Co sleeping and SIDS leaflet at doctors

[Rowanhart]

I was planning in co sleeping when our DD is born in three weeks.

I was at docs today waiting for whooping cough jab when saw a leaflet called Risks of co sleeping.

In it said that infant mortality due to co sleeping is high the area we live in and we should never co sleep.

Also had quotes from two mums whose babies had died due to co sleeping,

I thought it was recommended? Confused now but thinking co sleeping is a big no no...

Do you have a better appreciation of the scientific literature than Haycock and the NHS thunk? I certainly don't. Their advice is based in science. The majority of studies do show a risk associated with co-sleeping. It may be something completely tangental to the mum sharing bed with baby but correlated with it e.g. linked to the matress type.

It was also difficult for me not to co-sleep so I know where you're coming from. But clearly lots and lots of parents get through this somehow because co-sleeping in not the norm in the West.

I'm going on and on about this because I feel MNers go on and on about the benefits of co-sleeping and I think the other side of the story needs pushing.

We all worry so much about SIDS. We make sure the room is the right temp, baby is on back, nothing in cot, wrap baby lightly in special blankets etc. Then co-sleep. It doesn't make sense.

FWIW, I agree largely with your last paragraph. I had a prem DS. We frequently co-slept in the early days. I even (shock horror) put him to sleep on his tum from time to time. I broke a lot of rules....but I did so with my eyes open. For me, the risk factors are just that - they are statistical correlations. Babies die of SIDS when they have no risk factors whatsoever.

It seems really odd to me to decide some risk factors can be disregarded and others are taken to be rules of iron.

LeBFG - you are right. He is an anthropologist and therefore studies human behaviours and cultures. Who better placed to understand the massive differences between SIDS rates in different cultures, by which I mean the discrepancies between Western European based cultures and the rest of the world? SIDS rates in the West are higher than in other cultures where co-sleeping is often the norm. I would perhaps feel more sympathetic towards scientific research carried out by 'proper' scientists if they were to carry out worldwide studies. Also, as many have already pointed out, infant deaths when co-sleeping are most often caused by unsafe co-sleeping arrangements. If done safely and correctly, I believe it to be perfectly safe and natural.

I have used my instincts as a guide throughout my experiences of motherhood, choosing not to follow guides and manuals. In my experience, co-sleeping was what kept my sanity and helped me through the first weeks of breastfeeding my DD.

Ruby: it's all in the statistics I'm afraid. Cross-cultural studies are very difficult indeed to do. How SIDS is detected and evidence compiled for a start is very different in different countries.

You are entitled to believe what you like. The data speaks for itself. But be aware that gut instincts are not always very reliable...

I don't think any risk factors are taken to be rules of iron, I think you do what you can do and if you really can't achieve certain guidelines it is unhelpful to dwell on very low probability negative outcomes.

The NHS, as has been said above, takes a different tack on this from trust to trust so there isn't consensus. There is caution, as there was with peanuts in pregnancy. The situation is being monitored. However, to say it should be avoided at any costs and in all circumstances is not a position that has been taken universally, suggesting the evidence is far from clear cut. Again comparing it to cars, we know that people die in cars - they do so quite a bit - but there isn't promotional literature telling us to never, under any circumstances take a journey in a car. Instead the emphasis is on safety. Some NHS trusts take this stance: they highlight all the risks and allow families to make a decision based on balanced information. The NHS choices information I linked to above does this and does it well I think. However, to suggest that a blanket ban is promoted just doesn't have the research evidence to back it up. Believe me, if it had EVERY trust would be doing serious promotional work to reduce it.

I work in the NHS so I know that the type of promotional literature you might get in a doctor's surgery glossy leaflet really isn't the whole picture and that in reality scientific evidence in all fields is always equivocal. Over time, broad general patterns can emerge that are worthy of serious attention for everyone but it really takes quite a bit before you can really reliably trust some of this evidence and health promotion tends to err on the side of caution, with the view that people respond better to more simple messages. Particularly considering the risks to young teenage mothers who may be poor, drinkers and smokers etc, it may be that some trusts decide that it is safer to just say NO rather than OK if you do x, y and z etc.

I have been on quite a long journey with my own consideration of risk so I don't say any of this lightly. One of the biggest lessons for me in overcoming OCD about this is that risk awareness is not, in itself, protective. You can know all the risks and your baby may live, or your baby may die. You can be unaware of risk and your baby may live, or your baby may die. In reality, the truth is that until we know what actually causes SIDS, it may not really be preventable. The Back to Sleep campaign was a great success and that is amazing but I think that the fact it reduced deaths so much gives the impression that we can totally control SIDS when we probably can't. I wish we could but I think that is sadly a way off. I think it's important to remember in all of this that thankfully it is still a rare enough occurrence even in higher risk infants and that if a baby does die, it is not the parents' fault because they (like 45-70% of the world's population) took their baby into a bed to get some sleep.

