Why advice on co-sleeping with a baby is changing despite SIDS risk

When Emily Little gave birth to her first child, sleeping with her baby in bed was a no-brainer – despite all the public health messages telling her not to.

“I knew it was something I wanted to do,” said Little, a perinatal health researcher and science communications consultant who has studied bed-sharing cultures around the world. Few were attracted to the skin-to-skin closeness she could maintain with her baby throughout the night and the ease of breastfeeding without getting up. It seemed natural to sleep the way mothers and babies had slept “since the beginning of human history,” she said.

So she began researching ways to reduce the risks to her baby. Bed sharing has been shown to be less risky for full-term infants born in non-smoking, sober homes who are exclusively breastfed: check. Only the breastfeeding parent should sleep next to the baby: check. Since babies are less likely to suffocate on firm mattresses and no loose bedding, Little replaced her mattress topper and got rid of all her extra blankets and pillows. Because babies could fall out of bed or into a space between the bed and the wall, Little pushed the bed against the wall and filled the space with foam.

Emily Little shares her bed with her baby after breastfeeding. Little is a perinatal health researcher who created a discussion guide for parents and health care providers to address the nuances of bed sharing.

(Tanya Goehring / For Time)

Still, Little’s decision conflicts with advice from pediatricians and public health advocates, who warn that bed-sharing increases the risk that a baby will die during the night. For decades, U.S. pediatricians and public health officials have warned that the only way to avoid sudden unexplained infant death syndrome (SUID) is to stick to the “ABCs of safe sleep”: always have the baby sleep alone, on his or her back, in a separate crib, free of any pillows, blankets, stuffed animals and bumpers. One controversial campaign even depicted a baby lying next to a meat cleaver, sending the message that parents could be deadly weapons when sleeping next to a baby.

And it worked: The rate of sleep-related infant mortality declined significantly after campaigns for safe sleep began in the 1990s. But in recent decades, the rate has stabilized and even started to rise again, just as bed-sharing has become more popular among parents. So some advocates are moving instead toward a “harm reduction” approach that recognizes that parents want to sleep with their babies and offers advice on how to make this activity as safe as possible.

“Abstinence-only messages haven’t worked, and parents are often not honest with their pediatricians when asked. We all need to recognize that this is virtually unavoidable,” said Susan Altfeld, a retired professor at the University of Illinois at Chicago who has studied bed-sharing. “Developing new messages to inform parents about specific behaviors that are particularly risky and what they can do to reduce those risks can potentially lead to change.”

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A changing message on infant bed sharing

About 3,700 infants die suddenly and unexpectedly each year in the United States, a number that has remained stubbornly high for decades, according to data from the U.S. Centers for Disease Control and Prevention. The risk of sharing the sleep surface is real: Infants who sleep with adults are two to 10 times more likely to die than those who sleep alone in a crib, depending on their specific risk factors, the American Academy of Pediatrics, or AAP, wrote in its most recent safe sleep guidelines.

Nonetheless, the percentage of parents in the United States reporting that they usually bed-share increased from about 6% in 1993 to 24% in 2015. And in 2015, 61.4% of respondents reported bed-sharing with their baby at least occasionally. Although more recent national data is not available, more than a quarter of California mothers reported that they “always or often” bed-shared in 2020-2022.

Little touts the positive aspects of bed-sharing and helping families mitigate the risks.

(Tanya Goehring / For Time)

La Leche League International, a breastfeeding advocacy organization, offers “Safe Sleep 7” on its website to help parents share beds more safely. Little codified her own “harm reduction” tips for safer bed sharing into an online discussion guide for other parents to encourage nuanced conversation between parents and health care providers to help mitigate the risks of what is at least an occasional practice for most parents. She also touts the positive aspects of bed-sharing and helping families mitigate risks.

For example, it has been shown that babies who share a bed with their mother breastfeed longer. Parents who plan ahead and share their bed more safely can avoid accidentally falling asleep with a baby in the most dangerous situation: a recliner or sofa. And many parents feel it strengthens their bond with their baby, she said.

“Infants have a biological expectation to be in close contact with their caregivers at all times, especially in the first few months,” Little said. “To deny this because we, as a society, are incapable of having a conversation about risk mitigation and harm reduction really does a disservice to the well-being and mental health of infants.” »

Refusal of safe sleep advocates

The Academy of Pediatrics, in its 2022 guidelines, acknowledges that parents may “choose to regularly share a bed for a variety of reasons” and offers some safety suggestions if a parent “unintentionally” falls asleep with their baby. “However, based on the evidence, the AAP is in no position to recommend bed sharing,” the guidelines state.

It’s almost impossible to assess whether a family is truly low risk when it comes to bed-sharing, especially since many aren’t upfront with their doctors about alcohol, tobacco and drug use, said Dr. Rachel Moon, a pediatrician and researcher at the University of Virginia School of Medicine and lead author of the AAP report. Even if a parent is low risk some nights, when they have a glass of wine one night, they suddenly tip into a high-risk category, she said.

“I knew it was something I wanted to do.” Little, shown with her family, spoke about sharing a bed with her baby.

(Tanya Goehring / For Time)

Moon said advice on bed-sharing has been a topic of conversation for years at the academy, but given evidence of risks, the group decided to warn against the practice in all situations.

“It is not our responsibility to give [parents] permission,” said Moon, who deals with sleep-related deaths in her role as a researcher. “Every day I deal with babies who have died, and if it happened in a bed-sharing situation, [parents] regret it. I deal with this enough that I don’t want anyone to have this regret.

Changing the message about safe sleep would be a “slippery slope,” said Deanne Tilton Durfee, executive director of the Interagency Council on Child Abuse and Neglect, which leads the campaign for safe sleep in Los Angeles County. “You have to be extremely clear in your messaging” because many parents don’t pay attention to details, she said.

In 2024, 46 infants in Los Angeles County died in their sleep, and almost all of them were bed-sharers, Durfee said.

The reality at home for parents

Pachet Bryant, a Mission Viejo mother, felt deeply determined to sleep with her new baby from the moment she gave birth. “You’re growing a baby for nine to 10 months, and all of a sudden having them separated from your heart, from your presence, from your smell, can be traumatic,” she said.

But she wanted to do it as safely as possible. So when lactation consultant Asaiah Harville began working with her, the consultant offered advice tailored to the new mother’s situation, which Bryant took “very, very seriously.” Bryant had already done his own research and was able to modify his space accordingly. She also reassessed each night whether she thought it was safe for her baby to sleep in the bed; On nights when she was too exhausted, she put her daughter to sleep in a cradle.

“We know that parents will, intentionally or unintentionally, eventually fall asleep with their baby, and we need to think about creating the safest environment possible for that,” Harville said. In the lived reality of an individual family’s home, she said, “we can’t just teach abstinence.”

This article is part of The Times’ early childhood education initiative, focusing on the learning and development of California’s children, birth to age 5. For more information about the initiative and its philanthropic backers, visit latimes.com/earlyed.