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Co-sleeping: Parental Implications & Recommendations

Let’s talk about co-sleeping.

First of all, what is it?

Health care professionals should familiarize themselves with the terminology and definitions used for parent-infant co-sleeping due to their diversity and the fact they are often used interchangeably. The term ‘co-sleeping’ can be defined as ‘parents and infants sleeping in close proximity to one another, but not necessarily on the same surface.’ Bed-sharing, sofa-sharing and chair-sharing are all subsections of co-sleeping.

In recent years the issue of co-sleeping has led to a rather complex and at times, controversial conversation, given the fear of increasing a baby’s risk of Sudden Infant Death Syndrome (SIDS) or ‘cot death’ and accidental suffocation. As paediatric nurses, we aim to provide evidence-based advice about sleeping arrangements as a basic part of parental guidance in newborn care.

UNICEF has determined that around half of all parents will sleep with their baby at some point during the infant period, be it planned or unintended. Factors that influence the sleeping arrangements of infants and children are a combination of parental values, socioeconomic factors and cultural diversity. So how do we avoid the risk of SIDS considering the high occurrence of co-sleeping amongst parents and babies?

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SIDS is in fact very rare, occurring in around 0.03% of all newborns and although it will never be possible to eliminate all risks of SIDS occurrences, with careful health education and risk minimization, we could potentially reduce co-sleeping SIDS deaths by nearly 90%. Hazardous co-sleeping situations are identified as the main cause of SIDS when related to co-sleeping. Such hazardous situations include sleeping on a couch or armchair with a baby. This is particularly dangerous and should always be avoided. If parents do in fact fall asleep with their baby, they are much safer doing so in a bed.  For this reason, parents and caregivers should be especially attentive as to their level of alertness when feeding infants or lying with infants on a couch, or makeshift bed.

“UNICEF has determined that around half of all parents will sleep with their baby at some point during the infant period, be it planned or unintended. “

Furthermore, SIDS is more likely to occur if sleeping on an object with soft surfaces, a bed with heavy covers or multiple bed sharers and if parents co-sleep after consuming alcohol, taking drugs or sedatives, are cigarette smokers or are currently experiencing extreme fatigue and exhaustion. SIDS is also far more common in low birth weights infants or premature babies opposed to term infants.

The Recommendations:

Side Sleeping

To reduce the risk of SIDS, infants should be placed in a supine position to sleep (wholly on the back). Side sleeping, with or without an adult is not advised.

Firm Sleep Surface

Secondly, infants should be placed on a firm surface to sleep, covered by a fitted sheet with no other bedding or soft objects, such as pillows, stuffed toys or cushions, to reduce the risk of SIDS and suffocation. A firm sleep surface is one which will maintain its shape and have no indentations. It will not conform to the shape of the infant’s head when the baby is placed on the surface. Soft mattresses, including those made from memory foam, waterbeds, or even air mattresses could create an indentation and increase the chance of accidental infant suffocation.

Another option is bedside sleepers, which conveniently attached to the side of the parental bed and may be a good option for some parents.

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Keep baby close

It is recommended that infants sleep in the parents’ room, close to the parents’ bed, but on a separate surface designed for infants, ideally for the first year of life, but particularly for the first 6 months, as this arrangement is most likely to prevent suffocation, strangulation, and entrapment that could occur when the infant is sleeping in an adult’s bed.

Return baby to their bed after feeding

Additionally, infants brought into the adult bed for feeding or comforting should be returned to their own crib or bassinet when the parent is ready to return to sleep.

“When bed sharing and breastfeeding occur together, certain benefits can be derived by both mother and infant as mothers then enjoy a close night-time relationship with their young child…”

Bed-sharing has also been shown to be beneficial for breastfeeding, as breastfed infants who share a bed with their mother feed more often and for a longer duration than infants who sleep alone.

When bed sharing and breastfeeding occur together, certain benefits can be derived by both mother and infant as mothers then enjoy a close night-time relationship with their young child, who is more inclined to continue breastfeeding and it provides protection against hypothermia.


References

  1. AAP TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment. Paediatrics. 2016; 138(5):e20162938
  2. Das, R. R., Sankar, M. J., Agarwal, R., & Paul, V. K. (2014). Is “Bed Sharing” Beneficial and Safe during Infancy? A Systematic Review. International journal of Paediatrics, 2014, 468538. doi:10.1155/2014/468538
  3. Ball, H. L. (2017). The Atlantic Divide: Contrasting U.K. and U.S. Recommendations on Cosleeping and Bed-Sharing. Journal of Human Lactation, 33(4), 765–769. https://doi.org/10.1177/0890334417713943
  4. Blair PS, Sidebotham P, Pease A, Fleming PJ (2014) Bed-Sharing in the Absence of Hazardous Circumstances: Is There a Risk of Sudden Infant Death Syndrome? An Analysis from Two Case-Control Studies Conducted in the UK. PLoS ONE 9(9): e107799. doi:10.1371/journal.pone.0107799
  5. Straw J, Jones P (2017) Parent-infant co-sleeping and the implications for sudden infant death syndrome. Nursing Children and Young People, 29, 10, pp24-29. 2017. doi: 10.7748/ncyp.2017.e945

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