A decade after cobedding was introduced into the United States, there is a growing body of research into the risks and benefits of this practice. Studies looking at physiologic outcomes such as stabilization of vital signs and body temperature, apnea and bradycardia, nosocomial infections, weight gain, and physiologic stress have found few significant differences between cobedded and separately bedded multiples.1

Cobedding is not practiced universally. The potential risks of cobedding multiples in the hospital setting, such as temperature instability, patient misidentification, infection, exposure to unneeded oxygen, sleep disruption, and dislodged tubes or catheters, are often cited as reasons for not cobedding multiples. Research to date has not generally found cobedding to be associated with these risks; however, some studies were hampered by small sample size.1

One reason to carefully consider cobedding multiples before instituting this practice in the NICU is its possible effect on parents. Parents tend to adopt at home the sleeping arrangements they become familiar with in the hospital. In other words, if we cobed their twins or higher multiples in the hospital, they will more than likely cobed them after discharge. Unfortunately, no research is available to support the safety of cobedding multiples at home. There is evidence that an infant sleeping with other children (or with a parent and other children) has a 4-fold increased risk of sudden infant death syndrome (SIDS),2 and preterm infants are already at elevated risk for SIDS.

The American Academy of Pediatrics Committee on Fetus and Newborn, after reviewing all of the available evidence on cobedding multiples, has concluded that neither the safety nor the benefit of this practice has been documented in the published literature. Furthermore, parents should be instructed to follow established safe sleep practices for their infants at home.1

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