Sharing a bed with a baby does not increase the risk of cot death, says study that could change the way infants are cared for.
by Laura Donnelly, Health Correspondent
23 Nov 2008
Co-sleeping does not in itself increase cot death risk
Parents across Britain have been put off sharing a bed with their new babies by official advice which says it is safer for all children under the age of six months to be put in a cot in their parents' room.
This was based on research which appeared to establish a strong link between "co-sleeping" and sudden infant death syndrome – or cot death.
But the new study found that sharing a bed with a baby was only more dangerous if other factors were also involved.
Parents drinking alcohol were the greatest danger for babies who shared their beds.
Other risk factors included parents smoking or taking drugs, use of heavy bedding, adult pillows and soft mattresses, and when parents were "excessively tired" – defined as having had less than four hours sleep the night before.
The British study also shows that infants are at the greatest risk of all if they and their parents fell asleep on sofas.
However, it parents avoided all the other risk factors, sleeping in a bed with their baby proved no more risky than putting them in a cot in their parents' room.
Childcare experts said last night that the news would be received with relief by many parents, while midwives said it would help them to provide better advice.
But experts on sudden infant death syndrome urged caution until new advice was given.
Of about 300 UK unexplained infant deaths which occur each year, 45 per cent happen in beds shared by babies and their parents,
Experts have known for some time that parents' behaviours and the type of bedroom environment alter the risk of infant death among families who co-sleep, but this is the first detailed study to examine those circumstances in detail.
It concludes that once other factors are stripped out, co-sleeping does not in itself increase the risk to the baby.
Drink, drugs and extreme tiredness are likely to mean parents fall into a deep sleep, and will be less sensitive to both their body movements and the cues of a baby in distress. Heavy bedding, adult pillows and soft mattresses could squash and restrict the infant.
Childcare experts said the findings were "extremely significant," because previous studies have found that mothers who share a bed with their baby are more likely to breast-feed for longer, boosting the child's immune systems and improving their long-term health.
Researcher Dr Peter Blair, who will present his research to a conference of the charity Unicef, in Glasgow, this week, said: "This study shows that it is not co-sleeping that is unsafe, but the circumstances under which some parents co-sleep that create risks".
He said he hoped the findings would be used to give parents better and more sophisticated advice about whether or not to share a bed with their babies.
Dr Blair, from the University of Bristol, said the study of sudden infant deaths occurring in four years across the South West of Britain, was the most detailed study yet of the factors which could make co-sleeping risky.
The new research highlights the risks for mothers who follow official advice to put their babies in a cot, but find themselves falling asleep when they rise in the night to feed or comfort their babies.
"Over the past decade, the proportion of unexplained infant deaths which occur when parent and child fell asleep on a sofa has doubled, it will show.
Prof Cathy Warwick, general secretary of the Royal College of Midwives, said: "It will be really useful to have research shedding light on an incredibly important area.
"Until now we have had a default position that in the absence of information about why co-sleeping appears to carry risks, it is best for mothers not to do it.
"This will allow us to give much more sophisticated advice, and it will reassure a lot of women who want to share a bed with their baby but feel anxious about it".
All the experts warned that parents should think carefully about the extra risks if any alcohol had been drunk.
"Unless further details emerge, we would have to assume any alcohol drunk by parents could put the baby at risk," Dr Warwick said.
Belinda Phipps, chief executive of the National Childbirth Trust, said: "The findings sound extremely significant. We are really pleased to see that evidence about the safety of co-sleeping is building, because we know it improves breastfeeding rates.
"We also know a lot of parents prefer to do it but feel guilty because they are unsure about the risks".
She said precise information about the risks attached to type of bed and bedding would be vital for parents who wanted to safely share their bed with their baby.
In the absence of clear information about what kind of bed and bedding is safe, the NCT recommends the use of "alongside cots", a three-sided enclosed cot attached to the main bed, as a good compromise.
Justine Roberts, co-founder of Mumsnet, a web discussion group for mothers, said: "I think quite a few mums will be breathing a sigh of relief about these findings. Sharing beds can mean a better night's sleep all around, and a lot of mothers feel it is part of the attachment with their baby."
However, the Foundation for the Study of Infant Deaths urged parents to be cautious until the new findings had been published and peer-reviewed. Director Joyce Epstein said that until the evidence had been fully considered, the charity would not change its advice that the safest place for a baby to sleep for the first six months is in a cot in the parents' room.
She pointed to other studies which found a small increase in the risk of sudden infant death when bed sharing, even when several known risk factors were excluded.
A spokesman for the Department of Health said: "Our advice remains that the safest place for your baby to sleep is in a cot in a room with you for the first six months. However, we will examine this research and its findings carefully."
Safely sharing a bed with your child – what to avoid
Parents sharing a bed with a baby under the age of six months is no more dangerous than putting them in their own cot, provided:
– Parents don't smoke
– Parents don't drink
– Parents don't take drugs
– Bedding doesn't include adult pillows
– Bedding is not heavy
– Mattress is not soft
– Parents are not "excessively tired" – defined as having had less than four hours sleep the night before