The Truth About the Risks of Co-Sleeping

The topic of co-sleeping and bed-sharing can be challenging. While leading organizations like the American Academy of Pediatrics (AAP)—which notes that parents should sleep in the same room, but not the same bed, as baby—have clear public stances against the practice when it comes to infants, many families still co-sleep some or all of the time. A 2013 study in JAMA reported 45% of parents saying they shared a bed with their infant at least some of the time.

Indeed, in some cultures co-sleeping is the norm. Some parents believe that the purported benefits of co-sleeping outweigh the known risks. While other parents find themselves co-sleeping out of convenience or a desperate desire to get more sleep themselves.

The divide between experts' official stance and what parents actually do can lead to a lack of honest conversation between doctors and parents. That's why it's important for parents to equip themselves with the facts about co-sleeping and talk to their doctors about any concerns they have about their baby's sleep. Here's what all parents should know about the benefits and risks of co-sleeping.

What the Research Says

The difficult truth is that co-sleeping is associated with an increased risk of accidental death in babies. The AAP's safe sleeping guidelines, which were updated in June 2022, state that parents should never let their baby sleep in the bed with them—citing the risk of suffocation, sudden infant death syndrome (SIDS), and other sleep-related deaths.

Indeed, according to data compiled by NPR in 2018, a low-risk baby (meaning a baby who doesn't have any medical conditions that interfere with breathing or other risks factors such as prematurity) has a 1 in 16,400 chance of dying from SIDS in a parent's bed. The likelihood decreases to 1 in 46,000 while sleeping in a crib in the parent's room.

Furthermore, a 2021 review on the risks of co-sleeping from the Royal College of Obstetricians and Gynaecologists in the UK found that the risks are higher when:

• Co-sleeping is done on a sofa versus a bed
• The baby is under 98 days old
• Co-sleeping is done all night versus some of the night
• If the adult co-sleeping has consumed alcohol
• If the adult co-sleeping has smoked

Where a baby sleeps—whether co-sleeping with a parent or on their own—has a significant impact on their safety. For instance, the worst place for a newborn to doze is on a couch, armchair, or other soft, lumpy surface, which can create air pockets that make it difficult for them to breathe. This is especially dangerous during late-night feedings when both parent and baby are drowsy.

"If you think that there's even the slightest possibility that you may fall asleep [during a feeding], feed your baby on your bed, rather than a sofa or cushioned chair," says Lori Feldman-Winter, MD, FAAP, member of the Task Force on SIDS and co-author of the AAP's 2016 report on safe sleep guidelines for infants, in a statement. "If you do fall asleep, as soon as you wake up be sure to move the baby to [their] own bed," she adds.

Despite the evidence that highlights the risks, many families co-sleep. In fact, according to data from the Centers for Disease Control and Prevention (CDC) from 2015, more than half of mothers surveyed reported co-sleeping. So why do parents still choose to co-sleep with their babies? Well, along with some cultural practices, the purported benefits of co-sleeping are that it promotes bonding, helps children feel safe, and makes nighttime nursing easier. But how much truth is there to those claims?

Why Parents Choose Co-Sleeping

Even when doctors and leading health organizations strongly advise against co-sleeping, some parents still choose it for perceived benefits like bonding and convenience.

From a practical standpoint, co-sleeping offers convenience: Not only does bed-sharing keep parents physically close by to respond to the baby's needs at night, but the proximity can make it easier for the breastfeeding parent to nurse throughout the night with minimal interruption to their own sleep.

Beyond practicality, parents have an instinctual drive to stay close to their infant, and some parents believe that children derive a greater sense of security and well-being from sleeping near their parents.

"There is an instinctive need for the mother to be close to her baby," says Cynthia Epps, MS, a certified lactation educator at the Pump Station in Santa Monica, California. There are real benefits to babies being physically close to their parents. "Keeping the baby close, with skin-to-skin contact, calms the baby," says Epps. "And it can cement the emotional bond between mother and child."

There's also a historical and cultural precedent for the practice. For centuries, in many cultures all over the world, children of all ages have shared a bed with their parents.

Some families also co-sleep with older children, when the risks that affect babies are no longer an issue. For instance, Samantha Gadsden, a birth doula in Caerphilly, Wales, shares a bed with her three children, even though the UK's National Health Service (NHS) shares the AAP's stance against co-sleeping.