Thunks - well said.

LeBFG - yes, the statistics based in Western society where people may not be aware or educated in the correct methods of co-sleeping. Perhaps it would be better to say co-sleeping is riskier in Western European based society where it is no longer considered 'normal' practice and where parents are unaware of how to do it safely. Therefore, if you were to consider doing it, read up on UNICEF guidelines and WHO guidelines on how to do it. Interestingly, one 'Western' culture where co-sleeping is prevalent is Sweden - a country that is often seen as child and parent friendly - where children often sleep with their parents up until school age. As I said earlier, I think it's dependent on the childs needs, certainly our daughters sleep started to become more disrupted in the bed with us around 5 months of age and so we moved her into her own cot and at 6 months into her own room, where she was sleeping through from 8 months.

Maybe there should be a study done into the risks of cots in SIDS ie. the placement of infants away from their parents...

Comment to thhunk: The back-to-sleep campaign was (if I remember correctly) based on one of the first studies that revealed the correlation of prone sleeping with SIDS. At the time of the campaign, there was no evidence sleeping on backs would prevent SIDS. But people did it anyway and babies' lives were saved. The science was 'equivocal' (I don't like your use of this word btw - minor point) but saved lives.

Whether the SIDS baby is in bed or on it's belly, I don't think it helpful or constructive to apportion blame in these situations.

Ruby: just saw the long list of refs. Frankly, if you can't be bothered to read them then neither can I. My previous comment re expert opinion should explain my pov. And for someone so educated in the scientific literature you would already know that the SIDS risks in cots has already been (and continues to be) thoroughly investigated. That's why they don't recommend toys or pillows in cots etc.

Think you may have x posted me with sasamaxx.

Also, I don't mean what is put in the cots, but cots themselves as in the idea of baby being put to sleep away from mother. Incidentally, science itself is not always fool proof and whilst it may be popular opinion and consensus at the moment, this may well change in years to come. I just think it might be helpful for parents to feel confident in asking health professionals for guidance in safe co-sleeping practice if it is something they choose to do. I appreciate your opinion and that you feel very strongly about this and I am sure you can also appreciate the similar strength of my feelings on this subject.

Gosh, sorry Ruby. Yes, I did mean sasmaxx. Hard to keep up!

Not sure what you mean about SIDS risks and sleeping away from mum.

I actually don't feel strongly about this - I've been at pains to say I co-slept too. I don't see it as my position to advise people either way. We are both in agreement that people should get the information they need. The only thing I want to counteract is the endless posts on here saying co-sleeping is safe, or even safer, than cot sleeping. This is in contradiction to informed expert opinion based on the concensus of scientific studies.

Times and scientific results change, sure. Perhaps we'll find back sleeping has some nasty associations? Who knows? We can only base our decisions on the best advice available. We may still choose the riskier option (like I did, to co-sleep) but at least it's an informed choice.

Plus, of course, if you do choose to co-sleep, then doing it as safely as possible and having the information available is terribly important. I'm not in UK at the moment so don't know what different NHS trusts are recommending...perhaps it's something along the lines of 'we recommend baby sleeps in same room but not same bed as mum. But, if you do decide to co-sleep, here is some advice to do so as safely as possible...'

Certainly the NHS choice information suggested that it was potentially open to interpretation and not unambiguous. I'm not sure what you meant about my choice of words. In my experience, usually when discussion on MN becomes about the choice of individual words without much explanation it does not augur well for a sensible and mature discussion.

I have been arguing for a rational assessment of risk and probability in this and hardly pushing an outrageous or controversial agenda in stating that given that a very high proportion of people in all societies cosleep (including Western ones, with figures of up to 70% quoted from Canada and Sweden) and probably will continue to do so, that talk of blanket bans in health promotional literature is unhelpful and probably irresponsible. Given the information shared above that 7 babies who died in one study were on a sofa/chair because they were afraid of bedsharing, this is pretty much just common sense. I am in favour of balanced discussion of the research as in the NHS choices information and not simplified universalised recommendations that are hard for many people to comply with along with statements like x is "more dangerous" because it carries, on balance, a very very slightly increased risk compared to not doing x.

