Safe Sleep for Baby: Co-Sleeping & the AAP

Baby Safe Sleep Recommendations

Last week, the American Academy of Pediatrics released an updated statement on safe sleep practices for babies in the ongoing quest to reduce SIDS rates. If you would like to read the full statement and learn all of the many ways you can help to protect your infant from SIDS, you can do so at the AAP's website. However, there was one important topic that I would like to cover: co-sleeping, room-sharing, and bed-sharing.

For a long time AAP's guidelines have been that babies should always sleep alone, on their backs, and in their own beds. While these core recommendations remain in the updated statement, the AAP expanded their guidelines to recognize one very important reality about infant care that all parents face: its exhausting.

Parents have been trying very hard for years to comply with the AAP guidelines. However, when it's 2am, and you have already been up every night for weeks on end, it is difficult to stay awake! Parents sometimes bring their baby out to the couch or a chair to try to stay awake while feeding, but then inadvertently fall asleep anyway. The trouble with this is that, while an adult bed can be made into a safer environment for infant sleep, a couch, recliner, or other chair are always dangerous for infants.

Co-Sleeping & the AAP

Enter co-sleeping. Co-sleeping is a confusing term, because sometimes people use it to talk about sharing a bed or other sleep surface with the baby, and other times it just means sleeping in the same room, but on different surfaces.

Basically: co-sleeping is an umbrella term that can mean bed-sharing or room-sharing.

Because of this confusion as to what the term "co-sleeping" actually means when we use it, the AAP intentionally chose to not use it. Instead, they chose to use the terms room-sharing and bed-sharing in their recommendations.

Room-Sharing: Plan A

According to the AAP, Plan A for new baby sleep should be room-sharing. The guideline is that parents and babies room-share for the first 6 months at least, and up to 12 months if possible. The official stance of the AAP is that the infant is fed, and then placed back into their separate sleeping area afterward at night.

This is what safe room-sharing looks like according to the AAP:

  • The infant has his or her own sleep surface such as a crib, bassinet, or similar near the parent's bed.
  • The infant is always placed on his or her back to sleep.
  • The infant's sleeping surface is firm and doesn't have any loose blankets, bedding, pillows, bumpers, stuffed animals, or other suffocation or strangulation hazards.

This situation is the AAP's Plan A for infant sleep. It is what they hope parents are working toward. But, they also want parents to be prepared with a Plan B too.

Bed-Sharing: Plan B

The AAP isn't endorsing bed-sharing, or the practice of sleeping with the infant on the same sleep surface such as an adult bed, couch, or chair. Yet, it is recognizing that sometimes bed-sharing happens, whether intentional or not. For this reason, while feeding your baby at night, try to set yourself up in advance with safe bed-sharing practices. Officially the AAP recommends, if you do fall asleep with baby in bed, to return the baby to their own sleep space upon waking.

Basic safe bed-sharing guidelines look like this:

  • The infant and adult are on a firm, adult mattress.
  • The bed should be away from any loose cords, and care should be taken to reduce any risk of entrapment. Things like bedrails should not be used.
  • There is no loose bedding, blankets, pillows, etc. that could accidentally cover the infant.
  • The infant is never brought into bed with any adult that has been drinking alcohol, using drugs, or otherwise is impaired.
  • The infant is never taken to the couch, recliner, armchair, etc. if the parent is tired and may fall asleep. Infants can easily slide down and become entrapped.

However you choose to feed and sleep, it is important to learn what safe sleep looks like in any and all circumstances, and to take steps to make sure that you are doing what you can to protect your baby. Dr. James McKenna, a PhD who specializes in infant sleep at Notre Dame, has written many articles on the topics of room-sharing and bed-sharing. For more in-depth information about what safe sleep looks like, his website is a wonderful resource.

Also, a postpartum doula is familiar with the guidelines, and can help guide you into setting up a safe environment for sleep that works best for your individual family.

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