When is bringing your baby into bed definitely too risky?
Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Death in Infancy (SUDI) can be hard to talk about, because the thought of any precious little baby dying is distressing. But some things are important to know. You can find out why putting babies down to sleep on their backs matters so much here, how to keep sleep places as safe as possible here, and how to avoid baby overheating here.
It can be hard when you've always imagined you'd bring your baby into bed with you, but it turns out you or your baby have special vulnerabilities. Families who have special vulnerabilities sometimes use a wahakura or pepi-pod if they are bringing baby into bed anyway for cultural or other reasons, which keeps baby as safe as possible. Please discuss getting hold of one of these with your GP or with a health professional who cares for you and your baby.
Things which make it unsafe for you to bring your baby into your bed, and which can't be easily changed
Your baby has special vulnerabilities
It's unsafe for you to share the same sleep surface if your baby
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Is born prematurely or has a low birthweight. (Speak to your baby's doctor about when your baby might have caught up developmentally and be ready to more safely co-sleep.)
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Has been exposed to a cigarette smoker, whether tobacco or e-cigarettes, either during pregnancy or afterwards
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Has a medical condition which affects baby's capacity to protect her airways
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Has a fever. (This is tricky because we're more likely to want to bring the baby close when they're sick and waking frequently in the night for that reason. If you do bring your sick little one into the bed, pay special attention to a safe sleep surface and not letting her overheat.)
You have special vulnerabilities
It is unsafe for you to co-sleep if you, or your baby's other loving person in the bed
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Have been or are cigarette smokers, either tobacco or e-cigarettes, either in pregnancy or after the birth
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Drink more than two units of alcohol a day
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Use drugs
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Take medications that make you drowsy
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Are unwell
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Are a very large-bodied person, who sometimes has difficulty knowing the edges of your body.
Things which make it unsafe for you to have baby in your bed, but which you can easily change
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Sleeping with a baby on a couch or sofa (because your baby's airways can block off or baby's chest and breathing can become compressed if he falls into cracks or wedges between the parent and the back or arms of the sofa or couch)
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Wrapping or swaddling (due to the possibility of overheating and also wrapping makes babies less rouseable)
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Beanie or head covering (due to the possibility of overheating)
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Too many layers of garments (due to the possiblity of overheating)
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A pet shares the bed with you (which increases the possibility of baby's airways blocking off or baby overheating).
Recommended resources
The website Baby Sleep Information Source, by the Durham Infancy and Sleep Centre UK, is the world's leading source of information and photographs for parents about safer infant sleep.
Always put babies down to sleep on their backs (with a word about rolling and reflux, too)
How to keep the place where your baby sleeps as safe as possible
When your breastfeeding or breast milk feeding baby comes into bed with you
When your formula-feeding baby comes into bed with you
How to keep your baby at the right temperature in the night
Wrapping or swaddling your baby: how to do it safely and does it help with sleep, anyway?
Why is there so much conflicting advice about bringing your baby into bed?
Selected references
Ball H. Evolution-informed maternal-infant health. Nature Ecology and Evolution. 2017:DOI:10.1038/s41559-41017-40073.
Ball HL. Parent-infant bed-sharing behavior: effects of feeding type and presence of father. Human Nature. 2006;17(3):301-318.
Barry ES. Using complexity science to understand the role of co-sleeping (bedsharing) in mother-infant co-regulatory processes. Infant Behavior and Development 2022;67:101723.
Barry ES, McKenna JJ. Reasons mothers bedshare: a review of its effects on infant behavior and development. Infant Behavior and Development 2022;66:101684.
Bartick M, Young M, Louis-Jacques A, McKenna JJ, Ball HL. Bedsharing may partially explain the reduced risk of sleep-related death in breastfed infants. Frontiers in Pediatrics. 2022:doi:10.3389/fped.2022.1081028.
Blair PS, Ball HL, Pease AS, Fleming PJ. Bed-sharing and SIDS: an evidence-based approach. Archives of Disease in Childhood. 2023;108(e6):doi:10.1136/archdischild-2021-323469.
Cole R, Young J, Kearney L, Thompson JM. Challenges parents encounter when implementing infant safe sleep advice. Acta Paediatrica. 2021;110:3083-3093.
Cole R, Young J, Kearney L, Thompson JM. Infant care practices, caregiver awareness of safe sleep advice and barriers to implementation: a scoping review. International Journal of Environmental Research and Public Health. 2022;19:7712.
Eatt J, Watson S, Ball H, Sevar K, Galbally M. Maternal depression and early parenting: a comparison between culturally and linguistically diverse and Australian born mothers. Australasian Psychiatry. 2022;30(1):119-125.
Kim TH, Lee H, Woo S. Prenatal and postnatap factors associated with sudden infant death syndrome: an umbrella review of meta-analyses. World Journal of Pediatrics. 2024:https://doi.org/10.1007/s12519-12024-00806-12511.
Marinelli KA, Ball HL, McKenna JJ, Blair PS. An integrated analysis of maternal-infant sleep, breastfeeding, and Sudden Infant Death Syndrome research supporting a balanced discourse. Journal of Human Lactation. 2019;35(3):510-520.
Mitchell EA, Thompson JM, Zuccollo J. The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy: the New Zealand SUDI nationwide case control study. New Zealand Medical Journal. 2017;130:52-64.
Rudzik AEF, Ball HL. Biologically normal sleep in the mother-infant dyad. American Journal of Human Biology. 2021;33(5):e23589
Zimmerman FJ, Bartick M, Feldman-Winter L, Ball HL. ABM Clinical Protocol #37: Physiological infant care - managing nighttime breastfeeding in young infants. Breastfeeding Medicine. 2023;18(3):159-168.
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