FOR decades, new parents have been warned against sharing a bed with their babies. While snuggling up with your newborn may seem like the most natural thing in the world, prevailing medical advice says this increases the risk of sudden infant death syndrome (SIDS), sometimes called cot death. Instead, doctors say your little ones should sleep in a separate crib in your bedroom.
On the other side of the argument are anthropologists and proponents of 鈥渁ttachment parenting鈥�, who believe that infant-parent separation is unnatural and at odds with our evolutionary history. They favour not just room-sharing but bed-sharing 鈥� putting them in direct conflict with paediatric advice.
This debate was recently reignited by a study suggesting that room-sharing for up to nine months reduces a baby鈥檚 sleep, which in theory could have future health consequences. So what鈥檚 a sleep-deprived parent to do?
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Our ancestors slept in direct contact with their young in order to protect them, just as other primates do today, says at Durham University, UK. 鈥淏abies respond to close contact 鈥� their breathing, blood oxygen and heart rate are on a more even keel.鈥�
In Asia and Africa, still share their parents鈥� beds (see map). But in the West, bed-sharing fell during the industrial revolution as increased wealth let people afford separate rooms and value was placed on teaching early independence.
Then, in the 1990s, the perception of bed-sharing went from unfashionable to dangerous, after research suggested that SIDS was who slept in their parents鈥� bed. In 2005, the American Academy of Pediatrics (AAP) released , which were also adopted in the UK and Australia.
The AAP acknowledged that the association between SIDS and bed-sharing wasn鈥檛 clear-cut, but the link became gospel nonetheless. went up in the US depicting babies in adult beds with butchers鈥� knives lying next to them, warning: 鈥淵our baby sleeping with you can be just as dangerous.鈥�
鈥淣inety-nine per cent of paediatricians would tell you never to bed-share,鈥� says at Pennsylvania State University. 鈥淲e鈥檙e not sleeping on cave floors anymore, we鈥檙e on 21st-century mattresses with pillows and blankets that can suffocate babies.鈥�
鈥淣inety-nine per cent of paediatricians would tell you never to share your bed with your baby鈥�
But more recently, evidence has emerged that bed-sharing can be done safely. A of 400 SIDS cases in the UK found that sleeping with a baby is only associated with SIDS if it is on a sofa, or the parents smoke or consume more than two units of alcohol before bed.
Parents without these risk factors can prepare safe sleeping spaces for their baby, says Ball. 鈥淯se a firm mattress, keep pillows and blankets away,鈥� she says. Lab observations show mothers instinctively curl around their babies, she says, but if you are afraid of rolling onto your baby, place them in a bedside crib attached to the bed to form a continuous but protected surface.
In Japan, where bed-sharing rates are high but SIDS rates are low, protective measures are part of the culture, says at the University of Virginia. Japanese mothers generally sleep on firm futons, place babies on their backs, and don鈥檛 smoke much, she says.
Hong Kong also has high bed-sharing rates and low SIDS rates, although the SIDS definitions in Japan and Hong Kong are slightly different to those in Western nations. Other countries where bed-sharing is common don鈥檛 routinely collect data on SIDS.
Because we still don鈥檛 really know what causes SIDS, it鈥檚 difficult to know how bed-sharing and SIDS might be linked. But the latest research points to a role for biological factors unrelated to sleep location. For example, a found that babies who died of SIDS had faulty signalling from a brain chemical called orexin, which made it harder for them to wake up. Other research suggests the condition is caused by that make it harder for babies to regulate breathing.
However, Hauck, who co-authored the AAP鈥檚 most recent , says she is still not convinced about the safety of bed-sharing, as her team鈥檚 review of all the evidence suggested there is still a small risk of SIDS even if factors like parents being non-smokers are considered. 鈥淲e鈥檙e taking a cautious approach and continuing to recommend that infants sleep on a separate surface,鈥� she says.
Even if bed-sharing can be done safely, parents must still ask themselves whether it is worth it. Proponents say that the security children derive from sleeping with their parents helps make them more caring and empathetic, though little research has been done to support this. Others say it simply disrupts everyone鈥檚 sleep.
One clear advantage is that bed-sharing makes breastfeeding easier, says Ball, which is linked to a lower risk of SIDS, infections, allergic disease and obesity. She led a , in which babies were randomly assigned to sleep in their mother鈥檚 bed, a crib attached to her bed, or a standalone cot adjacent to her bed. It turned out that babies sharing a bed or in bedside crib breastfed twice as often as those in standalone cots.
However, little research has been done on the long-term impacts of bed-sharing. One study that followed 205 Californian children for 18 years found that bed-sharing as infants had , relationships with others, attitudes to sex, the use of drugs and alcohol, or criminal tendencies when they grew up. But teasing out the effect of sleep location among other factors on development is practically impossible, says Ball.
鈥淭here鈥檚 no one-size-fits-all guidance, and people shouldn鈥檛 reduce it to: 鈥榶ou should do this or do that鈥欌��
The long-term effects of room-sharing are also unknown. A survey of 230 mothers in the US found that 9-month-old babies slept 40 minutes less on average per night if they shared their parents鈥� room (Pediatrics, ). Poor sleep early in life could lead to cognitive and behavioural problems, says Paul, who carried out the study.
Whether this could have lasting effects is still conjecture. It is also unclear whether sounder sleep is desirable, since babies who wake up less are thought to be more at risk of SIDS, says Hauck.
Babies can usually be moved safely to their own room when they are about 6 months old, says Ball, when the risk of SIDS drops off sharply and infants start to develop object permanence 鈥� the understanding that objects still exist even when they can no longer be seen. 鈥淭hen babies understand that even though they can鈥檛 see their mum, she hasn鈥檛 disappeared forever,鈥� she says.
The AAP recently shifted from recommending at least one year of room-sharing to at least six months. 鈥淲e accepted concerns that sleeping in the same room for a year can be difficult,鈥� says Hauck. The UK鈥檚 NHS also recommends six months.
Parental choice
Educating parents is better than simply telling them what to do, says Ball. 鈥淭here鈥檚 no one-size-fits-all guidance, and it bothers me when people try to reduce it down to: 鈥榶ou should do this or do that鈥�.鈥�
Rigid guidelines can also backfire. For example, parents who have been warned never to bed-share may end up falling into an exhausted sleep with their baby on a sofa, which is more dangerous than a carefully prepared bed, says Ball.
This idea is starting to catch on. Since 2016, the AAP guidelines have included advice on how to bed-share more safely, in case parents choose to do it or it happens accidentally. And in 2014, the UK鈥檚 National Institute for 午夜福利1000集合 and Care Excellence recommended , instead of banning it outright. In Australia, the National 午夜福利1000集合 and Medical Research Council is also updating .
The debate remains polarised, but the evidence suggests your baby can sleep wherever works best for you, as long as it is done sensibly. If you want to bed-share, there are ways to reduce the SIDS risk. If you want to move your baby into their own room after six months, you are unlikely to stunt their emotional growth. The important thing is to have informed choice 鈥� and hopefully, a good night鈥檚 sleep.
This article appeared in print under the headline 鈥淟ullaby and goodnight鈥�
