UNICEF statement on mother-infant bed sharing

International Midwifery, Jan-Feb, 2004

Following the publication of a European study in the Lancet (1) on sudden infant death among bed-sharing babies, the UNICEF UK Baby Friendly Initiative issued the following statement on February 16, 2004.

'In recognition of the fact that mother-infant bed-sharing appears to be associated with longer and more successful breastfeeding, the UNICEF UK Baby Friendly Initiative has been working to help health professionals enable breastfeeding mothers to share a bed with their baby whilst maintaining the safest possible environment.

'The Lancet paper suggested a slight increase in the risk of sudden infant death among babies of non-smoking mothers who bed-shared all night in the first eight weeks of life.

'At present, the UNICEF UK Baby Friendly Initiative is unable to support recommendations against bed sharing in the early weeks for the following reasons:

* There is some controversy as to whether the results of the study clearly ... indicate an increased risk of bed sharing with non-smoking parents in the absence of other known risk factors ... Until these issues are resolved, it remains inappropriate to give advice to parents based on the results of this study.

* There is concern that simply, advising parents against bed sharing without giving practical information about how to cope with a very young baby at night may increase risk. Bottle fed babies are significantly, more likely to suffer infections and respiratory illness both of which put young babies at risk (2). There is evidence that bottle-fed babies are not as easily roused from sleep as those who are breastfed which again could put babies at risk (3).

* There is anecdotal evidence that health professionals may simply advise parents against bed sharing if they perceive it to be discouraged at ... national level. This means that parents are denied a full discussion about important topics such as the benefits, contraindications and safety issues. It is ... essential that ... parents be given full information appropriate to their needs in order to encourage safe practice and to protect breastfeeding (4).

UNICEF recommends that discussions with parents about bed sharing should address the following factors:

* the circumstances under which co-sleeping should be discouraged (parental smoking, alcohol or drug consumption, excessive tiredness, inappropriate sleep surfaces such as sofas, etc)

* the use of bed sharing as a care strategy for breastfeeding mothers and babies

* the additional risk of accidents if a baby sleeps in an adult bed, coupled with support to avoid or minimise these risks

UNICEF has agreed with the Royal College of Midwives that talks continue to ensure that adequate guidance on bed sharing be available to health professionals.

UNICEF further recommends that all future research into infant death and sleeping environments should unambiguously record data on ... the baby's sleep surface, maternal and paternal smoking status, alcohol and drug consumption and infant feeding method. These factors should be recorded at the time of infant death (rather than relying on data for other periods such as feeding method at delivery or smoking status during pregnancy) and the results adjusted to control for them.

(1.) Carpenter RG et al (2004). Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet 363: 185-91.

(2.) Standing Committee on Nutrition of the British Paediatric Association (1994). Is breastfeeding beneficial in the UK? Arch Dis Child 71: 376-380.

(3.) Home RSC et al (2004). Comparison of evoked arousability in breast and formula fed infants. Arch. Dis. Child 89: 22-25.

(4.) Blair PS, Ball HI, (2004). The prevalence and characteristics associated with parent-infant bed-sharing in England. Arch Dis Child, in press.

UNICEF UK leaflets for parents Feeding your baby and Breastfeeding your new baby are available in English, Arabic, Bengali, Gujarati, Hindi, Mirpuri, Punjabi, Spanish, Tamil, Turkish and Urdu; Sharing a bed with your baby is available in English and French www.babyfriendly.org.uk