Why Co-Sleeping Matters 1

Why Co-Sleeping Matters: An Evidence Based Look into the Benefits and Risks of Co-Sleeping

within the First Year of Life.

Jane Horne , Jeff Houston , & Kaylee Carlsen

Westminster College

NURS*370*01

November 22, 2020

Why Co-Sleeping Matters 2

Abstract​:

Co-sleeping is defined as sleeping in close proximity to the baby, sometimes in the same bed and

sometimes just in the same room. It is a controversial topic because there has not been a lot of

research on the subject. There are many documented benefits and risks to co-sleeping that are

evidence based and will be discussed below. The question that needs to be addressed is: What

are evidence based recommendations for “safe co-sleeping” within the first year of the infant’s

life? Three articles were found by using the key terms: Safe, Co-sleeping, & Bedsharing and they

were found through using the Westminster Online Library. The three articles all discuss the pros

and cons of co-sleeping. Health benefits include increased sleep for both the parent and newborn

and it increases frequency and duration of breastfeeding (Goldberg & Keller, 2007).

Alternatively, psychosocially it does not promote self-soothing and independence (Goldberg &

Keller, 2007). The information provided is useful for parents in making informed decisions about

safe sleeping methods. The research from the three articles came to the conclusion that

co-sleeping, if done properly, can be beneficial for both the infant and parents. Yet, the risk of

harm to the infant can outweigh the benefits, especially if the co-sleeping does not follow the

guidelines. In addition, it is imperative that new, first time parents be educated and given as

much information as possible on the subject.

Why Co-Sleeping Matters 3

Background:

In the past, new parents have been told by their pediatricians the many different ways to keep

their infants safe at night. There are many articles that debate whether co-sleeping is harmful or

beneficial. New information and findings can change standards based on the findings the

researchers find. It can be very difficult for new parents to know which is the best method,

especially when they are given such contradictory information. After lots of research, the three

articles were found to have the most up to date information, “Development and Evaluation of

'Sleep, Baby & You' - An Approach to Support Parental Well-Being and Responsive Infant

Caregiving", “Parent–Infant Co-Sleeping: Why the Interest and Concern?”, and “Helping Parents

Make Informed Decisions Regarding Bed-Sharing”.

The best recommendation for co-sleeping with an infant under one year of age is to “safe

co-sleeping”. This means the parent should follow guidelines that provide a safe environment for

the infant. These can include, but are not limited to, talking to the infant’s pediatrician prior to

co-sleeping, removing all big blankets from the bed, ensuring you have a firm mattress. Parents

should also skip the feather bed and avoid plush pillows, the headboard slats should be no farther

apart than 2 3/8 inches and there should be no gaps between the mattress and the frame. They

should avoid drinking alcohol, nor should they smoke or take any medication that impacts sleep

which helps make sure the parents are not sleep-deprived. In addition, the infant should not be in

a position where she/he is at risk for falling off the bed. Lastly it is wise to be sure both parents

are on board with the decision to bed-share.

Why Co-Sleeping Matters 4

Methods​:

The research methods began with a basic search in the Westminster Student Library online

database “Griffin Search” to help narrow down our focus. The databases “GALE ONE FILE”-

Nursing and allied health, “Wiley Online Library”, and “Academic Search Ultimate” were used

to find reliable sources. The articles were all found within the Griffin database. The key terms

that were prevalent in the search were: Safe, Co-sleeping, & Bedsharing. The initial investigation

found six articles that met the criteria of being written within the last 15 years, peer-reviewed,

had valid sources, and provided evidence based recommendations for co-sleeping. To narrow

down this search, three articles were ruled out because they; a.) did not focus on the links

between safe co-sleeping and evidenced based recommendations. b.) The age range of the

children who were assessed, were older than 1 year of age. c.) Did not contain prevalent

information or was outside of the 15 year range.

