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Breastfeeding and co-sleeping

Co-sleeping is more common than you think.

 

Find out how to do it safely and get more sleep yourself.

co-sleeping

Co-sleeping is a term that refers to a mother and/or her partner (or any other person) being asleep on the same sleep surface as a baby. 

If your baby ends up in your bed during the night, you're not alone. Many parents find that bringing their baby into their bed is easier. It helps them to care for their baby at night and everyone gets more sleep. Australian research has found that around 75% of babies spend at least some time co-sleeping in the first 3 to 6 months of life. 

It is recommended that babies sleep in their own safe sleeping space next to the parent's bed for the first 6 to 12 months of life. However, many parents choose to, or have no option but to, share a sleep surface with their baby.  

It’s not bed-sharing alone that is dangerous, but other factors which may interact in bed-sharing and shared sleep environments to increase the risk of a sudden unexpected death in infancy (SUDI).  

Breastfeeding has a protective effect against SIDS

There are several theories as to why breastfeeding protects against sudden unexpected deaths in infancy: 

  1. Breastfed babies are more easily woken up than formula-fed babies at 2 to 3 months of age, which is within the 2-to-4-month age when SIDS occurs most.  

  1. Breastfeeding provides babies with important immune factors (e.g. antibodies and white blood cells) which may help to protect babies from SIDS. 

  1. Some babies whose deaths are sudden and unexpected have had a minor infection in the days before that wasn’t considered sufficient alone to have caused death. Breastfed babies suffer fewer infections than formula-fed babies. 

Breastfeeding and co-sleeping 

Babies need to be fed during the night and many new mums fall asleep while feeding their baby. Co-sleeping helps to minimise disruption to sleep for both mum and baby.  

Breastfeeding and co-sleeping mutually support each other. Co-sleeping is convenient for night feeding so that’s why parents choose to do it. Mums who bed-share with their baby tend to breastfeed longer and keep exclusively breastfeeding for longer than those who do not co-sleep.

You may be concerned about co-sleeping with your baby. However, it has been found that when a breastfeeding mum co-sleeps, she usually lies in a position that helps her keep close physical contact and care of her baby.

  • She usually forms a protective "C'' shape around her baby. She keeps her baby at the level of her breast with an arm between her baby’s head and the pillow.  

  • She instinctively bends her legs making the protective space around the baby. It's impossible for another person to roll onto the baby without first touching her legs. 

  • A breastfeeding mum who co-sleeps with her baby also tends to be highly responsive to her baby’s needs. As long as she hasn’t drunk alcohol, taken illegal or sleep-inducing drugs and isn’t extremely tired.

  • Mums and babies who co-sleep tend to wake more during the night and this may protect against sudden unexpected infant deaths. The mum checks her baby and breastfeeds them more frequently when co-sleeping than when room-sharing. 

Risk factors for SUDI when co-sleeping 

Under certain circumstances, some studies have reported an increased risk of SUDI in co-sleeping babies. The following risk factors have been identified: 

Smoking 

A baby exposed to cigarette smoke (e.g. if the mother or father smokes, or the mother smoked during pregnancy) increases the risk of SIDS, no matter where the baby sleeps. Smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby. 

Parents who smoke are encouraged to room-share as long as the room the baby sleeps in is kept smoke-free. Their babies have an increased risk of sudden infant death and therefore require more checking. 

Alcohol, drugs or extreme fatigue 

Babies are at increased risk of a fatal sleeping accident if they co-sleep with someone who has consumed alcohol or illegal or sleep-inducing drugs or who is extremely tired. If this is you, don’t co-sleep with your baby. 

Sharing a sleeping surface with a sibling(s) or a pet(s) 

Babies are at increased risk of death if they co-sleep with more persons than their parents (e.g. other siblings) or with a pet. Co-sleeping with a sibling raises the risk. Babies should not co-sleep if there is anyone other than the parents in the bed. 

Obesity 

Parents who are obese may not be able to feel exactly where or how close their baby is and so may wish to room-share with their baby. Obese parents should not co-sleep with their baby. 

