7 minute read
Safer baby sleep
Safer babysleep BY DR ALISON MOONEY
As a Doctor, discussing the concept of co–sleeping or bed–sharing with parents remains a fairly controversial topic. Co–sleeping is defined as an adult and baby sharing a sleep surface (bed, couch, chair, etc) whereas bed–sharing is sharing an adult bed with a parent or parents for sleep. We are naturally concerned that we may be seen as promoting co–sleeping and worry about the risk of sleep related infant deaths.
Many parents feel ashamed to admit that they are co–sleeping for fear of how their health professional will react. In the past, it may have been easier to have a blanket statement that co–sleeping isn’t safe, but we may be missing an opportunity for non–judgemental exploration of the current sleep situation at home and education to promote safer infant sleep.
As a Mother, I can understand and relate to why 75–80% of babies spend some time co–sleeping in the first 3–6 months of life in Australia. My conviction that I had no intention of ever co–sleeping was not that realistic in the stark reality of my own exhaustion with a baby that just would not sleep. I attempted it in desperation and so the first time I gave it a go it was unplanned, I wasn’t thinking clearly, and I couldn’t remember all the safety checks. Luckily, nothing went wrong (no sleep happened either, both my boys thought it was party time)
If we advocate for never co–sleeping, a parent may choose to feed their baby in an armchair or sofa which we know can actually increase the risk of SIDS up to 50–fold. The mother may also try to feed sitting up in bed rather than planning safer side–lying breastfeeding. If we initiate a conversation, we can discuss how to plan for safer co–sleeping if or when the situation arises.
Sudden Infant Death Syndrome (SIDS)
SIDS is the sudden and unexpected death of a baby under age one with onset of the episode during sleep that is unexplained after a thorough investigation by a coroner. SIDS is very rare (in 2017, 6 in every 100,000 babies died of SIDS in Australia) but it is much more likely to occur in certain situations and is more common at age 2–3 months. There are key hazardous situations to avoid: Sleeping with your baby on a sofa, armchair or make–shift bed Sleeping with your baby after you have consumed alcohol or drugs (including over the counter medication that causes drowsiness) Sleeping with your baby if you are feeling unwell or overly exhausted Sleeping with your baby if you are a smoker or smoked during pregnancy Sleeping with your baby if they are currently unwell, they were born prematurely or had a low birth weight
Room–Sharing
It is recommended to sleep in the same room as your baby for the first 6 months of life as it significantly reduces the risk of SIDS compared to babies sleeping in a room alone. This is also applicable for day–sleeps where the baby should be in the same room as a parent. Options include cots, bassinets or Moses baskets close to the adult bed or a three–sided cot that attaches to the parents’ bed. Place baby on their back to sleep Place baby on a clear, firm, flat mattress Ensure baby’s head will not become covered Use a sleep sack or position with feet at the foot of the cot under a firmly tucked sheet Keep the baby in the same room for at least the first 6 months Prevent overheating Do not overdress or cover your baby with too many layers Keep room at 16–20 degrees The room is a smoke–free zone
Bed–sharing for the Breastfeeding Mother and Baby (Breast–sleeping)
Bed–sharing occurs when a baby shares the adult bed with one or both parents which may be intentional or used as a last resort. Bed–sharing promotes breastfeeding initiation, duration and exclusivity. Breastfeeding is a major protective factor against
SIDS in the absence of known hazards. The reason for this is multifactorial, including that most breastfeeding mothers naturally adopt a C–shape position by laying on their side facing their baby, knees drawn up under the baby’s feet and an arm above the baby’s head. This prevents the baby from moving down under a covering or up under a pillow. Breastfeeding mothers are also exquisitely alert to their baby’s movements and noises so easily wake to feed side–lying (the same behaviour does not occur in mothers who have never breastfed). Also, breastfed babies are more easily aroused from sleep than formula fed babies. Place baby on a clear, firm, flat mattress (waterbeds, bean bags and soft beds are not suitable) Place baby on their back to sleep, never on their tummy or side (they may feed on their back or side but should always be on their back to sleep) Keep pillows and bed coverings well away from your baby, especially their head and face Check there are no gaps around the bed or between the mattress and headboard that your baby could get wedged or trapped in and that your baby cannot fall off the bed Make sure you position yourself between your baby and other heavy–sleeping adults (avoid having pets or other children in the bed) Never leave your baby alone in the bed Keep the room at a comfortable temperature (16–20 degrees) Your baby should not be overdressed, safe sleeping bags with a fitted neck and armholes can be helpful
Practical Tips When preparing for when baby comes home ask yourself questions such as where will my baby sleep at night?
Where will they have day time naps? The night time space should be fairly dark, avoiding turning on bright lights for feeds and nappy changes (plus only change a nappy if it is absolutely necessary) Keep baby close if in a separate sleep space (cot/bassinet/3–sided cot) by the side of your bed so you can hear them stir. Ideally, offer a feed before they become too ‘dialled up’ as it may take longer to ‘dial down’ and at night it is best to do whatever gets everyone back to sleep as quickly as possible If your baby doesn’t settle try offering another feed, even if they have just fed (it is impossible to overfeed a breastfed baby). If we feed flexibly and frequently, rather than by the clock, we can help our baby stay ‘dialled down’ Have water next to your bed at night as breastfeeding can make you incredibly thirsty. You might even want to have a snack to hand. I had
many a midnight trip to the kitchen for a peanut butter sandwich! Day time naps in the same room as a parent can be in a bright and noisy environment giving baby helpful day time cues to set their circadian clock and promote them only taking the sleep they need to take the edge off.
Consider a portable sleep space or invest in a separate safe sleep space Planning a holiday? Take time to consider a safe sleeping arrangement for your baby while away
In summary, bed–sharing is extremely common and providing education to all parents on the concept of safer bed–sharing, regardless of their current beliefs, has the potential to reduce the risk of SIDS. Each baby and family are unique and armed with safe sleep information parents can make an informed decision while being aware of any potential risks.
Resources – Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019 by Blair et al. Breastfeed Med. 2020;15:5–16. DOI: 10.1089/ bfm.2019.29144.psb. www.unicef.org.uk/babyfriendly www.basisonline.org.uk
Dr Alison Mooney MBBS FRACGP DCH Clin Dip Pall Med Originally from Scotland, Alison achieved her Medical degree at the University of Newcastle upon Tyne in 2008 and has lived and worked on the Central Coast since 2010. She is currently working part time as a GP with special interests in women and child health. Following several years of fertility problems and IVF treatment, Alison and her husband are now delighted to have two very energetic boys! Alison has recently undertaken further rigorous training and is proud to be the first NDC accredited practitioner on the Central Coast and is thrilled to share her knowledge with families in her new service, The Moon Clinic.
www.moonclinic.com.au
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