Safe Co-Sleeping Habits Every Parent Should Know: Dos and Don'ts

DOS:

• Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, 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.
• 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.
• Place baby to sleep on his back.
• Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of "baby furniture." If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.
• Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.

DON'TS:

• Do not sleep with your baby if:

  1. You are under the influence of any drug (such as alcohol or tranquilizing medications) that diminishes your sensitivity to your baby's presence. If you are drunk or drugged, these chemicals lessen your arousability from sleep.

  2. You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering danger of pendulous breasts and large fat rolls.

  3. You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.

  4. 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.

  5. You are the child's baby-sitter. A baby-sitter's awareness and arousability is unlikely to be as acute as a mother's.

• 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.
• Don't 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.
• Do not sleep with baby on a free-floating, wavy waterbed or similar "sinky" surface in which baby could suffocate.
• Don't overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.
• Don't wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapments.
• Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby's tiny nasal passages. Reserve these enticements for sleeping alone with your spouse.

Use common sense when sharing sleep. Anything that could cause you to sleep more soundly than usual or that alters your sleep patterns can affect your baby's safety. Nearly all the highly suspected (but seldom proven) cases of fatal "overlying" I could find in the literature could have been avoided if parents had observed common sense sleeping practices.

More Sleep-Safe Precautions

DO'S:

• Place baby to sleep on her back or side, whichever way she seems to sleep the best.
• Spread sheets and under sheets smoothly and tuck them in tightly beneath the mattress. This lessens the chance of wrinkles in the bedding that could obstruct baby's breathing.
• Be particularly vigilant when traveling , since baby will be sleeping in an unfamiliar and potentially unsafe environment. Bring along a portable crib or a roll-out safe-sleeping mat. These are safer sleeping alternatives than soft adult mattresses, such as the ones used on sofa beds or rollaways in motels. If you are using a hotel-provided crib, do a safety check.
• Be equally vigilant when putting baby to sleep in a carriage . Observe the same precautions. Place infant to sleep on back or side, and remove any potentially dangerous objects from the carriage.
• Keep baby's environment as fuzz-free as possible, especially if your baby is prone to respiratory allergies. Besides removing stuffed animals, avoid bedding that is likely to collect lint, such as deep-pile lambskin or fuzzy wool blankets. Hypoallergenic mattresses and mattress covers are available for allergy-prone infants.

DON'TS:

• Don't put infants under six months to sleep on their tummies, unless there is a doctor-recommended reason for doing so.
• Don't put baby to bed on a soft surface, such as a waterbed, beanbag, adult foam mat, or any other squishy surface that could obstruct baby's breathing passages.
• Don't leave baby sleeping alone unsupervised in a carriage. An older child may caringly, but unsafely, want to snuggle a teddy bear next to baby's head. Carriage mattresses tend to be less cared for than other bedding, and they tend to collect dust and other allergens. Clean them as needed. Carriages are a common site of smothering in babies, second only to cribs.
• Don't use deep-pile lambskin or other deep-pile (greater than 1¼ inches or 3 centimeters) sleeping mats. These not only collect dust and other allergens, but also can obstruct baby's breathing passages, especially if they get wet from drool or spit-up.
• Don't cover baby's head after the first day or two. This is a baby's primary path of normal heat loss. Covering the head risks overheating the baby, which increases the risk of SIDS. (Very premature hospitalized babies often need their head covered to maintain their body temperature, but the medical staff monitors this.)
• Never smoke in the room where the baby sleeps. Smoke irritates baby's sensitive breathing passages.