A central theme when it comes to babies is sleep.
Sleep could easily dominate most conversations about infants, with maybe infant feeding being the only other topic to come up so frequently.
Do you co-sleep/ bedshare?
Does your baby sleep through the night?
Are you still feeding her at night?
How often does baby wake?
Be sure to put baby to sleep on her back!
Does she self-soothe?
These are questions many of us have heard at our baby’s health visits. It’s clear that both parents and healthcare professionals have the same goal of safe sleep for our babies.
But what is the actual evidence regarding safe sleep? What are best practice guidelines that not only ensure safe sleep for babies, but are realistic in homes?
Safe Co-Sleeping Guidelines For Health Professionals
UNICEF UK has developed easy to understand co-sleeping guidelines to help professionals better understand the evidence around infant sleep safety and the risk of SIDS.
Perhaps most importantly though, these guidelines provide ways to best relay that information to parents to help them make safe and informed decisions.
Is Co-Sleeping Safe?
Co-sleeping often refers to bed-sharing, but sometimes people use the term to mean sleeping in close proximately, but on different sleep surfaces. The UNICEF UK guidelines use the term co-sleeping interchangeably with bed-sharing which is what is used in this article as well.
According to the UNICEF guidelines, which are based on many evidenced-based research studies and publications, co-sleeping can be a safe option in many situations. However, there are also situations in which co-sleeping isn’t safe.
UNICEF UK encourages healthcare professionals to educate families about when it is and isn’t safe to co-sleep.
In recent decades, it has been the default to discourage any co-sleeping in hopes of reducing SIDS and suffocation. Whether planned or unplanned, around half of all parents will co-sleep at some point during their child’s infancy.
Unfortunately, completely discouraging co-sleeping has backfired in a few ways.
In the hope of avoiding bringing an infant to bed, some parents feed or soothe baby on the couch or other furniture during the night, but due to fatigue may fall asleep. Sleeping on a couch or other furniture poses a serious risk of entrapment and suffocation.
Due to being warned about co-sleeping, few parents research safe co-sleeping guidelines (or aren’t aware they exist). However, many parents find themselves utterly fatigued and with a baby refusing to sleep peacefully alone in their cot/crib.
It doesn’t take much for a sleep deprived parent to give into co-sleeping at 2am after three nights of teething. Unfortunately, if they aren’t aware of co-sleeping safety, they might bed-share in a hazardous set up.
When Is It Safe To Co-Sleep?
There are many published evidenced-based studies which provide safe co-sleeping guidelines. Many publications agree on the following:
- Baby is placed on her back to sleep
- A firm mattress is used
- Only biological parents in bed, baby next to mother
- A bed free of entrapment or entanglement hazards
- Completely sober parents
- Breastfeeding mother/baby pairs.
You can read more about safe co-sleeping in BellyBelly’s article Sleeping With Baby – Safe Co-Sleeping Tips.
When Is Co-Sleeping Dangerous?
Unfortunately, there’s no 100% risk free solution to infant sleep. However, we know we can drastically reduce the risk of SIDS or accidental suffocation by following infant sleep safety guidelines.
In regards to co-sleeping, the following are some examples of situations where co-sleeping isn’t recommended:
- If you’re under the influence of alcohol or drugs (including over-the-counter and prescription medication that cause drowsiness)
- You suffer from or are at risk for sleep apnea
- You smoked during pregnancy, are still smoking, or someone in the home smokes
- Any sleep surface or furniture item besides a firm mattress (e.g. water bed, couch, rocking chair, recliner, etc.)
- A bed frame with spaces between it and the mattress or wall where baby could become entrapped
- Plush blankets, pillows or other items near baby
- Baby was low birth weight or pre-term.
What Is The Risk Of SIDS?
The rate of SIDS does vary slightly country to country, but generally it’s a very low risk.
This guideline from UNICEF UK uses statistics based on about 700,000 babies born each year in Wales and England. Of those 700,000 babies, at least 350,000 will have slept in bed with one or both parents by three months of age, some intentional and some not.
In 2014, 212 infants in the UK died of SIDS. This was 0.03% of the 700,000 born. A very low risk, but still a public health concern.
Of those that died of SIDS:
- Half died in a crib/cot, bassinet or Moses basket
- Half died while co-sleeping – but 90% of those that died while co-sleeping, died in hazardous situations which were mostly preventable deaths.
Because 90% of co-sleeping SIDS deaths occurred in hazardous situations, properly educating parents has the potential to reduce the risk of SIDS related to co-sleeping.
We’re now seeing the downfall of professionals only advising against co-sleeping and seeing the importance of educating parents about all safe sleeping guidelines, co-sleeping or crib/cot.
Are There Benefits To Co-Sleeping?
There are several evidenced-based sources which shows co-sleeping can have several benefits for both mother and baby. When it comes to the researched benefits, they include co-sleeping meaning bed-sharing, but also co-sleeping on separate surfaces with baby in arms’ reach.
Some benefits of sleeping near baby include:
- Positive effects on breast milk supply and duration of breastfeeding
- Infants have more stable physiology including temperature, hearth rhythm and breathing pattern
- Infants often sleep more soundly, so parents get more rest
- Sleeping within arms’ reach, same or separate surface, can reduce the risk of SIDS when safe sleep guidelines are used.
Safe infant sleep and SIDS remain an important public health concern. The importance of this publication is that it genuinely seeks to connect healthcare professionals with parents. Rather than using only blanket statements, it addresses the complexity of early parenthood.
Not only do the guidelines recommend discussing co-sleeping guidelines with parents, it encourages care providers to share alternatives when co-sleeping isn’t safe that take into consideration the demands of parenthood.