1. Lewallen, Lynne P. PhD, RN

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Much of the information available about cobedding is anecdotal. In my opinion, nurses should not be promoting this practice until published research evidence supports it. A few studies have been conducted in neonatal intensive care units that show little harm due to cobedding, although no studies are available about cobedding healthy multiples, nor about continuing the practice of cobedding in the home after hospital discharge. This is not enough evidence to change practice, for cobedding has potential disadvantages, both while the infants are hospitalized and when they are at home.


Infants who are placed in the same bed have the potential for injuring each other. If one or both infants have medical equipment attached (e.g., monitoring devices, a naso-gastric tube) these could become dislodged or cause injury (DellPorta, Aforismo, & Butler-O'Hara, 1998). Cobedding could also possibly increase the chances of making medication or treatment errors because the infants are occupying the same small space. Another concern is that one infant could roll over onto the other; this potentially dangerous occurrence could result in the affected infant being unable to reposition his/her self or to move away, leading to injury from kicking, or in the worst case, asphyxiation. Very young infants may have difficulty breathing if their heads become wedged in bedding and they are prevented from moving freely due to another infant in the bed beside them.


Infants who are cobedded occasionally maintain higher body temperatures than infants sleeping separately (Nyquist & Lutes, 1998 G). Although this may be beneficial at times, the infants have a potential for becoming overheated, especially if bed covers are used, as is commonly the case at home. Overheating is a known risk factor for Sudden Infant Death Syndrome.


It is also possible that cobedding may promote prolonged periods of wakefulness, where one infant disturbs the sleep pattern of the other. Unless the infants are on exactly the same feeding schedule (which may be difficult to maintain) sleep disturbances can result for both infants and the parents. This may be particularly problematic if one infant is significantly larger than the other infant(s). It is quite unlikely that two or more infants can be maintained on exactly the same sleeping and feeding schedules. This is an important consideration, particularly for preterm infants who need periods of uninterrupted sleep to optimize their growth. Parents of multiples frequently feel overwhelmed, and parents report feeling especially anxious when both infants are crying to be fed at the same time (Holditch-Davis, Roberts, & Sandelowski, 1999). If this can be avoided, stress on the family may also be minimized.


Twins and other multiples frequently share close bonds. Although these bonds should be facilitated, there also needs to be time for individualization to develop. One cannot assume that because multiples shared a uterus, they need to stay constantly together. Ultrasound has shown us that, in some cases, multiples position themselves in utero in such a way as to avoid contact with their sibling (Leonard, 2002). If infants begin sharing a bed, there may be difficulty in separating from each other later on, when it is necessary. In my opinion, while it is important for parents to provide playtime for the infants together, sleeping is best accomplished separately.


Currently, there is insufficient research evidence for nurses to encourage parents to cobed their infants after discharge, and only limited evidence to encourage the practice among multiple birth infants who are hospitalized. Until more research is done with both healthy and compromised newborns, both in the hospital and at home, nurses should not recommend the practice of cobedding multiples.




1. DellPorta, K., Aforismo, D., Butler-O'Hara, M. (1998). Co-bedding of twins in the neonatal intensive care unit. Pediatric Nursing, 24( 6), 529-531. [Context Link]


2. Holditch-Davis, D., Roberts, D., Sandelowski, M. (1999). Early parental interactions with and perceptions of multiple birth infants. Journal of Advanced Nursing, 30( 1), 200-210. [Context Link]


3. Leonard, L. (2002). Prenatal behavior of multiples: Implications for families and nurses. Journal of Obstetric, Gynecologic and Neonatal Nursing, 31( 3), 248-255. [Context Link]


4. Nyquist, K. H., Lutes, L. M. (1998). Co-bedding twins: A developmentally supportive care strategy. Journal of Obstetric, Gynecologic and Neonatal Nursing, 27( 4), 450-456. [Context Link]