UNICEF UK Baby Friendly Initiative statement on new research into Sudden Infant Death Syndrome and bed-sharing

October 17, 2009 at 4:59 pm | Posted in co-sleeping | Leave a comment
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unicefFollowing the publication of new research on risk factors involved in Sudden Infant Death Syndrome (SIDS) 1 and subsequent media coverage, UNICEF UK Baby Friendly Initiative has issued the following statement.

The SWISS study, designed to investigate the factors associated with SIDS in 0-2 year-olds, draws a clear link between increased risk of SIDS and alcohol or drug use when co-sleeping with a baby, particularly on a sofa.

The study, examining 80 SIDS infants and two control groups, one randomly selected, one of babies at high-risk of SIDS, showed that many of the deaths in a co-sleeping situation could be explained by “a significant multivariable interaction between co-sleeping and recent parental use of alcohol or drugs (31 per cent v 3 per cent random controls) and the increased proportion of SIDS infants who had co-slept on a sofa (17 per cent v 1 per cent).” Other
significant factors included pillow use, swaddling, smoking during pregnancy, whether the infant was preterm and whether the infant was in fair or poor health for the last sleep.

The authors conclude that “the major influences on risk were from factors amenable to change within the infant’s sleeping environment….Parents need to be advised never to put themselves in a situation where they might fall asleep with a young infant on a sofa. Parents also need to be reminded that they should never co-sleep with an infant in any environment if they have consumed alcohol or drugs.”

Much media coverage yesterday focused on the study’s statistic that 54 per cent of the infants in the study died whilst co-sleeping, without noting whether it was in a bed or on the sofa. In fact, the percentage of infants that died whilst sharing the parental bed was 38 per cent, which was the same as the percentage of infants that died in the cot.

Furthermore, “the proportion of SIDS infants found co-sleeping in a bed with parents who had drunk two units or less of alcohol and taken no drugs was no different from that of the random control infants (18 per cent v 16 per cent). If parents who regularly smoked were further excluded, then five of the SIDS infants (6 per cent) were found in this less risky co- sleeping environment compared with nine of the random control infants (10 per cent).”

In their conclusion, the authors state “The safest place for an infant to sleep is in a cot beside the parents’ bed. Based on evidence from research into SIDS it is questionable whether advice to avoid bed sharing is generalisable and whether such a simplistic approach would do no harm.”

UNICEF UK has noted previously that bed-sharing has several benefits, such as helping parents to cope with babies who wake frequently to be fed or who are unsettled in the night. Bed-sharing is also associated with an increase in breastfeeding – possibly because many mothers find it hard to get enough rest if they do not breastfeed lying down 2. Breastfeeding is universally recognised as one of the pillars of child health and survival with well established evidence regarding the many health benefits to both babies and mothers. Of particular note is a recent review of the impact of breastfeeding which identified that breastfeeding reduces the risk of Sudden Infant Death Syndrome (SIDS) by 36 per cent in the industrialised world 3. Strenuous efforts are now being made by the Department of Health and others to increase the UK’s low breastfeeding rates in order to improve public health 4,5,6.

Young babies wake and feed frequently both day and night and tired parents are at risk of falling asleep with their baby, especially during the night, whatever their intention. Therefore, parents require full information regarding the various strategies for coping at night, along with the benefits and risks of all approaches in order to allow informed decision making.

In an interview with UNICEF UK, Dr Peter Blair, a co-author of the SWISS study, said “We need to remind parents that there are certain situations where you never share a bed and balance that with sharing a bed at other times…It might be that if you demonise the parental bed you’re still going to get tired mothers with young infants where the infant has woken up three or four times in the night and needs feeding and the mother’s walking around thinking
they can’t take them into the bed, so they go onto the sofa and there they fall asleep. That will and does happen. So coming out with a simplistic statement about bedsharing can do more harm than good.”

In recognition of this, the UNICEF UK Baby Friendly Initiative has for some time been working to assist health professionals to discuss bed-sharing with parents so that risks can be identified and minimised, rather than attempting to promote restrictions which cannot be applied in parents’ real worlds.

A sample bed-sharing policy has been developed for hospitals and a leaflet for parents produced with the Foundation for the Study of Infant Deaths (FSID). Both are designed to promote safety whilst protecting breastfeeding, by educating health professionals and parents on the benefits, contra-indications and safety issues surrounding this practice. UNICEF has also been urging NHS trusts to acknowledge the gap in health professional’s
knowledge and provide training on all aspects of bed-sharing, including best practice for hospitals and how to communicate the key messages effectively to parents depending on their needs and circumstances.

Footnotes
1. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EMA, Fleming P (2009). Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009;339:b3666
2. Blair PS and Ball HL (2004). The prevalence and characteristics associated with parent-infant bed-sharing in England. Arch Dis Child 89:1106-1110
3. Ip S. et al (2007) Breastfeeding and Maternal Health Outcomes in Developed Countries. AHRQ Publication. No.07-E007.
4. HM Government (2008) PSA Delivery Agreement 12: Improve the health and wellbeing of children and young people.
5. Department of Health (2008) Healthy Weight, Healthy Lives A Cross Government Strategy for England. London: The Stationery Office.
6. Department of Health (2008) Health Inequalities: Progress and Next Steps. London: The Stationary Office
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