Key learning points:
–There is an association between co-sleeping and sudden infant death syndrome (SIDS) and this is greater in circumstances where: the parent or carer has recently consumed alcohol, taken medication or drugs
– The association is likely to be greater when there is a smoker co-sleeping
–Co–sleeping can be intentional or unintentional. The risks will be greater if co-sleeping is unintentional
Being a new parent is exhausting and we know that many new mothers and fathers will, at some point or another, fall asleep with their newborn. This is especially pertinent in the early days and parents should not feel guilty or embarrassed. Some parents choose to sleep with their babies but we would urge every new parent to weigh up the known associated risks of co-sleeping, and in light of their own situation, make an informed choice.
Planned co-sleeping for many parents, especially for some cultures, is seen as perfectly normal. Sharing a bed at night with your baby can aid breastfeeding.
However, for many years the Department of Health has advised that the safest place for a baby to sleep is in a cot on their back and if that cot is beside the bed for the first six months this need not interfere with breastfeeding. This advice has not changed.
Hence the updated National Institute for Health and Care Excellence (NICE) guidance may at first seem a little confusing. However, the guidance should be seen as primarily referring to the associated risks of incidental or unplanned falling asleep with a baby on a sofa, chair or bed. A review of the evidence does not suggest that co-sleeping causes SIDS. However there does appear to be some “associated risks” and the recommendations focus on the relationship between co-sleeping and SIDS.
The main messages in the updated co-sleeping guidance are aimed at professionals such as midwives, health visitors, GPs and allied professionals. NICE recommends that all professionals who have contact with families from early pregnancy to the baby’s first birthday should have conversations with parents about the associated risks of co-sleeping in a non-confrontational manner. It is important that parents are given the most current evidence–based information, and are supported in making the safest choices for sleeping arrangements.
The data suggests that the associated risks of co–sleeping and unexplained deaths is greatest between the first month and up to the first year of life.
The role of the health visitor in communicating the associated risks of co–sleeping with families
Health visitors are the professionals who provide universal and targeted services to promote infant and family health. They work in partnership with parents and carers to lead and deliver the full Healthy Child Programme from ante-natal care through to school entry. They are mandated to provide the following five visits:
– Antenatal health promotion visits
– New baby review
– 6-8 week assessment
– 1 year assessment
– 2-2.5 year review
The updated co-sleeping guidelines apply to babies during the first year of life, which gives health visitors in particular a key role in having those conversations with parents and carers on four out of five of the mandated visits.
Conducting difficult conversations is an everyday part of health visiting practice and being able to discuss sleeping arrangements in a non-confrontational way with vulnerable parents is part of this role.
In order to be able to have meaningful conversations around topics such as co-sleeping, health visitors build effective relationships with parents and carers. This starts with the antenatal assessment visit when health visitors visit the family home to undertake a holistic assessment around the 28th week of pregnancy. This visit is key to developing a good relationship with the pregnant parent-to-be and to discuss their plans including those for sleeping arrangements, taking account of the practicalities and dynamics of the home environment.
By the time of the New Baby review visit, the realities of being exhausted as new parents may begin to become apparent and therefore the skills of the health visitor in active listening is one which cannot be underestimated. Co-sleeping can be a way in which a parent can reduce their own sleep-deprivation. Health Visitors can offer supportive advice for new parents such as asking family members to provide support around the general household chores, to suggest that mother takes a nap when the baby sleeps during the day and for working parents to support each other with the help from family members to catch up on sleep.
The health visitor will also discuss the importance of maintaining a good couple relationship during times of sleep deprivation by offering useful ideas based on each family’s individual circumstances. This not only benefits parent relationships but improves the attachment between mother and baby.
Being aware as new parents to the associated risks of co-sleeping is something every professional should discuss from pregnancy up to the first year of life. Offering strategies to combat sleep deprivation to prevent unintentional co-sleeping on a sofa, chair or bed has to be one of the fundamental core conversations health visitors can have with their families. And, if the parents choose to co-sleep, they should provide the advice around how best to plan co-sleeping to minimise any associated risks.
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