Introduction

Whether, and in what circumstances, the risk of sudden unexpected death in infancy (SUDI) is increased when an infant shares a sleep surface with another person has been the subject of extensive and vexed debate over the past two decades (1-6). This is largely because of opposing views as to the potential benefits and risks associated with this practice. Researchers remain divided on their stance towards shared sleeping and SUDI. While the United States American Academy of Pediatrics has strongly recommended against sharing a sleep surface with an infant for many years (7-9), a number of researchers in the United Kingdom and Australia question labeling a common sleeping practice a “risk factor” to be advised against. Instead the circumstances, rather than the shared sleeping itself, are recognized as the potential risk (3, 10-12). Whatever one's personal standpoint, from a clinical perspective, parents are entitled to clear information about the risks and benefits of shared sleeping to enable them to make a well-informed decision concerning the infant care practices they adopt. Health professionals, in both hospital and community settings, play a pivotal role in ensuring that parents are provided with this information, ideally in a non-judgemental manner that is relevant to their specific circumstances.

This chapter commences by defining the important terms used throughout. Second, it examines the prevalence of shared sleeping in both Western and non-Western countries and cultures. Third, it reviews the evidence base concerning the benefits and the risks of sharing a sleep surface with an infant. Fourth, the use of a risk-minimization, as opposed to a risk-elimination, approach in the provision of safe sleeping advice and education is discussed. Finally, the recent move towards devices designed to overcome the risk associated with “direct” shared sleeping, while still maintaining the close motherinfant proximity needed to facilitate breastfeeding, is discussed.

Definitions

Various terms have been used in the literature to define environments in which an infant sleeps in close proximity to a caregiver, including co-sleeping, bed sharing, and room sharing.