Co-sleeping: making safe decisions

For many parents, co-sleeping brings a special closeness with their baby. It can feel a natural way of feeding through the night and allows for more rest and sleep on both sides. This restful maternal and infant sleep is likely due to the sporadic effect of lactation hormones. Babies often appear calmer and, in turn mums, feel they can meet their babies needs around the clock much easier than when they have to get up every couple of hours.

However, does this mean it is right for all parents?

When I am working with families, the one question I will continuously ask is ‘What would feel right for you?’. ‘At this moment in time, right now, would this meet your own needs as well as the needs of your baby?’

With co-sleeping, as with many decisions, you can feel torn between your own ideas and that of others. We can read and read and still come up with different viewpoints. Myself, I would prefer to support families in their choice whichever one this is and then if you decide on co-sleeping then my role is to provide you with guidance to ensure you can do this safely.

Co-sleeping means different things to different people. Co-sleeping can be as simple as sharing the same room with your baby. For some families this may be the baby being in their own cot or in a side cot (co-sleeper). For others it can mean sharing the bed. So which is safer and does it matter?

The relationship between SIDS and Co-Sleeping is widely publicised, but does Co-Sleeping really increase the risk of SIDS occurring? Certainly, it is widespread and a culturally acceptable practice in many parts of the world, so what is the problem of this being adopted in the UK? One of the main differences is that in the UK and other Western Countries, the types of beds and bedding are completely different and therefore no accurate comparison can be made. Also, in many countries where bed-sharing is common place, there is no Central Heating which is another factor contributing to SIDS in the UK: babies find it difficult to regulate their own temperature and can therefore quickly overheat. As adults, we can throw bed covers off us, we can move freely without even being consciously aware. This is not the same for babies who can easily be caught under covers, or smothered by pillows. In certain countries there would be no need for blankets, duvets and loose bedding but in Western Countries they are part and parcel of our sleep environment.

What if we don’t include actual bed-sharing but instead turn to a side-cot/sleeper? Certainly this balances the need for the baby to be in close proximity to the parent and easily reached for feeding. It also means there is no danger of adults rolling on to the baby or for covers to be an issue.

And a separate cot? To be honest, most parents I work with wouldn’t see this as co-sleeping and so I am not going to cover this in this article.

The research on Co-Sleeping and SIDS also fails to distinguish between incidents where babies and parents have fallen asleep together on a chair or sofa and those incidents in a bed. We do know that there appears to be an association between bed-sharing and SIDS rather than an actual risk.

Using guidance from the Lullaby Trust, NICE and UNICEF these are factors I would encourage all parents to consider when choosing whether to co-sleep

  • Avoid falling asleep with your baby on a sofa or chair (this can happen very easily when we are enjoying cuddle time or feeding)
  • Do not smoke or allow anyone else to smoke in the home or around your baby. (Even smoking in a different room does little to reduce the health risk to babies and children)
  • Use a co-sleeper where the baby is in close proximity to you but is in their own sleep space.
  • When feeding at night, consider ways to ensure you won’t fall asleep whilst holding your baby (Have a snack available, some music to listen to)
  • If breastfeeding, use the ‘Protective Position’ (UNICEF). Lay on your side in a way similar to the Recovery Position. Have knees bent, lower arm above baby’s head with baby about 20-30cm from chest. (This is also called the ‘ball’ or ‘C’ position.)
  • When feeding in bed, keep your baby away from any pillows. (I often suggest that if breastfeeding mum wears a onesie which can be opened up for feeding but no actual bed covers nearby)
  • Ensure baby cannot fall out of the bed or become trapped between mattress and a wall
  • Never leave a baby alone in your bed. Even if your little one can’t roll yet… you never know when they suddenly will!
  • Do not co-sleep if you or your partner has taken prescribed medication or other drugs which may make you drowsy.
  • Bed-sharing with a baby of low birth weight (2.5kg/5 ½ lb or less) or a Premature baby (born before 37 weeks) is also linked to SIDS

If you are choosing to co-sleep when breastfeeding, again go through the guide above to ensure you are keeping as safe as possible. We do believe mothers who breastfeed and co-sleep touch their babies often unconsciously, seemingly to check baby’s temperature and positioning even when not fully awake; this also suggests mothers will rouse quicker if their baby does develop a temperature or become unwell in the night. Breastfeeding mothers also tend to have lighter sleep if their baby is demanding feeding at night.

Maybe one of the most difficult areas is that guidance recommends not bed-sharing when you are tired! I would suggest most parents of babies, particularly under a year are tried most of the time so, again, be open to ways of ‘safe sleeping’ which still allow you to make the right decision for you.

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