If You're Going To Co-Sleep, Follow This Advice

Bed-sharing is common, but both the Canadian Paediatric Society (CPS) and the American Academy of Pediatrics (AAP) have long advised new parents not to bed-share, warning that it's dangerous and poses suffocation risks, along with a higher risk of sudden infant death syndrome (SIDS).

• Room-sharing is safer than bed-sharing for young babies.
• The risks of bed-sharing are especially high for babies under four months, babies born preterm, and babies with low birthweight.
• Smoking, alcohol, cannabis, opioids and other sedating substances raise the danger significantly.
• Sofas, recliners, pillows, loose blankets and soft mattresses make sleep much less safe.
• Breastfeeding and pacifier use may be protective in some situations, but they do not make bed-sharing risk-free.
• If parents do end up bed-sharing, understanding the highest-risk situations can help them avoid the most dangerous ones.

Co-Sleeping is common

When parents are desperate for just a few hours of sleep, bed-sharing often happens. Anyone who has brought their infant into their bed for a 3 a.m. feed knows how easy it is to doze off while nursing, with the baby in your arms, whether you mean to or not.

A joint statement on safe infant sleep, put out by the CPS and Health Canada in 2021, backs up what many parents have experienced first-hand: One-third of Canadian mothers report bed-sharing regularly, and another-third say they do so occasionally.

A majority of Canadian parents are going to co-sleep at some point, regardless of the advice and regardless of their best intentions. The statement reflects that reality. “We knew that we had to address the elephant in the room,” says April Kam, a CPS adviser and pediatric physician based in Hamilton, Ont.

In the United States, almost half of mothers report that they sometimes, often or always co-sleep with a child, according to a study by the American Academy of Sleep Medicine.

Ultimately, Kam says that the safest place for infants to sleep is in a crib, cradle or bassinet, because bed-sharing increases the risk of suffocation and overheating.  It's the role of the CPS to be clear about where the risks of SIDS lie, says Kam, but it's up to parents to choose what works best for their families, and the more information parents have, the better.

This is why the joint statement was updated to include which behaviours, and which family circumstances, can put babies most at risk. According to the new statement, these risks are "particularly high for infants less than four months of age, or if the infant was born preterm or with low birthweight."

Because many exhausted parents end up bed-sharing at some point, here's expert-based guidance that spells out which situations raise the risk most and which safer alternatives parents should try first.

Breastfeeding is associated with a lower risk of sudden infant death syndrome (SIDS), and Canadian pediatric guidance says that protection appears to increase over time, especially in the first months. But experts stress that breastfeeding does not cancel out the added risks of bed-sharing.

Stay sober and smoke-free

Exposure to cigarette smoke during pregnancy and after birth is linked to a higher risk of SIDS, and the danger rises further when bed-sharing is involved. Health Canada and the Canadian Paediatric Society warn that bed-sharing is especially risky if a parent smokes, if the baby was exposed to smoke during pregnancy, or if either parent has used alcohol, cannabis, opioids or other sedating substances.

It's also why experts say bed-sharing should never happen when a parent is impaired, unusually overtired or harder to wake.

Kam stresses that babies should never be put down on a soft surface with loose bedding nearby. That means no pillows, duvets, comforters, nursing pillows, stuffed toys or crib bumpers. A baby sleeping on an adult bed is at greater risk if the mattress is soft, if there are gaps near the wall or headboard, or if bedding can cover their face.

A firm mattress with a tight-fitting sheet is the minimum setup for safety. Water beds, air mattresses and heavily padded pillow-top mattresses are particularly unsafe for infant sleep.

Sidecar cribs that attach to the bed, or co-sleeper bassinets with a drop-down side, are also not recommended because infants can become trapped in the gaps between the bed, the mattress and the co-sleeper. In fact, these kinds of products are largely not available to buy in Canada.

And avoid the whole "family bed" concept, too, adds Kam. Bed-sharing with other adults, older children, and pets further increases the risks of sudden infant death. The safest way to co-sleep is to limit the bed to just parent and baby.

When Galt first decided to embrace co-sleeping, she wanted to make sure she was doing it as safely as possible. “I read all the things and made sure nothing was dangerous. We never drank or smoked weed. Elliot slept without pillows, without blankets, and so did I,” she says.

Finally, don't sleep on a couch or in a chair with your baby in your arms, on your chest, or nestled next to you.

A well-fitting sleep sack is OK when co-sleeping, but never bed-share with a swaddled baby. The updated statement from the CPS also emphasizes that swaddling doesn’t reduce the risk of SIDS. In fact, Kam says swaddling can be dangerous in certain circumstances.

Regardless of where you put your baby down to sleep, “do not place a swaddled child on their side or their stomach, and discontinue swaddling if the infant is showing any signs of being able to roll,” says Kam. The swaddle should also be secured away from the baby's mouth or nose, closer to the shoulders, and not bunched up near the chin or face. If you use a blanket as a swaddle, choose a lightweight one so as not to overheat the baby.

Can pacifiers help keep co-sleeping babies safe?

Pacifiers may help reduce the risk of SIDS once breastfeeding is established. But they do not make bed-sharing safe or cancel out the added risks of sharing a bed.

Room sharing is a good, protective option that keeps infants near their parents overnight, but not in the same bed, says Kam. You can do this with a bassinet, travel crib or a regular crib, if you have the space in your bedroom. Or, some parents prefer to sleep on an adult-sized mattress in the nursery, next to the baby's crib.) Room sharing is associated with a lower risk of SIDS and is recommended for the first six months of life.

Because SIDS risks peak between two and four months, and it happens less often between six and 12 months, parents can relax a little as their babies get older.

Try a portable bassinet that rolls on wheels, that functions well on its own and can be rolled right up to parents' bedsides.

"As with most aspects of parenting, as the child ages, you can continue to modify and adjust to their developmental stages," Kam says. Once your baby learns to roll over, for example, you can stress less about making sure they're sleeping on their back—let them sleep on their tummies if they get there on their own.

Ultimately, there is a myriad of factors that affect safety and raise or lower the risks to the baby. Some bed-sharing situations are higher-risk than others, but bed-sharing still carries more risk than using a separate crib, cradle or bassinet.

Kam likes to use a cycling safety analogy: “Consider all the layers of protection we wear on our bike. Maybe we’d be safe with only some of those, and maybe we’d make it through with none. But it makes sense to protect ourselves as well as we can.” She says that parents have to do the best they can day-to-day, and her job is simply to make sure they’re as educated as they can be about the risk factors.

Baby Elliot is now almost two and still bed-sharing with his mom. "I only see him for an hour or two in the morning and at night, so sleeping is the longest time we have together on many days," Galt says. She's completely sold on co-sleeping now and will definitely continue with future babies.

"I know it's taboo," she says. "I thought we were going to do sleep training because that's the 'right' thing to do. But those first few months are freaking hell. And if you do all the research on co-sleeping, it can be done safely, in my opinion, and lead to better rest for everyone."

The bottom line

Bed-sharing might be common, but common doesn’t mean risk-free. Some families will still choose to bed-share or find themselves doing it unintentionally. If bed-sharing happens, the most important thing is to avoid the highest-risk situations—especially very young infants, couches or recliners, soft bedding, and smoking or sedating substances.

The goal is not to shame parents. It’s to make sure they have clear, current information about which sleep arrangements are safest, and which factors raise the danger most. For parents looking for the safest middle ground, room-sharing offers closeness overnight without the added risks of sharing a bed.