Parent-child bed-sharing: The good, the bad, and the burden of evidence

doi:10.1016/j.smrv.2016.03.003

Sleep Medicine Reviews

Volume 32, April 2017, Pages 4-27

https://doi.org/10.1016/j.smrv.2016.03.003 Get rights and content

Summary

The practice of parent and child sharing a sleeping surface, or ‘bed-sharing’, is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits – both physical and psychological – associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields – anthropology, psychology/psychiatry, and pediatrics – to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.

Section snippets

Child sleep practices

To bed-share or not to bed-share? This seemingly innocuous question has been labeled the ‘single most controversial topic related to pediatric sleep’ [1]. Bed-sharing (the practice of parent and child sharing a sleeping surface) and co-sleeping (shared sleep that includes room-sharing, bed-sharing, and everything in between) are hotly debated. The literature is often polarized, filled with interesting questions, creative designs, and ultimately, insufficient evidence.

Historically, humans have

Aims and method of the study

Following the taxonomy proposed by Cooper [10], this review is designed to exhaustively outline the research findings and associated debate on the topic of bed-sharing. Our goals are twofold: 1) to integrate the past literature, and 2) to identify central issues in the literature. The thorough and systematic review enabled us to create a world-wide ‘heat map’ (chloropleth) of bed-sharing prevalence. The review is organized thematically, grouping studies relating to the same idea and aiming for

Prevalence of bed-sharing around the world

To present the prevalence of bed-sharing practices around the globe, all studies were scrutinized for reported frequencies of bed-sharing. We used the following decision rules: we included only studies reporting prevalence rates for population-based (rather than clinical or high-risk) samples. For population-wide intervention studies, we considered the post-intervention sample prevalence rate, which was thought to provide the most recent stable estimate. If the intervention was applied to a

Reactive versus intentional bed-sharing

A cross-cultural study indicated that bed-sharing rates (higher for predominantly Asian countries than predominantly Caucasian countries) are stable during preschool years, suggesting little change over this period once bed-sharing becomes established [15]. However, parents bed-share for many reasons. Aside from tradition, reasons to bed-share include breastfeeding facilitation, infant irritability or illness, parental ideology, parental own sleep experiences, convenience, anxiety, child

‘Consequences’ and ‘Risks’ of bed-sharing

In the following paragraphs, we discuss associations between bed-sharing and multiple dimensions of child development. For the same reasons bed-sharing prevalence is difficult to establish – e.g., rates vary across cultures and socioeconomic clusters – it is also challenging to establish the relation between bed-sharing and many of the purportedly related risks or benefits.

Discussion

Following an exhaustive narrative review of 659 studies addressing bed-sharing, we note a rather disproportionate emphasis in the literature on the pathological, abnormal, and worrisome dimensions of bed-sharing. As a relatively new cultural phenomenon, the practice of putting infants to sleep in a separate surface has come to dominate the literature as the normal and correct strategy for infant sleep. The reviewed literature has many common themes that warn of dangers for bed-sharing parents –

Conclusion

If the reviewed literature is to be any indication, the debate surrounding bed-sharing is not likely to disappear. An increasing number of studies alleging SIDS risk in bed-sharing infants does not equate to a simple majority-wins vote-count, particularly if publication bias and methodological flaws restrict the clarity of the evidence. Much of the world bed-shares and appears to do so without great risks. Similarly, stating the ‘naturalness’ of a practice does not alleviate the stress that

Conflicts of interest

The authors have no conflicts of interest to disclose.

Acknowledgments

We gratefully acknowledge the contribution of Marit Spillenaar Bilgen, Nora Abdulgani Naji, and Afza Iqbal to the data collection. We also would like to thank Marinus van IJzendoorn and Henning Tiemeier for critical evaluation of the manuscript. The present study was supported by grants from the Netherlands Organization for Scientific Research (NWO): an NWO RUBICON prize no 446-11-023 to VRM-S, and NWO VICI grant no. 453-09-003 to MJB-K. MJB-K was also supported by the Gravitation programme of

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Clinical reviewParent-child bed-sharing: The good, the bad, and the burden of evidence

Summary

Section snippets

Child sleep practices

Aims and method of the study

Prevalence of bed-sharing around the world

Reactive versus intentional bed-sharing

‘Consequences’ and ‘Risks’ of bed-sharing

Discussion

Conclusion

Conflicts of interest

Acknowledgments

Leg Med (Tokyo)

J Obstet Gynecol Neonatal Nurs

Sleep Med

Sleep Med

Acad Pediatr

J Natl Med Assoc

Early Child Res Q

J Am Acad Child Adolesc Psychiatry

Child Adolesc Psychiatr Clin N Am

Infant Behav Dev

J Pediatr Health Care

Infant Behav Dev

J Pediatr

Infant Behav Dev

Sleep Med

Solve your child's sleep problems: new, revised, and expanded edition

Sleep in children: cross-cultural perspect

Co-sleeping

MCN Am J Matern Child Nurs

Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine

Am J Phys Anthropol

Co-sleeping, an ancient practice: issues of the past and present, and possibilities for the future

Sleep Med Rev

To co-sleep or not to sleep?

Acta Paediatr

Culture, development, and diversity: expectable pluralism, conflict, and similarity

Ethos

Commentary: sleep in German infants–the “cult” of independence

Pediatrics

Parent-infant cosleeping: the appropriate context for the study of infant sleep and implications for sudden infant death syndrome (SIDS) research

J Behav Med

Editorial

Psychol Bull

Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984-1998: implications for future prevention and research

Arch Dis Child

Reasons to bed-share: why parents sleep with their infants

J Reprod Infant Psychol

SIDS-protective infant care practices among Auckland, New Zealand mothers

N Z Med J

Barriers to best outcomes in breastfeeding for Maori: mothers' perceptions, whanau perceptions, and services

J Hum Lact

“Ghosts in the Nursery:” infant sleep and sleep-related cognitions of parents raised under communal sleeping arrangements

Infant Ment Health J

Child sleep arrangements and family life: perspectives from mothers and fathers

The physical and social environment of sleep in socioeconomically disadvantaged postpartum women

J Obstet Gynecol Neonatal Nurs

Factors influencing African American mothers' decisions about sleep position: a qualitative study

J Natl Med Assoc

Facilitators and regulators: antenatal maternal orientation and postnatal parenting practices

J Reprod Infant Psychol

Infant sleep-related deaths: why do parents take risks?

Arch Dis Child

Safe sleep practices and sudden infant death syndrome risk reduction: NICU and well-baby nursery graduates

Clin Pediatr (Phila)

Bed sharing in school-age children–clinical and social implications

J Child Adolesc Psychiatr Nurs

Consistency in infant sleeping arrangements and mother-infant interaction

Infant Ment Health J

Sleeping like a baby: attitudes and experiences of bedsharing in northeast England

Med Anthropol

Where will the baby sleep? Attitudes and practices of new and experienced parents regarding cosleeping with their new-born infants

Am Anthropol

The relationship between planned and reported Home infant sleep locations among mothers of late preterm and term infants

Matern Child Health J

Evaluation of bedtime basics for babies: a national crib distribution program to reduce the risk of sleep-related sudden infant deaths

J Community Health

Trends in popular parenting books and the need for parental critical thinking

Child Welf

Clinical review
Parent-child bed-sharing: The good, the bad, and the burden of evidence