The Cosleepy Top 10 List
Safe Bedsharing Non-Negotiables
Sleep Space
- Mattress is firm, flat, level, and clear
- No gaps in the headboard or in-between the mattress and bed frame, wall, furniture, etc.
- Nothing that dangles or tangles near the mattress
- Mattress is on the floor and/or steps have been taken to prevent falls
Baby
- Born healthy, full term, and at least 5.5 lbs (2.5 kg)
- Sleeps in the safest position: either chest-to-chest with Parent or on their back beside Parent
- Not swaddled; dressed lightly without a hat
Parent
- Non-smoker; did not expose Baby to smoke while pregnant
- Sober and able to respond (i.e. no fever; not ill or excessively tired)
- Breastfeeds Baby or adopts the safe practices of breastfeeding moms
As a new mom, I spent hours scrolling Reddit, Facebook groups, and the web for safe bedsharing guidelines. I eventually found a few books that addressed safe cosleeping, and I spent my contact naps trying to hold a book while my baby slept on my chest.
(Not an easy task, as you’re well aware.)
I was so anxious and stressed out about getting a handle on bedsharing safety, I wasn’t present with my new baby. Look back now, eight years later, it hurts to know that I can never get that time with him back.
Safe to say, I am determined to keep you from making the same mistake.
So sit down with your baby on your chest, get comfy, and let’s take a closer at The Cosleepy Top 10 List—the safe bedsharing non-negotiables.
Sleep Space
Mattress is firm, flat, level, and clear
Your baby’s sleep surface needs to be firm, flat, level, and clear of hazards. Hazards could be pillows, blankets, stuffed toys, or even pets and other children!
Sofas, recliners, beanbag chairs, and waterbeds do not meet this criteria.
No gaps in the headboard or in-between the mattress and bed frame, wall, furniture, etc.
You’ll need to ensure that there are no gaps for your baby to roll into and become entrapped. Dismantle your headboard from your bed frame if it is slatted or designed with decorative gaps.
Walk around your bed and look for problematic gaps between the mattress and bed frame, wall, and bedroom furniture and pack them according to the instructions in the Bedsharing Beginner’s Guide.
Nothing that dangles or tangles near the mattress
Make sure that nothing that dangles or tangles will be near the mattress—cords from window coverings, phone chargers, nightgown ties or strings, and even long hair.
Long hair should be twisted into a bun or top knot or in a bonnet, ideally not in a long ponytail or braid which could still present a strangulation risk.
Mattress is on the floor and/or steps have been taken to prevent falls
The mattress should be down on the floor or steps should have been taken to prevent the baby from falling off the side of the bed, such as installing a mesh bed rail or sidecar crib.
Baby
Born healthy, full term, and at least 5.5 lbs (2.5 kg)
In order to bedshare, a baby should have been born with no major health issues, at least 5.5 pounds (2.5 kg), and full term. Premature babies and those with Intrauterine Growth Restriction are at higher risk for SIDS, so it’s safer to practice bedside sleeping with them.
(Bedside sleeping refers to keeping your baby within arm’s reach, but on a separate surface—for example, in a sidecar crib attached to your bed frame.)
Sleeps in the safest position: either chest-to-chest with Parent or on their back beside Parent
If you are chest sleeping, your baby needs to sleep on their tummy, propped up at an angle on your chest with their head higher than their bottom. Each time you move out of position to feed or change your baby throughout the night, you will need to make sure they are returned to the correct chest-to-chest position.
For complete safety information, see The Chest Sleeping Guide.
If you are cuddle curling, your baby needs to sleep on their back when they are not nursing. Back sleeping is one of the best ways to prevent SIDS. If your baby falls asleep while nursing, you can gently roll them onto their back anytime you notice it. Sleeping in the cuddle curl position will help keep them on their back.
You can find thorough safety information on this in The Cuddle Curling Guide.
Not swaddled; dressed lightly without a hat
Your baby should be dressed lightly to compensate for being up against your warm body. Studies have demonstrated an increased risk of SIDS when babies overheat while sleeping, so it’s not safe to let them sleep in a hat or swaddle.
Parent
Non-smoker; did not expose Baby to smoke while pregnant
You should be a non-smoker, as tobacco smoke-exposed babies have a greater risk of SIDS—whether exposed pre or postnatally. Further, a baby who sleeps with a smoker has an even greater risk of SIDS.
If your partner smokes, they should sleep across the bedroom in a room sharing setup or in a separate bedroom until the baby is at least 6 months old, as the risk of SIDS drops dramatically at that point.
If your partner smokes but doesn’t bedshare with you or expose the baby to secondhand smoke, it’s still possible that thirdhand smoke could increase the baby’s risk of SIDS. However, currently there are no studies that confirm this, so you can use your best judgement to decide if this enough cause to choose room sharing over bedsharing.
Sober and able to respond (i.e. no fever; not ill or excessively tired)
You (and your partner, if they are also in the bed), should be sober of alcohol, recreational drugs, and prescriptions or over-the-counter medication that affect your alertness, so that you can notice and respond to your baby if they need you.
