The Safe Sleep Question
(July 2016)
In my antenatal breastfeeding sessions one of the most common subjects brought up independently is that of safe sleeping and the avoidance of cot death, also known as sudden infant death syndrome (SIDS). There is invariably thinly disguised fear evident in the room combined with, in my experience, a desire to talk about it but avoid it at the same time. After all, talking about the potential death of a child makes for uncomfortable discussion.
Currently in the UK there are approximately 288 unexplained infant deaths per year. This includes babies 0-12 months though a small percentage of the total (6.6%) were between 12 and 24 months. Since the launch of a safety campaign (Back to Sleep) in 1991, the incidence of cot death has reduced by 65%. Recommendations include primarily putting the baby to sleep on their back, in the same room as the parents for the first 6 months of life with their feet to the bottom of the bed. Further research has added to the recommendations and it is now known that breastfeeding reduces the risk and smoking increases the risk.
Organisations such as Unicef, The Lullaby Trust, the NHS and the Infant Sleep Information Source are in agreement that the safest place for a baby to sleep is in their own bed, in the same room as their parents. The NICE Guidance on postnatal care was updated in 2014 to include an infants’ first year of life and spoke about sudden infant death. The guidance made a distinction regarding the language which I felt was interesting – that the evidence did not tell them that co-sleeping causes SIDS so therefore they say that there is an ‘association’ between cot-death and co-sleeping and the association is likely to be greater when either carer smokes, drinks, takes drugs or if the baby had a low birthweight or was premature.
The reason I find this so interesting is to do with language and the ultimate effect it has on parents. When we talk about risk with parents, we are usually giving them a number to hang their hat on. If you do this thing then there is a chance of this percentage that this thing will happen. With association there is no such absolute. If a parent always puts their baby to sleep in a cot with the perfect mattress, breastfeeds exclusively, never smokes, drinks or takes drugs, has the perfect ambient temperature at all times, has a perfectly healthy baby born at just the right gestation and the perfect weight, then their baby may still die – they have still not eliminated their likelihood of cot death. Because if we knew which of these caused SIDS then we would have eliminated SIDS by now.
Even writing this makes me feel uncomfortable but my background is from losing my brother to SIDS and watching my mother go round and round in circles trying to understand why, what behaviour, what factor caused his death. His diagnosis following post-mortem was sudden infant death syndrome. It was an unexplained death but that doesn’t stop the questions of a bereaved mother. I don’t know and will never know if he had been born just 10 years later whether it might not have happened post the Back to Sleep campaign and that is just it; we will never know. How do you a fight something so slippery.
Ultimately ‘association’ is what we have available to us but I believe we need to ensure that we are talking to parents using the correct language. That by abiding by the recommendations they may reduce the likelihood of SIDS happening but we don’t know the risk factors or the percentage chance of each. That co-sleeping is acknowledged as a common occurrence – at least a fifth of all infants at any one time at night in the UK will be sleeping in the same bed as their parents (The prevalence and characteristics associated with parent-infant bed-sharing in England. Blair & Ball, 2004), and those parents can reduce the likelihood of SIDS by ensuring they have a lifestyle which doesn’t include smoking, drinking and taking drugs and does include breastfeeding.
We need to be confident of the facts we have and clear with what we can, and cannot, be certain about.
References and Information sources
https://www.isisonline.org.uk/sleep_health/sids_and_safety/
http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/caringatnight_web.pdf
https://www.nice.org.uk/guidance/cg37/chapter/1-recommendations#maintaining-infant-health
http://www.lullabytrust.org.uk/statistics
Currently in the UK there are approximately 288 unexplained infant deaths per year. This includes babies 0-12 months though a small percentage of the total (6.6%) were between 12 and 24 months. Since the launch of a safety campaign (Back to Sleep) in 1991, the incidence of cot death has reduced by 65%. Recommendations include primarily putting the baby to sleep on their back, in the same room as the parents for the first 6 months of life with their feet to the bottom of the bed. Further research has added to the recommendations and it is now known that breastfeeding reduces the risk and smoking increases the risk.
Organisations such as Unicef, The Lullaby Trust, the NHS and the Infant Sleep Information Source are in agreement that the safest place for a baby to sleep is in their own bed, in the same room as their parents. The NICE Guidance on postnatal care was updated in 2014 to include an infants’ first year of life and spoke about sudden infant death. The guidance made a distinction regarding the language which I felt was interesting – that the evidence did not tell them that co-sleeping causes SIDS so therefore they say that there is an ‘association’ between cot-death and co-sleeping and the association is likely to be greater when either carer smokes, drinks, takes drugs or if the baby had a low birthweight or was premature.
The reason I find this so interesting is to do with language and the ultimate effect it has on parents. When we talk about risk with parents, we are usually giving them a number to hang their hat on. If you do this thing then there is a chance of this percentage that this thing will happen. With association there is no such absolute. If a parent always puts their baby to sleep in a cot with the perfect mattress, breastfeeds exclusively, never smokes, drinks or takes drugs, has the perfect ambient temperature at all times, has a perfectly healthy baby born at just the right gestation and the perfect weight, then their baby may still die – they have still not eliminated their likelihood of cot death. Because if we knew which of these caused SIDS then we would have eliminated SIDS by now.
Even writing this makes me feel uncomfortable but my background is from losing my brother to SIDS and watching my mother go round and round in circles trying to understand why, what behaviour, what factor caused his death. His diagnosis following post-mortem was sudden infant death syndrome. It was an unexplained death but that doesn’t stop the questions of a bereaved mother. I don’t know and will never know if he had been born just 10 years later whether it might not have happened post the Back to Sleep campaign and that is just it; we will never know. How do you a fight something so slippery.
Ultimately ‘association’ is what we have available to us but I believe we need to ensure that we are talking to parents using the correct language. That by abiding by the recommendations they may reduce the likelihood of SIDS happening but we don’t know the risk factors or the percentage chance of each. That co-sleeping is acknowledged as a common occurrence – at least a fifth of all infants at any one time at night in the UK will be sleeping in the same bed as their parents (The prevalence and characteristics associated with parent-infant bed-sharing in England. Blair & Ball, 2004), and those parents can reduce the likelihood of SIDS by ensuring they have a lifestyle which doesn’t include smoking, drinking and taking drugs and does include breastfeeding.
We need to be confident of the facts we have and clear with what we can, and cannot, be certain about.
References and Information sources
https://www.isisonline.org.uk/sleep_health/sids_and_safety/
http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/caringatnight_web.pdf
https://www.nice.org.uk/guidance/cg37/chapter/1-recommendations#maintaining-infant-health
http://www.lullabytrust.org.uk/statistics
Comments
Post a Comment
I positively welcome messages and comments however please note this is a personal blog and abuse will be deleted. That said, there's always room for lively debate so make yourself at home.