New guidelines on co-sleeping with babies empower parents to make informed choices

Parents or carers with a child under the age of 1 should be told about the factors associated with co-sleeping (falling asleep with your baby in a bed, or on a sofa or chair) and SIDS to allow them to weigh up the possible risks and benefits and decide on sleeping arrangements that best fit their family, according to the updated guidance from the National Institute for Health and Care Excellence (NICE).

The updated guidance is a departure from previous national messaging around co-sleeping which discouraged parents from sleeping with their babies without exception, prompting many NHS Trusts to implement ‘never bed-share’ policies.

NICE panel member Professor Helen Ball is a leading expert in parent-infant sleep behaviour and Director of the Durham Infancy and Sleep Centre (DISC) at Durham University.

She said: “The new guidance recommends that parents should be informed of the statistical association between co-sleeping and SIDS, but does not tell parents to never sleep with their babies.

“The key message is that health professionals must give parents balanced information to help them make decisions about where their babies sleep. The first thing the guidance asks health professionals to do is discuss the circumstances of co-sleeping with parents and carers, as individual families may need to consider different things.”

The updated recommendations – which cover the first 12 months of a child’s life – state that healthcare professionals such as midwives, health visitors, GPs and others should:

• Inform parents and carers that the association between co-sleeping and SIDS is likely to be greater when they, or their partner, smoke.
• Inform parents and carers that the association between co-sleeping and SIDS may be greater with:
  • recent alcohol consumption by the parent or carer, or
  • drug use by the parent or carer, or
  • low birthweight or premature infants.

Professor Mark Baker, Director of the NICE Centre for Clinical Practice, said the updated guidance is important to consider alongside other safe sleeping advice:“For many years, the Department of Health has advised that the safest place for a baby to sleep is on its back, in its own cot or moses basket in the parents’ room for the first 6 months. This advice had, and continues to have, a significant effect on reducing baby deaths.

“Sadly, there remain a small number of babies who will die unexpectedly for no apparent reason.

“We don’t know what causes these babies to die suddenly, but we do know that if a parent smokes, drinks alcohol or takes drugs then Sudden Infant Death Syndrome is potentially more likely to occur if they then co-sleep with their infant. There also appears to be an association between co-sleeping and SIDS if the child was born prematurely or with a low birthweight.”

Gabrielle Osrin, a bereaved parent who helped NICE to develop the updated recommendations, said: “Since my daughter died unexpectedly as a baby, I have learnt a lot about SIDS. But, having this information shouldn’t be a privilege.

“It is every parents right to know - whatever their personal circumstance or beliefs – the factors that may make SIDS more likely for their precious baby. If we have this information, I think it would be negligent to not include it in pre- and post-natal advice.”

Francine Bates OBE, Chief Executive of The Lullaby Trust, welcomed the updated guidance: “The Lullaby Trust works with families whose lives have been devastated by the sudden and unexplained death of a baby. The new guidelines from NICE will help professionals have conversations with families both before and after the birth of their new baby.

“We want all health care professionals to be fully informed of the association between co-sleeping and SIDS. Parents hugely value and trust the information and support they receive from GPs, midwives and health visitors. All of us should be working together to give clear messages to new parents empowering them to make decisions which are in the best interest of their baby."

Research by the Durham Infancy and Sleep Centre and its Baby Sleep Information Source influences what advice is given to parents about looking after their babies at night as well as hospital policy and healthcare practice, both within the UK and beyond.

The research is cited widely in UK and overseas policy, supports guidance and recommendations to parents around the world, and is shared informally by support groups, parenting charities, and parent-to-parent discussions.

The updated NICE guidance comes after the Department of Health asked the institute to review its recommendations last year in light of new research. These recommendations replace some, but not all parts of NICE’s 2006 postnatal care guidance.