Background Curtailed sleep (shorter than average sleep duration) in a child’s first 1,000 days of life is associated with early childhood obesity. Children sharing a room with a parent, compared to independent sleepers, have less nighttime sleep, shorter sleep stretches, and unsafe sleep practices. The goal is to optimize children’s sleep duration and consolidation. Empirical examination of children’s sleep behaviors in real-world, population-based samples is limited. From a diverse sample of U.S. families, we deconstructed the mechanisms for bedsharing behaviors. We hypothesize that unhealthy relationships with family members and partners, and nurturing behaviors, are associated with bedsharing.

Methods This analysis included 4,539 U.S. mother-child dyads actively enrolled in the Parents as Teachers (PAT) home visiting program July 2015 through July 2020 from affiliate sites meeting the highest programmatic quality standards. Exclusion criteria due to potential confounding consisted of: substance abuse, child abuse, incarceration, unstable housing, and mental illness, or missing data on the outcome variable. In a multivariable logistic regression model examining the outcome of bedsharing ‘sometimes’ or ‘always’ compared to ‘never,’ we investigated maternal relationships with family, partners, and maternal nurturing as scored lower than the target on the Life Skills Progression instrument, while controlling for low income, low education, young parent (< age 21), multiple children younger than age six, single parent, first time parent, child’s age, and number of home visits.

Results In our sample of children ages 0 to 4 years, 44.8% bedshare. Our sample included: 10.5% young parents, 25.7% multiple children younger than six, 19.4% single parents; 22.8% first time parents, 35.5% low education, 71.7% low income, and 10.4%, 14.9%, and 6.3% respectively scoring less than target on the quality of the family and partner relationships, and nurturing scales. Mothers scoring low on the quality of the partner relationship are more likely to bedshare (aOR: 1.3 (95% CI: 1.1–1.6)); quality of the family relationship, and nurturing scores were not statistically significant (model c-statistic: 0.59).

Conclusion Women with multiple partners, violent relationships, who have lost contact with partners, have frequent verbal fights with partners, or who have inconsistent or conditional partner support are more likely to bedshare. Addressing these social determinants of health should be a priority before addressing parenting behaviors.