Room-Sharing Without Bed-Sharing

  • Fern R. HauckEmail author


Room-sharing without bed-sharing is perhaps the most controversial of the safe infant sleep recommendations, with many parents and clinicians alike resisting adherence. This chapter describes the controversies associated with the recommendation, the evidence base for the recommendation, and advice to clinicians about how to counsel parents, with attention to the potential barriers and suggestions about how to overcome them.


Bed-sharing Room-sharing Infant sleep Education Guidelines Sudden infant death syndrome Sudden unexpected infant death 


  1. 1.
    Hauck FR, Herman SM, Donovan M, Iyasu S, Merrick MC, Donoghue E, et al. Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics. 2003;111(5):1207–14.Google Scholar
  2. 2.
    McKenna JJ, Thoman EB, Anders TF, Sadeh A, Schechtman VL, Glotzbach SF. Infant-parent co-sleeping in an evolutionary perspective: implications for understanding infant sleep development and the sudden infant death syndrome. Sleep. 1993;16(3):263–82.CrossRefGoogle Scholar
  3. 3.
    McKenna JJ, Ball HL, Gettler LT. Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Physical Anthropol. 2007;Suppl 45:133–61. Scholar
  4. 4.
    Task Force on Sudden Infant Death Syndrome. SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162938. Scholar
  5. 5.
    Blair PS, Fleming PJ, Smith IJ, Platt MW, Young J, Nadin P, et al. Babies sleeping with parents; case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ: Br Med J. 1999;319:1457–62.CrossRefGoogle Scholar
  6. 6.
    Mitchell EA. Smoking: the next major and modifiable risk factor. In: Rognum TO, editor. Sudden infant death syndrome. New trends in the nineties. Oslo: Scandinavian University Press; 1995. p. 114–8.Google Scholar
  7. 7.
    Mitchell EA, Thompson JM, Zuccollo J, MacFarlane M, Taylor B, Elder D, et al. 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. N Z Med J. 2017;130(1456):52–64.PubMedGoogle Scholar
  8. 8.
    Moon RY. SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics. 2016;138(5):e20162940. Scholar
  9. 9.
    Mao A, Burnham MM, Goodlin-Jones BL, Gaylor EE, Anders TF. A comparison of the sleep-wake patterns of cosleeping and solitary-sleeping infants. Child Psychiatry Hum Dev. 2004;35(2):95–105. Scholar
  10. 10.
    Mindell JA, Sadeh A, Kohyama J, How TH. Parental behaviors and sleep outcomes in infants and toddlers: a cross-cultural comparison. Sleep Med. 2010;11(4):393–9. Scholar
  11. 11.
    Smith LA, Geller NL, Kellams AL, Colson ER, Rybin DV, Heeren T, et al. Infant sleep location and breastfeeding practices in the United States, 2011–2014. Acad Pediatr. 2016;16(6):540–9. Scholar
  12. 12.
    Hauck FR, Thompson JM, Tanabe KO, Moon RY, Vennemann MM. Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis. Pediatrics. 2011;128(1):103–10. Scholar
  13. 13.
    Frankel LA. RE: room-sharing until 12 months. Pediatrics. 2017;139(3):e20164132B. e20164132B [pii].CrossRefGoogle Scholar
  14. 14.
    Miller CC, Carroll AE. Should your baby really sleep in the same room as you? New York Times. 2016 November 4. p. 2.Google Scholar
  15. 15.
    Volkovich E, Ben-Zion H, Karny D, Meiri G, Tikotzky L. Sleep patterns of co-sleeping and solitary sleeping infants and mothers: a longitudinal study. Sleep Med. 2015;16(11):1305–12. Scholar
  16. 16.
    Paul IM, Hohman EE, Loken E, Savage JS, Anzman-Frasca S, Carper P, et al. Mother-infant room-sharing and sleep outcomes in the INSIGHT study. Pediatrics. 2017;140(1):e20170122. Scholar
