Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
23 Jan

Co-Sleeping: How to Do It Safely

babymotherLast week, I broached the topic of co-sleeping. The reception was almost unanimously positive, with plenty of you chiming in with your own c0-sleeping success stories. Before you toss the crib, however, realize that co-sleeping isn’t as simple as flopping down in bed with your baby and drifting off to sleep. Co-sleeping is a healthy, effective, and arguably “natural” way to raise independent children, but it must be done safely. Remember those studies I cited last week where co-sleeping was associated with infant deaths? Yeah, when co-sleeping is done poorly or incorrectly or unsafely, it becomes an effective way to harm children. Sadly, most parents no longer have access to the “village,” that treasure trove of knowledge full of parents and grandparents and aunts and uncles and infinite cousins with parenting advice for days, so we read books, and articles, and magazines, and blogs for tips and knowledge. These aren’t the same, sure, but they are helpful in their own way. Certainly better than left to fend for ourselves.

So, how does one co-sleep safely?

First off, let’s go over what not to do. Let’s identify unsafe co-sleeping. It may sound like a lot of don’ts, but c’mon – these are our kids!

Co-Sleeping DON’Ts

Do not smoke, drink, or use drugs that affect judgment and awareness (prescription, illegal, or over the counter – think Tylenol PM), especially before bed.

Overlaying (where a sleeping parent absentmindedly rolls over onto the child) is a rare occurrence that pretty much only happens when the parent is too messed up to wake up and realize they’ve just rolled over onto a small human. A sober, alert parent will wake up if it ever happens. Heck, I sometimes have to hide the ball from Buddha (my lab) in bed at night to keep him from pestering me to toss it, and if I roll over onto it, I wake up in a flash. A huge part of the benefit of co-sleeping is the increased awareness of the baby’s position and status, but being inebriated removes that entirely.

Avoid tobacco altogether. 

You know how when a smoker comes into the room, you know it just from sniffing? That smell only lingers because the smoke itself – with all the tars and toxins – lingers on the clothes, in the hair, and on the skin of the person who smokes. Now imagine how much of that smoke the baby will be ingesting, and just how little smoke is needed to hurt the little thing. This goes for mom, dad, and, you know what? Just make the entire house smoke-free and don’t let people smoke around the baby. They’re a lot more sensitive to the stuff than we are.

Don’t let babies sleep next to other children or pets.

As sensitive as your dog is, there’s a good chance he’ll think nothing of walking all over this strange new creature in the night, scratching its tender feet, or laying a fluffy tail across its nasal passageway. Toddlers, who are even less thoughtful than dogs and have opposable thumbs, are probably even worse.

Do not co-sleep on the couch, sofa, loveseat, or recliner.

Couches are plush and cushy, and they have cushions that infant heads slip between all too easily. They’re elevated off the ground and relatively narrow, meaning the baby can easily fall off and crack something. I’ll make an allowance for rickety wooden rocking chairs, but avoid doing so in a room full of cats.

Be careful with very small, very young infants.

By virtue of their diminutive size, very small infants are more susceptible to being smothered, crushed, or otherwise roughly manhandled. Plus, if this is your first kid, or your first attempt at co-sleeping, you’re already going to be nervous about what to do and how to do it and likely sleep-deprived. Consider room-sharing for the first few weeks to months, where the baby sleeps in an adjoining cot or mattress. You can still reach out and touch those cute puffy cheeks, but you won’t worry about making any catastrophic mistakes.

Don’t co-sleep if you’re a heavy sleeper, are excessively sleep deprived, are obese (disregard if you’re a bodybuilder with obese BMI; just cool it on the pec popping) and/or have sleep apnea.

These conditions will all reduce one’s ability to stay apprised of what’s going on in the bed. You need to be sensitive to your child if you’re going to share the bed safely. They may also make any mistakes made all the more damaging. If you’re severely sleep deprived – which will happen fairly often – consider keeping an adjoining cot/bed/crib in the room next to your bed so that you can still room share when necessary.

Don’t use thick bedding.

Huge frothy comforters full of imitation goose down are unnecessary for most people and downright dangerous (suffocation, smothering, overheating risk) for young babies. Even normal pillows and blankets can be excessive for infants; consider that most crib babies are bedded down with minimal bedding, a sheet or light blanket at most. That’s kinda what the adult co-sleeping bed should look like, too.

Don’t use overly soft mattresses.

Don’t use anything that you or the baby can “sink” into, like beanbag mattresses or those really soft beds that some people seem to like. Water beds are out, obviously, and not just because it’s no longer the 1980s.

Don’t co-sleep if not everyone is onboard. 

Co-sleeping is a family event. Both mom and dad need to be up for it for it to work. If there’s major anxiety about the method, I have to think it’s going to manifest as poor sleep (or worse).

Co-Sleeping DOs

Keep the bed low, preferably on the floor.

