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JAMA Pediatrics Patient Page
November 2013

The Controversial but Common Practice of Bed Sharing

JAMA Pediatr. 2013;167(11):1088. doi:10.1001/jamapediatrics.2013.4150

Bed sharing, also known as co-sleeping or co-bedding, refers to a caregiver sleeping in the same bed as an infant. This practice takes place in many cultures including the United States. In this month’s JAMA Pediatrics, a large research study found that between 1993 and 2010 the number of US caregivers who bed share with infants had increased from 6% to 13.5%.

Potential Benefits of Bed Sharing

  • Breastfeeding: Bed sharing can provide easy access for mom and baby to breastfeed throughout the night. Research studies, including a study in this month’s JAMA Pediatrics, found that babies who were bed sharing had both higher rates and longer duration of breastfeeding. Among caregivers who decide to bed share, about 60% said it was to breastfeed.

  • Parent sleep: Studies suggest that parent sleep is improved by bed sharing, because the baby can be fed or settled down quickly without having to stand up or walk to another room. Bed sharing makes pacifier reinsertion easier and some parents may feel that they sleep better just knowing their baby is near.

  • Bonding: Bonding between a caregiver and baby is promoted by skin-to-skin contact through the night.

Potential Risks of Bed Sharing

  • Accidental suffocation: Studies show an association between bed sharing and risk of accidental suffocation. This could happen if a caregiver accidently pulls the covers over a baby so that he or she cannot breathe or rolls over onto the baby while sleeping.

  • Sudden infant death syndrome (SIDS): Research studies show that bed sharing is associated with a nearly 3-fold increased risk of SIDS, increasing to 6-fold among smoking mothers. There is no evidence that bed sharing protects against SIDS.

For parents who decide to bed share, there are several safety practices to consider:

  • Do a safety check of the sleep environment: The sleep environment includes the type and size of bedding and all the pillows and blankets on the bed. Remove all excess pillows, heavy blankets, quilts, and comforters to reduce the risk that your baby will be trapped under these coverings. Ensure that the bed is large enough for the caregiver(s) and infant without the infant rolling off or a caregiver rolling onto the infant. Do not take toys or stuffed animals into the bed, as these may increase the risk of suffocation. Bed sharing on a couch has a much higher risk because the infant can become trapped in the cushions, roll off the couch, or become trapped between the couch and caregiver.

  • Avoid smoking and drinking alcohol: Parents who bed share should ensure that the bedroom is smoke free and avoid alcohol use before bedtime, which may impact a caregiver’s sleep and ability to recognize that the infant is in danger.

  • Room temperature: Bedrooms that are hot and stuffy lead to more risks that the infant will become overheated.

  • Proximal sleep environment: Placing the baby’s crib alongside the parent bed keeps the baby very close but minimizes safety risks.

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The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Resource: American Academy of Pediatrics

Correction: This article was corrected on November 4, 2013, for typographical errors.

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    3 Comments for this article
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    You've got to be kidding me!
    Merrily Wholf | Public Health Nurse
    What happened to the AAP recommendations to reduce the risk of SIDS and sleep-related deaths?? While this article pays lip-service to making sure the bed sharing arrangement is as safe as possible, the accompanying graphic shows a sweet baby in a death trap of blankets, pillows and a sleeping adult's arm dangerously draped over the infant. Ask any child fatality review board how many deaths they have reviewed with similar scenarios. As public health professionals, we need to advocate for the highest standard of health and safety In a non-judgemental manner. This article appears to advocate the opposite.
    CONFLICT OF INTEREST: None Reported
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    Improper parent education
    Scott Krugman | MedStar Franklin Square Medical Center
    The safest sleep position for infants is alone, on their back, and in a crib (ABC of safe sleep). The relative risk of dying in a adult bed for infants under 6 months is so significantly higher than placing a child in a safe position that to recommend \"safe bedsharing\" is not appropriate. The recent AAP policy statement clearly states that \"there is insufficient evidence to recommend any bedsharing as safe.\" (Pediatrics 2011;128:e1341–e1367) To promote bedsharing in this journal, especially coupled with the recent commentary that bed sharing per se is not dangerous runs counter to current AAP policy and what is known by everyone who is working on preventing sudden unexpected deaths in infants. The ABC safe sleep message works, bedsharing does not.
    CONFLICT OF INTEREST: None Reported
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    Bed Sharing is not a Safe for Infants
    Eileen E. Tyrala, MD FAAP | Medical Director, Cribs for Kids, PIttsburgh, PA
    In 2011, the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome issued an expansion of its' 2005 recommendations for a safe infant sleeping environment. The purpose of both of these statements was to reduce not only the risk of SIDS but also infant deaths that occur due to accidental strangulation and suffocation in a sleep environment. These recommendations, among other things, emphasize the importance of maintaining a separate but proximate (and uncluttered) sleep environment for an infant for maximum safety. Dr. Moreno 's comments on bed sharing imply that because bed sharing (or at least our knowledge and/or awareness of it) is becoming more common, that this makes it a more legitimate sleep practice for infants and parents. As opposed to a safety check, the reality check here is that in 2010 alone, 3610 infants died a sleep related death, many of which could have been prevented if the infant had been in a safe sleep environment. Bed sharing with an infant in an adult bed is not a safe practice and can result in the death of an infant. Dr. Moreno's comments do not emphasize the real hazards of this practice and I fear may reassure many unsuspecting parents that this is a safe and reasonable practice for them to adopt. Nothing could be further from the truth.Eileen E. Tyrala, MD FAAPMedical Director, Cribs for KidsPittsburgh, PA
    CONFLICT OF INTEREST: None Reported
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