10 things I wish NICE would say [or Co-sleeping, bed sharing, SIDS and the need for balanced info]

The National Institute for Health and Care Excellence (NICE) is updating its guidance on the prevention of SIDS (Sudden Infant Death Syndrome). It has published new, draft recommendations for consultation that say midwives, GPs and health visitors should ensure parents and carers are told of the link between co-sleeping (falling asleep with a baby in a bed, or on a sofa or armchair) and SIDS.

It’s great that NICE wants to reduce the number of baby deaths from SIDS. However, once again, guidance does not seem to be taking reality into account and may actually lead to increased risky behaviours.

Fellow doula and blogger Rebecca talks about this eloquently from the point of view of her own personal experience on her Hackney Doula blog.

Here are 10 things I wish all new parents could be told about infant sleep:

1, it is NORMAL and HEALTHY for your baby to wake at night, and this means frequently (think every 2-3 hours at least) in the very early weeks. Any plans you make for caring for your baby at night should take this into account. Don’t have a plan that only works if the baby sleeps through.

2, it is NORMAL for babies to want to only fall asleep or stay asleep with someone. Does it seem like your baby thinks being left in a Moses basket will kill them? Well, the evolutionary and biological imperative is that an infant being left alone will die. You know that is a fancy-pants moses basket with a specially chosen hypoallergenic mattress in a temperature controlled and monitored bedroom in a safe part of town. Your baby does not.

3, it is NORMAL for parents of a baby to be tired. And that’s true whether the baby is 2 days old, 2 months old or even older. Any plans you make for caring for your baby at night should take this into account. Don’t have a plan that works only if you aren’t tired yourself.

4, Having your baby sleep in a separate room significantly raises the risks of SIDS. Babies need to be sleeping in the same room as a carer. So do what you need to do to make this possible, at least until baby is 6-8 months old, when the risk of SIDS drops.

5, If either parent, or any night-time carer smoke, this significantly increases the risks of SIDS. Smoking only outside the home and even washing before bed does NOT negate this risk. If at all possible, all potential carers of a baby (so anyone that might babysit, such as grandparents too) should quit smoking before baby is born. Midwives, GPs and health visitors will be delighted to help you do this and you’ll be helping keep your baby safe in doing so.

6, Co-sleeping is a term that encompasses all forms of a carer sleeping alongside a baby, from the recommended safe option of baby in a separate cot with you in the room, to a drunk babysitter passing out on the sofa. So if you see a headline that says “Co-sleeping is…” know that the author does not understand what they’re talking about, as co-sleeping is not ONE thing.

7, Sofa/Couch/Chair sleeping with a baby is particularly dangerous. The risk is NOT that baby might fall on the floor. Realistically, a fall or slither of less than a metre onto a carpeted floor is not likely to hurt your baby. The risks are to do with the baby getting wedged between sections of the furniture, between the adult and the furniture or just ending up sleeping on or facing a soft surface.

8, In a bed, the risks for baby are primarily soft things. Falling out of bed onto the floor is not likely to seriously hurt your baby (though falling out of bed and getting stuck could). And newborn babies cannot really move and, if they do, will instinctively move towards their mother. The risky things are soft mattresses (e.g. waterbeds), pillows and duvets. A soft surface increases the risks of SIDS as well as the risks of accidental smothering. Do NOT think that wedging your baby up with pillows will keep them safe. It won’t and you’ll be putting them at greater risk.

9, Breastfeeding, especially exclusively breastfeeding, reduces the risk of SIDS. Mothers who bedshare are more likely to exclusively breastfeed for longer.

10, There is not yet good evidence either way on whether a baby sleeping next to non-smoking mother, who has not consumed alcohol or drugs, and has provided a relatively safe sleeping area (i.e. firm mattress, pillows/duvet well out of the way) increases, reduces or has no effect on SIDS rates. The review that the change in NICE recommendations is based on is full of issues (and that’s the opinion of Dr Charlotte Russell PhD, of the Infant Sleep Informtation Source – as outlined at the 2014 Doula UK Conference – not just me). Studies in other countries and of specific minority groups in the UK have demonstrated that in these populations, a high rate of bed-sharing is associated with extremely LOW rates of SIDS. Perhaps we could learn from them?

We do not know what causes SIDS. There is no way to completely eradicate the risk of SIDS. As with everything as parents, the ultimate responsibility is yours. So you have the make the best decisions you can for your baby and your family.

For evidence based, balanced information on infant sleep, see ISISonline or the UNICEF leaflet ‘Caring for Your Baby at Night’.