Unintended Consequences


What’s a breastfeeding mother to do?  Is it riskier to bedshare with her baby during the night or is it riskier not to?  That’s what a survey of 4789 U.S. mothers with babies under one year clarified.1

In the U.S. parents are admonished never to sleep with their babies.2 The Milwaukee, Wisconsin health department, for example, uses the image of an adult headboard transformed into a tombstone as a warning about the dangers of bedsharing. (Click here for a video on this campaign.) 

Bedsharing appears even more dangerous when—as often happens in the U.S.—infant deaths are blamed on it even when other more hazardous practices are present, such as adult alcohol intoxication and drug use and when the “bed” is actually a recliner, chair or sofa.  One Scottish study, for example, found that the risk of an infant dying was nearly 67 times higher on a sofa compared to an adult bed.3

According to the U.S. mothers surveyed, despite their awareness of these public campaigns, nearly 60% of their babies shared their beds for at least part of the night.  Among the mothers who attempted to follow the recommendations against bedsharing, 55% fed their babies at night in chairs, recliners, or sofas and 44% of these (25% of the total) reported falling asleep some of the time in these much more dangerous places.  In other words, their attempts to “follow the rules” often led to the unintended consequence of much riskier behaviors.

The authors of this survey concluded that safe-sleep campaigns should include information on safe bedsharing, because when this information is absent, parents will continue to bedshare in unsafe ways.  The Japanese experience confirms this.  As bedsharing as has become more common in Japan (it is now the cultural norm), rates of SIDS have decreased. 4What’s different there is that Japanese families bedshare safely.  Families sleep together on futons on the floor away from walls, so babies cannot fall far or get trapped.  Fluffy pillows and bedclothes are not used. 

To save more lives, U.S. safe-sleep campaigns should consider taking a page from the Japanese playbook.  By emphasizing how to create a safe sleeping environment—rather than trying to browbeat parents into avoiding bedsharing—more babies’ lives would be spared.  And as an extra plus, more families would also get a better night’s sleep.

For a brochure for parents on safe sleep, click here.


1Kendall-Tackett, K., Cong, Z., and Hale, T.W.  Mother-infant sleep locations and nighttime feeding behavior.  Clin Lact 2010; 1(1):27-30.

2American Academy of Pediatrics, Task Force on SIDS.  The changing concept of sudden infant death syndrome: Diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk.  Pediatrics 2005; 116:1245-55.

3Tappin, D. et al.  Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: A case-control study.  J Pediatr 2005; 147:32-37.

4McKenna, J., Ball, H., and Gettler, L.T.  Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine.  Amer J Phys Anthropol, Suppl 2007; 45:133-61.