The Drawbacks of Co-Sleeping

On the flip side, Lynelle Schneeberg, PsyD, director of the behavioral sleep program at Connecticut Children's Medical Center, tells Parents that sharing a family bed almost always, eventually, becomes problematic for a variety of reasons. Helping kids become confident, independent sleepers is more important than any positive effects of co-sleeping, says Dr. Schneeberg. In fact, Dr. Schneeberg notes, some of the risks of co-sleeping go beyond physical safety.

Your kids may develop a sleep crutch

Always having a parent around at bedtime can become a strong "sleep onset association," also called a sleep crutch or sleep prop, which is something your kid can't drift off without. "Children need to learn how to fall asleep without a parent nearby," says Dr. Schneeberg.

Your kids may display anxious behaviors

In addition to developing the sleep crutch, some children will come to expect interactions like back rubbing, patting, and being held to fall asleep. "They may be misdiagnosed as anxious because, since they have a hard time falling asleep without a parent nearby, they sometimes display anxious behaviors to convince a parent to stay nearby at bedtime," Dr. Schneeberg explains.

One bedtime doesn't fit all

Children of different ages need different amounts of sleep, and their bedtimes vary accordingly. In families that share a bed, parents and older children often end up turning in much earlier than they might otherwise, based on when the youngest children need to, explains Dr. Scheeberg. This situation easily becomes frustrating for everyone involved.

Your sleep quality may suffer

As notoriously restless and active sleepers, children can disrupt their parents' sleep by kicking or thrashing around, Dr. Schneedberg explains. "I've seen many families in which one parent—most often, the father—ends up sleeping in a different room entirely," she says. "The parent with the children often becomes exhausted by either the restless sleep of the kids or the needs of each kid after an awakening."

Your relationship may suffer

For many couples with children, evenings are the only time they have to be alone together. When you're sharing a bed with your kids, however, they're literally separating you from your partner. The co-sleeping arrangement could lead to limited time or space for intimacy.

It increases the risk of SIDS and suffocation

And of course, don't forget that co-sleeping increases the risk of sudden infant death syndrome. Parents or objects (like pillows or blankets) may unknowingly roll onto the baby at night, leading to injury, suffocation, or death. The AAP says co-sleeping is especially dangerous if the baby is younger than 4 months, was born prematurely, or had a low birth weight. The risk also increases if someone in bed smokes, drinks, or takes drugs—or if the co-sleeping surface is soft and has bedding.

Safe Alternatives to Co-Sleeping

If you are considering co-sleeping with your baby, the first thing you should know is that you don't have to be afraid to talk to your doctor about your questions or concerns about your family's sleep. For instance, if you're having trouble sleeping or your baby won't nurse unless they're attached to you all night, your doctor may be able to recommend resources that can help.

In fact, many of the reasons that lead parents to consider co-sleeping in the first place have other safer solutions. One of those safe alternatives is room-sharing.

While the AAP strongly advises against parents bed-sharing with infants, they strongly recommend room-sharing, which keeps babies close to their parents in the same room (often within arm's reach) but on their own safe sleeping surface like a bassinet or crib. This closeness still supports breastfeeding and allows parents to quickly attend to their baby's needs at night while reducing the risks associated with co-sleeping.

The benefits of room-sharing are so strong that the AAP recommends room-sharing for the first year of an infant's life, or at minimum, the first 6 months of life.

The Bottom Line

If you're worried about fostering a close relationship with your baby at night, or that putting your baby to sleep in a crib or bassinet is somehow abandoning them, you can take a deep breath. "Location is not as important as relationships—how parents build attachment and love," says James McKenna, PhD, an anthropologist specializing in infancy and development and director of the mother/baby behavioral sleep laboratory at the University of Notre Dame in South Bend, Indiana.

That is to say that you create strong bonds and secure attachments with your baby whether or not you co-sleep. Your baby can benefit from bonding activities, physical closeness, and skin-to-skin contact without bed-sharing at night.

If you've been sharing your bed because you feel it will be easier for your little one to sleep that way, it's not too late to break the habit and help your child to fall asleep in their own bed.