Make sure the bed is as low as you can manage it. This will make any falls less catastrophic, and as a bonus, it will force you to do more “floor living.” Those with carpeting can get away with higher beds, while those with hardwood flooring are advised to go a bit lower.

Use a firm mattress.

There should be minimal “give” to the sleeping surface. This will reduce the chance of suffocation.

Use a tight-fitting sheet.

Make sure the sheet fits well, without bunching up. Bunched up sheets can be a choking or suffocation hazard.

Breast feed.

Studies show that breast feeding makes for safe co-sleeping, while bottle feeding is associated with SIDS. According to James McKenna, the “breast feeding-bedsharing landscape is highly differentiated from the bottle feeding-bedsharing landscape.” (PDF) In his clinical experience, “breast feeding mothers typically keep their babies away from pillows, position their infants on their backs, placing them below their shoulders, while raising their arms above them,” and they “lay on their sides… in ways that can prevent accidental overlays.”

Put the kid next to mom, not wedged in between mom and dad.

By virtue of not having given birth, the dad is going to be less “connected” to the baby and possibly less aware during the night. Plus, a big advantage of co-sleeping is the ease of breast feeding, and you don’t want your baby getting confused in the middle of the night, reaching for the wrong breast, and ending up with a mouthful of hairy man nipple (although that would definitely establish a connection between father and child).

Place your baby on its back to sleep.

Sleeping in the supine position (on its back) is the safest way for a baby to sleep and reduces the risk of SIDS.

Eliminate any crevasses that the baby could fall into.

If the bed is up against a wall or headboard, make sure it is flush against the surface – no cracks or openings. Some people even pull their bed away from the wall to eliminate the possibility of getting stuck between the bed and the wall. If you can’t eliminate the crevasses, consider pulling the bed away from the wall. Products like these are also helpful for preventing falls or crevasse wedging.

Get a bigger bed.

When it comes to co-sleeping, bigger is usually better, particularly when you start introducing multiple co-sleepers.

Pay close attention to the list of don’ts up above.

Don’t do the don’ts.

I’d highly recommend picking up a copy of James McKenna’s book on the subject, Sleeping With Your Baby: A Parent’s Guide to Cosleeping. It’s under $10, it’s a quick read, and it’s written by the premier expert.

And whatever happens, don’t feel like you have to co-sleep. Try room sharing, perhaps, which offers most of the same benefits as bed sharing. Convert cribs into side-cars that sit alongside the adult bed, thereby making it bigger. Just do what works for you and your family.

Now let’s hear from you guys. Co-sleepers: how did you do it? What did you learn? What didn’t you do? How did you determine co-sleeping was right for you? Everyone else: what made you choose the methods you chose? Let’s get a good discussion going. Let’s get our own village established.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. “Don’t co-sleep if you’re a heavy sleeper, are excessively sleep deprived….”

    What parent with an infant isn’t sleep deprived”

    Steve wrote on January 24th, 2013
  2. I like to keep my newborn perpendicular to me, as an added protection, so that if I somehow rolled onto her it would be on to her feet. It hasn’t happened yet.

    Also, on the rare nights I have taken melatonin I have pulled out a drawer for her to sleep in on the bed next to me. :)

    a wrote on January 24th, 2013
  3. We co-slept with our first born. It was great at first, but it was extremely difficult transitioning her to her own room and bed. She is now 10 years old and still fights everynight going to bed. She always waits till her siblings are asleep and then crawls into bed with them. Co-sleeping with her was a huge mistake!

    28oz wrote on January 24th, 2013
  4. I did co-sleeping 24 years ago, when some people were telling me what a horrible mother I was for doing it! She was with me in the same bed for about 2 years, then went to her own bed in the same room until she was 9 and was ready to move into her own space. I now have a beautiful, highly independent, secure, responsible 24 year old daughter, whose experience of co-sleeping, in my view, had only positive results.

    Sooz wrote on January 24th, 2013
  5. Co-sleeping and breast feeding are a great combination, when it suits both Mom and baby. I had three babies all breast fed for over a year each. I would bring each baby to bed at times but our youngest was a full time co-sleeper. It was relaxing to just turn to nurse a fussing baby instead of getting up and stumbling about half asleep to try tend to a hungry infant. It was easier on me because I would go back to sleep even when baby was nursing. Papa wouldn`t be wakened nor would sleeping sisters. It actually made for restful sleep for the whole household. I would recommend it, with the precautions Mark has listed.
    I was a light sleeper and we had a king size bed, making plenty of room for baby, mom & dad.

    Shelley C wrote on January 24th, 2013
  6. Slept with my now 20-something sons for several years each. Best thing we ever did! I was told, among other things, I was making them “dependent.” Both of them chose to go to college on the East coast; we’re from IL. I think meeting their dependency needs allowed them to become independent as they became ready. Western/ American culture seems to have such a problem with the idea of families sleeping together. I always like to say that Jesus did not have a Better Homes and Garden nursery to sleep in!!

