Another hot topic in the sleep world that always divides opinion is bedsharing. You may be aware that the American Academy of Paediatrics have recently updated their safe sleep guidelines.
There really weren’t many changes to it since the last revision in 2016 – in fact, I had to have both guidelines open and read them line by line side by side to even figure out where the changes were (spoiler: they were subtle). Bottom line for this post today is that their position on bedsharing remains unchanged – which is – that they don’t recommend it at all.
It’s one of those topics that people feel strongly about, but I’d like to talk for a few minutes about why it’s inappropriate to have either a blanket ban, or a widespread green light on bedsharing. There is so much stigma, blame, guilt and confusion, and I’d like to share why I don’t think a cookie cutter response to bedsharing is best for families.
To dive into the topic a little, I’ll unpack a research article about long term bedsharing. Numerous people have tagged me to ask my opinion of it, so now that I’ve had a chance to read the whole thing, here goes…
The article is a write up of a longitudinal cohort of 1564 Chinese families by Yang and colleagues (2022). They found that 10.1% never bedshared, 18.35% of parents only bedshared with their kids early on (under 6 months), nearly 28% were not bedsharing under 6 months but were by 24 months, and 43.6% were what the researchers called ‘persistent bedsharers’ – i.e. they had always bedshared and continued to do so. Their hypothesis was that bedsharing in infancy would be linked with greater risk of adverse sleep patterns at the age of 24 months.
They recorded bedsharing status at 2, 6, and 24 months and briefly they found that among the persistent bedsharing and late onset bedsharing groups, they found an association with shorter overnight sleep durations and longer daytime sleep durations.
The authors suggest that bedsharing may reduce sleep consolidation and point out that the AAP (American Academy of Pediatrics) do not recommend bedsharing….
But before we throw the baby out with the bathwater, let’s have an intelligent think about this. Here are my ten biggest issues with this:
- Bedsharing is not only anthropologically normal for humans, but it is culturally normal in China, as evidenced by the fact that almost 90% of the children were bedsharing at some point, and nearly half bedshared for the first 2 years and beyond. If there are sleep pattern differences in half the population, then are we really going to pathologise that? Or should we be acknowledging that sleep differences exist and as long as the sleep is meeting the children’s needs, then why is it a problem?
- I’m personally confused and disappointed by the reference to the AAP bedsharing stance. SIDS rates around the world are very variable by country, and in fact, the SIDS rates in the USA are among the highest. It is arguably not appropriate to assume the same risk factors, environmental and contextual differences exist for a completely different population. SIDS risks are affected by multiple variables including sleep position, smoking, breastfeeding and infant vulnerability, as well as factors that remain unclear. In countries where bedsharing is the cultural norm and where SIDS risks are far lower, is it reasonable to use the same guidelines? Personally I don’t think so…
- The study actually found that among the persistent bedsharers and late onset bedsharers, the parents actually perceived less problematic sleep – suggesting that their children’s sleep patterns didn’t bother them per se. The suggestion that bedsharing is associated with sleep problems therefore feels wildly out of touch with what the parents are saying. It’s almost invasive to project an assumption that this is a problem when the parents don’t find it to be so in my humble opinion.
- Why were the interviews done at 2, 6, and 24 months? It seems strange to me to make a whole load of assumptions about a behaviour when you have data collected 18 months apart. What happened to the children between 6-24 months? What was the reason that the late onset bedsharers started bedsharing having previously slept solo? It could well be that the bedsharing was in response to problematic sleep, which would explain why the parents did not perceive it to be a problem…. i.e. rather than assume that bedsharing caused the sleep problems, could it be that the children who struggled to sleep solo, slept better when kept in close proximity to their parents? Essentially, did bedsharing ‘fix’ the sleep problems caused by solo sleeping?
- There is no evidence that the children’s sleep was inadequate, just a different pattern, with shorter nighttime duration and more sleep in the day. It’s also culturally normal for many people in China and most of Asia for that matter, to have more naps in the day, and less nighttime sleep, even into adulthood. It is not ‘problematic’ that we do not all sleep the same way in every culture.
