A culturally sensitive approach for pediatricians to navigate co-sleeping conversations with families
In the ICU as a pediatric resident physician, I cared for an infant whose life was forever altered by a co-sleeping accident. Now ventilator and G-tube dependent, the child had suffered irreversible brain damage—an outcome that began with a choice many parents make in the belief that co-sleeping is the safest way to nurture their child. Co-sleeping accidents can occur if a parent rolls onto the infant or if the infant suffocates on soft bedding leading to oxygen deprivation, which in severe cases may result in brain injury and death. This tragedy illustrates the delicate balance pediatricians must navigate when discussing safe sleep practices, especially when those choices are shaped by culture, tradition, and the realities of parenting. While safe sleep guidelines are often discussed by children’s pediatricians to prevent sudden infant death syndrome (SIDS), many families continue to co-sleep, often motivated by exhaustion, feeding needs, bonding or cultural norms. In 2022, there were approximately 1,529 deaths from SIDS in the United States alone, highlighting the critical need for education on safe sleep practices.
It’s important to note that many sleep-related infant deaths, particularly those involving co-sleeping, are now more commonly categorized under the broader term Sudden Unexpected Infant Death (SUID). This includes SIDS, but also deaths due to accidental suffocation and strangulation in bed (ASSB) and those classified as undetermined. In total, over 3,700 infants died from SUID-related causes in 2022. The shift in classification reflects evolving diagnostic standards—rather than a true decline—making continued awareness and culturally sensitive outreach more important than ever.
Clinical clarity, along with cultural humility, is crucial in these conversations, as many families value sleeping close to babies, seeing it as protective and nurturing. The practice of placing infants in a separate room and bed to sleep is not universal, and pediatricians’ advice should not assume that these norms are shared by all. Pediatricians should be aware of their own cultural lens while recognizing and respecting the differences of their patients’ beliefs to help build trust and collaboration.
Instead of simply warning families about the dangers of co-sleeping, pediatricians should start with open, nonjudgmental questions such as, “Can you tell me how your baby sleeps at night?” or “What’s most important to you when it comes to nighttime care?” This approach invites families to share their perspectives and experiences without fear of shame or correction. Research shows that even when parents know about safe sleep guidelines, simply having that knowledge doesn’t always lead to change. Trust, understanding and respectful communication are key to helping families make informed decisions.
When families are open to other sleep options, pediatricians can suggest alternatives that still allow for closeness while reducing risks. Room-sharing, where the baby sleeps in a separate crib or bassinet in the same room as the parents, is the safest option, allowing for proximity without sharing the same bed. For families who insist to bedshare or do so occasionally , especially when breastfeeding or dealing with night wakings , pediatricians can focus on risk reduction. Rather than simply advising against bedsharing, providers can equip families with strategies to minimize risk: avoiding smoking, alcohol, and sedating medications; using a firm mattress without heavy blankets or pillows; placing the baby on their back; and never sleeping with the infant on sofas or recliners. This type of anticipatory guidance acknowledges the realities of parenting and reduces the likelihood of unsafe, unplanned co-sleeping scenarios.
In the end, pediatricians have an important role in promoting infant safety, but it is vital to do so in a way that respects each family’s values. Conversations about co-sleeping should aim to understand a family’s routines, respect their concerns, and offer personalized support. By focusing on dialogue rather than simply giving orders, pediatricians can build trust and encourage safer sleep practices that align with each family’s needs. Combining evidence-based practices with cultural respect helps pediatricians to give families the tools to make safer, more informed decisions without compromising their autonomy or dignity.
By Dr. Sarah Stockum, a resident in the Department of Pediatrics
Any opinions, conclusions, and recommendations expressed in this article are those of the author and do not represent the views of Baylor College of Medicine.