    Deniseregina wrote on January 24th, 2013
  7. good !!!!!!!!!!!!!!!!
    thanks for the information

    Herbal Pills Store wrote on January 25th, 2013
  8. Co-sleeping still pretty much standard practice in Japan. Usually the mother and baby, plus other children. Dad often luckily gets pass to sleep alone, in a separate room. As most of us in the Ancestral health world now the value of sleep, co sleeping is roughest on dads in the room, so getting a pass to sleep soundly alone is a great compromise – the mother having the convenience of co-sleeping dad sleeps soundly in his pitch black room (co -sleeping ideally mums need some minor light, for safety and feeding.)

    Shochu wrote on January 25th, 2013
  9. I’m so glad to see these two positive, sensible articles about bed sharing, thank you Mark. Living in a country where half the population seems to get their info from the Daily Mail, it’s refreshing to read something non-alarmist!

    However, I want to take issue with two points. It makes me extremely angry to constantly be told breast feeding mothers are so much more attuned. I failed to produce enough milk for my babies, to the point of exhaustion on my daughter’s part, & ended up having to formula feed.

    I heard every movement. I woke up instantly whenever needed. I woke up a few minutes before they starting asking for milk. My instincts were perfectly intact thank you very much. Yes, breast milk is best & it kills me inside to this day that I couldn’t provide that for them (I was I tears at the first FF, because I was convinced I was poisoning my tiny baby). Those of us who do FF do not need this constant added guilt about how much better attuned BF mothers are. It’s about your instincts, attitude & I would say bed sharing as much as FF or BF. (And yes, I clearly have guilt & anger issues about this. Don’t get all psychological on me ;)

    Second, please don’t discount Dad’s instincts as well. The first night home with both if ours, I was exhausted – not safe to sleep with babies. My husband held them tummy-down on his chest, elbows on the bed, hands on their waists All. Night. Long. When he woke up, neither he nor they had moved an inch. We always slept with baby on my dude for the beginning of the night, Daddy’s side after the first feed. If anything he was even more attuned than me at that point because he was worried that he was supposedly unsafe compared to me.

    Sophie wrote on January 25th, 2013
  10. These are great tips! When my son was born my husband and I had no intention of cosleeping but my son had other plans! A couple of weeks of getting no sleep were enough to get us to start using a cosleeper. Now, 19 months later, I wouldn’t change it for the world…even if he does deliver some well-placed kicks to the ribs nightly. He spend so much of his time at day care during the day that snuggling up together as a family at night let’s us spend some time with him that we wouldn’t otherwise have. I only wish that the stigma would be removed. I can’t tell you how many times someone has clucked to me, “You’ll never get him out of your bed!”

    Tiffany wrote on January 25th, 2013
  11. What do you think of this, Mark?

    http://www.stopsidsnow.com/index.html

    Seems like pretty compelling evidence for a real cause of SIDS.

    Tim wrote on January 25th, 2013
  12. Also very important is where the baby is positioned with respect to your own body… hold your baby in kissing position by your face, not in sling position down by your gut. There is not the slightest chance of smothering if you don’t allow the baby to sleep low down your trunk. Falling asleep with your baby high on your chest near your neck is the most relaxing thing in the world. And don’t worry about baby’s comfort… you’re the world’s best pillow and your baby will instinctively nuzzle in until he or she is fully comfortable.

    Clayton wrote on January 25th, 2013
  13. Still cosleeping with our breastfed 12-month-old. There are definitely times I wish he were in his own bed already,but there are also some perks. Biggest is that I get more/better sleep. He still needs a diaper change and a nurse 1-3 times a night, and if I have to get up out of bed, change him, nurse him back to sleep, and put him back in his own bed without waking him… that means I’m awake for like an hour every time he squirms. That almost guarantees me a monster migraine the following 2-3 days, so cosleeping lets me be functional and human.

    But it also means fewer wet diapers. My son squirms in his sleep when he has to pee, so we keep a training potty by the bed and when he starts squirming, I just strip off his diaper and set him on the potty, he pees (mostly, he doesn’t even wake up!), and then I re-diaper him and we both go back to sleep after a brief nurse. I’m hoping this will make the “real” potty training easier later. I’m a light sleeper, but I don’t think I’d catch that cue fast enough if he were not sleeping right next to me.

