In some non-Western cultures, bed-sharing is common and the number of infant deaths related to it is lower than in the West. Differences in mattresses, bedding, and other cultural practices may account for the lower risk in these countries.
Despite the possible pros, various medical groups have warned parents not to place their infants to sleep in adult beds due to serious safety risks. Bed-sharing puts babies at risk of suffocation, strangulation, and SIDS. Studies have found that bed-sharing is the most common cause of deaths in babies, especially those three months and younger.
Babies get less sleep at night and sleep for shorter stretches when they sleep in their parents’ room after four months old, a new study finds. Parents are also more likely to engage in unsafe sleep practices, such as bringing their child into their bed or leaving pillows, blankets or stuffed animals with the baby when the infant shares their room.
The findings appear to contradict recommendations from the American Academy of Pediatrics for safe infant sleep, creating more confusion for parents trying to choose the safest.
The AAP recommends infants share a parents’ room, but not a bed, “ideally for a year, but at least for six months” to reduce the risk of sudden infant death syndrome (SIDS). Approximately 3,700 infants died of sleep-related causes in 2015, including 1,600 from SIDS, according to the Centers for Disease Control and Prevention.
Although this recommendation has technically been part of AAP policy for years, it was largely overlooked due to the policy’s wording until last October, when new recommendations were released.
At the time, some prominent pediatricians questioned the evidence behind it. Among the skeptics was Ian Paul, lead author of the new study published Monday in Pediatrics.
“It’s important for the Academy to have strong evidence and not just expert opinion to support our recommendations because these guidelines have such influence on practice and on parenting and child health,” Paul says. “One of the reasons we wanted to explore this is that the evidence is really weak for 6 to 12 months. I think in [the Academy’s] strong desire to prevent every single case of SIDS, they have looked at the data with a biased perspective.”
Paul analyzed data from 230 families participating in a randomized, controlled trial for up to two years. Half the mothers were encouraged to consider moving their children at 3 months old to wherever the child would sleep at one year old. The other half received intensive advice on reducing SIDS risk, in which nurses visited the home and provided specific feedback on improving the safety of the sleep environment.
The percentage of infants sleeping in their parents’ room at four and nine months old, however, didn’t end up differing between the groups. More than half the infants were sleeping in their own room by four months old, and just over a quarter were sleeping independently between four and nine months
And infants who slept in their own rooms after four months slept for longer, in general. Nine-month-old room-sharing infants slept an average 9.75 hours per night, compared to one 0.5 hours for those who began sleeping alone by four months and one 0 hours for those who began sleeping alone between four and nine months.
Infants who slept alone after four months also slept for longer stretches: nine hours compared to 8.3 hours for those infants who slept in their parents’ room between four and nine months and 7.4 hours for those who continued to share their parents’ room after nine months old.
By 2.5 years old, all the children got a similar amount of total daily sleep, although those sharing their parents’ room through nine months old got four to five minutes less at night.
Given these findings, Paul worries about unintended consequences of encouraging parents to keep children in their parents’ room until one year old.
“There are so many other factors in child and parent health that are consequences of this decision,” Paul says. He said it’s completely impractical for parents to start sending children to their own room at one year old, when separation anxiety peaks. “That’s the worst time to make a change from a developmental perspective.”
Experts in developmental infant sleep generally agree with him, according to Jodi Mindell, associate director of the Sleep Center at Children’s Hospital of Philadelphia. Mindell founded the Pediatric Sleep Council’s website babysleep.com, a free resource of evidence-based information on children’s sleep.
“We want babies and parents to get a good night’s sleep because we know that will affect infant safety, infant development and family wellbeing,” Mindell says. “It’s a balance of trying to make sure babies are safe, everyone’s getting enough sleep and everyone’s developing appropriately.”
Past research has shown that infants sleep better, go to bed earlier and sleep for longer periods at a time when they sleep in their own rooms, Mindell says. In this new study as well, infants sleeping on their own at four months old were twice as likely to have a consistent bedtime and be in bed by 8 pm than the other infants. Families should feel free to decide without fear whether their babies sleep in the parents’ room or their own room, she says.