Co-Sleeping With a Baby: The Dangers of Bed Sharing & How to Sleep Safely
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The safest way to sleep close to your baby is to share the roomânot the bed.
The American Academy of Pediatrics recommends that infants sleep in the parents' room on a separate sleep surface designed for infants, ideally for at least the first 6 months.
Bed sharing means an infant sleeps on the same surface as another person. Adult beds, couches and armchairs can expose babies to suffocation, entrapment, strangulation, overlay and other sleep-related risks.
Keep your baby's crib, bassinet, portable crib or play yard close to your bed so your baby is nearby for feeding and comforting while still having a separate safe sleep space.
- âCo-sleepingâ can mean different things, so it is better to distinguish room sharing from bed sharing.
- Room sharing means baby sleeps near you but on a separate infant sleep surface.
- Bed or surface sharing means baby sleeps on the same surface as another person.
- The AAP recommends room sharing without bed sharing.
- Couches and armchairs are particularly dangerous places to fall asleep with a baby.
- Bed-sharing risk is especially high with very young infants, prematurity or low birth weight, smoking, alcohol, drugs, sedating medications, extreme fatigue and soft bedding.
- Bring your baby into bed for feeding or comforting if needed, but return the baby to the separate sleep space before you go back to sleep.
- Safe sleep applies during every sleepâday and night.
What Does âCo-Sleepingâ Actually Mean?
Parents use the word co-sleeping in several different ways.
One parent may mean that the baby's bassinet is beside the adult bed.
Another may mean that the baby sleeps directly in the adult bed.
Those are very different sleep arrangements.
For that reason, the American Academy of Pediatrics recommends using more precise terms.
Room Sharing
Your baby sleeps in the same room as you but on a separate sleep surface, such as a crib, bassinet, portable crib or play yard that meets applicable safety standards.
Bed Sharing or Surface Sharing
Your baby sleeps on the same surface as another person.
That surface might be an adult bed, couch, sofa, recliner or chair.
When parents ask me whether âco-sleepingâ is safe, this distinction is the first thing I want to clarify.
Is Bed Sharing With a Baby Safe?
The American Academy of Pediatrics does not recommend bed sharing with an infant.
An adult bed is designed for adultsânot for infant sleep.
It may contain pillows, sheets, blankets, comforters, soft mattress surfaces, gaps or other conditions that can become hazardous to a baby.
There is also another person in the sleep environment.
An exhausted sleeping adult may move without realizing where the baby is.
- Suffocation against soft bedding
- Head or face becoming covered by bedding
- Entrapment between a mattress and wall or bed frame
- Wedging into gaps
- Strangulation
- Being accidentally covered or compressed by another person
- Falling from the adult bed
Why Are Babies Younger Than 4 Months Especially Vulnerable?
Very young infants have limited head control, mobility and ability to escape from a dangerous position.
The AAP evidence review identifies infants younger than 4 months as a particularly vulnerable group during bed sharing.
Importantly, this increased risk is present even for a healthy, full-term, normal-weight infant whose parents do not smoke and even when the infant is breastfed.
That does not mean bed sharing becomes recommended after 4 months.
It does not.
The AAP recommendation remains room sharing without bed sharing throughout infancy.
Premature and Low-Birth-Weight Babies Have Additional Risk
Infants born prematurely or at low birth weight are particularly vulnerable to sleep-related risks.
These babies may have less mature respiratory control, motor ability and arousal responses.
If your baby was premature or had a low birth weight, following safe-sleep recommendations is especially important.
The Couch or Recliner Is Even More Dangerous
This deserves special attention because it happens so easily.
You sit on the couch for a nighttime feeding.
The room is quiet.
The baby is warm against you.
You have slept very little for days.
And suddenly you wake up.
The problem is that couches and armchairs create particularly dangerous situations for infants.
The baby can become trapped between the adult and the cushions, wedged against the side of the couch, or have the face obstructed by soft material.
The AAP evidence review describes couches and armchairs as extremely dangerous places for infant sleep and reports dramatically increased risk of sleep-related infant death in these environments.
If you are becoming sleepy while holding or feeding your baby on a couch or recliner, move to a safer situation before you fall asleep.
What If I Bring My Baby Into Bed to Breastfeed?
Many parents feed their babies in bed, particularly during the night.
Feeding in bed is not the same thing as intentionally planning to sleep with the baby there.
