New study doesn’t support AAP guidelines on infant room-sharing

Last year, Claire Caine Miller and I teamed up to write about the then-new AAP guidelines on infant sleep. Those guidelines recommended that infants sleep in the same room as their parents until they were one year of age. We took issue with that.

We noted that the “evidence” for this recommendation consisted of one out-of-print book from the 1990’s, and three old case-control studies, none of which took place in the US. We noted that cultural practices in other countries differ from those here. We noted that the incidence of SIDS has been greatly reduced from when those studies were conducted, so there may be diminishing returns to interventions. We also noted that it would likely result in poorer sleep for all involved, which isn’t good for anyone.

A new study was just published in Pediatrics. As part of an obesity prevention trial RCT involving responsive parenting, researchers gathered data on sleep patterns of new mothers. They looked at sleep duration and overnight behaviors of all mothers, comparing early independent sleepers (an infant in his or her own room by 4 months of age), late independent sleepers (own room by 9 months of age), and room-sharers (sharing still at 9 months of age).

What they found was that early independent sleepers had better sleep consolidation (sleeping longer at a stretch of time) by four months of age. At nine months, early independent sleepers slept 40 minutes longer over the course of a night than room sharers; they also slept 26 minutes longer than late independent sleepers. They also slept much more at a time without waking up. These differences were still seen at 30 months of age, even when the changes occurred earlier.

Further, those who room shared had a much greater chance (OR 4.24) of transitioning to bed-sharing in the middle of the night when the baby woke up. That’s considered very unsafe. The AAP guidelines strongly recommend against that.

But, come on, when you have a baby in the room, and it keeps waking up… that’s eventually what parents do. I can tell you this from experience, and from empirical studies now.

So, to recap, when parents room-share their babies sleep less overall, they wake up more, everyone gets less sleep, and parents often respond by bringing them into the bed with them – which is very unsafe. Let me quote for you from the conclusions of the paper (emphasis mine):

While substantial progress has been made over the past several decades to improve the safety of infant sleep, the AAP recommendation that parents room-share with their infants until the age of 1 year is not supported by data, is inconsistent with the epidemiology of SIDS, is incongruent with our understanding of socioemotional development in the second half of the first year, and has the potential for unintended consequences for infants and families. Our findings showing poorer sleep-related outcomes and more unsafe sleep practices among dyads who room-share beyond early infancy suggest that the AAP should reconsider and revise the recommendation pending evidence to support room-sharing through the age of 1 year.

Those of you who read our column in the NYT last November* already knew that.


*So far this is my one appearance in the Sunday NYT. I’m rather proud of that. Plus, I got to write with Claire Cain Miller!

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