Never Sleep with Baby? Or Keep Me Close But Keep Me Safe: Eliminating Inappropriate “Safe Infant Sleep” Rhetoric in the United States

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Creating public health messages regarding how mothers should sleep close and safely with their babies is tricky and complex. It requires an appreciation of what exactly the term “sleeping with baby” and “co-sleeping” can mean. It also requires sensitivity to what parents will or can do if told emphatically “never sleep with your baby.” In the United States, well-intentioned public health messages from prominent government agencies about safe infant sleep have increasingly used language that equates “safe infant sleep” with the absence of the mother. Many messages seemingly imply that all forms of “co-sleeping” are dangerous and that those parents that practice it are acting irresponsibly. Messages such as “babies sleep safest alone” conflict with both laboratory and epidemiological findings as well as with recommendations from most medical organizations, including the American Academy of Pediatrics, who state that mothers and babies should sleep on separate surfaces close together in the same room. Moreover, studies reveal that breastfeeding and forms of co-sleeping, including both roomsharing and bedsharing, are functionally interdependent and that many mothers worldwide find that they can manage their own and their infants needs more easily by adopting at least intermittent bedsharing. Hence, simple, unqualified recommendations against ever bedsharing are not likely to be followed. According to recent studies the most effective public health recommendations are likely to be those that educate parents and facilitate parents in implementing bedsharing safeguards alongside their own choices. This approach does not exclude informing parents of what we know can be dangerous about some bedsharing practices, nor where and when it should be avoided altogether. Rather, it acknowledges that while separate surface co-sleeping in the form of roomsharing should always be recommended, nonetheless, many parents will appreciate and benefit from the opportunity to learn how to reduce the risks associated with bedsharing.