Queensland parents expressed a desire for more information and non-judgemental education on improving safety while sharing sleep with their baby, and there is an urgent need for public health messaging on safer infant sleep to better align with the lived experiences of parents through adoption of a universal, proactive risk minimization approach to shared sleep.
Key Findings
Results
Nearly a third of the cohort reported difficulty following advice to sleep their baby separately in a cot.
Sample consisted of 3,341 primary caregivers, 97% of whom were mothers, of infants aged approximately three months
Participants were born in Queensland between April and May 2017
Data came from the 2017 Infant Care Awareness and Routines Evaluation among Queenslanders (I-CARE Qld Study) cross-sectional survey
Free-text responses related to co-sleeping/bedsharing were extracted and analysed qualitatively using directed content analysis
Results
The top rationales caregivers cited for difficulty following cot-only sleep advice were infant temperament/needs, breastfeeding, and caregiver fatigue or exhaustion.
These rationales align with earlier international findings on bedsharing
Infant temperament and needs was identified as a primary driver of shared sleep practices
Breastfeeding was specifically cited as a reason making separate sleep difficult to implement
Caregiver fatigue or exhaustion was the third major rationale identified
Results
Queensland parents expressed a desire for more information and non-judgemental education on improving safety while sharing sleep with their baby.
Parents sought practical guidance rather than abstinence-only messaging
The findings indicate parents felt current public health messaging did not adequately address their real-world experiences
The desire for non-judgemental education suggests existing messaging may be perceived as stigmatizing
Results
Some parental awareness of risk minimization strategies to improve shared sleep safety was evident and aligned with current Queensland Clinical Guidelines.
Parents demonstrated some existing knowledge of strategies to reduce risks during shared sleep
This awareness was in alignment with current Queensland Clinical Guidelines on infant sleep safety
The finding suggests a foundation exists upon which risk minimization education could be built
Background
The risk elimination approach to shared sleeping has dominated public health messaging for decades but has been unsuccessful in reducing Sudden Unexpected Deaths in Infancy (SUDI) rates, while bedsharing rates have remained stable.
Decades of risk elimination messaging have not achieved reductions in SUDI rates
Bedsharing rates have remained stable despite longstanding cot-only public health recommendations
The risk minimization approach is identified as an alternative, pragmatic framework for reducing controllable risks
The study was conducted in the Australian context but findings were assessed for alignment with international literature
Conclusions
The authors conclude there is an urgent need for public health messaging on safer infant sleep to better align with the lived experiences of parents and families through the adoption of a universal, proactive risk minimization approach to shared sleep.
Co-designing guidance with parents was recommended as a strategy to bridge the gap between idealized and real-world implementation
The study supports shifting from a risk elimination to a risk minimization framework in public health messaging
A universal and proactive approach was specifically recommended rather than reactive or case-by-case guidance
What This Means
This Australian study examined the real-world experiences of over 3,300 parents trying to follow public health advice to always place their baby to sleep in a cot. Using written comments from a large Queensland survey, researchers found that nearly one in three parents struggled to follow cot-only sleep advice, with the most common reasons being their baby's temperament or needs, breastfeeding, and exhaustion. Despite decades of messaging telling parents never to share a bed with their infant, bedsharing rates have not declined and rates of sudden unexpected infant deaths have not improved, suggesting the current approach is not working.
Parents in this study said they wanted practical, non-judgemental information about how to make shared sleep safer — not just to be told not to do it. Some parents already knew about strategies to reduce risks when sharing sleep, which aligns with official Queensland clinical guidelines. This suggests that parents are seeking harm-reduction information but are not consistently receiving it through standard public health channels.
This research suggests that public health advice on infant sleep safety needs to be redesigned to reflect how families actually live and make decisions, rather than promoting an idealized scenario that many parents find unachievable. The authors recommend shifting to a 'risk minimization' approach — one that acknowledges bedsharing happens and gives parents clear, evidence-based guidance on how to do it more safely — and suggest that involving parents in co-designing this guidance could make it more effective and trusted.
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Grubb C, Young J, D'Souza L. (2026). Caregiver lived experiences attempting to follow safe sleep recommendations to sleep their baby in a cot: a qualitative directed content analysis.. Primary health care research & development. https://doi.org/10.1017/S1463423626101273