Sleep is one of the most talked about topics regarding babies. During pregnancy, women are warned to get as much sleep as possible in preparation for the exhausting newborn days. Many new parents are surprised by how little sleep they get with a newborn at home.

Those early days can be exhausting, and sleep deprivation can cause many problems. It’s no wonder parents are keen to discover the secret to helping their baby sleep through the night.

When surrounded by unsolicited advice and probing sleep questions, it’s not surprising new parents lose confidence in their baby’s sleep habits.

Night feeds are normal newborn behavior; it can be challenging, though, for parents to adjust to the disturbed nights.

As a result, some families turn to co-sleeping to improve their sleep; healthcare professionals must offer safe co-sleeping guidelines to ensure this is done safely.

How families choose to sleep will depend on many things, including parenting beliefs, family setup and home. Education plays a crucial role in creating a safe sleep environment.

What is co-sleeping?

Co-sleeping is when parents sleep in close contact with their baby. When most people use the term co-sleeping, they are referring to bed-sharing. Bed-sharing means sharing a sleep surface with a baby.

Co-sleeping simply means sharing a sleep space with a baby. This could be done following the safe sleep guidelines in a bed or an accidental nap on the sofa; both situations would be covered by the term ‘co-sleeping’. From a safety perspective, however, these two situations are very different.

Co-sleeping can also be used to describe sleeping near to, but not sharing a sleep surface with, a baby. For example, a baby sleeping in a side cot is co-sleeping because the baby is within arm’s reach.

Safe co-sleeping guidelines for health professionals

Many babies co-sleep at least some of the time. Some parents plan to co-sleep; others do it on a whim, because of tiredness. Unplanned co-sleeping is dangerous if safety guidelines are not followed, which is why education is essential.

A Swedish study published in 2021 found that co-sleeping was becoming more popular as more parents turned to bed-sharing to get a decent night’s sleep.

UNICEF UK has developed easy-to-understand safe sleeping guidelines to help professionals better understand the evidence around infant sleep safety and the risk of Sudden Infant Death Syndrome (SIDS).

Perhaps most importantly, though, these guidelines provide ways to relay that information to parents, to help them make safe and informed decisions. Most sleep-related infant deaths are avoidable and it is hoped that safe sleep guidelines will reduce the number of deaths.

Is co-sleeping safe?

Co-sleeping often refers to bed-sharing but sometimes people use the term to mean sleeping in close proximity but on different sleep surfaces. The UNICEF UK guidelines use the term ‘co-sleeping’ interchangeably with ‘bed-sharing’.

According to the UNICEF guidelines, based on many evidence-based research studies and publications, co-sleeping can be a safe option in many situations. However, there are also situations in which co-sleeping isn’t safe.

UNICEF UK encourages healthcare professionals to educate families about when it is and isn’t safe to co-sleep.

In recent decades, it has been the default to discourage co-sleeping in the hope of reducing SIDS and suffocation. Whether it’s planned or unplanned, around half of all parents will use co-sleeping at some point during their child’s infancy.

Unfortunately, downright discouragement of co-sleeping has backfired in a few ways. To avoid falling asleep in the same bed, some parents feed or soothe the baby on the couch or other furniture during the night but, due to fatigue, they fall asleep. Sleeping on a sofa or other furniture poses a serious risk of entrapment and suffocation.

Due to being warned about co-sleeping, few parents research safe sleeping guidelines; many aren’t aware they exist. As a result, many parents find themselves utterly fatigued and with a baby who refuses to sleep peacefully alone in a cot or crib.

It doesn’t take much for sleep-deprived parents to give in to co-sleeping at 2 am after three nights of teething. But, unfortunately, if they aren’t aware of co-sleeping safety, they might bed-share in a hazardous setup.

Is co-sleeping recommended?

This depends on where you live. Although the UK has adopted UNICEF’s safe sleep guidelines to ensure parents are educated on how to bed-share safely, other countries still advise against sharing a bed.

The American Academy of Pediatrics (AAP) strongly recommends against bed-sharing and instead encourages parents to sleep in the same room as their baby. The AAP considers room sharing on separate sleep surfaces to be the safest way for a baby to sleep.

When is it safe to co-sleep?

First, babies born premature or with low birth weight are at a greater risk of Sudden Infant Death Syndrome (SIDS) and should not share a bed with their parents. Second, babies exposed to maternal smoking during pregnancy should not bed-share due to the increased risk of SIDS. For these babies, room sharing is a safer option.

Safe co-sleeping guidelines

There are many published evidence-based studies that provide guidelines for safe co-sleeping. Many publications agree that to co-sleep, it’s essential to:

Place babies on their back to sleep
Use a firm mattress
Have only biological parents in the bed
Position the baby next to the mom
Ensure the bed is free of entrapment or entanglement hazards
Ensure both parents are completely sober
Ensure both parents are non-smokers
Breastfeed.