The safest plan is to return your baby to the separate infant sleep space when you are ready to sleep.
But parents are human, and sleep deprivation is real.
The AAP specifically acknowledges that parents sometimes unintentionally fall asleep while feeding an infant.
If there is a realistic possibility that you may fall asleep while feeding in bed, remove pillows, sheets, blankets, pets and other soft or loose objects from the area where the baby is being fed.
If you do accidentally fall asleep, return your baby to the separate infant sleep surface as soon as you awaken.
Safe-sleep counseling has to work at 3 a.m., not just sound good at a daytime doctor's appointment.
If you know you are exhausted, think ahead about nighttime feeding before you are barely able to keep your eyes open.
The goal is to prevent an exhausted parent from unexpectedly falling asleep with a baby in one of the most dangerous placesâespecially a couch or armchair.
What Makes Bed Sharing Even More Dangerous?
Some circumstances substantially increase the risk associated with sharing a sleep surface with an infant.
- The adult is extremely fatigued or difficult to awaken.
- The adult has consumed alcohol.
- The adult has used marijuana, opioids, illicit drugs or other substances that impair alertness.
- The adult has taken medication that causes sedation or makes waking more difficult.
- A parent or caregiver currently smokes.
- The pregnant parent smoked during pregnancy.
- The infant is younger than 4 months.
- The infant was born prematurely or at low birth weight.
- The sleep surface is soft.
- Pillows, blankets or other soft bedding are present.
- The baby shares the surface with someone other than a parent, including another child.
These factors do not create the entire risk of bed sharingâthey make an already nonrecommended sleep arrangement even more hazardous.
Does Breastfeeding Make Bed Sharing Safe?
No.
Breastfeeding is associated with a reduced risk of sleep-related infant death and has many health benefits.
But breastfeeding does not transform an adult bed into an infant-safe sleep surface.
A breastfeeding baby should still be placed on a separate infant sleep surface when the parent is ready to sleep.
The two recommendations can coexist:
Support breastfeeding and practice safe infant sleep.
What About Alcohol, Marijuana or Sedating Medication?
Anything that reduces an adult's ability to awaken or respond normally makes surface sharing particularly dangerous.
This includes alcohol and other substances that impair alertness.
Some prescription and over-the-counter medications can also cause significant drowsiness.
If you are unsure whether a medication may impair alertness, ask your physician or pharmacist.
If you have consumed alcohol or used a substance or medication that significantly impairs your alertness, do not sleep on the same surface with your baby.
What About Smoking or Nicotine Exposure?
Exposure to tobacco smoke and nicotine is associated with increased risk of sleep-related infant death.
Bed sharing is especially hazardous when a caregiver smokes, even if that person does not smoke while actually in bed.
The safest approach is to avoid nicotine and smoke exposure during pregnancy and after birth and to keep the infant on a separate safe sleep surface.
Can My Older Child Sleep in Bed With the Baby?
No.
An infant should not share an adult sleep surface with siblings or other children.
A sleeping child cannot reliably monitor the baby's position or respond to a dangerous situation.
The AAP evidence review identifies surface sharing with someone other than the infant's parentâincluding other childrenâas an additional risk.
What About Twins?
Twins may have spent months very close together before birth, and parents sometimes assume they should therefore share the same sleep surface.
The AAP recommends separate sleep surfaces for twins and higher-order multiples.
Each baby should have an appropriate individual infant sleep space.
Are Bedside Sleepers the Same as Bed Sharing?
Noânot when the product provides the baby with a separate sleep surface and meets applicable infant sleep safety standards.
A bedside sleeper can keep your baby very close while maintaining a separate infant sleep area.
Always use the product exactly according to the manufacturer's instructions and limitations.
Do not improvise by attaching an ordinary bassinet or crib to an adult bed in a way the manufacturer did not intend.
What About Products That Claim to Make Bed Sharing Safe?
Be cautious.
The AAP reports that there is insufficient evidence to recommend devices promoted as making bed sharing safe.
A product marketed as a âco-sleeper,â nest, pod or similar device should not automatically be assumed to make an adult bed safe for infant sleep.
The safer solution is straightforward:
Give the baby a separate sleep surface designed and safety-tested for infant sleep.
What Is the Safest Way to Keep My Baby Close at Night?
- Place a crib, bassinet, portable crib or play yard close to your bed.
- Place your baby on the back to begin every sleep.
