Public-health campaigns promoting the "ABCs" of safe sleep sharply reduced infant sleep deaths in the 1990s, but the trend has stalled as bed-sharing has become more common. Some experts now advocate a harm-reduction approach that accepts parents often sleep near infants and offers concrete steps to reduce risk. The AAP still cannot recommend bed-sharing—research shows infants sleeping with adults are 2–10 times more likely to die depending on risk factors—yet many advocates urge honest clinician-family conversations and targeted safety guidance to prevent deaths.
'We Can't Just Teach Abstinence': Bed-Sharing Guidance Is Shifting Toward Harm Reduction
Public-health campaigns promoting the "ABCs" of safe sleep sharply reduced infant sleep deaths in the 1990s, but the trend has stalled as bed-sharing has become more common. Some experts now advocate a harm-reduction approach that accepts parents often sleep near infants and offers concrete steps to reduce risk. The AAP still cannot recommend bed-sharing—research shows infants sleeping with adults are 2–10 times more likely to die depending on risk factors—yet many advocates urge honest clinician-family conversations and targeted safety guidance to prevent deaths.
09:31 PM, 11/18/2025Health
When parents sleep with babies, public-health guidance is evolving
When Emily Little had her first child, sharing a bed felt inevitable despite repeated public-health warnings against it. A perinatal health researcher and science communicator, Little valued the skin-to-skin closeness through the night and the ease of breastfeeding without getting up. To her, sleeping as mothers and infants have for much of human history felt natural.
Taking steps to reduce risk
Rather than follow blanket prohibitions, Little researched ways to lower risks. Evidence suggests bed-sharing poses less risk for full-term infants in homes without parental smoking or substance use and when babies are exclusively breastfed. Little adopted several commonly recommended safety measures: only the breastfeeding parent slept next to the baby, she removed a soft pillow-top mattress and extra pillows and blankets, and she pushed the bed against the wall and filled the gap with foam to prevent falls.
"Infants have the biological expectation to be in close contact with their caregivers all the time, especially in the early months," Little said. "Denying that because we as a society are unable to have a conversation about risk mitigation and harm reduction is really doing a disservice to infant well-being and mental health."
What the data and pediatric groups say
Public-health campaigns in the 1990s that encouraged the "ABCs of safe sleep" — Alone, on their Back, in a separate Crib free of pillows, blankets, stuffed toys and bumpers — helped reduce sleep-related infant deaths. Still, about 3,700 infants in the U.S. die suddenly and unexpectedly each year, according to the Centers for Disease Control and Prevention, and progress has stalled in recent years.
The American Academy of Pediatrics' (AAP) most recent guidance notes that infants who share a sleep surface with adults are two to 10 times more likely to die than those who sleep alone in a crib, with the exact risk depending on factors such as parental smoking, substance use and prematurity. For that reason the AAP states it cannot recommend bed-sharing under any circumstances, although its 2022 policy acknowledges some parents may choose to do so and offers safety advice for unintentional situations.
"It's not responsible for us to give [parents] permission," said Dr. Rachel Moon, lead author of the AAP report. "Every day I deal with babies who have died, and if it happened in a bed-sharing situation, [parents] regret it."
Why some experts recommend a harm-reduction approach
As bed-sharing has become more common — surveys show the share of U.S. parents who usually bed-share rose from roughly 6% in 1993 to about 24% in 2015, with 61.4% reporting occasional bed-sharing that year — some advocates argue that abstinence-only messaging is unrealistic. Susan Altfeld, a retired researcher who has studied bed-sharing, says frank conversations about which behaviors are especially risky and practical steps families can take to reduce danger may be more effective than strict prohibition.
Supporters of harm reduction point out benefits associated with safe bed-sharing practices, including longer breastfeeding duration and reduced likelihood that exhausted parents will fall asleep with a baby in a far riskier place such as a sofa or recliner. Lactation and breastfeeding organizations, like La Leche League International, now offer practical checklists (for example, their "Safe Sleep 7") to help parents reduce risk if they choose to sleep near their infant.
Practical considerations and real-family choices
Clinicians warn it can be difficult to determine which families are truly low-risk: disclosure about alcohol, smoking and drug use is sometimes incomplete, and a parent's risk profile can change from night to night. Public-campaign leaders worry that shifting to nuanced harm-reduction language might dilute the clarity of safety messages and reduce their effectiveness.
Still, some families follow a pragmatic path. Pachet Bryant of Mission Viejo wanted to sleep near her newborn but assessed safety nightly; with guidance from a lactation consultant, she modified her sleep space and used a bassinet on nights she felt too exhausted to bed-share safely. Lactation consultant Asaiah Harville said, "We know that parents are either intentionally or unintentionally at some point going to wind up falling asleep with their baby, and we have to think about creating the safest possible environment for that. In the lived reality of an individual family's home... we can't just teach abstinence."
Moving forward: honesty, targeted messaging and shared decision-making
Experts on both sides agree on core goals: reduce sleep-related infant deaths and support families. That requires honest conversations between parents and clinicians about practical risks, targeted education about high-risk behaviors (for example, smoking, alcohol, drugs, very soft surfaces), and pragmatic safety measures for those who choose to sleep near their infant. While the AAP maintains that it cannot endorse bed-sharing, many clinicians and advocates say a harm-reduction framework — not simplistic abstinence-only messaging — may better reflect family realities and help prevent tragedies.
This article originally appeared in the Los Angeles Times and draws on guidance from the American Academy of Pediatrics and data from the U.S. Centers for Disease Control and Prevention.