The Safe Co-Sleeping Checklist

on November 5 | in Co-Sleeping | by | with 21 Comments

News Stories Often Talk . . .

About “another co-sleeping death” as if co-sleeping is inherently dangerous. The Milwaukee Health Department has gone so far as to compare it with putting baby to bed with butcher knives. But according to some well-respected experts, nothing could be further from the truth. Dr. James McKenna, head of the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory, says “This is akin to suggesting that because some parents drive drunk with their infants in their cars, unstrapped into car seats, and because some of these babies die in car accidents that nobody can drive with babies in their cars because obviously car transportation for infants is fatal. You see the point.”

So what is the co-sleeping equivalent of driving safely? That’s what you wanted to know after I posted this last week, so here it is!

#1: Put Baby To Sleep On Her Back

Babies who snooze on their tummies sleep harder than babies on their backs, which seems like a good thing until you consider that “light stage sleep is thought to be physiologically more appropriate and safer for babies, because it is easier to awaken to terminate apneas (episodes where one stops breathing), than it is when babies are in deeper stages of sleep.” (Sources: Our Babies, Ourselves p 134, An Overview of the Benefits of Co-Sleeping).

Since babies are biologically hardwired to take cues from mama, light sleep stages create a protective mutual awareness when co-sleeping is practiced. Mama is able to act quickly if baby becomes distressed, and baby is able to synchronize her breathing, body temperature, sleep stages and even heartbeat to mama! (source) This can be very helpful to babies who are still developing rhythms neurologically.

I do have a concern about back sleeping, though.

Too much time in any position can mold baby’s soft cranial bones into an unnatural shape, as can excessive use of car seats, swings and other devices. To prevent this, alternate the way baby’s head faces while they sleep when you put them down and limit their time in car seats. I don’t recommend the use of bouncy seats, exersaucers and jumparoo-type devices at all because they can damage the pelvis, but have no fear! There is a way to get things done and entertain baby at the same time: babywearing.

Oh yes, watching all that you do from the best seat in the house is brilliant on so many levels. It has been shown to reduce plagiocephaly and one study found it cut crying and fussiness in half. My favorite benefit, though, is that it’s a great alternative to tummy time! (Note: When choosing a carrier make sure to look for a soft wrap or sling. Crotch danglers have the same downsides as bouncy seats, etc., and are strongly discouraged by the Hip Dysplacia Institute)

One last thing before we move on: I didn’t follow this advice to a “t.” Micah slept on his belly for the first few weeks of his life, but he was nestled skin-to-skin on my chest. In my opinion there is nothing safer than a baby hearing mama’s heartbeat and feeling her breath rise and fall, so let the experts say what they will about that. Side sleeping may be an option, too, if these safety precautions are observed.

#2: Breastfeed

Ugh, I really don’t want to write this one! According to Dr. James McKenna, head of the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory, formula feeding disrupts the biological feedback loop between mother and baby in two ways:

Sleep Position

Breastfed babies instinctually stay close to their mothers at night. The smell of their mothers milk serves as a homing beacon that keeps them from roaming around.

According to this article, “Data from Consumer Product Safety Commission indicate that the greatest risks to a baby sleeping in a bed with an adult is not, as many would assume, from an adult overlaying or rolling over onto the baby, but from the infant strangling or becoming wedged or trapped between a wall, a piece of furniture, the bed frame, headboard or footboard and the mattress.”

Another way baby’s orientation on bed tends to be affected by formula feeding is that breastfed babies tend to sleep at chest level with their mother, while formula fed babies tend to be placed further up on the bed near the pillows.

Sleep Awareness

The second factor is that formula-fed babies tend to sleep more deeply and wake less often. Because the sleep patterns of mothers often synchronizes with the baby’s this can lead to decreased awareness of one another in the sleep environment and may result in a sleep-related injury. For these reasons Dr. McKenna strongly that formula-fed babies sleep in a sidecar/nearby crib arrangement rather than bed share. (source)

#3: Create A Safe Sleep Environment

Did you know that the carbon dioxide you exhale while sleeping next to your baby may stimulate them to breathe? It’s true! (source) And while that’s totally awesome, the downside is that baby’s heightened sensitivity to air quality may not be a good thing in some cases.  Mattresses routinely contain arsenic, antimony and other toxic substances which some fear could be a driving factor behind SIDS.

If that sounds a little far-fetched to you, consider this: Back in the 1880s thousands of children died mysteriously until a scientists realized that  arsenic-laced pigments in wallpaper, curtains and carpets interacted with household bacteria and fungi to create a deadly nerve gas called trimethylarsine (source).

Of course, most of us (including me!) have slept on a less-than-ideal mattresses with our babies. Personally, I think these compounds are most likely to have an effect if other factors are present – a vaccine reaction, serious illness, underdeveloped neurology with respect to breathing patterns, etc. Now that we know better we will do better, so I’m saving my pennies to buy a non-toxic mattress using this shopping guide. In the meantime, though, I’m using the inexpensive wrap option at the end of the guide. Would I still bedshare without a cover? Absolutely. For me the physiological benefits of mother/baby pairs sleeping close to one another outweighs this risk.

