Safe Sleep


Ever since the Federal Consumer Product Safety Commission issued a study in October 1999, warning parents not to bring babies into their mothers’ beds to sleep, the controversy over this practice has heated up enormously. Parents have, of course, been sleeping with their babies throughout recorded history, and this night-time sharing of beds is still the norm in most societies around the world. (In one study, Mayan mothers in Guatemala expressed shock at the idea that anyone would put an infant to sleep in a room all alone, considering that tantamount to child abuse.) All caring parents, of course, have their babies’ safety in mind and do not want to follow any practice that would endanger their infants. On the contrary, they want to follow those practices that will enhance their children’s well-being. Shared sleeping often promotes infant health and development.

I have been closely following the recent warnings against co-sleeping, since my research during the recent revision of THE COMPLETE BOOK OF BREASTFEEDING found that mothers who bring their babies into bed with them breastfeed more often and for a longer time. These babies become very closely attuned to their mothers’ sleep patterns and thus learn such safe sleep habits as moving through the different states of sleep and adjusting their breathing patterns accordingly. Many prominent child care specialists continue to maintain that co-sleeping is safe, when certain precautions are followed.

Parents need clear guidelines to help them protect their babies. They don’t need scare tactics (“Don’t ever do this!”) because many mothers will bring their babies to bed with them, no matter what some “experts” say. What parents do need is help in recognizing the risks that do exist—and how, with care and thought, they can minimize them, and get the benefits of safe co-sleeping. Furthermore, co-sleeping is not an all-or-nothing proposition. Sometimes parents will bring their infants into bed with them, and sometimes they will put the babies to sleep in their own cradles or cribs. Safe sleeping practices are important no matter which option parents choose.

The following guidelines for safe co-sleeping and also separate sleeping have been endorsed by Lawrence M. Gartner, M.D., chairperson of the Work Group on Breastfeeding at the American Academy of Pediatrics (which issued the newest AAP policy statement on breastfeeding), James J. McKenna, Ph.D., Director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, and Marvin S. Eiger, M.D., pediatrician and consultant on THE COMPLETE BOOK OF BREASTFEEDING.


  • Put the baby to sleep on his or her back, not on the stomach or side.
  • Be sure that the bed or crib mattress is firm and that it fits tightly on its frame, with no more than a one-inch space between the mattress and any side. This will prevent your baby’s nose and/or mouth from getting caught in sagging or loose bedding. New cribs and crib mattresses by law must fit this standard. However, older cribs may no longer meet this requirement because of wear, damage, or manufacture before current regulations. New cribs may fail to meet the standard due to improper assembly. Adult beds are covered by no such restriction.
  • Put a sleeper-suit on the baby instead of covering him or her with a blanket. Do not use heavy quilts, comforters, or blankets in bed with baby.
  • Do not let the baby sleep on or near a pillow. Remove all other soft items, including stuffed toys, from the baby’s bed.
  • Be sure that no objects can topple or collapse onto the bed.
  • Be sure that the baby cannot get tangled up in his or her clothing, and that there is nothing in the bed that can catch the clothing and ensnare the baby.
  • Do not put the baby to bed with a pacifier on a cord, or with anything around the neck.
  • Do not put the baby in a bed close enough to a drapery or Venetian blind cord that she or he could reach or get caught in.
  • Do not put the baby on a plastic mattress or sheet covering.
  • Do not let any plastic bags remain on the floor, on the bed, or nearby where the baby could roll over and fall into them.
  • Bars on a crib or those attached to the side of a bed should be spaced no farther apart than 2 3/8 inches.


  • Examine the structure of the bed closely so the baby cannot get trapped between the mattress and the wall, bed frame, headboard, footboard, bed railings, other furniture, or anything else. Parents often move the bed against a wall in the belief that this will prevent a baby from falling onto the floor, but the danger of the baby’s getting wedged between the mattress and the wall still exists because parents may fail to notice when the mattress has come away from the wall. Babies who learn how to rock from side to side, roll over, or move up to hands and knees and propel themselves by pushing against a flat surface can often move to a corner of the bed, but if they become wedged between two objects they may not have the strength and coordination to free themselves.
  • Do not let your baby sleep with you if you have had alcoholic drinks or any drugs (medicinal or recreational) that could make you sleep heavily.
  • Do not let older children—including toddlers—sleep next to the baby.
  • If you’re overweight, put baby to sleep in his or her own cradle or crib. Many parents use a side cart attached to the side of the bed.
  • Do not put the baby to sleep in a waterbed.
  • Do not put the baby to sleep on a sofa; it is apt to be both too soft and too narrow. Furthermore, babies can slip between the pillows and the back of the bed and suffocate.
  • Do not smoke in bed or near the sleeping baby.
  • Be sure the bed is low enough and that the floor is covered with a firm but soft covering so that if the baby does fall out of bed, she or he will not be injured.
  • When both parents sleep in the same bed with the baby, each one needs to mentally acknowledge before falling asleep the presence of the infant in the bed. This consists of a mental notation like the car stickers that say “Baby on Board”; but in this case the message is “Baby in Mind.” This can virtually guarantee that the parents will not overlie the baby during sleep, since almost all healthy, undrugged parents sleep lightly when they know that the baby is in the bed with them.

©Sally Wendkos Olds