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

When Emily Little gave birth to her first child, co-sleeping in bed was a given, despite all the public health messages telling her not to.

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

So she began looking for ways to reduce her baby's risk. Bed sharing has been found to be less risky for full-term babies in non-smoking, non-drinking, exclusively breastfed families: check. Only the nursing parent should sleep next to the baby: check. Because babies are less likely to suffocate on firm mattresses and without loose bedding, Little replaced the pillow-top mattress and got rid of all the blankets and extra pillows. Because babies could fall out of the bed or into the gap between the bed and the wall, Little moved the bed up against the wall and filled the gap with foam.

However, Little's decision flies in the face of advice from pediatricians and public health advocates, who warn that bed-sharing increases a child's risk of dying at night. For decades, U.S. pediatricians and public health officials have warned that the only way to avoid sudden unexplained infant death (SUID) is to follow the “ABCs of Safe Sleep”—always let your baby sleep alone, on his back, in a separate crib, clear of pillows, blankets, stuffed animals and bumpers. One controversial campaign even featured a picture of a child lying down. next to the meat knifesending the message that parents can become lethal weapons when they sleep next to their baby.

And it worked: sleep-related infant mortality rates dropped significantly after safe sleep campaigns began in the 1990s. But in recent decades, the rate has stabilized and even started to rise again, while bedsharing has become more popular among parents. So some advocates are moving instead to a “harm reduction” approach, which acknowledges that parents want to sleep with their babies and offers advice on how to make it as safe as possible.

“Abstinence messaging hasn't worked, and parents are often not honest with their pediatricians when asked about it. We all have to accept that it's almost inevitable,” said Susan Altfeld, a retired University of Illinois at Chicago professor who has studied bedsharing. “Developing new messages to inform parents about what specific behaviors are particularly risky and what they can do to reduce those risks can lead to change.”

Changing views on bed-sharing

About 3,700 babies die suddenly and unexpectedly in the United States each year, a figure that has remained high for decades. According to the US Centers for Disease Control and Prevention. The risks of co-sleeping are real: Babies who sleep with adults are 2 to 10 times more likely to die than those who sleep alone, depending on specific risk factors, the American Academy of Pediatrics (AAP) wrote in its report. Latest recommendations for safe sleep.

However, the percentage of U.S. parents who said they usually sleep in the same bed increased by about 6% in 1993 To 24% in 2015. And in 2015, 61.4 respondents reported that they shared a bed with their infant at least occasionally. Although more recent national data are not available, more than a quarter of mothers in California said they “always or often” shared a bed between 2020 and 2022.

La Leche League International, a breastfeeding advocacy organization, suggests “Safe Sleep 7” on their website to help parents share a bed more safely. Little has codified her own “harm reduction” advice for safer co-sleeping into an online guide for other parents that helps encourage detailed conversations between parents and health care providers to help reduce the risks of what is at least a casual practice for most parents. She also highlights the positive aspects of co-sleeping and helps families reduce risks.

For example, babies who share a bed with their mothers have been shown to breastfeed longer. Parents who plan ahead and share beds more safely can avoid accidentally falling asleep with their baby in the most unsafe situation—on a reclining chair or couch. Many parents find it strengthens their bond with their child, she said.

“Babies biologically expect constant close contact with their caregivers, especially in the first months of life,” Little said. “Denying this fact because we as a society fail to have conversations about risk reduction and harm reduction actually does a disservice to children's well-being and mental health.”

Opposition from safe sleep advocates

The Academy of Pediatrics acknowledges in its 2022 guidelines that parents may “choose to regularly share a bed for a variety of reasons” and offers some safety tips if a parent “unintentionally” falls asleep with their child. “However, based on the available evidence, the AAP cannot recommend bedsharing under any circumstances,” the guidelines state.

It's nearly impossible to assess whether a family truly poses a low risk when it comes to bedsharing, especially since many don't tell their doctors about their drinking, smoking 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 some nights a parent is low-risk, she says, one night when they have a glass of wine, they suddenly fall into the high-risk category.

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

“We don't have to give [parents] “Every day I deal with babies who have died, and if it happened in a situation where they slept in the same bed, [parents] I'm sorry about that. I deal with this enough and I don’t want anyone to regret it.”

Changing safe sleep messages would be a “slippery slope,” said Deanne Tilton Durfee, executive director of the Interagency Council on Child Abuse and Neglect, which runs the safe sleep campaign in Los Angeles County. “You have to be very clear with your messages” because many parents may not pay attention to details, she said.

In 2024, 46 babies in Los Angeles County died while sleeping, and almost all of them slept in the same bed, Durfee said.

Reality in parents' homes

Pachet Bryant, a Mission Viejo mother, felt deeply ready to sleep with her newborn baby from birth. “You raise a baby for nine to 10 months, and suddenly being separated from your heart, from your presence, from your scent can be traumatic,” she said.

But she wanted to do it as safely as possible. So when lactation consultant Asaiah Harvill began working with her, the consultant offered personalized advice tailored to the new mother's situation, which Bryant took “very, very seriously.” Bryant had already done her research and was able to modify her space accordingly. She also reevaluated each night whether she thought her baby was safe to sleep in the bed; at night, when she was too tired, she put her daughter to sleep in the crib instead.

“We know that parents, either intentionally or unintentionally, fall asleep with their baby at some point, and we need to think about creating the safest possible environment for that to happen,” Harvill said. In the real life of a single family home, she said, “we can’t just teach abstinence.”

This article is part of The Times' Early Childhood Education Initiative, which focuses on the learning and development of California children from birth to age 5. For more information about this initiative and its charitable sponsors, visit latimes.com/earlyed.