- Use a firm, flat, noninclined infant sleep surface.
- Use only the fitted sheet designed for the mattress.
- Keep pillows, blankets, bumpers, stuffed animals and other soft objects out.
- Bring your baby close for feeding and comforting.
- Return your baby to the separate sleep space when you are ready to sleep.
This arrangement keeps your baby nearby without introducing the suffocation, entrapment and overlay hazards of an adult sleep surface.
Why Does the AAP Recommend Room Sharing?
Room sharing keeps the baby physically close to the parents while preserving a separate sleep surface.
The AAP recommends room sharing without bed sharing, ideally for at least the first 6 months.
It also makes practical sense.
Your baby remains close enough for nighttime feeding, comforting and monitoring without being placed in the adult bed for sleep.
What If My Baby Won't Sleep Unless Next to Me?
This is where safe sleep can become difficult in real life.
Some babies strongly prefer contact and wake quickly when placed down.
You can feed, cuddle and comfort your baby while you are awake.
But when you are going to sleep, move the baby to the separate infant sleep surface.
If severe exhaustion is making this increasingly difficult, involve your partner or another trusted adult when possible so caregivers can obtain protected periods of sleep.
Persistent sleep difficulty can also be discussed with your pediatrician.
What If I Accidentally Fall Asleep With My Baby?
Do not assume that because it happened once, you have failed.
Instead, use the experience to change the setup for the next feeding.
As soon as you awaken, place your baby back on the separate safe sleep surface.
Then think about why you fell asleep.
- Were you feeding on a couch because you were trying not to wake someone?
- Were you more exhausted than you realized?
- Could another adult help with part of the nighttime routine?
- Can the bassinet or crib be positioned closer to your bed?
Planning for exhaustion is more useful than pretending exhaustion will not happen.
Frequently Asked Questions
Is co-sleeping safe?
The word co-sleeping is ambiguous. Room sharingâsleeping in the same room while your baby has a separate infant sleep surfaceâis recommended. Bed or surface sharing with an infant is not recommended by the AAP.
Is it safe to sleep with my newborn in my bed?
The AAP does not recommend bed sharing. Infants younger than 4 months are particularly vulnerable to sleep-related risks associated with surface sharing.
Is bed sharing safe if I don't smoke or drink?
Avoiding smoking, alcohol and sedating substances removes important additional hazards, but it does not make bed sharing the AAP-recommended sleep arrangement. Room sharing on separate surfaces remains the safer recommendation.
Is sleeping with a baby on my chest safe?
Holding your baby while you are awake and alert is different from sleeping while holding the baby. If you are becoming sleepy, place your baby on a separate safe infant sleep surface.
Is sleeping with my baby on the couch safer than bed sharing?
No. Couches and armchairs are particularly dangerous places to fall asleep with an infant because of the risks of suffocation, entrapment, wedging and overlay.
Can I breastfeed my baby in bed?
Parents commonly bring babies into bed for feeding. The baby should be returned to a separate infant sleep surface when the parent is ready to sleep. If there is a possibility you may unintentionally fall asleep during a feeding, avoid couches and armchairs and remove soft or loose objects from the immediate feeding area.
When does bed sharing become safe?
AAP safe-sleep recommendations apply throughout the first year of life and do not designate an infant age at which bed sharing becomes recommended.
How long should my baby sleep in my room?
The AAP recommends room sharing without bed sharing, ideally for at least the first 6 months.
Dr. G's Pearl
Keep your baby close enough to hear, feed and comfortâbut give your baby a separate place to sleep.
I understand why exhausted parents bring babies into bed. At 2 or 3 in the morning, convenience matters.
But an adult bed was designed for adults. A baby's crib or bassinet was designed for a baby.
Put the bassinet close enough that you can practically reach over and touch it. You can have the closeness parents want while preserving the separate sleep surface babies need.
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References
- Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and Committee on Fetus and Newborn. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022;150(1):e2022057990.
- Moon RY, Carlin RF, Hand I. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics. 2022;150(1):e2022057991.
- American Academy of Pediatrics. Safe Sleep: Back Is Best, Avoid Soft Bedding, Inclined Surfaces & Bed Sharing. HealthyChildren.org.
Related Parent Resources
Explore more pediatric guidance about safe infant sleep, bassinets, cribs, nighttime waking and healthy sleep habits in the Pediatric Parent Guide Sleep Library.