FAQs about bedsharing, baby safety, and apnoea monitors

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.

• You can find out and how to avoid baby overheating here.

• You can find out about bedsharing with your baby here and here.

This article deals with six questions parents often ask when we're talking about baby sleep safety.

Q1. Is it dangerous to sleep your baby between you and your partner?

Many guidelines still recommend that you avoid sleeping your baby

• Between the parents

• Next to other children.

This advice, however, doesn't derive from research studies. It's important to pay attention to creating a safe sleep surface, including not having edges a baby can fall over or gaps a baby can become wedged in. Avoiding an edge might mean that it's safer to sleep the baby between the parents, if you're bedsharing.

Q2. How relevant is the advice to avoid bedsharing if you're a heavy sleeper?

Often guidelines recommend not sharing the bed with your baby if you are a heavy sleeper. Certainly it's not safe to share the sleep surface with an adult who uses medications or drugs which create drowsiness. But drugs and medications aside, what constitutes a heavy sleeper, really?

There is no evidence to draw from, and no one-size-fits-all approach to this. Professor Helen Ball, whose research I draw on heavily in my articles on safer baby sleep, observes in a podcast conversation we had together that partners usually know whether the other partner is such a heavy sleeper that he or she or they would have no awareness of where the baby is in the bed.

But the ordinary exhaustion of parenting doesn't mean you can't share a bed with your baby.

Q3. How relevant is the advice around overweight parents and bedsharing?

Many of us are overweight in advanced economies, and in increasing numbers of countries around the world. Although there is no research to demonstrate that overweight or obese parents place their babies at increased risk of SIDS or SUDI, Professor Helen Ball suggests that when a parent has such a severe weight problem that he or she or they has difficulty knowing where his or her or their body begins and ends in space, it may be safest for baby if this parent doesn't share a sleeping surface with their little one.

Q4. Do you have to lie in a cuddle curl or C-shaped position (also known as breastsleeping) when your baby is in bed with you?

In the picture below, both parents have taken up a cuddle curl position, with an arm resting on the mattress above the baby's head and legs bent up a little, under babies' feet. A video study showed that this is position is typically adopted by breastfeeding women when they share their bed with their baby. If you're comfortable in that position, that's great. If you are formula feeding, it makes sense to sleep your baby on his back with his little head at chest height, not up high amongst the pillows.

This doesn't mean that you have to adopt this C-shaped position for safety, if it isn't comfortable for you in the night. Safer baby sleep is concerned with the interaction between many different factors. Being physically comfortable when you share a surface with your baby is essential (or you won't sleep, which is the whole idea)! By far the most important and proven protections come from sleeping baby on her back, by keeping the shared sleep surface safe, and by avoiding overheating.

Once you're across all the elements of safer sleeping, you can relax into enjoying having your baby up close in the bed, arranging your own body in a way that is comfortable for you. Your body positioning will naturally change throughout the night.

Q5. Is it possible to prevent your baby developing a flat spot on the back of the head?

It's true that the number of babies who develop a flat spot on the back of their skulls, known as positional plagiocephaly, increased after about 1992, when we started to sleep babies on their back. Positional plagiocephaly results from the pressure effect of a baby lying with their head on a mattress or surface in the one position for periods of time.

Positional plagiocephaly usually resolves over time as your baby develops. If your baby has positional plagiocephaly, please discuss this with your GP.

• You can find out about a flat spot on your baby's skull and what you might do about it, and whether or not it can be prevented, here.

• You can find out how to best support your baby's motor development here.

• You can find out how helpful baby carrier use can be here, and how to do it safely here.

• You can find an in-depth discussion about infant positional plagiocephaly, sleep, and motor development here.

Q6. Do apnoea monitors help your baby sleep more safely?

Sometimes because of your baby's medical history, your doctors will recommend that you set up an apnoea monitor for your baby. In this situation, an apnoea monitor plays an important safety role.

But otherwise, there's no evidence that apnoea monitors reduce the risk of SUDI. Worse, they can be disruptive for babies and their families, producing scary false alarms, and worsening worry unnecessarily for everyone.

Acknowledgements

The photo below is from the Baby Info Sleep Source basisonline.org.uk, taken by Rob Mank.

Recommended resources

The website Baby Sleep Information Source, by the Durham Infancy and Sleep Centre (DISC) UK, is the world's leading source of information and photographs for parents about safer infant sleep.

You might be interested in a podcast conversation I had with Professor Helen Ball, from DISC, in which we discuss sleeping babies safely available here.

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

When is bringing your baby into bed definitely too risky?

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.

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.