Other chemicals to avoid: Harsh detergents and perfumes. Not only do these often contain hormone-disrupting chemicals, they mask your “homing beacon” scent.

#4: Secure The Perimeter

This simplest way to do this is to move all furniture and possible entrapment hazards away from your bed and then put it on the floor. If your bedroom has wood/tile/concrete floors it might be a good idea to cushion a bit with a yoga mat or carpet pad, but avoid placing pillows or other soft items around the bed to protect from falls since they can be a choking hazard.

If floor-sleeping is not your thing, Dr. Sears recommends that you

“place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby’s limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.

Note: If you can fit your fingers between the rail and mattress there is a risk of entrapment. To create a safer setup simply roll up a towel or blanket and stuff it between the rail and mattress until it’s so snug you can’t reach in. A humanity family sleeper is also an option. And of course, use a firm mattress, a cotton fitted sheet, and avoid big fluffy comforters, stuffed animals, etc, and keep pillows away from baby.

#5: Make Sure There’s A Place For Everyone, And Everyone Is In Their Place!!!

Dr. Sears recommends that you “Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby’s presence even while sleeping, that it’s extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby’s presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby’s presence.” (source)

He also suggests that toddlers never be allowed to sleep in bed with babies. I’m not sure I agree with this. For sure, toddlers and babies should not be allowed to sleep in the same bed unsupervised since they’re infamous for their kung fu moves and other antics. However, when mama is sleeping with baby on one side and a toddler on the other I believe her increased nighttime awareness keeps her tuned into what both kids are doing throughout the night. At least, this is what I found to be true when Micah was a newborn. This is what our sleep setup looked like:

♥ Micah ~ Me ~ Daddypotamus ~ Katie ♥

Now, just to clarify we have a giant bed (actually two beds pushed together). Small, crowded spaces are not safe for co-sleeping infants. We also put our kids to bed separately until we went to bed (Micah was in the co-sleeper next to the bed).

#6: Keep Cool

“Keeping the room cool (around 65-68 degrees) is recommended for lowering the risk of SIDS. Sleeping next to your baby will raise her body temperature, so keep that in mind when you’re gauging the room temperature. In fact, cooler environments make for better adult sleep as well, so a lower temperature is better for everyone . . . Wear a long-sleeve shirt and dress your baby in a night outfit in which she doesn’t need a blanket. That way you can keep the covers safely down, and your arms won’t get cold.” (source)

# 7 Do Not Sleep With Your Baby If . . .

  • You or your partner smoke or are under the influence – “Both maternal and paternal smoking during pregnancy or after birth are major risk factors for infant deaths. If you smoked when you were pregnant, or you do now, you should use a co-sleeper or bassinet instead of sharing the sleep surface with your baby. Drinking or drugs will make you less responsive at night. If you or your partner drink or take medications at night, don’t bring your baby into bed.” (source)
  • You are extremely obese. There is some controversy about this, so I’m including it so you can decide for yourself. Some say obesity poses a smothering danger often causes sleep apnea, which makes mama difficult to rouse. Others say obese mothers can co-sleep safely provided they follow basic safety guidelines and have no health issues that diminish their awareness during sleep.
  • You are exhausted from sleep deprivation. “This lessens your awareness of your baby and your arousability from sleep.” (source)
  • You are breastfeeding a baby on a cushiony surface, such as a waterbed or couch. “An exhausted mother could fall asleep breastfeeding and roll over on the baby.” (source)
  • You are the child’s baby-sitter. “A baby-sitter’s awareness and arousability is unlikely to be as acute as a mother’s.” (source)

Also, don’t . . .

  • Allow older siblings to sleep with a baby under nine months. “Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby. (source) I’m including this one even though I think there are safe ways to bedshare with a baby and toddler.”
  • Fall asleep with baby on a couch. “Baby may get wedged between the back of the couch and the larger person’s body, or baby’s head may become buried in cushion crevices or soft cushions.” (source)
  • Sleep with baby on a free-floating, wavy waterbed or similar “sinky” surface in which baby could suffocate. (source)
  • Overheat or overbundle baby. ‘Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.” (source)
  • Wear lingerie with string ties longer than eight inches. “Ditto for dangling jewelry. Baby may get caught in these entrapments.” (source)

Did I miss anything? Share your co-sleeping tips and advice below!

Plagiocephaly image credit: By GdB (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC-BY-SA-3.0-2.5-2.0-1.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

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21 Responses to The Safe Co-Sleeping Checklist

  1. K says:

    What do you use to wrap your mattress?

    • Heather says:

      Hi K! I link to the company in the mattress shopping guide: http://www.mommypotamus.com/how-to-buy-a-non-toxic-mattress/

      • k says:

        Thanks a nd sorry I misread… Sleep deprivation! I appreciate the tip on he wraps as when I originally researched them, I could only find the crib-sized ones and was frustrated. I’m going to order one now and, if I can, I’ll mention that you sent me. Question though… Would these hold up to some kid bouncing? Also, how well do they stay on if the mattress were to be moved around. We have a futon that we stack on top of the mattress and slide off at night (both are on the floor), which is a GREAT space saver but things like sheets always fall off!

