When is sleep surface- and bedsharing, forms of co-sleeping, extra risky?

When is sleep surface- or bedsharing, forms of co-sleeping, extra risky?

Bedsharing is a family choice, but poses risks. Although the American Academy of Pediatrics (AAP) recognizes that parents bedshare with infants for a variety of reasons, such as beliefs that it is better for their infant, cultural values, and facilitating breastfeeding, it also recommends against bed or sleep surface sharing. Room-sharing, on the other hand, is recommended for at least the first 6 months. Also considered to be a type of co-sleeping, room-sharing is when the baby sleeps on a separate surface than the parents. The AAP updated its Safe Sleep recommendations in June/July 2022 and included some circumstances under which bed or surface sharing is extra risky.

The following circumstances make bed or surface sharing more than ten times as risky as bed or surface sharing in general:
• Bedsharing with an adult whose alertness or ability to wake up is impaired due to fatigue, sedating medication, and/or other substances
• Smoking – bedsharing with an adult who smokes or with a baby whose pregnant parent smoked during pregnancy
• Bedsharing on a soft surface (waterbed, old mattress, sofa, couch, or armchair)

These circumstances make bed or surface sharing five to ten times as risky as bed or surface sharing in general:
• Bedsharing with babies younger than 4-months-old (even for breastfed babies)
• Bedsharing with a non-parental caregiver or other children

Finally, these circumstances make bed or surface sharing two to five times as risky as bed or surface sharing in general:
• Bedsharing with pre-term or low birth weight infants
• Bedsharing with soft bedding (pillows, blankets)

Also – should my infant twins sleep together?

The AAP does not endorse infant twins or other multiples sleeping on the same surface, or cobedding, and indicates that the risks outweigh the potential benefits.