Ashwin Lewis
Co-sleeping with a newborn can be a controversial topic. While some believe that it is unsafe and can lead to sudden infant death syndrome (SIDS), others argue that it is a natural instinct for both mothers and babies and has been practised for over 200,000 years. The truth is that co-sleeping can be done safely if certain precautions are taken, such as ensuring the baby sleeps on their back on a firm, flat, and smoke-free surface, and avoiding co-sleeping when under the influence of substances or extremely tired.
Can you safely co-sleep with a newborn?
| Characteristics | Values |
|---|---|
| Safe sleeping environment | Firm, flat, and level surface, free from toys, blankets, pillows, sheets, and other items that could cover the baby's head or cause overheating |
| Baby's sleeping position | On their back, not on their front (unless on an adult's chest) |
| Parent's sleeping position | "Cuddle curl" position, with knees bent and arm tucked under the head, creating a protected space for the baby |
| Breastfeeding | Reduces the risk of SIDS |
| Risks | Smoking, alcohol or drug use, risky surfaces like sofas, formula feeding, preterm birth, low birth weight, illness, and extreme tiredness |
| Safe alternatives | Co-sleepers or bassinets attached to the bed, rooming-in (keeping the baby close by in a separate bassinet or crib) |
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What You'll Learn
The benefits of co-sleeping
Co-sleeping with a newborn can have several benefits, but it is important to understand the various options and considerations to ensure it is done safely.
Firstly, co-sleeping can promote a close bond between parent and baby. The physical contact and proximity of co-sleeping help release oxytocin, the love hormone, which plays a vital role in bonding and attachment. This secure attachment means that babies develop a sense of security and trust, knowing that their caregiver will meet their needs.
Secondly, co-sleeping can support and encourage breastfeeding, which has multiple benefits for both mother and baby. Breastfeeding can be easier when co-sleeping as the baby is within close proximity and can be fed without the need for the mother to get up fully. This convenience may also promote longer and more frequent breastfeeding, which is beneficial for the baby's health and helps maintain a healthy milk supply for the mother.
Thirdly, co-sleeping can help regulate the baby's body temperature and oxygen levels. The presence and touch of the parent help stabilise the baby's temperature, and the baby can breathe more regularly and use energy more efficiently. This regulation also contributes to a reduced risk of Sudden Infant Death Syndrome (SIDS) as the baby's self-preservation instinct is heightened, allowing them to rouse easily if there is a danger such as overheating, cold, or a blocked airway.
Lastly, co-sleeping can result in better sleep for both the baby and the parents. The baby sleeps more lightly and rouses more often, which is safer, especially in the first few months, as it allows caregivers to check on them frequently. This lighter sleep is also important for the rapid growth of connections between neurons in newborns. Additionally, both adults and babies tend to sleep longer overall due to the reduced disruption and convenience of co-sleeping arrangements.
While co-sleeping has potential benefits, it is important to approach it with caution and be aware of the possible risks. It is crucial to follow guidelines for safe co-sleeping practices and create a safe sleep environment for the baby.
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Safe co-sleeping practices
The sleeping surface:
- It is recommended to use a firm, flat, and level surface, such as a mattress, for co-sleeping.
- Remove pillows, sheets, blankets, toys, and other items from the baby's sleeping area to avoid creating a strangulation or suffocation risk.
- Keep the baby's sleep space clear, ensuring there are no items that could cover their head or cause them to overheat.
- Avoid co-sleeping on a couch, chair, or any other soft surface, as this can obstruct the baby's airways and lead to suffocation.
Sleeping position:
- Place the baby on their back to sleep, as this helps to keep their airways open and reduces the risk of Sudden Infant Death Syndrome (SIDS).
- Avoid placing the baby between parents or next to other children or pets. This reduces the chance of the baby being covered by bedding or accidentally harmed.
- Consider using a side-along or bedside co-sleeper that attaches to the bed, providing a separate but adjacent sleeping space for the baby.
Parental factors:
- Avoid co-sleeping if you or your partner smoke, consume alcohol, or use drugs or medications that cause heavy sleep or impair your ability to respond to the baby.
- Ensure you are well-rested and not extremely tired, as fatigue can increase the risk of accidental suffocation.
- If you are unwell, it is recommended to avoid co-sleeping and provide the baby with a separate sleep space.
- Breastfeeding mothers may find that co-sleeping is safer due to the natural protective mechanisms that breastfeeding induces, such as the "cuddle curl" position.
Baby's condition:
- Avoid co-sleeping if your baby was born prematurely, has a low birth weight, or is unwell. These factors can increase the vulnerability of the baby to SIDS and accidental injury.
- Keep the baby's sleeping environment smoke-free, as exposure to second-hand and third-hand smoke is harmful to infants and increases the risk of SIDS.
- If using a separate crib or bassinet, consider warming it with a hot water bottle before placing the baby inside to prevent them from waking up due to the chill.
Remember, the safest place for a baby to sleep is in their own separate sleep space, such as a cot or Moses basket. However, if you choose to co-sleep or find yourself unintentionally co-sleeping, following these safe co-sleeping practices can help reduce the risks associated with bed-sharing.
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Risks of co-sleeping
Co-sleeping with a newborn can be dangerous and may even be fatal. The risks of co-sleeping include:
Sudden Unexpected Death in Infancy (SUDI): Co-sleeping is associated with an increased risk of SUDI, including Sudden Infant Death Syndrome (SIDS) and fatal sleep accidents. SIDS is a significant risk factor for vulnerable babies, and the risk increases if the baby is formula-fed.
