Health professionals are aware that bed-sharing is an infant care issue caught between two public health objectives, both addressing infant health and well-being – one being breastfeeding promotion, the other being infant death prevention (accidental and SIDS [Sudden Infant Death Syndrome]). As a consequence, advice to parents varies from country to country around the world according to the local priorities, attitudes to risk, breastfeeding rates, and existence of local research. In some countries (such at the UK) the official guidance on bed-sharing emphasises informed choice, acknowledging the reasons parents bed-share (both intentionally and unintentionally), and the real or perceived benefits, whilst cautioning against unsafe scenarios and potential risks (e.g. NICE 2014; UNICEF 2016). In other coutries advice emphasises only the risks and does not report any benefits, recommending simply that babies be returned to their cots for sleep. All participants in this discussion have the interests of parents and babies at heart, but due to different emphases, the messages (and research findings) can seem contradictory, causing confusion and anxiety for parents, health professionals, and parenting support organisations. For example, one study (Carpenter et al., (2013) found that bed-sharing, even when done “safely” (non-smoking or when drugs or alcohol have been consumed and breastfed), increases the risk of SIDS fivefold. On the other hand another recent study (Blair et al., 2014) found that there was “no statistically significant” increase in risk in bed-sharing infants in the absence of hazards (defined as parental sofa-sharing, alcohol consumption and smoking). They even found that bed-sharing was protective in infants over the age of 3 months. Despite the differences in the findings of these two studies, they are consistent in finding bed-sharing to be a risk when parents have been smoking or consuming alcohol.
Understanding that there is no single simple message that is optimal for all families and all situations is an important component to understanding this issue and to helping families make informed choices.
In the following pages we summarise information on the implications of bed-sharing, and consider the published evidence and guidelines regarding the issues relating to this infant sleep location.
Providing information to parents
The NICE guidance on Co-sleeping and SIDS made recommendations regarding the strength of the evidence around co-sleeping and SIDS in 2014 (since updated in 2021), and an Infographic and Health Professionals’ Guide was jointly produced by UNICEF, Lullaby Trust, and Basis in 2016 to help support health professionals to tailor their conversations with families. Parents need information with which to make informed decisions, and should be encouraged to weigh up any potential risks and benefits of bed-sharing in light of their own individual circumstances. This information is clearly detailed in the UNICEF leaflet ‘Caring for your baby at night’.