- The children who had shorter sleep duration were also more likely to snore, which suggests that there may be some underlying sleep pathology in some of the children – again, bedsharing might have been in response to sleep challenge, rather than the other way around. The long term bedsharers also experienced more sleep onset problems – and we could argue the same point. The bedsharing did not necessarily cause this, and persisting with solo sleep might have caused more stress and challenge.
- Because of the pattern of data collection, it is unclear when the late onset bedsharers started sharing a bed with their parents. This is problematic because the data was collected at 24 months, but we have no idea how long they had been sharing a bed. They could have started 2 days before data collection, and yet the research finds an association between late onset bedsharing and adverse sleeping patterns. Hhhmmmm – couldn’t the adverse sleeping patterns have started months ago while the child was solo sleeping then?
- There is no association between early bedsharing and later adverse sleeping patterns. The researchers hypothesised that bedsharing in infancy would be linked to adverse sleep patterns at 24 months, and they claim that bedsharing may affect long term sleeping patterns. They point out in their article that many sleep problems in children and adults can be traced back to problems in infancy. Yet, that’s not what they found, so this is a bit of a stretch really. The babies who only bedshared at 2 and 6 months had no associated problems with sleep pattern at 24 months. Again, because of the pattern of data collection, it limits the usefulness, because we have no idea whether the babies actually bedshared until 12 or 18 months, because there is no data… I’m not a genius, but this seems like a real omission to me.
- There is only patchy data on breastfeeding. They collected breastfeeding statistics at 1 and 4 months of age from doctors’ records, and indeed, they found that breastfeeding parents at 1 and 4 months were more likely to bedshare. But it would have been really useful to see whether the 24 month olds were still breastfeeding, because bedsharing might have been maintained to facilitate breastfeeding.
- There is a tendency in the article to focus on statistical significance, rather than clinical significance. For instance, they justify their claim that bedsharers have more sleep onset problems by referring to the sleep latency differences. There was a statistically significant difference in time taken to fall asleep. But what was the actual difference in minutes my friends? Well, the children who never bedshared fell asleep in 22.3 minutes, and the persistent bedsharers fell asleep in 26.62 minutes. Wow. A whole 4 minutes longer….. Interestingly, the children who had bedshared early on fell asleep faster than the never bedshare group – make of that what you will…What about the nighttime sleep duration? Well, the never bedshare children achieved 9.7 hours of sleep, versus the persistent bedshare children who achieved 9.35 hours. I’m not about to lose any sleep over that friends (pardon the pun!
Does this mean I think we should promote bedsharing to all? No! Absolutely not. Bedsharing is culturally normal in many parts of the world. It’s also strongly associated with breastfeeding, which also reduces the risk of SIDS. But none of that means it’s always right.
There are some infants who have increased vulnerability, some populations about which we know so little that it’s not safe to use the same guidelines. There are some families who have additional risk factors, and let’s not forget, there are some families who just don’t want to bedshare, or who find that it doesn’t in fact facilitate sleep.
So, suffice it to say that I’m not convinced anyone needs to get bent out of shape about bedsharing on the strength of this article. Sure, there are some differences. They’re not massive, and the parents weren’t bothered.
If bedsharing works for you and your family, that’s great. If it doesn’t, there are ways you can make some gradual shifts – loads of tips in my Sleep Transitions guide especially, but also my Gentle Night Weaning webinar and check out Let’s talk about your new family’s sleep and Still Awake for a ton of evidence based, no-BS support with normal sleep.
Lyndsey Hookway is a paediatric nurse, health visitor, IBCLC, holistic sleep coach, PhD researcher, international speaker and author of 4 books. Lyndsey is also the Co-founder and Clinical Director of the Holistic Sleep Coaching Program, co-founder of the Thought Rebellion, and founder of the Breastfeeding the Brave project. Check Lyndsey’s speaker bio and talk brochure, as well as book her to speak at your event by visiting this page. All Lyndsey’s books, digital guides, courses and webinars can be purchased here, and you can also sign up for her free monthly newsletter here.