Recommendations for Child Sleep Arrangements: When to Stop Co-Sleeping
Infants should sleep in the parents' room, close to the parents' bed, but on a separate surface designed for infants, ideally for the first year of life, but at least for the first 6 months. 1
Room-sharing vs. Bed-sharing
Room-sharing (recommended)
- Room-sharing without bed-sharing decreases the risk of SIDS by as much as 50% 1
- The infant's crib, portable crib, play yard, or bassinet should be placed in the parents' bedroom close to the parents' bed 1
- This arrangement reduces SIDS risk and removes the possibility of suffocation, strangulation, and entrapment that might occur when the infant is sleeping in the adult bed 1
- Room-sharing facilitates feeding, comforting, and monitoring of the infant 1
Bed-sharing (not recommended)
- Bed-sharing (sleeping on the same surface) is not recommended for infants 1
- Devices promoted to make bed-sharing "safe" (e.g., in-bed co-sleepers) are not recommended 1
- Infants may be brought into the bed for feeding or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep 1
High-Risk Bed-sharing Situations to Avoid
Parents should avoid bed-sharing in the following situations:
- When the infant is younger than 3 months, regardless of whether the parents are smokers or not 1
- With a current smoker or if the mother smoked during pregnancy 1
- With someone who is excessively tired 1
- With someone using medications (e.g., antidepressants, pain medications) or substances (e.g., alcohol, illicit drugs) that could impair alertness 1
- With anyone who is not a parent, including other children 1
- With multiple persons 1
- On soft surfaces such as waterbeds, old mattresses, sofas, couches, or armchairs 1
- On surfaces with soft bedding, including pillows, heavy blankets, quilts, and comforters 1
Transition from Room-sharing to Independent Sleeping
- The American Academy of Pediatrics recommends room-sharing ideally for the first year of life, but at least for the first 6 months 1
- The first 6 months are particularly critical because rates of SIDS and other sleep-related deaths, particularly those occurring in bed-sharing situations, are highest during that period 1
- Although there is no specific evidence for moving an infant to their own room before 1 year of age, room-sharing during the first 6 months is especially critical 1
Safety Considerations
- A review of 8 years of data showed 515 deaths of children younger than 2 years who were placed to sleep on adult beds, with 121 due to overlying by a parent, adult, or sibling and 394 due to entrapment in the bed structure 2
- Sleeping on couches and armchairs places infants at extraordinarily high risk of infant death, including SIDS and suffocation 1
- Approximately 3,500 infants die annually in the United States of sleep-related deaths 3
Cultural and Personal Factors
- Bed-sharing practices vary across cultural and ethnic groups, with higher rates among Black, Hispanic, and American Indian/Alaska Native families 1, 4
- Parents choose to bed-share for various reasons including convenience for feeding, comforting a fussy infant, helping the infant/mother sleep better, bonding, and family tradition 1, 4
- Despite these cultural practices, the evidence supports room-sharing without bed-sharing as the safest sleep arrangement 1
Additional Recommendations for Safe Infant Sleep
- Keep soft objects and loose bedding out of the crib 1
- Breastfeeding is recommended and associated with reduced risk of SIDS 1
- Avoid alcohol and illicit drug use during pregnancy and after birth 1
- Ensure infants get adequate sleep: 12-16 hours per 24 hours (including naps) for infants 4-12 months 5
In summary, while there are cultural and personal reasons why families may choose to bed-share, the evidence strongly supports room-sharing without bed-sharing as the safest sleep arrangement for infants. After 6-12 months, when the risk of SIDS decreases significantly, parents may consider transitioning the child to their own room.