You can read more about safe co-sleeping in BellyBelly’s article Co-Sleeping With Baby – Safe Co-Sleeping Tips.

The safe sleep guidelines are there to educate parents and help healthcare professionals start open and honest conversations with parents. Parents who are terrified of falling asleep in bed with their babies are likely to seek solace on the sofa. The sofa, however, poses a greater risk if the parent then accidentally drifts off.

When is co-sleeping dangerous?

Unfortunately, there’s no 100% risk-free solution to infant sleep. However, we know we can drastically reduce the risk of SIDS or accidental suffocation by following infant sleep safety guidelines.

With regard to co-sleeping, the following are some examples of situations where co-sleeping is not recommended:

You have consumed alcohol or drugs (including over-the-counter and prescription medication that cause drowsiness)
You suffer from or are at risk of sleep apnea
You smoked during pregnancy or are still smoking, or someone in the home smokes
You use any sleep surface or furniture item apart from a firm mattress (e.g., water bed, couch, rocking chair, recliner, etc.)
You use a bed frame with spaces between it and the mattress or wall, where the baby could become entrapped
There are plush blankets, pillows or other items near the baby
The baby was low birth weight or pre-term.

What is the risk of SIDS?

The SIDS rate varies slightly from country to country but, generally, it’s a very low risk.

This guideline from UNICEF UK uses statistics based on about 700,000 babies born each year in Wales and England. Of those 700,000 babies, at least 350,000 will have slept in a bed with one or both parents by three months of age – sometimes intentionally and sometimes not.

In 2014, 212 infants in the UK died of SIDS. This was 0.03% of the 700,000 born. It’s a low risk but still a public health concern.

Of those that died of SIDS:

Half died in a crib/cot, bassinet or Moses basket
Half died while co-sleeping – but 90% of those who died while co-sleeping died in hazardous situations, mostly preventable.

According to UNICEF UK, the risk of SIDS is:

1 in 3,710 babies in England and Wales
1 in 919 while co-sleeping with a regular smoker
1 in 203 while co-sleeping on a sofa
1 in 203 while co-sleeping after parents consumed drugs or alcohol.

Because 90% of co-sleeping SIDS deaths occur in hazardous situations, properly educating parents can reduce the risk of SIDS related to co-sleeping.

We’re now seeing a reduction in professionals only advising against co-sleeping and more about the importance of educating parents about all safe sleeping guidelines, co-sleeping, or crib/cot.

The benefits of co-sleeping

There are several evidence-based sources that show co-sleeping can have several benefits for both mother and baby. When it comes to the researched benefits, they include co-sleeping, meaning bed-sharing, but also co-sleeping on separate surfaces with the baby within arm’s reach.

Some benefits of close mother-infant sleep proximity:

A 2022 study found that bed-sharing was associated with higher levels of breastfeeding
Infants have more stable physiology, including temperature, heart rhythm and breathing pattern
Infants often sleep more soundly, so parents get more rest
Sleeping within arm’s reach, on the same or separate surface, can reduce the risk of SIDS when safe sleep guidelines are used.

If you’d like to know more about the benefits of sharing the same surface with your baby, look at Babies And Co Sleep: The Benefits Of Co Sleeping.

Why healthcare professionals need to discuss safe sleep guidelines

Safe infant sleep and SIDS remain significant public health concerns. The importance of this publication is that it genuinely seeks to connect healthcare professionals with parents. Rather than using only blanket statements, it addresses the complexity of early parenthood.

The safe sleep guidelines aim to educate parents about the risk factors and how to create a safe infant sleeping environment. In addition, the guidelines aim to help parents sleep without putting the baby at risk.

Not only do the guidelines recommend discussing co-sleeping with parents but, when co-sleeping isn’t safe, they also encourage care providers to share alternatives that take into consideration the demands of parenthood.

A study published in Pediatrics in 2020 found that sleep intentions do not always correlate with what happens in reality. An exhausted parent might make different choices from those they had planned. This is why it’s so important to educate all parents about safe sleeping practices.

Parents must be aware of the risks so as to make informed choices about bed-sharing. It’s also important that healthcare professionals have frank conversations about what qualifies as normal newborn behavior. For example, night wakings are expected and night feeds are normal. Sometimes, just knowing this can make the tiredness easier to cope with.

It’s important that healthcare professionals are able to have non-judgemental, informative, and evidence-based conversations with parents about sleep. The close relationship between couples and their healthcare providers during the antenatal period and beyond allows these honest conversations to take place during the postpartum period.