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Health message about risk of co-sleeping with babies is failing to reduce infant mortality


Midwives and health visitors have a key role in preventing sudden infant deaths by alerting new parents to the risk of  co-sleeping with babies, according to a review of unexplained child mortality in Wales.

Advice provided by midwives, health visitors and social workers to parents – particularly around sleeping arrangements – is an essential part of stopping these types of deaths, the report found.

However, the review also said it was “concerning” that public health messages about parents co-sleeping with children and related risk factors had not been more effective at reducing sudden infancy deaths.

”It is concerning that the [public health] message [about the risk of co-sleeping] has not been more effective at reducing these deaths”

Sudden Unexpected Death in Infancy report

The review called for regular training for frontline professionals on key information that should be given to parents about this and other risk factors to avoid sudden infant death syndrome.

The report - called Sudden Unexpected Death in Infancy - A Collaborative Thematic Review 2010-2012 – looked at possible causes for the sudden deaths of 45 children under the age of one during the three-year period.

It was carried out jointly by the All Wales Perinatal Survey and the Child Death Review Programme, with a key recommendation for the Welsh government, Public Health Wales and healthcare providers to recognise the “particularly important roles of midwives, health visitors and GPs” in advising families.

Analysis of the 45 cases revealed that the rate of parents co-sleeping with their infants was high (almost 60%) and that this was combined with other risk factors which made it unsafe.

“Many factors contribute to the risk of unexplained sudden infant death… future efforts to prevent these tragic deaths must be a collective effort”

Gaynor Richards

These risk factors include sofa-sharing, infants born prematurely or with a low birth weight, parents who smoke, or have consumed alcohol or drugs or are excessively tired.

Data indicates the total number of unexpected child deaths related to co-sleeping appears to have declined since the 1990s but not by as much as cot-death rates, said the report.

It concluded that that while health promotion work around cot deaths has been very successful, it had been less so in preventing co-sleeping related deaths.

“The review identified a particular issue around unsafe co-sleeping, i.e. where other known risk factors are present and co-sleeping appears to be a major aggravating factor,” the report states.

It added: “This health promotion message has been clearly identified since the 1990s and it is concerning that the message has not been more effective at reducing these deaths.”

While the Welsh government should not introduce blanket discouragement of parents sleeping with children, said the report, it must instead “emphasise that co-sleeping in association with other risk factors” carries a very high risk of SIDS.

More effort should be made to reduce smoking among parents during pregnancy and in the first year after child birth, added the report.

Gaynor Richards, chair of the review panel, said: “It was clear that many factors contribute to the risk of unexplained sudden infant death and that future efforts to prevent these tragic deaths must be a collective effort.

“Together, we must do all we can to reduce to an absolute minimum the number of these deaths in Wales.”


Readers' comments (3)

  • As a HV this is an area that is discussed always in our workplace at a NBV and AN visits where carried out Our comm MWs also excellent at reinforcing message We cannot be responsible for parents that smoke, drink and fall asleep on sofas despite advice given Where there are particular vunerabilities i.e. safeguarding msg emphasised Unfortunately these occasional tragedies will continue whilst the aforesaid behaviours continue (Although there are occasionally tragic exceptions with no identified aggravating factor) inevitable but sad

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  • Like most parents, we wanted to do the 'right thing' to raise our children. Whether or not to have them sleep away from my husband and I after they were born was a big issue for me. I read around the subject for months while pregnant, spoke to many mothers and did a lot of heart searching. I decided it was the right thing for us to do. My husband and I do not smoke, did not drink alcohol or indulge in illicit drugs and we slept in a double bed, changing to a kingsize with a cot open alongside the bed when baby number two arrived three years later.
    My sister, a mother of three, said I would never get the children out our bed. By the time our oldest was around four and the youngest around two they were in their own single beds sharing a room. Now, 16 years later, they happily have their own rooms!

    There was a defining book for us, namely "Three In A Bed" by Deborah Jackson, also named on the National Childbirth Trust (NCT) website. I read and reread that book. (I still have it, just in case I can hand it on to someone who is having the same dilemma I had.) Within the pages of that book Ms Jackson states that incidents where children have been killed when sharing their parents' bed occurred because illicit drugs or alcohol were involved.
    I believe sleeping with our children made a positive difference to our quality of family life because of the closeness and relaxation gained by not turning the early years into a night-time battleground. Now, if only that worked on young adults!!!
    (I work as a Nurse in the NHS and have nursed since the late 1980s.)

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  • Did they actually sleep in your bed or in a cot alongside?
    All the most recent evidence, which we have to use in evidence based practice and which is newer than 1980, suggests that risk of SUD is greater with co-sleeping (i.e. in the same bed as parents). Statistics bear this out. Sleeping in an appropriate basket or cot alongside the bed is encouraged. In the end it is the parents who have to make a decision based on current research and information and to decide whether to take that risk. (HV)

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