Co-sleeping
Sharing a sleep surface (typically a bed) with an infant, as distinct from room-sharing.
| Prevalence (UK/US) | 9% proactive; higher reactive |
| Cultural variation | 59% in Japan vs 9% in US |
| Peak risk period | 0–3 months |
| Risk after 3 months | No elevated risk (non-smoking families) |
Types of Co-sleeping
Proactive co-sleeping — Planned family bed arrangement, often culturally influenced. More likely to continue full night and include naps.
Reactive co-sleeping — Unplanned bed-sharing due to sleep difficulties or exhaustion. Parents often fall asleep during night feeds unintentionally.
Safety Risks
Co-sleeping increases SIDS risk even in low-risk families. Among families with no other risk factors, approximately 1 in 7,100 would need to avoid co-sleeping to prevent one death.
Risk factors that dramatically increase danger:
- Parental smoking (current or during pregnancy)
- Alcohol or drug use by either parent
- prematurity
- Soft sleep surfaces (air beds, water beds, mattress toppers)
- Presence of siblings, pets, or non-parent adults
Risk reduction after 3 months: No elevated SIDS risk in non-smoking, non-drinking families.
Safe Co-sleeping Requirements
If choosing to co-sleep, all conditions must be met:
- Both parents: Non-smoking, no alcohol, no drugs
- Sleep surface: Firm mattress only—no toppers, pillows, blankets
- Bed placement: Away from walls; remove headboard/footboard
- Supervision: Never leave infant unsupervised in adult bed
- Exclusions: No siblings, pets, or other adults present
- Consider: Mattress directly on floor
Safety note: Prepare bed for safe co-sleeping even if not planning to bed-share. Most parents unintentionally fall asleep with baby at some point.
Sleep Quality Effects
Co-sleeping infants wake more frequently than crib sleepers. Children who continue bed-sharing beyond infancy sleep less overall and wake more often throughout childhood.
Successful co-sleeping requires:
- All parties willingly choosing arrangement
- All family members sleeping well
- Clear exit strategy with timeline
- No partner relegated to separate room
Medical Position
AAP recommends room-sharing (same room, separate surface) for minimum 6 months but advises against bed-sharing under any circumstances. This position reflects evidence from over 60,000 paediatricians and multiple meta-studies confirming SIDS link.
See also: Room-sharing, [[safe sleep Guidelines]], SIDS Risk Factors, [[infant sleep patterns]], [[sleep training Methods]]