Parent and Infant Co-Sleeping

Co-sleeping, or the practice of mothers (or fathers) sleeping with an infant, has varied across time and between cultures. In the United States, co-sleeping is a highly debated practice, some groups advocate co-sleeping while others urge against it. Both sides have strong arguments. The debate makes decision-making for parents difficult. This evidence-based parenting article focuses first on outlining the issue on both sides of the debate. Then we provide safe sleeping recommendations that hold regardless of where (and potentially with whom) the infant sleeps.

Supporters argue that co-sleeping produces a host of benefits. Mothers who sleep with their infants frequently breastfeed longer than mothers who do not. For example, one study published in the journal Birth reported that women who reported at least some co-sleeping with their infant were more likely to breastfeed longer. Studies like this suggest that co-sleeping may help families achieve the American Academy of Pediatrics’ Recommendation of exclusive breastfeeding for 6 months. Co-sleeping advocates also argue that parental presence during sleep minimizes infant sleep disturbances. One such study, published in Annual Progress of Child Psychiatry and Child Development, found that infants whose parents attended to them quickly upon waking because of co-sleeping were able to get back to sleep more quickly than infants whose parents took longer to respond because they were in another room. Another pro co-sleeping argument is that co-sleeping protects infants by bringing their sleep cycles and breathing patterns in alignment with their mothers’, which allows meaningful non-verbal communication between infant and mother. A study that was published in the American Journal of Physical Anthropology argued maternal-infant co-sleeping is the predominant model throughout history, and that separating infants during sleep emerged only the past 100 years and is a sleep arrangement that may not meet infants’ needs.

On the other side of the debate is evidence indicating that co-sleeping is a risk factor for Sudden Infant Death Syndrome (SIDS). For example, a study published in The Journal of Forensic Science, reported that 48 percent of Sudden Infant Death Syndrome (SIDS) deaths occurred while the infant was co-sleeping, while only 8 percent of SIDS deaths occurred when the infant was asleep on his or her back or side alone in a crib. Evidence like this led to recommendations that infants should sleep alone and on their backs.  Another argument against co-sleeping, exemplified in a review article published in the journal Early Childhood Development and Care, is that it contributes to infant sleep problems because they do not develop the ability to soothe themselves back to sleep. Still others suggest that co-sleeping and its corresponding noises and nocturnal movements undermine sleep quality and overall well-being of both mom and baby.

Parent Recommendations

The debate surrounding co-sleeping focuses on where an infant sleeps, while giving little attention to the basic necessity of safe sleep: infants need to breathe during sleep (regardless of whether they sleep alone or with a parent). Toward that end, these recommendations focus on specific activities to enable infant to breathe during sleep.

• Face up. Always place infants to sleep on their backs to keep infants’ airways open and allow them to breath.
• Face Clear. Make sure the infant’s mouth and nose are uncovered.
• Put infants to sleep on firm surfaces. Keep soft or loose bedding and objects such as pillows, blankets, bumper pads or stuffed animals out of the crib or bed.
• Avoid sleeping on couches or chairs where infants’ faces can get wedged between parent and furniture.
• Avoid using wedges or positioners.
• Smoke-free. Keep babies close but in a separate space if parents smoke or mothers smoked during pregnancy—cigarette smoking increases infants’ risks by lowering their natural drive to breath.

* This Evidence-Based Parenting article was supported by funds from the George Kaiser Family Foundation awarded to the Oklahoma State University Center for Family Resilience. Joseph G. Grzywacz is the Kaiser Family Endowed Professor of Family Resilience and Director of the Center for Family Resilience. He can be reached at joseph.grzywacz@okstate.edu or 918-594-8440.