Synthesis:

The first article, "Development and Evaluation of 'Sleep, Baby & You'- An Approach to Support

Parental Well-Being and Responsive Infant Caregiving", written by Helen L. Ball, discusses

disrupted parental sleep and how infant sleep is related to increased symptoms of depression and

anxiety among new mothers and fathers. The study uses quantitative data and systematic reviews

that were examined to identify programs employing responsive to infant needs and promoting

parent and infant well-being. They found that “The Possums Sleep Program (PSP)” (Ball, 2020)

was the only intervention meeting all of the selection criteria. The program was intended to

educate parents in basic sleep science and how this relates to their infant’s development. It offers
Why Co-Sleeping Matters 5

strategies for optimising healthy function of the biological sleep regulators in order to protect

against excessive night-waking. The author used a qualitative online survey with parents who

had used the PSP. ‘Sleep, Baby & You’ is a promising tool for promoting parental attitude and

behavior-change, that aims to adjust parental expectations and reduce negative thinking around

infant sleep, promote responsive infant care in the face of infant-related sleep disruption and

fatigue, and support parental well-being during the first year of parenthood. Initial field-testing

provided insights useful for further development and subsequent testing via a randomised trial.

This article had valid authors and was written very recently in August of 2020.

The second peer-reviewed article titled, “Parent-Infant Co-Sleeping: Why the Interest and

Concern?” used many reliable sources as well as prevalent information that is recent. The article

discusses information that many first time mothers are told about safe sleeping habits. It

discusses the pros and cons of co-sleeping and other sleeping methods during the first year of the

infant's life. The article used the key words: co-sleeping, bedsharing, infant development, sleep

problems, and infant safety. The article was written by psychologists and social behavior

specialists.

The third article, “Helping Parents Make Informed Decisions Regarding Bed-Sharing”,

from the International Journal of Childbirth Education goes into detail about the educational

standpoints on the issues of co-sleeping and bedsharing with infants under a year old. It discusses

the education new parents receive in the hospital and how the parents are not always informed

about new information or controversies surrounding this topic. A lot of the information is based

on government standings and what is taught is based on their specific guidelines. They take into

account many different cultures. The authors also brought in different studies based on similar

topics and compared them to their results. This article was written within the last 5 years and had
Why Co-Sleeping Matters 6

relevant information. The authors have their Master's of Science in Nursing, nurse practitioners,

and their PhD. They also used many references that had valid sources and were related to the

topic of bed sharing and co-sleeping.

According to these articles there are “safe” methods that parents should follow if they

would like to co-sleep with their infant. Some of these methods include but again are not limited

to talking to your pediatrician first and foremost. Next they should remove all big blankets from

the bed, ensure they have a firm mattress, skip the feather bed and avoid plush pillows. In

addition the headboard slats should be no farther apart than 2 3/8 inches and there should be no

gaps between the mattress and the frame. Parents should also avoid drinking alcohol, should not

smoke or take any medication that impacts sleep in order to make sure they are not

sleep-deprived. The infant should not be left in a position where they are at risk for falling off the

bed. Most importantly both parents should be on board with the decision to bed-share. This is a

very controversial topic because co-sleeping and bedsharing have many risks and benefits

associated with it and because there are many different opinions.

Results:

The benefits of co-sleeping include increasing frequency and duration of breastfeeding, the

infant is in close proximity so the parents can watch for breathing disturbances or other issues, it

promotes maternal bonding, and it can improve maternal sleep (Goldberg & Keller, 2007).

Some research has shown that families that begin co-sleeping in the first year of the child’s life

tend to be significantly more independent in their living skills and social interactions compared

to the children that sleep alone (Golberg & Kelly, 2007). Co-sleeping can also make for more

convenient nighttime nursing, it may help baby get back to sleep faster after feedings and sleep

for longer stretches, may help put mom’s sleeping more in sync with baby’s, can provide parents
Why Co-Sleeping Matters 7

more time with their babies, especially if they haven't seen them much during the day and

promotes physical closeness as a way of forming close emotional bonds.

