Bed-sharing and co-sleeping: the risks and what guidelines say

The safest place for your baby to sleep is their own cot or bassinet, on their back, in your room for at least the first 6 months. The AAP, NHS, Lullaby Trust, Unicef UK and Red Nose all agree on that. Where they differ is on what to tell families who bed-share anyway: the American Academy of Pediatrics (AAP) says avoid it in any circumstances, while UK and Australian bodies don't recommend it but explain how to make a bed safer, because many parents end up sharing a bed whether they plan to or not. All of them agree on the situations that make bed-sharing especially dangerous, and that falling asleep with a baby on a sofa or armchair is the riskiest of all.

What's the difference between co-sleeping, bed-sharing and room-sharing?

These words get used loosely, which makes advice confusing. The Lullaby Trust uses these definitions:

Feeding or cuddling your baby in bed while you're awake isn't bed-sharing in the Lullaby Trust's definition. In Australia, the Australian Breastfeeding Association (ABA) uses "co-sleeping" and "bed sharing" to mean the same thing: sleeping on the same surface as your baby. When you read advice, check which meaning the source has in mind.

What do health authorities say about bed-sharing?

All of them put a separate sleep space in your room first. They differ on how they talk about bed-sharing itself.

The AAP's safe sleep guide recommends room-sharing for at least the first 6 months, with your baby's sleep area near, but not in, your bed. If you bring your baby into bed to feed or comfort them, it says to return them to their own sleep space before you fall asleep.

The NHS says the safest place is a separate cot or Moses basket, in your room for every sleep for at least the first 6 months. Red Nose recommends the same in Australia: baby in their own safe sleep space in your room for at least the first 6 months. Its co-sleeping guide says it does not recommend sharing a sleep surface but acknowledges that some parents choose to, and others co-sleep unintentionally.

Why do UK and Australian bodies give bed-sharing advice at all?

Because a flat "never" can backfire. Unicef UK's guide for health professionals explains that tired parents trying to avoid their bed may feed on a sofa or armchair instead, which is far more dangerous, or sit up to feed and fall asleep in a riskier position. It says that on any night around 22% of babies in England bed-share. The ABA cites Australian research showing around 75% of babies spend some time co-sleeping in their first 3 to 6 months.

The Lullaby Trust says research suggests around half of SIDS deaths happen while co-sleeping, mostly in high-risk situations. Unicef UK's guide, using earlier UK data, says 90% of those babies died in hazardous situations that are largely preventable. That's why the advice focuses so heavily on the circumstances below.

When is bed-sharing most dangerous?

These are the situations the sources single out. Several sources name most of them; the right-hand column shows where each one comes from.

The AAP puts numbers on some of these. It says the risk is more than 10 times higher when a baby bed-shares with someone who is fatigued, medicated or using substances. It says bed-sharing risk is 5 to 10 times higher when a baby is younger than 4 months, and 2 to 5 times higher for babies born preterm or with low birthweight.

The NHS adds that for premature babies, you should follow the safer sleep advice for a year from their due date.

Why is a sofa or armchair so dangerous?

Soft cushions and narrow gaps make it easy for a baby to slip into a position where they can't breathe. The AAP says the risk of sleep-related death is up to 67 times higher when a baby sleeps with someone on a couch, soft armchair or cushion. The Lullaby Trust says never to fall asleep on a sofa or armchair with your baby, and warns that babies can become trapped.

Unicef UK's professional guide puts the overall risk of SIDS for babies in England and Wales at about 1 in 3,710, compared with 1 in 203 when co-sleeping on a sofa. It says that if parents do fall asleep with their baby, they are much safer in a bed than on a sofa or chair.

If you often feed at night on the couch, plan an alternative before you're exhausted. The ABA says feeding on a bed that's been set up with safety in mind is safer than feeding on a sofa or armchair.

If you might fall asleep with your baby in bed, how can you make it safer?

