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Health visitors and midwives urged to discuss co-sleeping SIDS risk with parents

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Health visitors and midwives should advise parents or carers with a child under the age of one about the risk of co-sleeping and Sudden Infant Death Syndrome, according to new guidelines.

The updated guidance from NICE clarifies the association between co-sleeping – defined as falling asleep with a baby in a bed, or on a sofa or chair – and SIDS to help parents understand the potential risks and benefits to help them decide on sleeping arrangements that best fit their family.

The institute noted that more than 200 babies in England and Wales die unexpectedly in their sleep every year. Little is known about why it happens, but research suggests that co-sleeping combined with other factors may play a part in some way.

“The conversation about co-sleeping and the factors that may make SIDS more likely should begin before the baby is even born”

Elaine McInnes

The updated NICE guidance acknowledges that co-sleeping can be intentional or non-intentional. It advises midwives, health visitors and GPs to recognise this and discuss the issue with parents.

Elaine McInnes, a practice teacher of health visiting and professional development officer from the Institute of Health Visiting, helped to develop the new NICE co-sleeping recommendations.

She said: “The conversation about co-sleeping and the factors that may make SIDS more likely should begin before the baby is even born and discussed at every visit, up until the child reaches its first birthday.

“It’s important that parents are given the most current evidence-based information as far as possible, are comfortable and happy in the decision they make with regard to sleeping arrangements and are supported in making the safest choices for sleeping arrangements,” she added.

The updated recommendations – which cover the first 12 months of a child’s life – also include a range of other recommendations for midwives, health visitors and GPs regarding SIDS risk factors.

It calls on them to inform parents and carers that the association between co-sleeping and SIDS is likely to be greater when they, or their partner, smoke.

In addition, it recommends they explain that the association between co-sleeping and SIDS may be greater with recent alcohol consumption, drug use, or low birthweight or premature infants.

Professor Mark Baker, director of the NICE Centre for clinical practice, said the updated guidance was important to consider alongside other safe sleeping advice.

“For many years, the Department of Health has advised that the safest way for a baby to sleep is on its back, in its own cot or moses basket in the parents’ room for the first six months,” he said.

Mark Baker

Mark Baker

“This advice had, and continues to have, a significant effect on reducing baby deaths,” he said. “Sadly though, 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,” said Professor Baker.

He added: “There also appears to be an association between co-sleeping and SIDS if the child was born prematurely or with a low birthweight.”

“We want all health care professionals to be fully informed of the association between co-sleeping and SIDS”

Francine Bates

Francine Bates, chief executive of The Lullaby Trust, said “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,” she added.

Janet Fyle, professional policy advisor at the Royal College of Midwives, said: “This is useful guidance for midwives and other healthcare professionals.

Royal College of Midwives

Janet Fyle

“Our advice is very clear that parents should not co-sleep if they have drunk alcohol, If they smoke or if they have taken drugs, including prescription medication which renders them drowsy or sleepy,” she said.

The updated guidance comes after the Department of Health asked NICE to review its recommendations last year in light of new research.

The new recommendations replace some, but not all parts of NICE’s 2006 postnatal care guidance.

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