Is Co-Sleeping Safe for Babies?

As a new mom, there’s nothing like having your baby close to you when you sleep. But is co-sleeping with a baby under a year old safe? That may depend on what baby co-sleeping means to you.

About 3,400 babies in the U.S. die suddenly and unexpectedly every year while sleeping, according to Centers for Disease Control and Prevention (CDC). There are serious risks to some forms of co-sleeping, but many parents choose to co-sleep, at least occasionally, so it’s important to understand what the risks are and how to minimize them if you do decide to co-sleep with your baby.

Bed-sharing with baby

For many parents, co-sleeping means sharing the same bed as their baby. The American Academy of Pediatrics (AAP) and the CDC both advise against sharing a bed with children under a year old because bed-sharing increases the risk of suffocation, strangulation and SIDS in babies younger than 12 months of age. In 2019, 28% of all sudden unexpected infant deaths (SUID) were caused by strangulation and suffocation in bed, according to the CDC.

“We may not be able to prevent all SIDS deaths, but we can minimize the risks,” Michael Goodstein, MD, a neonatology physician at WellSpan Health in York, Pennsylvania, and director of the York County Cribs for Kids program, told TODAY Parents. “Suffocation and strangulation are environment-driven problems that can be prevented.”

There are several things that make co-sleeping bed situations with adults and babies dangerous. For example, when you're sharing the same bed, it’s possible you could roll over onto your baby while sleeping. Your bedding could also obstruct the baby’s breathing or cause overheating. There are also conditions that can make bed-sharing with babies under a year old even more dangerous, according to the AAP, such as if:

• You’re bed-sharing with a baby that’s younger than 4 months old.
• The baby was born prematurely or with a low birth weight.
• The sleep surface is soft or has soft bedding like pillows, comforters or blankets. This increases the risk of SIDS by 20 times. Soft bedding is the single biggest SIDS risk factor for infants 4-12 months old, according to Dr. Goodstein.
• Anyone sharing the bed is a smoker (even if you do not smoke in bed).
• The mother of the baby smoked during pregnancy. (These babies are more than twice as likely to die of SIDS, according to a study published in April 2019 in the AAP journal Pediatrics.)
• Anyone sharing the bed has taken medicines or drugs that may make it harder to wake up.
• Anyone sharing the bed drank alcohol.
• The person sharing the bed is not the baby’s parent.
• The bed surface is soft, such as a waterbed, old mattress, memory foam, sofa, couch or armchair.

Sleeping with baby on your chest

As tempting as it is to catch a quick nap with your baby asleep on your chest, it’s a big risk. Sleeping on a couch, armchair or recliner with an infant increases the risk of SIDS death by up to 70%, said Goodstein. An adult could crush and smother the baby or the baby could become wedged between the adult and a cushion and be forced to rebreathe air (breathe in more carbon dioxide than oxygen), until it asphyxiates

Sam Hanke, MD, a pediatric cardiologist at Cincinnati Children’s Hospital and the founder of Charlie’s Kids, an organization that promotes safe sleep practices, learned this the hard way. As a new dad, Dr. Hanke fell asleep on a couch with his three-week-old son Charlie on his chest. Although Hanke woke up, his son Charlie didn’t, according to the organization’s website. It’s safe for your baby to nap on your chest as long as you remain awake and aware of the baby. But if you fall asleep too, it raises the risk of injury (or death) to your baby.

Sharing a bedroom with baby

Another form of co-sleeping with newborns is room-sharing. The AAP does recommend that babies sleep in the same room as their parents for the first six months — and ideally for one year. How do you safely co-sleep in the same room as your baby? Put the baby to sleep in a certified crib, bassinet or play yard in your bedroom. Use a fitted sheet on the mattress, but don't add blankets, pillows, crib bumpers or stuffed animals. When safe co-sleeping guidelines are followed, this co-sleeping practice of room-sharing can decrease the risk of SIDS by as much as 50% and prevent suffocation, strangulation or the type of entrapment that could occur when the infant is sleeping in the adult bed.

