Article: Family under the microscope

April 18, 2010 at 9:26 am | Posted in breastfeeding, co-sleeping, Controlled crying, Routine | Leave a comment
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Interesting article today in the Guardian from Oliver James:

To follow a routine or not – that is the question when it comes to your baby’s care. Several studies find that if parents do controlled crying (leaving the child to cry for gradually increasing periods), babies and toddlers will sleep for longer uninterrupted periods than ones whose mothers pick them up and cuddle or feed them. There is similar evidence for feeding: if you gradually increase the gap between night-time feeds, the child will eventually demand them less often, with larger gaps.

This suits parents, especially working ones. However, it’s not necessarily so good for the child. There is persuasive evidence that babies are more secure and less difficult (irritable, fussy, standoffish) if they are responded to quickly, sensitively and lovingly when they indicate they want attention (mostly by crying). Unresponsiveness has been proven to have long-term adverse consequences. To take an extreme example, a key indicator of personality disorder (called dissociation) is predicted 30 years later by unresponsiveness of care, aged 0-2.

Early unresponsiveness from carers makes us emotionally insecure in later relationships. In one study, maternal negativity towards their four-week-old baby predicted insecurity 30-40 years later. This is a bad sign: the insecure are much more prone to mental illness.

On its own, this evidence is strong grounds for concern about the modern vogue for taming the beast in the nursery with routines that suit the parents. The defence is that when a baby is left to cry it learns to “self-soothe” or “self-regulate”. However, this may be “too much, too young”.

Severely neglected orphanage children are prone to indiscriminate friendliness, a people-pleasing false self. One-year-olds who are not picked up and soothed sensitively when crying at night are significantly more likely to be insecure. Mothers who respond rapidly to crying in the night have babies at three months who are less fussy and irritable. Breastfed on demand, babies are more secure. It looks likely that, while it suits parents to get a baby to fit in with them, it may not be good for their state of mind and long-term mental health.

A comprehensive review of the evidence on co-sleeping bears this out. It demonstrates that having babies or toddlers sleeping in a separate room is completely at variance with human history. In 127 cultures surveyed around the contemporary world, 79% of the societies normally have their infants in the same room, 44% in the same bed. Despite social and medical pressures against co-sleeping in developed nations, as much as half of babies do so sometimes in the first months. Some developed nations still do co-sleeping normatively: 59% of Japanese under-fours are in the bed.

The review challenges medical advice on the danger of cot death, showing that co-sleeping may be safer. It promotes more and easier breastfeeding, and although both partners wake more frequently, when carefully observed they get more hours overall than if sleeping alone.

Babies do need routines, but originating in their needs, not the mother’s. If a parent-led routine is the only way a parent is going to stay sane, then that is ultimately best for the child – a depressed parent is even worse. But for those who can tolerate being led by the infant in the early months, that is best.

Co-sleeping review: McKenna, JJ et al, American Journal of Physical Anthropology 134, 133-161. Oliver James’ How Not To F*** Them Up is out in June,


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.

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

SAFE co-sleeping…. (the debate continues)

October 15, 2009 at 9:17 am | Posted in co-sleeping | Leave a comment
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Mother_holding_infant_aa3dIf you read my previous post, you’ll know where I stand on this. When safety guidelines are followed, I think co-sleeping is a great option for many families – including my own.

When Darling Son (DS) was a baby, I had many months of sleepless nights – constantly getting up and down to feed him, settle him, comfort him. He would often end up in our bed, simply because I was so exhausted. I didn’t know about the safety guidelines in advance, only that it was taboo to sleep with your baby, and it became something Darling Husband (DH) and I didn’t discuss with others.  And therein lays the problem, if you’re told you shouldn’t co-sleep, you are ill-prepared when and if it does happen, and if the reports are read carefully, this seems to be when tragic accidents are most likely to happen. We were in the fortunate majority – DS was fine and is now an active pre-schooler who regularly still appears in our bed during the night if he has a bad dream or just needs a cuddle.

When I was pregnant with Darling Daughter (DD) I read-up co-sleeping safety so we could be properly prepared and so that I’d be able to get some sleep this time around!

General Safety Guidelines are:

  • Parents should not sleep with their babies if they are smokers or have ingested alcohol or drugs.
  • Bedding should be tight fitting to the mattress.
  • The mattress should be tight fitting to the headboard of the bed.
  • There should not be any loose pillows or soft blankets near the baby’s face.
  • There should not be any space between the bed and adjoining wall where the baby could roll and become trapped.
  • The baby should not be placed on his stomach.
  • The surface should be a hard bed/mattress not a water bed or other soft surface such as a sofa or chair.

Here are some of the useful resources I found on safe co-sleeping:

There are some great benefits from co-sleeping, and I feel that as long as we are aware of the risks and act responsibly, our DD is safe with us. We have a large Kingsize bed, and a co-sleeping cot alongside which acts as a bed extension – our mattress is very firm and DD sleeps next to me – generally I wake up curled around her while she is flat out on her back. At 6 months she is already strong enough to kick her blanket off, and as a breastfeeding mother, I sleep lightly enough to keep putting it back on her without fully waking.

Each parent needs to do what they feel is the best for them, and hopefully this debate will help more people to become informed and for health professionals to provide more balanced information on something that WILL continue whether they like it or not.

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