  17. 17.
    Galland BC, Taylor BJ, Elder DE, Herbison P. Normal sleep patterns in infants and children: a systematic review of observational studies. Sleep Med Rev. 2012;16(3):213–22. Scholar
  18. 18.
    Moon RY, Hauck FR. Are there long-term consequences of room-sharing during infancy? Pediatrics. 2017;140(1):e20171323. Scholar
  19. 19.
    Vennemann MM, Hense HW, Bajanowski T, Blair PS, Complojer C, Moon RY, et al. Bed sharing and the risk of sudden infant death syndrome: can we resolve the debate? J Pediatr. 2012;160(1):44–8.e2. Scholar
  20. 20.
    Scheers NJ, Dayton M, Kemp JS. Sudden infant death with external airways covered. Arch Pediatr Adolesc Med. 1998;152:540–7.CrossRefGoogle Scholar
  21. 21.
    Unger B, Kemp JS, Wilkins D, Psara R, Ledbetter T, Graham M, et al. Racial disparity and modifiable risk factors among infants dying suddenly and unexpectedly. Pediatrics. 2003;111(2):E127–E31.CrossRefGoogle Scholar
  22. 22.
    Kemp JS, Unger B, Wilkins D, Psara RM, Ledbetter TL, Graham MA, et al. Unsafe sleep practices and an analysis of bedsharing among infants dying suddenly and unexpectedly: results of a four-year, populationbased, death-scene investigation study of sudden infant death syndrome and related deaths. Pediatrics. 2000;106(3):e41.Google Scholar
  23. 23.
    Drago DA, Dannenberg AL. Infant mechanical suffocation deaths in the United States, 1980–1997. Pediatrics. 1999;103(5):e59–66.CrossRefGoogle Scholar
  24. 24.
    Fu LY, Moon RY, Hauck FR. Bed sharing among black infants and sudden infant death syndrome: interactions with other known risk factors. Acad Pediatr. 2010;10(6):376–82. Scholar
  25. 25.
    Blair PS, Mitchell EA, Heckstall-Smith EM, Fleming PJ. Head covering – a major modifiable risk factor for sudden infant death syndrome: a systematic review. Arch Dis Child. 2008;93(9):778–83. Scholar
  26. 26.
    Baddock SA, Galland BC, Bolton DPG, Williams SM, Taylor BJ. Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics. 2006;117(5):1599–607.CrossRefGoogle Scholar
  27. 27.
    Ball H. Airway covering during bed-sharing. Child Care Health Dev. 2009;35(5):728–37. Scholar
  28. 28.
    Ostfeld BM, Perl H, Esposito L, Hempstead K, Hinnen R, Sandler A, et al. Sleep environment, positional, lifestyle, and demographic characteristics associated with bed sharing in sudden infant death syndrome cases: a population-based study. Pediatrics. 2006;118(5):2051–9. 118/5/2051 [pii]. Scholar
  29. 29.
    Scheers NJ, Rutherford GW, Kemp JS. Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations. Pediatrics. 2003;112(4):883–9.CrossRefGoogle Scholar
  30. 30.
    Erck Lambert AB, Parks SE, Cottengim C, Faulkner M, Hauck FR, Shapiro-Mendoza CK. Sleep-related infant suffocation deaths attributable to soft bedding, overlay, and wedging. Pediatrics. 2019;143(5):e20183408. Scholar
  31. 31.
    Colson ER, Willinger M, Rybin D, Heeren T, Smith LA, Lister G, et al. Trends and factors associated with infant bed sharing, 1993–2010: the National Infant Sleep Position Study. JAMA Pediatr. 2013;167(11):1032–7. Scholar
  32. 32.
    Hauck FR, Signore C, Fein SB, Raju TN. Infant sleeping arrangements and practices during the first year of life. Pediatrics. 2008;122(Suppl 2):S113–20. Scholar
  33. 33.
    Kendall-Tackett K, Cong Z, Hale TW. Mother-infant sleep locations and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clin Lact. 2010;1(1):27–31.CrossRefGoogle Scholar
  34. 34.
