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16 February
2004
UNICEF statement on mother-infant bed
sharing
Following the recent publication of a study in the
Lancet (1) on Sudden Infant Death among bed-sharing babies and a
subsequent meeting at the National Patient Safety Agency to consider
guidance on bed-sharing, the UNICEF UK Baby Friendly Initiative has issued
the following statement:
In recognition of the fact that
mother-infant bed-sharing appears to be associated with longer and more
successful breastfeeding, the UNICEF UK Baby Friendly Initiative has for
some time been working to help health professionals enable breastfeeding
mothers to share a bed with their baby whilst maintaining the safest
possible environment. 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 documents are designed to promote safety while protecting
breastfeeding, by educating health professionals and parents on the
benefits and contra-indications to bed sharing and the safety issues
related to it. UNICEF has also been urging NHS trusts to acknowledge the
need to provide training for health professionals on all aspects of
bed-sharing, including effective communication to parents of key messages
appropriate to their needs and circumstances.
The Lancet paper
suggested a slight increase in the risk of sudden infant death among
babies of non-smoking mothers who bed-shared all night in the first eight
weeks of life. This was followed by a large amount of publicity and media
coverage advising against bed sharing.
At present, the UNICEF UK
Baby Friendly Initiative is unable to support blanket recommendations
against bed sharing in the early weeks for the following
reasons:
- There is some
controversy as to whether the results of the Lancet study clearly and
unambiguously indicate an increased risk of bed sharing with non-smoking
parents in the absence of other known risk factors. There is serious
disagreement among the study authors about the statistical methods
employed, the significance of the findings and their implications for
parents. Similar concerns have also been raised about a forthcoming
Scottish study on the same subject. Until these issues are resolved, it
remains inappropriate to give advice to parents based on the results of
this study.
- There is concern
that simply advising parents against bed sharing without giving
practical information about how to cope with a very young baby at night
may increase risk. Breastfed babies often feed frequently and for long
periods in the first few weeks after delivery. Breastfeeding can also
have a soporific effect on the mother (this is nature's way of allowing
her to rest). If mothers feel that they must not bed share there is a
least a theoretical risk that they will sit on a sofa or chair and fall
asleep there, putting their babies in far more danger than if they had
shared a bed. There is an additional concern that the sleep deprivation
caused by sitting up for large parts of the night will drive mothers to
eventually either ignore the recommendation and take their baby into bed
when they are excessively tired (a known risk factor) or to give up
breastfeeding.
- Bottle fed babies
are significantly more likely to suffer infections and respiratory
illness both of which put young babies at risk (2). There is evidence
that bottle-fed babies are not as easily roused from sleep as those who
are breastfed which again could put babies at risk (3). The health benefits of
breastfeeding to mothers and babies are considered so great that targets for increasing breastfeeding have been set
in the UK and health professionals all over the country are working hard
to achieve them.
There is anecdotal
evidence that health professionals may simply advise parents against bed
sharing if they perceive it to be banned or discouraged at an
institutional or national level. This means that parents are denied a full
discussion about important topics such as the benefits, contraindications
and safety issues. Parents may also be less likely to raise the subject
for fear of disapproval. Nevertheless, recent research conducted in the UK
(4) indicates that while all-night bed sharing is relatively unusual, it
is very common for parents to take their baby into bed for shorter periods
at night, particularly for breastfeeding, comforting and settling babies.
It is therefore essential that the benefits, risks and
alternatives to bed sharing are carefully weighed and that parents be
given full information appropriate to their needs in order to encourage
safe practice and to protect breastfeeding. The UNICEF UK Baby Friendly
Initiative recommends that:
- Health
professionals should ensure that parents are given full information
about this issue in the antenatal and early postnatal period. Community
staff should reinforce the information once mothers and babies are at
home. The UNICEF/FSID leaflet 'Sharing a
bed with your baby' is designed to support this.
- All NHS Trusts
should develop guidelines for staff in order to ensure safe and
appropriate practice both in hospital and at home.
- Trusts should
provide all relevant health care staff with adequate education to allow
them to discuss this issue with all parents as appropriate to their
needs.
UNICEF recommends that
discussions with parents about bed sharing should address the following
factors:
- the circumstances
under which co-sleeping should be discouraged (parental smoking, alcohol
or drug consumption, excessive tiredness, inappropriate sleep surfaces
such as sofas, etc)
- the use of bed
sharing as a care strategy for breastfeeding mothers and
babies
- the additional risk
of accidents if a baby sleeps in an adult bed, coupled with support to
avoid or minimise these risks
UNICEF has suggested
to the Royal College of Midwives and the Community Practitioners' and
Health Visitors' Association that talks continue to ensure that adequate
guidance on bed sharing be available to health professionals, including
the issue of effective risk assessment for all mothers and babies.
All interested parties have agreed that the joint UNICEF/FSID
leaflet 'Sharing a bed
with your baby' provides clear, comprehensive and evidence-based
information for parents and that it should continue to be used. UNICEF
will continue to monitor research developments to ensure that the leaflet
remains evidence-based.
UNICEF further recommends that all future
research into infant death and sleeping environments should unambiguously
record data on all important factors, which must include the baby's sleep
surface, maternal and paternal smoking status, alcohol and drug
consumption and infant feeding method. These factors should be recorded at
the time of infant death (rather than relying on data for other periods
such as feeding method at delivery or smoking status during pregnancy) and
the results should be adjusted to control for them.
1. Carpenter RG et al
(2004). Sudden unexplained infant death in 20 regions in Europe: case
control study. Lancet 363: 185-91 [Full text]
2. Standing Committee on Nutrition
of the British Paediatric Association (1994). Is breastfeeding beneficial
in the UK? Arch Dis Child 71: 376-380.
3. Horne RSC et al
(2004). Comparison of evoked arousability in breast and formula fed
infants. Arch. Dis. Child 89: 22-25 [Abstract]
4. Blair PS, Ball HL (2004). The
prevalence and characteristics associated with parent-infant bed-sharing
in England. Arch Dis Child. in press.
This is a research
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