“We want babies close to us so we can hear if they get into trouble or accidentally roll over or get on their side and get in trouble,” Carolynne Harvey, a baby sleep consultant for 4moms and founder of Dream Baby Sleep, told TODAY Parents. If you’re in the same room, it’s easier to monitor and comfort your little one.

Room-sharing is also a convenient option for breastfeeding moms. Not only is it a short distance to get to the baby, it can help them continue breastfeeding, which can be further beneficial, since studies suggest that breastfeeding may reduce the risk of SIDS by 50%.

Breastfeeding in bed

It’s not uncommon for overly-tired mothers to breastfeed their infant in bed. In fact, the AAP recommends breastfeeding in bed over breastfeeding on a chair or couch because it’s a safer option if mom falls asleep and the baby slips out of her arms. Since a baby’s head is twice the weight of its body at birth, young infants don’t have the strength to reposition their head. If the baby’s nose leans against a surface like a pillow, a wall or a mattress, or even the mother’s body, it could lead to suffocation.

To reduce the risks of suffocation and overheating, breastfeeding moms should create a safe zone for the baby. Before bringing the baby into bed to nurse, all blankets, comforters, pillows, nursing pillows, and loungers should be removed from the area where the baby will be.

If you do doze off while feeding your baby, place baby on his back in his own crib, bassinet or other certified sleep device as soon as you wake up.

How to choose a safe crib, bassinet or play yard

The AAP also recommends that babies sleep in cribs, bassinets, portable cribs like a Pack ’n Play or play yards that are certified by the Consumer Product Safety Commission (CPSC).

Here are some things to keep in mind when choosing a certified sleep device:

• The crib, bassinet or play yard should have firm mattresses with a snug fit — no more than two fingers width of space between the mattress and the side of the crib or device.
• A firm mattress should not mold to the shape of the baby or allow them to sink in too deeply.
• No matter how firm the mattress feels to you, don’t add a mattress topper if your baby is younger than one year.
• Before purchasing a mattress or sleep device product, make sure it has not been recalled.
• Cover the mattress with fitted sheets made specifically for that device.
• Remember, there shouldn’t be anything else in the crib with your baby.
• Finally, don’t put baby to sleep in a crib with drop sides or one that was manufactured before June 2011 when the current safety standards went into effect.

Free portable baby cribs

Anyone in need of a safe crib should be able to get one. There are local non-profit organizations throughout the U.S. that provide low-income new parents (or those expecting a baby) with a certified sleep device so their baby has a safe place to sleep. For a state-by-state listing of these organizations, visit We Have Kids.com or Cribs for Kids.org.

What you need to know about other baby sleepers

There are a number of sleep devices that are not endorsed by the AAP because the organization doesn’t have the data necessary to make a recommendation for or against them. These include bedside sleepers (those that are attached to the side of the parent’s bed) and in-bed sleepers (portable containers for baby that go in the parents’ bed).

It’s important to note that bedside sleepers that have one side that folds down pose risks for entrapment and suffocation. If a baby’s head goes over the half-side of the sleeper, it may suffocate if it cannot lift its head off the side. Bedding from the adult bed can also spill over into bedside sleepers, which could cause overheating, suffocation, strangulation or SIDS.

On June 2, 2021, the CPSC banned a range of sleep products that have accounted for at least 90 infant deaths. One of these types of products, inclined sleepers, puts the baby on a substantial incline of up to 30 degrees, which could cause an infant’s head to slump down, the chin to rest on the chest and compress the airway, and potentially lead to suffocation.

Other banned products include baby tents, small travel beds and portable bassinets. Manufacturers of these products have one year to conform to the same federal standards as cribs, bassinets, bedside sleepers and play yards. In the meantime, these items are still on the market, so beware. Your safest bet is to choose only those devices that are recommended by the AAP and certified safe by the CPSC.

This story first appeared on TODAY.com. More from TODAY:

• Are baby crib bumpers safe?
• Is it safe to swaddle babies?
• Risky or loving? Co-sleeping study divides parents and doctors