    Lahr MB, Rosenberg KD, Lapidus JA. Maternal-infant bedsharing: risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction. Matern Child Health J. 2007;11:277–86. Scholar
  35. 35.
    Fu LY, Colson ER, Corwin MJ, Moon RY. Infant sleep location: associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. J Pediatr. 2008;153(4):503–8. Scholar
  36. 36.
    Salm Ward TC, Balfour GM. infant safe sleep interventions, 1990–2015: a review. J Community Health. 2016;41(1):180–96. Scholar
  37. 37.
    Mathews AA, Joyner BL, Oden RP, Alamo I, Moon RY. Comparison of infant sleep practices in African-American and US Hispanic families: implications for sleep-related infant death. J Immigr Minor Health. 2015;17(3):834–42. Scholar
  38. 38.
    Joyner BL, Oden R, Ajao TI, Moon R. Where should my baby sleep? A qualitative study of African-American infant sleep location decisions. J Natl Med Assoc. 2010;102:881–9.CrossRefGoogle Scholar
  39. 39.
    Horsley T, Clifford T, Barrowman N, Bennett S, Yazdi F, Sampson M, et al. Benefits and harms associated with the practice of bed sharing: a systematic review. Arch Pediatr Adolesc Med. 2007;161:237–45.CrossRefGoogle Scholar
  40. 40.
    Blair PS, Heron J, Fleming PJ. Relationship between bed sharing and breastfeeding: longitudinal, population-based analysis. Pediatrics. 2010;126(5):e1119–26.
  41. 41.
    McKenna JJ, Mosko SS, Richard CA. Bedsharing promotes breastfeeding. Pediatrics. 1997;100(2):214–9.CrossRefGoogle Scholar
  42. 42.
    Huang Y, Hauck FR, Signore C, Yu A, Raju TNK, Huang TT-K, et al. Influence of bedsharing activity on breastfeeding duration among US mothers. JAMA Pediatr. 2013;167(11):1038–44. Scholar
  43. 43.
    Ball HL. Breastfeeding, bed-sharing, and infant sleep. Birth. 2003;30(3):181–8.CrossRefGoogle Scholar
  44. 44.
    McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev. 2005;6(2):134–52.CrossRefGoogle Scholar
  45. 45.
    Bartick M, Smith LJ. Speaking out on safe sleep: evidence-based infant sleep recommendations. Breastfeed Med. 2014.
  46. 46.
    Should I sleep with my baby? La Leche League, International. Accessed 15 Oct 2019.
  47. 47.
    Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #6: guideline on co-sleeping and breastfeeding. Revision, March 2008. Breastfeed Med. 2008;3(1):38–43. Scholar
  48. 48.
    Co-Sleeping and SIDS: a guide for health professionals. UNICEF. 2019. Accessed 29 Oct 2019.
  49. 49.
    Ways to reduce the risk of SIDS and other sleep-related causes of infant death. National Institute of Child Health and Human Development. Accessed 15 Oct 2019.
  50. 50.
    Parents and caregivers: learn what parents and caregivers can do to help babies sleep safely. Centers for Disease Control and Prevention. Accessed 15 Oct 2019.
  51. 51.
    Moon RY, Hauck FR. Risk factors and theories. In: Duncan JR, Byard RW, editors. SIDS sudden infant and early childhood death: the past, the present and the future. Adelaide: University of Adelaide Press; 2018.Google Scholar
  52. 52.
    Carpenter R, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, Smuk M, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. BMJ Open. 2013;3(5):e002299. Scholar
  53. 53.
    Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-sharing in the absence of hazardous circumstances: is there a risk of sudden infant death syndrome? An analysis from two case-control studies conducted in the UK. PloS One. 2014;9(9):e107799. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Family MedicineUniversity of VirginiaCharlottesvilleUSA

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