If we all took every possible precaution against everything that had a possible mortality rate of 0.49 per 1000 individuals we would most likely never move outside our front doors and indeed, might have difficuty undertaking many simple mundane actions even within our own homes. This is what severe OCD looks like. There are people right now in places like the Maudsley etc who literally can't walk across a room because they are so afraid of something bad happening. Awareness of very small risks is not always a good thing and can in itself be damaging. I have been lucky that even though my perinatal OCD was classed as severe, I have been able to stay at home with the support of the outpatient perinatal mental health team. Research is a good thing and it is great that it is done, but premature pronouncements on safety can do unintended damage, whether that is making the 2-4% of us who will suffer with perinatal anxiety disorders stressed out or sending sleep deprived parents to the sofa when the dangers in a safe bedsharing environment are probably less. Sensible relaying of what has been found in research is wonderful. More absolutist use of language around risk e.g. half of all babies who die do so in their parents bed is not helpful as the NHS itself clearly recognises in the NHS choices article on the reporting of this language in mainstream media.

LeBFG that's exactly what the information I was given from the NHS states

Cross post there LeBFG.

There seems to be something happening at the moment where some trusts are doing as you suggest: we don't recommend it but here's how to do it if you're going to and the more recent development where it is just DON'T DO IT. I am in favour of the first but not of blanket bans.

I had ds1 three years ago. At that point in my trust, I was given information on safe bedsharing. When I had ds2 four months ago, I was told not to do it. Full stop.

My HV still tells me it's against "guidelines" and my DS is 13 months.

Awareness of very small risks is not always a good thing and can in itself be damaging. Agree. But I point to the honey issue. It's one everyone I know adheres to but carries little/no risk. Would you feed honey to an under-1? You've brought up the car risks earlier - clearly something which I suspect more babies die of than SIDS. It is all about a bit of persepective. At the same time, denial of risk is undesirable too.

Research is a good thing and it is great that it is done, but premature pronouncements on safety can do unintended damage.....premature announcements like put babies on their backs? This advice came as an avalanche shock. Even I remember Anne Diamond on the breakfast morning thing campaigning about this. This was based on new research that had not been tested. Sometimes the research and premature pronouncements on safety can actually do a lot of good. Let's put this on its head: is it OK to withold information about risks and safety if they are deemed 'too small'?

Just had a look there, and the Leeds Safeguarding Board (my trust) has written in its annual report 2011-2012 the following:

Category 10 (Sudden unexpected, unexplained death) accounts for 10 deaths. 9 of these were babies who were found dead during their sleep. Of these, 5 involved cosleeping with one or more people in the bed or on a sofa. For all 9 babies, either mother or father or both were current smokers at the time of death. In 4 cases, soft bedding or over-wrapping were noted to be factors, although information was not available for all cases. As noted previously, alcohol use by a parent was noted to be present in 4 cases, and drug use by a parent in 3 cases.

Based on these deaths, recommendations were made to update cosleeping advice. The Panel had already made recommendations in 2009 that smoking should be targeted in all pregnancies and a further recommendation was made that the Director of Public Health at NHS Leeds and Leeds City Council should initiate social marketing work to ensure that co-sleeping messages are disseminated widely and appropriately to target populations.(March 2012):

A piece of insight work into co-sleeping practices in targeted parts of the city has been undertaken by Social Marketing Gateway, involving young parents and professionals. This has led to the development of tailored resources built around the message: ?Let me sleep safe; Let me sleep on my own.? Resources are now being disseminated in targeted areas.

So to me, it would appear that the messages arose out of safeguarding concerns and it was decided from working with communities at risk that a simple message was best.

On the other hand, here is an advice leaflet from Stockport on how to bedshare/cosleep that matches evidence while also saying that cosleeping is not recommended.

Portsmouth have a document which I can't link to for some reason which says that 70% of babies who die are in the same bed as their parents (don't think this is very accurate) and advising health staff to question parents on their sleeping arrangements, indicate this risk to them and record it in the notes.

So very different approaches taken based on local need, I guess. As is usual in the NHS.

The Anne Diamond thing is interesting. No one in their right mind would argue it was anything but a good thing but that isn't always the case and it's hard to extrapolate. For example, a few weeks ago the Jeremy Vine show ran a piece on the risks of using contact lenses while swimming. A listener had lost sight in her eye because she had contracted an infection in the pool. Later on in the show, another listener called in to say that she had also lost her sight because of an infected daily disposable lens that had been contaminated during manufacture in Singapore.

The risk of swimming is probably avoidable and amenable to change though apparently the risk is very small and some people might judge it more important, say, to be able to see their kids in the pool given that there is also a risk if you have small children who are not very well supervised. The risk of contamination from wearing daily disposable lens is much much smaller and the only way to avoid it would be to never ever wear lenses It wouldn't be sensible, in my mind, to put a blanket ban on contact lens wearing in either situation though information about the dangers of swimming with contact lenses in is good for people to know.