Formula-fed babies 

Dr James McKenna recommends that formula-fed babies room-share with their parents rather than co-sleep, because mothers who formula feed their babies do not show the same responsive night-time parenting practices as breastfeeding mothers. 

Sofa-sharing 

Sleeping a baby on a sofa, couch, beanbag or armchair increases the risk of a fatal sleeping accident. Caregivers should never co-sleep with a baby on a sofa, couch or armchair. Babies can suffocate against cushions or become wedged between the seat and the back of the sofa whether or not a sleeping adult is present. 

Young baby and overheating or head covering 

It’s possible there is a higher risk of death in a young baby who co-sleeps with a parent if the baby overheats or if the baby’s head becomes covered. Some studies have reported a higher risk of death when a young baby (i.e. under the age of 12 weeks) shares a bed with a parent. These studies did not however consider all known risk factors such as alcohol or drug use, or multiple bed-sharers. In addition, the peak age for SIDS has always been within this range no matter where the baby sleeps.

Baby alone on an adult bed 

Leaving a baby unattended on an adult bed increases the risk of a fatal sleeping accident.

Infant wrapping and swaddling 

Do not wrap baby if sharing a sleep surface as this restricts arm and leg movement. 

Room-sharing is safer than sleeping alone 

There is a lower risk of SIDS when a baby room-shares with parents as compared to a baby sleeping alone in another room. Sleeping in a room with other children has no protective effect.  

As long as you don’t smoke and haven’t been drinking... 

The main risks of co-sleeping are overheating and head covering. If you want to co-sleep: 

  • Put your baby to sleep on their back.  

  • Don’t swaddle or wrap your baby. 

  • Don’t use electric blankets.  

  • Keep your baby away from pillows, doonas, blankets or sheets.  

  • Keep your baby’s head clear. 

  • Use a firm, flat mattress. 

  • Make sure your baby cannot become trapped against a wall or another bed between the sides of the bed and the mattress.

Summary 

  • Most SUDI deaths occur when a baby is sleeping alone outside the supervision of a committed adult. 

  • Parents who co-sleep need to be aware of the risks and arrange the sleeping space to minimise these risks. 

  • Co-sleeping with a parent who smokes increases the risk of SUDI including SIDS. Smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby. 

  • Parents affected by alcohol, drugs or extreme fatigue should not co-sleep with their baby while under the influence of those conditions. 

  • A sofa is not a safe sleeping place for a baby with or without a parent present as it increases the risk of infant death. 

  • Co-sleeping has the potential to benefit babies in that it supports breastfeeding and therefore a baby’s health. 

  • Co-sleeping helps parents get more sleep. 

  • The challenge is to lower infant death rates without compromising breastfeeding. 

  • It is unlikely that bed-sharing in itself is a risk factor for SUDI. It’s more likely to be the particular circumstances in which co-sleeping occurs. 

For further information 

 

Download ABA's information leaflets about breastfeeding and co-sleeping

Six ways to reduce the risk of sudden unexpected death in infancy and sleep baby safely (from Red Nose)

Blue heart

1. Sleep  baby on the back  from birth, not on the tummy or side 

Blue woman

2. Sleep baby with  head and face uncovered

Blue star

3. Keep baby  smoke free  before birth and after

Blue heart tree

4. Provide a safe sleeping environment  night and day

Blue people heart

5. Sleep baby in their  own safe sleeping place in the  same room as an adult care-giver  for the first six to twelve months

Blue heart shirt

6.  Breastfeed baby

Research

1. Queensland Health 2008 Safe Infant Care to Reduce the Risk of Sudden Unexpected Deaths in Infancy Policy Statement and Guidelines. Queensland Government, Queensland Australia 

2. Alm, B., Wennergren, G., Mollborg, P., Lagercrantz, H 2015, Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatr 105(1),31–38.  

3. Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., Vennemann, M.M 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 128(1),103-10. 

4. Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., Vennemann, M.M 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 128(1),103-10. 

5. Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., Vennemann, M.M 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 128(1),103-10. 

6. Sankar, M.J., Sinha, B., Chowdhury, R., Bhandari, N., Taneja, S., Martines, J., Bahl, R (2015), Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 104(467),3-13. 

7. Ball HL, Hooker E, Kelly PJ 2000, Parent-infant co-sleeping: Fathers’ roles and perspectives. Inf. Child Dev 9: 67-74. 

8. Rigda RS, McMillen IC, Buckley P 2000, Bed sharing patterns in a cohort of Australian infants during the first six months after birth, J. Paediatr Child Health 36: 117-121. 

Cole R, Young J, Kearney L, Thompson J 2020, Infant care practices and parent uptake of safe sleep messages: a cross-sectional survey in Queensland, Australia. BMC Pediatr 20:27.  

 9. Ball, H.L 2002, Reasons to bed-share : why parents sleep with their infants, Journal of reproductive and infant psychology, 20 (4):207-222. 

10. Ball, H.L 2003, Breastfeeding, bed sharing and infant sleep. Birth. 30(3): 181-188. 

11. Blair, P.S., Heron, J., Fleming, P.H 2010, Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis Pediatrics 126(5): e1119-e1126. 

12. McCoy, R.C., Hunt, C.E., Lesko, S.M., Vezina, R., Corwin, M.J., Willinger, M., Hoffman, H.J., Mitchell, A.A 2004, Frequency of bed sharing and its relationship to breastfeeding Dev Behav Pediatr. 2004, 25(3),141-114. 

13. Young, J 1998, Bed-sharing with Babies: The Facts, RCM Midwives Journal, 1(11),338-341. 

14. Young, J 1999, Night-time behaviour and interactions between mothers and their infants of low risk for SIDS: a longitudinal study of room-sharing and bed sharing, PhD thesis: Institute of Child Health,University of Bristol. 

15. Baddock, S.A., Galland, B.C., Taylor, B.J., Bolton, D.P.G 2007, Sleep arrangements and behavior of bed-sharing families in the home setting Pediatrics. 119(1),e200-e207. 

16. Young, J 1999, Night-time behaviour and interactions between mothers and their infants of low risk for SIDS: a longitudinal study of room-sharing and bed sharing, PhD thesis: Institute of Child Health,University ofBristol. 

17. Baddock, S.A, Galland, B.C., Taylor, B.J., Bolton, D.P.G 2007, Sleep arrangements and behavior of bed-sharing families in the home setting Pediatrics. 119(1), e200-e207. 

18. McKenna, J.J., McDade, T 2005, Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding Paediatr Respir Rev. 2005, 6(2),134-52. 

19. Blair, P.S., Ward-Platt, M., Smith, I.J., Fleming, P.J and the CESDI SUDI Research Group 2006, Sudden infant death syndrome and the time of death: factors associated with night-time and day time deaths. International Journal of Epidemiology 35(6),1563-1569. 

20. Mosko, S., Richard, C., McKenna, J 1997, Maternal sleep and arousals during bedsharing with infants. Sleep. 20(2),142-150. 

21. Horne, R.S., Parslow, P.M., Harding, R 2004, Respiratory control and arousal in sleeping infants Paediatr Respir Rev. 5(3),190-198. 

22. Baddock, S.A., Galland, B.C., Bolton, D.P., Williams, S.M., Taylor, B.J 2006, Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting Pediatrics. 117(5),599-1607 

23. Young, J 1999, Night-time behaviour and interactions between mothers and their infants of low risk for SIDS: a longitudinal study of room-sharing and bed sharing, PhD thesis: Institute of Child Health,University ofBristol. 

24. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191. 

25. Scragg, R., Mitchell, E.A., Taylor, B.J., Stewart, A.W., Ford, R.P.K., Thompson, J.M.D., Allen, E.M., Becroft, D.M.O on behalf of the New Zealand Cot Death Study Group 1993, Bed sharing, smoking, and alcohol in the sudden infant death syndrome. BMJ 307,1312-1318. 

