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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 update from the UNICEF UK Baby Friendly Initiative. To
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