Safe sleeping for babies

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A baby’s sleeping patterns, or lack of, seem to be a major preoccupation of new parents these days.  I often hear that loaded question, “does your baby sleep through the night?” and am fascinated by the answers.  On most occasions I will challenge a group to find out what sleeping through the night means to each of them.  The answers are very varied – from a five hour stint of midnight to 5am, all the way to a twelve hour uninterrupted 7 til 7.  The majority of Mums are happy with a sleep through from a late-night (dream) feed til morning, i.e. the 7 or 8 hour stretch that we need to feel revitalised!  The question is, how can we optimise good sleeping and what are safe practices?

I was hugely privileged to hear Professor Helen Ball, an Anthropologist from Durham University, talking about infant sleep and “Is Co-sleeping Wrong?” at the recent MAMA conference in Scotland.  She identified the following reasons why parents choose to bed-share – ease and convenience of feeding at night, enjoying close contact with their baby, necessity due to lack of space, anxiety re infant health/safety, to settle a fractious infant or a family bed ideology/culture.  Interestingly, until the late 1800s our books portray mother-infant sleep contact as normal.  The reasons we started to sleep apart was as a consequence of changes in childbirth – the introduction of anaesthesia for example, and also due to the introduction of behaviourist child-rearing paradigms – e.g. promoting independence in children.  Also, a mother’s body was no longer necessary for infant survival as feeding alternatives became more widely available.  Professor Ball questions whether  infant development and well-being became overlooked, citing mammalian experiments such as those on Harlow’s monkeys which showed that comfort, contact and security were vital for baby development.  I remember only too vividly, when training to become a Baby Massage Teacher, Peter Walker talking about those babies in international orphanages who died – babies who received food and basic attention, but no physical contact or comfort.  There was no medical reason for those babies to die and therefore the best terminology anyone could use was “failure to thrive”.  Peter’s conclusion was that these babies died from lack of touch – a baby’s prime need in the first year of life. (If anyone is interested in investigating the subject further then Tiffany Field, from the Touch Institute, has written a couple of excellent books.) Physical contact has been shown to: soothe and calm infants, promote sleep, conserve heat/energy, act as an analgesic in newborns, reduce stress in mother and baby, be effective in breastfeeding initiation and maternal awareness of a baby’s needs.  I can sound like a broken record sometimes in recommending to new Mums that they spend skin-to-skin time with their baby, but I honestly believe it is one of the best practices to help a mother and baby get acquainted, help establish feeding, settle a baby and continue to boost the feel-good hormones.

What is SIDS?  A very distressing subject to raise, but again I think it is so important not to skirt around an issue, but confront it and know the facts.  SIDS (Sudden Infant Death Syndrome) is a sub-category of SUDI (Sudden Unexpected Deaths in Infancy) i.e. relates to a baby whose death cannot be explained as opposed to one that can.  According to Professor Ball there need to be three factors in play for a baby to die from SIDS.  They need to be a vulnerable infant – that can be one who was born prematurely, had a low birth weight, born to a mother who smokes etc.  There is no diagnostic test to show that a baby is “vulnerable”.  They need to be in the Critical Development Period – 2-3 months is the prime range of SIDS.  And there needs to be an outside stressor – a smoky environment, sleeping in the prone position (on the tummy) for example.  A study in the 1980’s in New Zealand showed that in 79% cases there were three risk factors – babies slept prone, mothers smoked in pregnancy and mothers didn’t breastfeed.  Since the “Back to Sleep” campaign, SIDS deaths have fallen considerably.  Further risks were identified – smoking near a baby, head covering, over wrapping, overheating, bed-sharing, infant illness, soft bedding/surfaces.  More recent studies have shown that although bed-sharing does not reduce the risk of SIDS, room-sharing does.

Some of the findings of Professor Ball and her fellow researchers on the Born in Bradford study were in the media recently.  In looking at two distinct ethnic groups living in the same town they saw that the Pakistani community were far more likely to bed-share, breastfeed, but not to smoke or drink.  However, the White British community were less like to bed-share and breastfeed, more likely to sofa-share, and more likely to smoke and drink.  The occurrences of SIDS were far higher in the second group.

So, what are safe sleeping practices?

* Baby sleeps on the outside of either parent, not in the middle

* Baby sleeps away from pillows

* Baby sleeps away from the parents bedding – duvet/quilt and has his/her own bedding

* Parents do not fall asleep with the baby on a sofa

* Parents don’t smoke

* Parents don’t sleep with the baby when under the influence of drink/drugs

* Baby sleeps on his back

* If in a cot, the baby sleeps in the foot to foot position

* Parents remove anything from the sleep environment that is a risk to the baby in terms of strangulation

* Parents ensure adequate ventilation

Various clients have asked me about the safety of cot bumpers and having looked into the subject it seems that there was some concern a decade ago that cot-bumpers were contributing to SIDS possibly due to reducing ventilation in a cot, and/or strangulation.  This has not been proved or disproved.  There do seem to be alternatives on the market now to take into account the concerns.  Another product which is relatively new to the market and seems popular is the bed nest.  Again, I am sure there are various options out there, but the principle is that the baby’s bed attaches to the parents’, thereby giving each a separate, but joined sleeping environment.  A clever compromise perhaps!

Finally, a word on the babies waking in the wee hours.  A mother’s prolactin levels are at the highest between the hours of 3 and 6am – we produce our best milk then.  It makes sense because those are the hours where, as primitive women, we were least likely to be disturbed by anything else, so most able to focus on our babies.  So, if you are awake and feeding then, perhaps you can reassure yourself that your baby is getting the best of the best.  And, as I always remind new Mums, try to sleep when the baby sleeps during the day – not the easiest thing to do, but certainly beneficial.  The saying that formula milk will help a baby sleep through is a myth – it may take an extra hour for the foreign proteins to be digested, but it won’t buy you more than that.

I don’t have a magic wand sadly, but if you want more information about sleep patterns and about Professor Helen Ball’s work then visit http://www.isisonline.org.uk/