Breathing Hazards: All babies are at risk of breathing hazards when co-sleeping, such as suffocation due to pillows, sheets, blankets, or other objects obstructing their airways. Sleeping on sofas or chairs is particularly dangerous as babies can be trapped between cushions or the space between the parent and the furniture.
Rollover Risk: If parents are under the influence of drugs, alcohol, or certain medications, they may roll over onto the baby during sleep, causing injury or death.
Respiratory Problems: Babies born prematurely, underweight, or with respiratory issues are at higher risk of respiratory problems when co-sleeping, especially if exposed to second-hand smoke.
Unsafe Sleep Environment: Co-sleeping on an unsafe surface, such as a soft mattress, water bed, or recliner, increases the risk of suffocation or entrapment. A safe sleep environment should be firm, flat, and level, with a clear space around the baby, free from objects that could cause strangulation.
While co-sleeping has its risks, it is a common practice that many cultures have engaged in for thousands of years. However, it is essential to prioritize the safety of the newborn and take steps to mitigate these risks if choosing to co-sleep.
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Recommendations from health organisations
The American Academy of Pediatrics (AAP) recommends rooming-in, which involves keeping the newborn very close to their parent but on a separate sleeping surface, such as a bassinet or side-car crib. The AAP advises that "infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep."
The World Health Organization (WHO) also recommends rooming-in as an important part of postnatal care. Rooming-in promotes skin-to-skin contact, improves breastfeeding, and develops a healthy bond between caregiver and child.
The National Library of Medicine and the National Center for Biotechnology Information also recommend rooming-in.
The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the nation's medical research agency, making important discoveries to improve health and save lives.
The Sleep Foundation recommends creating a comfortable sleeping environment for the baby while following consistent bedtime routines to help the baby know what to expect.
The UK-based Lullaby Trust provides safer sleep advice, including reducing the risk of SIDS by sleeping the baby on their back and keeping other children or pets out of the bed. They also recommend keeping the baby's sleep space free from toys, blankets, and pillows, and advise that the safest place for a baby to sleep is in their own separate sleep space, such as a cot or Moses basket.
The Raising Children Network provides recommendations for co-sleeping, including placing the baby on their back, on a firm, flat, and level surface, in a clear, smoke-free, and not-too-hot environment. They also advise against co-sleeping if either parent smokes, uses alcohol or drugs, or is extremely tired or unwell, or if the baby was born prematurely or with a low birth weight.
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Co-sleeping alternatives
Co-sleeping with a newborn is not recommended due to the risk of sudden infant death syndrome (SIDS) and fatal sleep accidents. However, if you are still considering co-sleeping, there are ways to make it safer. For instance, breastfeeding mothers tend to automatically assume a "cuddle curl" position, which is nature's way of protecting the baby. In this position, the mother's knees are bent, and the arm is either tucked under the head or pillow or curled around the baby, creating a protected space.
- Room-sharing: The baby sleeps in the same room as the parent(s) or carer but in their own separate sleeping space, such as a crib, bassinet, cot, or Moses basket. This arrangement is recommended for at least the first six months and can help reduce the risk of SIDS by up to half. It also makes it easier to respond to the baby's needs during the night.
- Safe Sleep Seven Checklist: This checklist, covered in Chapter 19 of the book "Breastfeeding, Bed-sharing, and Infant Sleep" by H. L. Ball, outlines ways to reduce the risks associated with co-sleeping. It includes recommendations such as keeping the baby's sleep space clear of hazards like pillows, blankets, and toys, and avoiding smoking, alcohol, or drug use.
- Baby Carrier: Using a baby carrier during the day can help promote bonding and closeness with the baby without the risks associated with co-sleeping.
- Skin-to-skin Cuddle Time: Engaging in skin-to-skin cuddle time, also known as kangaroo care, is a safe way to promote bonding and has various benefits for both the parent and the baby.
- Playing and Reading: Spending time playing and reading with your baby during the day can help strengthen your bond, so you don't feel the need to co-sleep for connection.
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Frequently asked questions
Co-sleeping with a newborn can be safe if you follow the correct precautions. The safest place for a baby to sleep is in their own separate sleep space, such as a cot or Moses basket. However, many parents choose to co-sleep. If you plan to co-sleep, there are ways to reduce the risks, such as ensuring your baby sleeps on their back on a firm, flat, and level surface, in a smoke-free environment.
The risks of co-sleeping with a newborn include breathing hazards and an increased risk of sudden infant death syndrome (SIDS). The risk of SIDS is 50 times higher for babies who sleep on a sofa or armchair with an adult.
Co-sleeping with a newborn can promote skin-to-skin contact, improve breastfeeding, and develop a healthy bond between the caregiver and the child. It can also be convenient for parents who want to keep their baby close and may help the baby sleep better.
To make co-sleeping with a newborn safer, ensure your baby's sleep space is clear of any items that could cause strangulation or suffocation, such as pillows, sheets, blankets, toys, and jewellery. Keep your baby on their back and away from the edge of the bed. Avoid co-sleeping if you or your partner smoke, drink alcohol, or take any medicines that cause heavy sleep.
If you don't want to co-sleep with your newborn, you can try rooming-in, which involves keeping your baby very close to you in the same room but on a separate sleeping surface, such as a bassinet or side-car crib. You can also try warming up your baby's bassinet with a hot water bottle before placing them in it.
