by Mary Ryngaert
December 07, 2009

When parents first bring home an infant, they often experience the conflicting demands of the infant and their own fatigue. Babies feed frequently, often fall asleep at the breast and remain asleep better when in the arms of a parent. Co-sleeping, as it is called, is understood to be beneficial to breastfeeding. The mother is available to nurse her infant at the frequent intervals that nature has dictated and is able to rest and yes, even sleep, while her baby is receiving nourishment. But how does a breastfeeding family reconcile the concerns of so many in the pediatric community about the possible increased risk of Sudden Infant Death Syndrome (SIDS) in babies who sleep with their parents and the sleep needs of parents and babies?

A new study published this month in the British Medical Journal intends to provide clarity for parents and health care providers about the factors that contribute to SIDS. It determined that sleeping in a parent’s bed was no less risky for SIDS than sleeping alone in a crib. Media outlets focused, however, on one factor—that more infants died while sleeping with a parent than not. What was not emphasized was the fact that parental use of alcohol or drugs when co-sleeping greatly increased the risk and that the highest risk to an infant was sleeping with a parent on a sofa.

Research
The study, “Hazardous co-sleeping environments and risk factors amenable to change: case control study of SIDS in south west England,” by Dr. Peter Blair is known as the SWISS study, and includes the comparison of 80 SIDS deaths from two control groups—one randomly selected group of same-age infants and one group of infants at high risk for SIDS (young, socially deprived, with mothers who smoked).

Results
The study showed that babies who died of SIDS were more than twice as likely (54 percent compared to 20 percent) to have slept in the parent bed than control group children. It’s important to recognize that of these, many might also have been impacted by their parents’ consumption of alcohol or drugs. Fully 31 percent of the parents of the babies who died of SIDS had taken drugs, compared to just 3 percent in the control group. There were significantly more deaths among infants who slept on a couch—17 percent to only 1 percent in the control group.

In an effort to clarify the study’s findings, UNICEF-UK issued a statement. Dr. Peter Blair, one of the SWISS study’s co-authors, reported in the statement, “We need to remind parents that there are certain situations where you never share a bed and balance that with sharing a bed at other times… It might be that if you demonize the parental bed you’re still going to get tired mothers with young infants where the infant has woken up three or four times in the night and needs feeding and the mother’s walking around thinking they can’t take them into the bed, so they go onto the sofa and there they fall asleep. That will and does happen. So coming out with a simplistic statement about bedsharing can do more harm than good.”

In addition, UNICEF-UK developed both a brochure and a sample hospital policy that provides parents and hospital staff with the information required to make good decisions and support families who choose to co-sleep.

The American Academy of Pediatrics issued a policy statement in November 2005 addressing infant sleep position and environment relative to SIDS. Their recommendations are similar to those in the UNICEF statement. The benefit to breastfeeding continuation is recognized and supported, as long as parents take care to avoid those factors that place infants at highest risk.

Recommendations
While there is no certain formula for risk-free parenting, the results of this research should provide some comfort for parents who choose to sleep with their infants. Here are the basic points parents need to know to make good decisions about their baby’s sleep environment:

• Always place your baby on her back to sleep. Don’t place your baby on her tummy or side.
• Dress your baby in a single layer of clothing. Don’t let your baby get too warm.
• Use a single, lightweight blanket or place your baby in a sleep sack.
• Don’t place your baby to sleep on sofas, chairs, or waterbeds.
• Place your baby in a safety-approved crib with a firm mattress.
• Keep your baby’s crib free of pillows, toys, comforters and stuffed animals.
• Breastfeed your baby.
• Do not place your baby alone in an adult bed.
• Do not place your baby in an adult bed with older children.
• Do not sleep with your baby if you are overly tired.
• Do not sleep with your baby if you smoke.
• Do not sleep with your baby if you have used alcohol or drugs.
• Do not sleep with your baby if you are very overweight.

If you have additional questions about safe sleep, please talk with your baby’s health care provider.