Safe Sleep 7, Is it Actually Safe?

Did you know that September is baby safety month? Safety, among many other things, is at the top of our parent priority list. I’m sure you are diligent about checking that your child is secure in the carseat before taking off, ensuring no small objects are on the floor for your child to put in his/her mouth, and all those high risk choking foods are cut as small as possible to reduce the risk of your child choking in front of you.  But, when it comes to sleep, do we act with that same diligence? In the recent years, and even months (since the AAP updated their safe sleep guidelines) there has been more attention brought to safe sleep, but also the idea of safe co-sleeping, if there is such a thing. This leads me to discuss Safe Sleep 7.

Let’s start by first exploring,  What is Safe Sleep 7?
Safe Sleep Seven is “7” guidelines to promote safer bed-sharing (also called co-sleeping) between baby and their parents. The concept, originally from a book from 1999 called “Sweet Sleep”, aims to normalize bed-sharing, especially during the early months when your baby is waking frequently to feed. Their point was to eliminate the logistics of having to move your baby in and out of a separate sleeping space when you are already tired. It’s primarily recommended for moms whom are breastfeeding day and night, however it’s mentioned that it can also apply to infants who bottle-feed too.
 What are the Safe Sleep 7 Guidelines?
  1. No smoking
  2. Sober. Mom must not be under the influence of any alcohol, drugs, or sedating medications 
  3. Nursing mother, day and night. The baby should be at the level of mom’s breasts
  4. Healthy baby. Applies to infants whom were born full term, without medical conditions
  5.  Baby on Back. The baby is placed on his/her back to sleep 
  6. No sweat. The baby is dressed lightly during sleep and is not swaddled
  7.  Safe surface. The mattress should be firm without extra or loose pillows, blankets, or toys

Can you practice safe sleep 7 while sleep “training”?

The short answer: no.  The reason behind this is due to habit. Most times when a mom and baby are co-sleeping (or bed-sharing), the baby is waking multiple times per night to nurse. In fact, some of my clients have no idea how many times their baby wakes to nurse and others believe their little ones nurse “every hour” while in bed with them. Co-sleeping/bed-sharing allows for easy access to milk for your baby, but most times leads to “comfort nursing”; meaning your little one isn’t taking in milk for hunger or calories, but more because it makes them comfortable and drowsy enough to fall back asleep. If this happens repeatedly night after night, month after month, the baby learns to need that source of comfort to fall and stay asleep. This learned pattern becomes a habit (we all have them).

So, If we are working to shift your little one from taking multiple small “comfort snacks” all night long to quality milk consumption to meet their caloric needs, it becomes confusing to them if you allow them to sleep by your breast all night long but don’t allow them to suck intermittently for comfort. Thus, it’s difficult to teach your child how to initiate sleep independently (which is the definition of sleep “teaching”) while co-sleeping. This ultimately leads to more confusion from the infant, delayed consolidation of sleep cycles and more emotional distress for all involved.

So, that leads to the bigger questions… “Is Safe Sleep 7 actually safe” and “Can you safely Co-sleep?”
We don’t know for certain. We know what the American Academy of Pediatrics‘ stance is, and that’s to avoid any form of co-sleeping or bed-sharing as to reduce the risk of SIDS. This was based on a 2013 study, which showed an increased risk of death when bed-sharing, in the absence of hazardous circumstances. However, this study has been criticized for having unrealistic comparison groups in the study.
There have been other studies that suggested the opposite, in fact, this study found bed-sharing in the absence of hazards to be protective against SIDS in infants older than 3 months. Also to note, many other countries with high bed-sharing rates have low rates of sleep-related deaths; why that is, is still unclear. What we do know is that breastfeeding (day and night) appears to have a protective benefit against SIDS. The reason behind this is also unclear, but the thought is breastfed infants are shown to have increased arousability and the possibility that immunoglobulins and cytokines in breastmilk are protective against SIDS.  So, all this to say, there is no one study that proves co-sleeping/bed-sharing to be completely safe, yet no study to accurately confirm it’s an independent risk for SIDS. What we do know is most studies that looked at the safety of bed-sharing as “protective” against SIDS are highly skewed towards mothers breastfeeding their infants day and night.
What are The American Academy of Pediatrics Guidelines on Safe Sleep?
  1. Baby on back for sleep
  2. Safe sleep surface on a firm mattress without pillows, blankets, or toys
  3. Avoid parent and infant exposure to drugs, alcohol, and nicotine
  4. Breastfeeding your infant for at least the first 2 months
  5. Room-share with your infant (but not bed-share) for the first 6 months
  6. Use of a pacifier
  7. If infant is swaddled, must come out of swaddle once exhibiting any signs of rolling
  8. Weighted swaddles and sleep sacks should be avoided
If you compare these guidelines to the Safe Sleep 7 guidelines, 4 of them are exactly the same. The biggest difference is that when co-sleeping or bed-sharing, the parent cannot control what happens with her body/position once said parent falls asleep. Most breastfeeding moms assume their baby’s head stays at the level of their breast/chest all night but we cannot guarantee that.
Other factors to consider when asking if co-sleeping is safe:
  1. Is baby healthy and born full term?
  2. How exhausted is mom? Just because mom hasn’t consumed any alcohol, medications, or drugs, if she’s extremely sleep deprived, is she still considered “sober”?
  3. How “deeply” does mom or any other person in the bed sleep?
  4. How mobile is the baby or parent while asleep?
  5. Does parent tend to sleep “hot” or sweat during sleep, therefore increasing risk for baby to sweat?

Co-sleeping typically happens for 2 reasons: One, it’s the culturally acceptable thing to do, or two, it’s just what is working at the current moment when you are exhausted and running on fumes and desperate to get any amount of sleep.  

My first question when clients share with me that they are co-sleeping is “how are you sleeping”. If they say “great” then don’t change, you probably don’t need me. But when they say “nobody is sleeping” then it’s time to look at other options. As your child becomes more aware, more mobile, and more sensitive to his/her surroundings, co-sleeping becomes more difficult. Your once peaceful little snuggler whom stirred a few times in the night, nursed and went back to sleep is suddenly sitting up at any little sound, flipping 360 degrees in your bed through the night, and snacking every 1-2 hours. How did that happen? Babies grow and their needs change, and so can your family’s.  If co-sleeping was once working for your family but now nobody is getting any shut eye, it’s okay to make a change. I’m here to support you when that happens.

Kendra Dove

is happily married to the love of her life for 10 years and is the mother of 2 amazing boys. She is an Indianapolis-based sleep "trainer"/coach and primary care-trained physician assistant. She has helped countless families, both locally in the Indy area and all over the US, get restful nights' sleep. She loves sharing her sleep knowledge and expertise and is passionate about identifying each family's sleep struggles and deeply understanding their needs to reach success!