What I read tells me that if you have additional risk factors, bedsharing/cosleeping are probably not worth the risk even though it is still small. I really don't see sufficient evidence for a blanket ban for everyone in all situations based on what is known and I think that giving information on safe bedsharing is, on balance, probably a lot more sensible for the majority. I think it's very sad that of the 9 babies who died in Leeds, up to 7 may have had a parent who was taking drugs/alcohol on the night of their death and that smoking may have been a factor in all (though we don't know for sure). Bedsharing and cosleeping themselves don't seem to have been the sole concern, but bedsharing and cosleeping in conjunction with these risk factors. That seems different to me to the simple, easily carried out advice of the Back to Sleep Campaign. People tend to comply with directives that are easy to comply with but it's very hard to get full compliance where carrying out the advice is difficult for people. I think in situations where people are very poor and using drugs and alcohol, perhaps it's easier to put a baby to bed on their own than it is to cease using recreational drugs.. or is presumed to be. Maybe it's not. However, for the small minority of babies who do not have additional risk factors who die in their parents' bed the belief that cosleeping is inherently dangerous may be very difficult.

It's not easy to decide what risks to promote avoidance of heavily and which to inform people of without advising against in all circumstances, which I assume it isn't for the NHS either.

This is the problem with very small sample sizes and why only large scale investigations are really very interesting to make conclusions from. Very obviously it is dangerous to sleep with babies after drinking/drug taking. This does not mean co-sleeping without drinking/drugs carries no risk at all.

I don't think co-sleeping is banned (yet!)? All this is just advice. If I suggested someone co-slept and they did so safely but the baby then died of SIDS, I'm not sure I could live with myself. So why do people suggest co-sleeping if they aren't certain it's safe? (they may think it safe but know the topic is controversial - only a very odd person would be 'certain' their pov was accurate)

i dont think anyone is trying to say it carries no risk at all, just taht you can do things to make it safer and reduce the the risk and that you have to weigh the risk up yourself.

also statistically it about 50/50 for babies taht die in a cot/co-sleeping, surely if co-sleeping was THAT big a risk, you would see larger numbers oc sids where there is/was co-sleeping?

it is advice now that babies under 6mths should always be in a room iwth an adult when they are asleep, ie dont put them upstairs ont heir own in the evening or during the day, but lots and lots of people still do and i have seen people on here say the guildines are rididculous etc.

mine would only sleep on me/being held by me or in bed with me, so it wasnt an issue for me, but it is one that i have seen come up.

there are also some australian studies that have looked more closely into the co-sleeping risk and concluded that done safely it is ok, and on par with the risk of a baby sleeping in a cot. when i get the chance i shall try and have a google to findd the links, but i have a toddler needing a nappy change and i want a shower, something that has neglected to happen today, dam these children wanting my attention

well the leaflet the op states is clearly saying DONT do it EVER and i have had similar advice, but have also had good co-sleeping advice, it seemed to be pot luck and down to the individual midwife/hv, some where happy to share co-sleeping guildlines, othesr made out it was akin to a mortal sin!

also this came up ona birth /midwife type prog recently as well, and they gave very strong views that co-sleeping was not to be done, ther ewas a debate on mnet at the time.

why suggest cot sleeping which isnt entirely safe as 50% of sids deaths occur in a cot. i will suggest co-sleeping but would ALSO list the things you need to do to do it safely and suggest further research. that way a parent can make an informed choice.

I am not making conclusions from this sample size, simply saying it is this sample size that changed advice in my area from being "we don't recommend it but here's how to do it safely" to "don't do it at all" vs large scale investigations.

Nothing in life carries no risk. That's just life. In terms of what you're saying about cosleeping and a baby dying of SIDS, well I suppose you could say something similar about advising someone to travel to a certain destination by car. The human mind is such that if you did so, you would feel guilt if they died.. but your advice didn't kill them, any more than withholding that advice might have saved them. People die and we seek to find reasons why to make sense of it but in general it is mainly out of our control.

In saying that, I'm not advocating some sort of fatalistic, existential feck-it-we're-all-going-to-die-so-let's-ignore-all-risks but the proportions are so, so small in this particular circumstance and so unknown that it's hard to know what to do.

I would still avoid co-sleeping if I could but numerous attempts to get my child to sleep without screaming have been unsuccessful so I will just have to suck it up. My experience tells me that things will calm after six months but in the meantime for me, in my circumstances, cosleeping is more or less unavoidable.

When it comes to how others have advised me, generally I find people say something like: "it's not for everyone but have you considered co-sleeping?" - I don't think that anyone should feel guilty for putting it out there as a possibility when people are at the end of their tether even if the unthinkable happens.

Agrees with everything LeBFG says!!