    Cord wrote on January 26th, 2013
  14. We used a combination of bassinet next to the bed (where baby was put to sleep) and baby in the bed (for night nursing). Every night was a little different. When the baby was in our bed, I always slept on my side with baby facing me. We definitely had a structure/schedule about bedtime, and I was pretty insistent that they learn to go to sleep in their own beds as babies, even if they ended up in our bed later. Both babies moved into their own rooms around 4 months, when they were too large for the bassinet, and when they could easily fall asleep by themselves, but naps together were still common until 3-4 years. Many other family members have remarked throughout the years how easily my kids went to bed. I think you just have to trust your gut from day to day and do what feels right at the time. But anyone considering co-sleeping definitely need to follow the safety guidelines!

    Paula wrote on January 26th, 2013
  15. I LOVE THIS POST!!! And the baby wearing one. ROCK ON.

    Do a natural birth series!!!! (if you have I’ve just been too swamped with a newborn to get to it)

    I’ve read to not do it, but I thought it was all hogwash. She’s happier and we both get more sleep.

    Erin wrote on January 29th, 2013
  16. We began co-sleep with our first because a cesarean, not taking pain meds, and frequent breast-feedings were too painful the first few weeks. With our second even though we had a VBAC we had learned that co-sleeping was just easier and didn’t interrupt our sleep as much (and the extra cuddle time was very precious to us. Each of our kiddos slept with us full time for the first 1 1/2 to 2 years. Part time for comforting for a bit after. I wouldn’t have changed it for anything!

    Amber wrote on January 31st, 2013
  17. I’m a deep sleeper and a co-sleeping breast feeder on a really high bed. Works for us! I fantasize that I look like a Klimt painting, the way I often sleep with one arm up under my ear and over the baby’s head. We say we’re sleeping “like a moon and a star” (because “spooning” sounded creepy when applied to babies). My daughter moved out – a whole 4 yards away – at 4 months largely because it was annoying to have her between us but necessary for safety, but we have a sidecar bed for my son (which we use more as a backstop that lets him sleep on the outside rather than in the middle) and I can’t see him going anywhere until he needs something with higher sides. At which point I’ll put both kids on a double mattress on the floor to avoid the shock of suddenly sleeping alone.

    You know what I’m still not sure of though? Sleeping bags are best for babies, sure. But those are babies sleeping by themselves. My child spends half the night in his sidecar bed and half under the covers with me. So how should I bundle him? At this stage we’ve settled on thin PJs, no sleeping bag and a relatively heavy blanket on his bed to match ours (we live in the Alps and this is February)

    Lauren wrote on February 14th, 2013
  18. I’m not sure that the SIDS research that you link to is the most relevant. It says that ” infants placed in the prone position or in the side position are no more likely to experience an extreme cardiorespiratory event compared with infants placed in the supine position”.

    This might be more helpful:

    Changing Concepts of Sudden Infant Death Syndrome: Implications for Infant Sleeping Environment and Sleep Position
    Task Force on Infant Sleep Position and Sudden Infant Death Syndrome
    Pediatrics 2000;105;650

    http://pediatrics.aappublications.org/content/105/3/650.full.pdf

    Scott UK wrote on February 25th, 2013
  19. I really have to thank you for these co-sleeping articles you wrote. It REALLY opened my eyes. I have 16 month old twins and my daughter especially wants to get in our bed everynight and I always let her but I’ve been feeling stressed about it. I’m very new to the paleo lifestyle and am ingrained with American ideals about how to promote independence and the most well rounded behavior in children so this really helped me to let go of my ideals and just enjoy snuggling with my little scoobies which has actually been helping me sleep better and rise a little more naturally since my daughter is totally an alarm clock… about 8am she starts playing with my hair and putting her little fingers all over my face :D haha.. i’m literally LOLing thinking about it.

    Jennapher wrote on February 27th, 2013
  20. I love the Arm’s Reach. It ties to my bed and adjusts to the perfect level. It’s an extension of my own bed but completely separate sleeping space for baby. Rollovers and drops, I think, are impossible. I don’t have to stumble out of bed. Baby can hear and see me because I’m that close. And, yes, when my babies grew, we converted these perfect cosleepers to casual furniture and no one knows they used to be baby beds. They also have great resale value if you don’t want to keep it in the family for next generation.

    shoe wrote on March 1st, 2013
  21. Another tip: If baby’s in the bed with you (and others), then place baby at your head/shoulder or higher. Rolling is side to side. Who rolls UP, to the head of the bed? Scooch yourself down. Keep baby close to your senses.

    shoe wrote on March 1st, 2013
  22. My son just turned 8 yrs old and isn’t very keen on sleeping on his own at all. For a while, me, my husband and my son all slept together, but since my husband sometimes has to rise extremely early to travel, he found it more convenient to sleep in my son’s room, in my son’s bed. Especially since my son tends to move around a lot while he’s asleep. I’m hoping that my son (who’s nearly as big as I am now but I’m a small person) will want to move back to his own bed on his own. But I’m not sure how or when or even if that will happen. I don’t want to set up a deadline because he’s a very sensitive only child. Sigh.

    LW wrote on March 2nd, 2013
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