at your waist height and wear an extra layer yourself. Use a well-fitted baby sleeping bag so your baby has their own bedding, and do not swaddle a baby in bed. Remove slatted or decorated headboards. Check your baby cannot fall out or become trapped between the mattress and the wall. No other children and no pets in the bed. Never leave your baby alone in an adult bed.

Red Nose adds: place the baby to the side of one parent rather than between two adults or next to other children; tie up long hair and remove jewellery, teething necklaces and dummy chains; move the bed away from the wall; and consider putting the mattress on the floor. On soft-sided pods and nests used in an adult bed, the Lullaby Trust is clear that these do not make bed-sharing safer — the safest surface is a clear space on a firm, flat mattress, the same as in a cot.

For twins, the Lullaby Trust advises not bed-sharing with more than one baby at a time.

Feeding at night

The Lullaby Trust addresses the fear directly. Breastfeeding reduces the risk of SIDS, and if you think you might fall asleep while feeding, "we recommend you prepare the bed to make it safer for baby" in advance. The point is that the decision gets made when you are alert, not when you are half asleep. And whatever you do, do not move to the sofa to avoid the bed.

When to ask

Talk to your midwife, health visitor or public health nurse about how you sleep at night — they are asked this constantly and the conversation is meant to be practical rather than a telling-off. The Lullaby Trust runs a baby safety helpline on 0808 802 6869 for questions about your own set-up, and a bereavement support helpline on 0808 802 6868.