26. Vennemann, M.M., Hense, H.W., Bajanowski, T., Blair, P.S., Complojer, C., Moon, R.Y et al 2012, Bed Sharing and the risk of sudden infant death syndrome: can we resolve the debate? Pediatr. 160(1),44-48.e2. 

27. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191. 

28. Vennemann, M.M., Hense, H.W., Bajanowski, T., Blair, P.S., Complojer, C., Moon, R.Y et al 2012, Bed Sharing and the risk of sudden infant death syndrome: can we resolve the debate? Pediatr. 160(1),44-48.e2. 

29. Hauck, F. R., Herman, S. M., Donovan, M., Iyasu, S., Moore, C., Donoghue, E., et al. (2003). Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study. Pediatrics, 111(5), 1207–1214. 

30. Red Nose 2017, Sharing a sleep surface with a baby. Accessed 6/8/17 from https://rednose.com.au/article/sharing-a-sleep-surface-with-a-baby 

31. McKenna, J 2012, Frequently Asked Questions, Accessed 6/8/17 from: http://cosleeping.nd.edu/frequently-asked-questions/ 

32. McKenna, J 2012, Frequently Asked Questions, Accessed 6/8/17 from: http://cosleeping.nd.edu/frequently-asked-questions/ 

33. McKenna, J 2012, Frequently Asked Questions, Accessed 6/8/17 from: http://cosleeping.nd.edu/frequently-asked-questions/ 

Ball, H.L 2006, Parent-infant bed-sharing behavior : effects of feeding type, and presence of father. Human nature : an interdisciplinary biosocial perspective, 17(3),301-318. 

34. Blair, P.S., Fleming, P.J., Smith, I.J., Ward, Platt, M., Young, J., Nadin, P., Berry, P.J., Golding, J., CESDI SUDI Research Group 1999, Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ 319,1457-1461. 

35. Byard, R.W., Beal, S., Blackbourne, B., Nadeau, J.M., Krous, H.D.F 2001, Specific dangers associated with infants sleeping on sofas. J Paediatr Child Health 37,476-478. 

36. Vennemann, M.M., Hense, H.W., Bajanowski, T., Blair, P.S., Complojer, C., Moon, R.Y., et al 2012, Bed Sharing and the risk of sudden infant death syndrome: can we resolve the debate? Pediatr. 160(1),44-48.e2. 

37. Blair, P.S., Fleming, P.J., Smith, I.J., Ward, Platt, M., Young, J., Nadin, P., Berry, P.J., Golding, J., CESDI SUDI Research Group 1999, Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ 319,1457-1461. 

38. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191. 

39. McGarvey, C., McDonnell, M., Hamilton, K., O’Reagan, M., Matthews, T 2006, A 8 year study of risk factors for SIDS: bed-sharing versus non-bed-sharing. Arch Dis Child 91.318-323. 

40. Ruys, J.H., de Jonge, G.A., Brand, R., Engelbert,s A.C., Semmekrot, B.A 2007, Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr 96,1399-1403. 

41. McKenna, J.J., McDade, T 2005, Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding Paediatr Respir Rev 6(2),134-152. 

42. Red Nose 2017, Sharing a sleep surface with a baby. Accessed 6/8/17 from https://rednose.com.au/article/sharing-a-sleep-surface-with-a-baby 

43. Scragg, R.K.R., Mitchell, E.A., Stewart, A.W., Ford, R.P.K., Taylor, B.J., Hassall, I.B., Williams, S.M., Thompson, J.M.D 1996, Infant room-sharing and prone sleep position in sudden infant death syndrome. Lancet 347,7-12. 

44. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191. 

45. McKenna, J.J., McDade, T 2005, Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding Paediatr Respir Rev 6(2),134-152. 

46. McKenna J.J., Mosko, S.S 1997, Bedsharing promotes breastfeeding, Pediatrics. 100(2 Pt 1),214-219. 

 

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