This also means that you are not too ill or excessively tired, which could have the same effect as being intoxicated by drugs or alcohol. If you have a fever, your elevated temperature could cause your baby to overheat.
Breastfeeds Baby or adopts the safe practices of breastfeeding moms
You should breastfeed your baby at least part-time throughout the night. Babies who breastfeed for at least 2 months are at a reduced risk for SIDS. In addition, research shows that all breastfeeding moms behave in a particular, protective way—such as sleeping in the cuddle curl position and consistently waking at the same time as their baby.
A breastfeeding mom’s behaviors keep their baby’s face homed into the breasts, keep bedding out of the baby’s sleep space, and prevent the baby from sleeping prone.
Moms who have never breastfed have been documented bed sharing in a more variable manner with safety risks such as turning their backs to their babies and placing their babies on or between their pillows.
If you are unable to breastfeed, or you simply don’t want to, I’m not here to tell you that your bottle-feeding family should never bedshare! But you should be informed: bottle-fed babies, and in particular formula-fed babies, are at a higher risk of SIDS, ASSB, entrapment, and overlay.
So adopting the safe practices of breastfeeding moms, committing to heightened awareness of your infant throughout the night, and maintaining a safe sleep setup will be extra important for you.
Yes, that’s it—there are only ten things for you to focus on right now. No more overwhelm. You don’t have to continue searching ChatGPT, scrolling Instagram, or trying to make the Safe Sleep 7 work for you.
In fact, I designed The Cosleepy Top 10 List to be more realistic for modern parents who don’t always get to bedshare under the “ideal” circumstances.
For example, it will apply to you if you bottlefeed, if you sleep with your baby in the chest-to-chest position, or if you need your partner to sleep with your baby instead.
These are all common, real life circumstances that other guidelines ignore.
The Cosleepy Top 10 List appears in an introductory chapter of my forthcoming book, Cosleepy, in bookstores next year. Like the entirety of my book, the list has been reviewed by Dr. Helen Ball, Director of the Durham Infancy & Sleep Centre.
I hope that they help you breathe a little bit easier tonight, as you’re lying down with your baby.
Sources
- Thompson, J. M., Mitchell, E. A., & New Zealand Cot Death Study Group (2006). Are the risk factors for SIDS different for preterm and term infants? Archives of disease in childhood, 91(2), 107–111. https://doi.org/10.1136/adc.2004.071167
- Cohen, E. (n.d.). Underlying Mechanisms of SIDS – Investigation in to the Effects of Intra-uterine Growth Restriction on the Heart and Circulation. Red Nose. https://rednose.org.au/research/underlying-mechanisms-of-sids-investigation-in-to-the-effects-of-intra-uter
- Vedula, P. (2019, April 12). Thirdhand Smoke. Institute for Health Policy and Leadership. https://ihpl.llu.edu/blog/thirdhand-smoke#
- Blair, P.S., Fleming, P.J., Bensley, D., et al. (1996). Smoking and sudden infant death syndrome: Results of the 1993-1995 case-control study for confidential enquiry into stillbirths and deaths in infancy. BMJ, 313(7051), 195. https://doi.org/10.1136/bmj.313.7051.195
- Liebrechts-Akkerman, G., Lao, O., Liu, F., et al. (2011). Postnatal parental smoking: an important risk factor for SIDS. European Journal of Pediatrics, 170(10):1281–1291. https://doi.org/10.1007/s00431-011-1433-6
- Ball, H. L. (2006). Parent-infant bed-sharing behavior: Effects of feeding type and presence of father. Human Nature, 17(3), 301–318. https://doi.org/10.1007/s12110-006-1011-1
- McKenna, J. J., & Mosko, S. S. (1994). Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine. Acta paediatrica, 397, 94–102. https://doi.org/10.1111/j.1651-2227.1994.tb13271.x
- McKenna, J. J., Mosko, S., Dungy, C., et al. (1990). Sleep and arousal patterns of co-sleeping human mother/infant pairs: A preliminary physiological study with implications for the study of sudden infant death syndrome (SIDS). American Journal of Physical Anthropology, 83(3), 331–347. https://doi.org/10.1002/ajpa.1330830307
- Ball, H. L. (2025). How Babies Sleep: A Science-Based Guide to the First 365 Days and Nights. Balance.
- Thompson, J. M. D., Tanabe, K., Moon, R. Y., et al. (2017). Duration of Breastfeeding and Risk of SIDS: An Individual Participant Data Meta-analysis. Pediatrics, 140(5), Article e20171324. https://doi.org/10.1542/peds.2017-1324
- Li, R., Ware, J., Chen, A., et al. (2022). Breastfeeding and post-perinatal infant deaths in the United States, A national prospective cohort analysis. The Lancet Regional Health – Americas, 5, Article 100094. https://doi.org/10.1016/j.lana.2021.100094
