Room-Sharing

In many countries parents are advised to sleep their babies in a cot or Moses basket (UK terminology is used throughout. In the UK a cot is the same as a US crib. A UK ‘Moses basket’ equates to a US ‘bassinette’) in the same room as them until the baby is at least 6 months old. The advice from some authorities, particularly in the US, has emphasised that a cot in the parents’ room is the only safe place for a baby to sleep ? When guidelines emphasise parents’ room this means ‘the same room as a parent’. It does not mean the parent’s bedroom in the absence of a parent, although this is a common misinterpretation. This guidance also applies to day-time sleep, which could mean a living room, or any other room in which the baby is asleep and a parent is in close proximity.

^{? – http://www.cpsc.gov/CPSCPUB/PREREL/PRHTML99/99175.html, http://aappolicy.aappublications.org/cgi/reprint/pediatrics;116/5/1245.pdf , http://www.nichd.nih.gov/publications/pubs/upload/090458_BTS_general.pdf}

Room-sharing advice can be implemented inconsistently, as parents are advised “the safest place for your baby to sleep is in a cot in a room with you for the first six months.”

^{( http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_096299.pdf )}

Because many households only have a cot in a bedroom parents may interpret the cot as the priority, rather than the presence of the parent. It is the proximity of a caregiver that is protective, not the bedroom environment.

Research evidence supporting the recommendation that babies sleep in their parents’ room at night is based on the increased risk of SIDS associated with infants sleeping alone.

Over the past 15 years studies have found that significantly fewer babies die suddenly from unexplained causes (SIDS) when sleeping in the same room as their parents compared to sleeping alone. This does not mean that room-sharing protects every baby as some deaths still occur during room-sharing, but the proportion is lower. Room-sharing therefore reduces the risk of SIDS in comparison to separate room sleeping. The magnitude of the difference in the risk of these two sleep locations varies between studies (one study estimated that 36% of SIDS deaths could be prevented if all babies had slept in cots in the same rooms as the parents (Carpenter et al 2004), ^{(Carpenter et al. 2004. Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363:185–91.)} but the table below gives some idea of the consistency of the effect. (Information on odds ratios and how to interpret them can be found here.)

Compared to sleeping in a room alone, it is often assumed that room sharing babies can attract parents’ attention, and that parents respond promptly. However, research on responsiveness in relation to mother-infant proximity at home involves comparisons of bed-sharing versus sleeping in a separate room (Quillin& Glenn 2004; Ball 2002; McKenna & Volpe 2007) rather than comparison of room sharing with separate room. Other studies have examined the effects of postnatal room-sharing in hospital rather than at home (Yamauchi & Yamanouchi 1990; Buxton et al. 1991; Waldenstrom & Swenson 1991; Keefe 1987, 1988).

Although room-sharing has not yet been examined directly at home, the research mentioned above suggests that benefits of room sharing (compared to separate room sleeping arrangements) involve facilitating night-time feeding, enabling parents to hear their baby’s waking and hunger cues and respond to them more quickly, less infant crying, and more maternal and infant sleep.

Reduced risk of SIDS with room-sharing

		Percent exposed
Author	Country	Case	Control	Univariate OR	Multivariate OR
Scragg et al 1996	New Zealand	20.7	37.1	0.44	0.25
Blair et al 1999	England	25.3	39.0	0.53	0.51
Hauck et al 2003	United States	20.8	28.1	0.67	Not reported
Carpenter et al 2004	Europe	28.0	44.5	0.49	0.32
Tappin et al 2005	Scotland	35.8	63.5	0.32	0.31

Table after Mitchell 2009:1715