        I really appreciate this info!

  2. Janelle says:

    I don’t co-sleep. Not because I think it’s wrong or anything. I actually like what I read about it. It’s just that the times I have slept with my baby in bed with me I have not been able to relax and have an aweful time sleeping well. I also don’t enjoy breastfeeding lying down…very uncomfortable in my experience. I’ve been thinking a lot about trying co-sleeping lately. Any advice for me? Do you lay your baby on it’s side or back? I always swaddle my baby. Is it easier if they’re not swaddled?

    • Heather says:

      Hi Janelle! Some mamas do sleep better when they have a bed to themselves and that’s okay! You can actually still co-sleep by keeping your baby within arm’s reach in the same room. Now, regarding breastfeeding I had the same experience with my son until I realized he was tongue-tied. When we had that corrected breastfeeding lying down became much more doable. It’s a pretty common but often undiagnosed condition (thanks to all the plastics in our environment), so it might be worth exploring that to see if there is a structural reason it’s not comfortable. Hope that helps!

  3. Chelsea says:

    I love the picture for this post! Brought back great memories of sleeping with my babies. I shared a bed with two of my three children! I slept better with them next time me and had wonderful bonding with the baby and husband!

  4. Kelly says:

    Very informative! I started co-sleeping with my DS when he was about a month old because I would get no sleep. He just wouldn’t go to sleep unless he was comfort nursing. One day I decided to nurse him while laying down and we both slept very well. I felt brand new! Haha. I love waking up to him and seeing him smile. Makes us both happy to co-sleep. :)

  5. Monica says:

    What do you do with your baby while cooking? I’ve always heard that cooking while wearing babies is unsafe; Not to mention difficult! I know that putting them on a blanket with toys is an option, but she doesn’t seem to enjoy that for more than a few minutes.

    • Heather says:

      Well, I don’t have any babies right now so it’s not really fresh in my mind, but I remember I used the crock pot a lot. Micah tended to wake up and want to play on the floor a bit in the morning so i used that time to prep dinner. Hope that helps!

      • Nicole says:

        Baby wearing on the back might be an option for during cooking times. At least that’s what I did (when they were old enough). I believe the main issue with babywearing while cooking is that they can grab hot or sharp things because they are right at that level. Swinging them around to your back removes that danger.

        • Heather says:

          I was always terrible at getting baby settled on my back, but when Daniel was home and could help it was great. Good suggestion!

          • Monica says:

            Thanks for the ideas! I haven’t mastered the back carry, but I did finish making dinner last night with her in the side carry.

  6. Nicole says:

    Heather- I didn’t know about the whole “don’t put the baby between you” thing. It must really depend on the dad. My first born slept nestled in my hubby’s arms until he was almost a year old. My husband was very very very attuned to the kids when we co-slept, and would wake up whenever they wanted to nurse. I do think co-sleeping is one of those things that you really have to see how your family dynamics are. My son slept with us for a year, then stopped sleeping solidly in our bed. We moved him to a crib- and he started sleeping well again. When he was 3, he started climbing into our bed at night to sleep, and then kinda stopped on his own about 4. My daughter co-slept with us for about 6 months. Then she started no longer sleeping well. We moved her to a pack’n’play in our room. She did the same thing as her brother when she got a little older (started climbing in our bed sometime around 2 – and is just now stopping – she’s almost 4). I found that interesting.

    • Heather says:

      Yes, I really think it depends on the dad. :) And just because I think this issue is often confused, sleeping in the same room is considered co-sleeping. A lot of people think it’s the same thing as bedsharing when really co-sleeping can and is often practiced without having baby in bed. We need better terms, don’t you think?

  7. I love that you did this article! There is too much misinformation out there on co-sleeping. We do it and love it, but realize it’s not for everyone. I think more would do it if they knew there was a safe way!

  8. Sara says:

    What advice do you have for co-sleeping with twins? Is it even possible?

  9. Nicki says:

    heather! how do/did you do nap time? i am struggling to find info on how best to do naps? almost three and a one year old here (with the hopes of a third down the road:). thanks so much!

    • Kristen says:

      Good question Nicki. I’d love to hear your thoughts on this too, Heather. We’ve bed-shared since day 1, and my 18 month old is super reliant on breastfeeding and sleeping near me. I side-nurse her to sleep for naps and nighttime, but she doesn’t usually sleep longer than 2 cycles without me (roughly 1.5 hrs, sometimes 2 hrs). Since I only have one child, I can continually go back to her to nurse her back down, but I don’t see how this would ever be possible with more than one child. It’s been making me wonder if bed-sharing (and breastfeeding to sleep) made my daughter need me in order to sleep, or perhaps that’s just her personality?
      I’d love to hear how your family co-sleeps and/or bedshares and how naps work with you all.
      Thanks!

  10. […] head of the University of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory. This post and this post are based on his […]

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