Risks associated with co-sleeping according to The American Academy of Pediatrics,

risk for suffocation, marital intimacy may suffer from co-sleeping, may prevent the child from

becoming independent presenting problems which can include separation anxiety, inability to set

limits and a disturbed mother-infant relationship. Some researchers may say that bedsharing is

only a risk if the parents are engaging in hazardous tasks like smoking, or using drugs (Golberg

& Keller, 2007). It has been said that the first year as an opportunity for infants to learn how to

master consoling themselves while they sleep and regulating their sleep (Golberg & Keller,

2007). Some other risks include It increases the risk of SIDS and parents can benefit from

room-sharing without the risks of bedsharing, parents won’t be worried about rolling over onto

the baby, and babies who sleep in a family bed may have more trouble transitioning to a crib

later on and may also have a harder time learning to fall asleep by themselves.

According to the Center for Disease Control,​ “sleeping with your baby on the same

surface is not safe at any time and every year about 3,500 babies die in the United States of

sleep-related causes (CDC, 2018). They also thate that more than half of moms (61 percent)

report bed-sharing with their babies, and 2 in 5 (38.5 percent) report using soft bedding in their

babies' sleep areas (CDC, 2018). Even with the 1990s “Back to Sleep” safe sleep campaign,

there were sharp declines in sleep-related deaths following. However, even though the declines

have slowed since the late 1990s, the risk for babies still persists. This is most likely due to the

lack of knowledge and education given to parents about safe co-sleeping and bedsharing.
Why Co-Sleeping Matters 8

Conclusion:

Although there is a massive amount of conflicting data, it is felt that parents need to be given

more education on this topic before leaving the hospital. It is imperative that they be given as

much information and knowledge so they can, in turn, make the safest and informed decisions

regarding sleep locations that are best for their individual infant. Nurses in hospitals should be

providing the parents with pamphlets that are easy to understand and read about the safe sleeping

methods mentioned above. They should provide teaching throughout the parent’s stay in the

hospital and the nurse should also assess the parents ability to co-sleep if they choose to do so.

They should assess drinking habits, drug abuse, bed safety, sleeping habits or issues, and

educational level. ​It is recommended that this research continues in order to find a more concrete

answer about bed sharing and if it is a practice new parents should be using or not. In conclusion,

co-sleeping, if done properly, can be beneficial for both the infant and parents. Yet, the risk of

harm to the infant can outweigh the benefits, especially if the co-sleeping does not follow the

guidelines so providing this education is the key to successful co-sleeping.

Why Co-Sleeping Matters 9

References

Ball, Helen L., et al. (2020) "Development and Evaluation of 'Sleep, Baby & You'-An Approach

to Support Parental Well-Being and Responsive Infant Caregiving." PLoS ONE, vol. 15,

no. 8, 2020, p. e0237240. Gale OneFile: Nursing and Allied Health,

https://link.gale.com/apps/doc/A631879528/PPNU?u=wcslc_main&sid=PPNU&xid=64b

6ae3. Accessed 14 Oct. 2020.

CDC (2018), About 3,500 Babies in the US are Lost to Sleep-Related Deaths Each Year.

Retrieved November 04, 2020, from

https://www.cdc.gov/media/releases/2018/p0109-sleep-related-deaths.html

Goldberg, W. A., & Keller, M. A. (2007). Parent–Infant Co-Sleeping: Why the Interest and

Concern? Infant & Child Development, 16(4), 331–339. https://doi.org/10.1002/icd.523

Grubb, C. (2019, March 06). How Do I Safely Bedshare? Retrieved November 18, 2020, from

https://thebeyondsleeptrainingproject.com/faqs/how-do-i-safely-bedshare

Matlock-Carr, N. L., & Ward, K. S. (2015). Helping Parents Make Informed Decisions

Regarding Bed-Sharing. International Journal of Childbirth Education, 30(1), 77–81

https://search.ebscohost.com/login.aspx?direct=true&db=edo&AN=103293445&site=eds

-live