This doesn't make bed-sharing safe, and it doesn't apply if any of the high-risk situations above are true. It's what the Red Nose co-sleeping guide, the ABA, the Lullaby Trust and the NHS advise if bed-sharing happens:

1. Lay your baby on their back to sleep, every time.
2. Use a firm, flat mattress. The Lullaby Trust and NHS advise against pods and nests.
3. Keep pillows and adult bedding away from your baby. The Lullaby Trust suggests keeping bedding at your waist height so it can't cover their face or head.
4. Put your baby beside one adult only, never between two adults, and never next to other children or pets (Red Nose, ABA).
5. Stop gaps and falls. Red Nose suggests moving the bed away from the wall so your baby can't get trapped; the Lullaby Trust suggests removing slatted or decorated headboards. Make sure your baby can't fall off the bed.
6. Don't wrap or swaddle. Red Nose and the ABA suggest a safe sleeping bag with no hood and your baby's arms out.
7. Avoid overheating. The Lullaby Trust suggests wearing an extra layer yourself rather than adding bedding, and checking your baby's chest or the back of their neck.
8. Tie up long hair and take off jewellery, including teething necklaces (Red Nose, ABA).
9. Never leave your baby alone on an adult bed, even briefly.
10. Decide again before every sleep. The Lullaby Trust says if you're unwell or have drunk alcohol, use a separate sleep space such as a cot.

The AAP's version is shorter: if there's any possibility you might fall asleep with your baby in your bed, move pillows, blankets and other items away from them, and move your baby back to their own sleep space as soon as you wake.

How is bed-sharing linked to breastfeeding?

The ABA says breastfeeding itself protects against SUDI, possibly because breastfed babies rouse more easily, breast milk carries immune factors, and breastfed babies tend to have fewer infections. It describes the protective "C" shape many breastfeeding mums form around their baby in bed: baby at breast level rather than near the pillows, her arm between baby's head and the pillow, and her legs bent. Red Nose lists "breastfeed baby, if possible" as one of its six safe sleep recommendations.

Unicef UK's 2025 parent guide says the more you breastfeed, the greater the protection, and suggests asking your midwife or health visitor about feeding positions that help you rest while keeping your baby safe. It's still clear that a separate sleep space is safest. The AAP's advice for breastfeeding families is to feed in bed if you like, then return your baby to their own sleep space before you fall asleep.

For more on night feeds and sleep, see feeding or rocking to sleep and latch and positioning.

How can you get more rest without sharing a bed?

Most families bed-share because they're exhausted and it's the only way everyone sleeps. Some things that help:

• Put the cot or bassinet right beside your bed. Unicef UK suggests keeping it there for at least the first 6 months, so you can reach your baby easily.
• Plan for the riskier nights. Unicef UK suggests having another adult on hand if you've had alcohol, and checking the sleep set-up when you're away from home, as beds and bedding differ.
• Take turns. A partner or support person can settle the baby or give a bottle so you can sleep in a quieter room.
• Rest when you can in the day. Unicef UK suggests letting visitors help with chores so you can catch up.
• Use a safe option for travel. Red Nose suggests calling ahead to check there's a cot or portable cot that meets Australian safety standards, and never sleeping your baby on an adult bed, couch, beanbag or cushion.

The sleep deprivation guide has more ideas, and safe sleep and sleep environment cover setting up the cot. Products sold to make bed-sharing safer, such as pods and nests, aren't recommended — see sleep products to avoid.

When to get help

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) now if your baby has difficulty breathing, has blue, grey, pale or blotchy skin, lips or tongue, or is difficult to wake or can't be woken. The NHS guide to serious illness lists these as emergencies. If your baby isn't breathing, follow the call-taker's instructions.

Get support soon if you're so exhausted you're falling asleep while holding your baby, or if you're relying on a sofa or armchair at night. Your GP or child-health nurse, midwife or a parenting support service (Tresillian or Karitane in Australia, your health visitor in the UK, your pediatrician's office in the US) can help you make a plan. a breastfeeding helpline (the Australian Breastfeeding Association on 1800 686 268 in Australia, the National Breastfeeding Helpline on 0300 100 0212 in the UK) can help with feeding positions.

Call a crisis line (Lifeline on 13 11 14 in Australia, Samaritans on 116 123 in the UK, 988 in the US) or your local emergency number (000 in Australia, 999 in the UK, 911 in the US) if you have thoughts of harming yourself or your baby. You can also talk to a perinatal support line (PANDA on 1300 726 306 in Australia, Samaritans on 116 123 in the UK, the National Maternal Mental Health Hotline on 1-833-852-6262 in the US) about how you're coping.

Mention it at your next check if your baby was premature or small, or you're unsure how the advice applies to your family.