This piece is part of Scientific American's column The Science of Parenting. For more, go here.
Before her son was born in 2020, Candace St. John had no plans to bed-share with her baby. As a public health professional in New Hampshire, she’d known for years that bed-sharing, often called co-sleeping in the U.S., was a huge no-no. Besides, she didn't understand why anyone would sleep next to a baby in bed. Why not just put them in a crib? (If you just laughed at that question, welcome to the club).
Then came reality. For the first two weeks, her baby woke up every 45 minutes to eat. Each time, St. John took him out of his crib and sat upright in bed to try and keep herself awake while he fed. Then, one night, she accidentally fell asleep. Her son rolled out of her arms and landed with a horrifying thud on the floor.
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He was fine. St. John was not. "I felt shame and guilt and like I was a fraud," she says.
She could have brought her son into bed and fed him lying down. But it had been drilled into her head—including by hospital staff just hours after her son's birth—that bringing her baby into bed, under any circumstances, could kill him. The reasons given were many and awful. She could roll onto him while they slept. Or he could get stuck in a crack of the bed or be suffocated by a stray pillow or blanket or a too-soft mattress.
But several months later, and after other risky situations that included her husband falling asleep with their son in an armchair, she began to research bed-sharing. (While sleeping on the same surface as a baby is often known as “co-sleeping” in the U.S., researchers prefer the term “bed-sharing,” since internationally “co-sleeping” tends to mean simply having a baby close to you.) St. John was blown away to learn that exactly how someone co-slept could make it more or less risky, and that their current setup, where they both tried to fight sleep to feed their son anywhere but lying down in bed, was likely the most dangerous of all. The lactation consultant who saw her at the hospital hadn’t even mentioned side-lying breastfeeding, a technique normally done in bed. St. John set up a floor bed, started feeding her son lying down and put a moratorium on armchairs—now knowing that the risk of death for an infant that falls asleep with someone on a sofa is up to 67 times higher than on a crib or bed.
After weighing the risks, St. John found herself leery of the all-or-nothing narrative about sleeping next to babies so prevalent in her field. She began bed-sharing. And, realizing how many other parents must be navigating similar situations, she launched an educational platform for both health providers and parents.
With so much judgment in the U.S. regarding where a baby should sleep, stories like St. John’s are rarely shared publicly. But as a journalist who often reports on infant sleep, I've heard from dozens of parents who, told not to bed-share, have unintentionally fallen asleep in extremely high-risk settings with their baby.
It’s not because these parents didn't get any safe-sleep messaging. It's because they did—but it was the black-and-white “baby must be alone, on their back, in a crib,” or “ABCs” of sleep, with zero guidance about how to minimize risk if crib sleeping wasn’t working. Making matters worse, these folks told me they weren't comfortable asking for advice because they felt their doctors would judge them for even considering (or for accidentally winding up) bed-sharing. Some told me hospital staff even asked them to sign paperwork just hours after giving birth, saying that they wouldn’t bed-share, before they could be discharged.
This abstinence-only approach has been the mainstay of most U.S. safe-sleep campaigns for the last 20 years. It also sets parents up to fail. For one, it glosses over just how different babies and families really are. Not all babies will settle in a crib. And not all families have the means, or ability, to physically get up and resettle an infant multiple times a night.
Besides, abstinence-only education doesn’t generally work. Take sex education: adolescents still have sex, and when they do, they know less about how to do it safely. Being told not to bed-share doesn’t seem to decrease bed-sharing rates, either. Today, even after years of abstinence-only messaging, many U.S. parents are falling asleep with their babies. For some, bed-sharing is a closely-held cultural tradition. But even for parents for whom it isn’t an ideal, a high proportion (by some measures, almost half) are doing it accidentally, sometimes with tragic consequences. Some parents whose infants died suddenly have said that they’d deliberately taken their babies to an armchair or sofa instead of the bed. The reason? They were afraid to bed-share.
One recent review found that for almost every infant death that occurred while sleeping with a caregiver, there were “multiple unsafe sleep factors present,” such as pillows, that went beyond the surface-sharing itself. Rather than rejecting bed-sharing entirely, health professionals could educate parents on how to bed-share more safely when necessary.
The current guidance also overlooks inherent contradictions. Parents are told to breastfeed (to reduce risk of sudden infant death syndrome, for example), which releases relaxation-inducing hormones in both baby and mother—but never to fall asleep breastfeeding. And that’s even though bed-sharing is known to help parents breastfeed longer.
The research on bed-sharing is not as clear as the public health messaging suggests. Much of it is tangled up with additional risk factors, like an inebriated parent or soft bedding. One of the most commonly cited analyses found even “safer” bed-sharing came with a higher risk of SIDS for babies under three months old (though not older). But, as other researchers have pointed out, this study was deeply flawed. Another (better-designed) study found the opposite: Bed-sharing in the absence of additional hazards was no less safe.
Ultimately, when it comes to informing parents, it might not matter. “We can fight as much as we want about what ‘less risk’ means. But actually, out in the real world, families are there, sleeping with their infants,” says SIDS researcher Anna Pease of the University of Bristol in England, a co-author of the better-designed study. "And we take the approach that they have a right to information about what makes that environment as least risky as possible."How to do that is something that, for the most part, researchers do agree on.
The London-based Lullaby Trust campaigns for safer sleep. The organization says you should never sleep on the same surface as a baby if anyone in the bed has used alcohol or drugs; taken any medications that might make them drowsy; smokes; or if the baby was born premature or weighed less than 5.5 pounds at birth. Otherwise, it's important to set up the sleep space as safely as possible (and remember never to fall asleep with a baby in an armchair or couch). This includes: keeping pillows and bedding as far away from the baby as possible, moving curtains or blind cords out of the way and pushing a bed against a wall away so a baby can’t roll into the crevice.
What might a better approach to informing parents look like? One example is in British Columbia, Canada, which began moving away from simply telling parents not to bed-share in 2017. This pamphlet given to new parents explains that a separate sleep surface helps keep a baby safe and offers a bed-sharing quiz. Parents are asked things like whether they’ve smoked, or if their baby was premature. Those who tick all “no’s” are sent to the next page—which provides a checklist for how to set up a bed-sharing space to be as safe as possible.
The U.S. might be heading in more of an informed-consent direction, too—though far more slowly. The most recent American Academy of Pediatrics guidance provides more information on what makes bed-sharing more or less risky and encourages health providers to have “open and nonjudgmental conversations” about sleep.
Still, in most U.S. doctors’ offices, offering parents something like a bed-sharing risk quiz seems all but inconceivable. Until families get information on how to bed-share more safely, they may continue to accidentally fall asleep with their babies in the riskiest of situations.
This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.