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To mark Sleep Safer Week, we caught up with infant sleep expert Professor Helen Ball who leads our award-winning Durham Infancy and Sleep Centre.
The centre is part of our Anthropology Department and has been researching infant sleep and parenting behaviour since 1995.
It won a Queen’s Anniversary Prize for its influential work and here Professor Ball shares her expertise during this special week focusing on safe sleep practices with babies.
They’re an opportunity for activities that raise awareness of particular issues – each year the key organisations involved in preventing Sudden Unexpected Infant Deaths (SUDI) - which is what infant sleep safety is all about - focus on topics where there is new information to share, or where messaging needs clarifying or strengthening. This week, for instance, Lullaby Trust who are the UK’s leading SUDI prevention charity are focusing on safer co-sleeping. A named week to raise awareness of those issues helps generate publicity, galvanises action and creates media interest – all of which helps spread the word.
We have been researching parent-baby sleeping practices for almost 30 years; parent-baby co-sleeping - sharing any surface for sleep - and bed-sharing have been key topics. We have examined the link between breastfeeding and bed-sharing, how to reduce some of the risks associated with bed-sharing for babies, and understanding why parents might bedshare.
We have videoed mothers and babies, and sometimes dads, sleeping with their babies at home, in birth centres and hospital wards, and in our parent-infant sleep lab to better understand what happens to babies during the night. We found that rigid guidance to never bed-share was stigmatising and ineffective, and had a negative impact on women who were trying to breastfeed. Nowadays parents are informed about co-sleeping risks and bed-sharing safety.
Interestingly the concerns we hear most frequently are that parents worry that having their baby in bed with them will create ‘bad habits’ i.e. their child will always need them to be present to fall asleep – and relatedly that they will never get their child out of their bed. Both these concerns arise due to historical attitudes about infancy and parenting that have persuaded Western parents that creating children who can sleep alone from a very early age is desirable – something that is unheard of in other cultures who recognise the helplessness and dependency of infants. We reassure concerned parents that babies crave contact and comfort, which allows them to settle, relax and sleep. Some children need their parent’s presence for several years, others can sleep alone much sooner. Either way, they won’t be in your bed by the time they’re teenagers!
Two key sleep safety issues are can a baby breathe freely, and could they overheat? Be sure a baby’s airways are always clear, that their windpipe is not kinked and that they can easily fill their lungs. Also remember a baby loses heat through their head, so anything that insulates the head is an overheating risk – pillows, cushions, bedding, hats – should all be avoided.
It's easy to see that breathing and overheating risks are more likely to happen when sleeping with a baby on a sofa or armchair than on a clear flat bed, if a parent is not sober, if pets or other children are in a baby’s sleep space, or if the baby’s sleep space is cramped. These scenarios should be avoided for all babies. Premature, low birthweight, and smoke-exposed babies are especially vulnerable and so co-sleeping/bed-sharing is advised against for these babies.
Safer sleep guidance has reduced the number of SUDI deaths dramatically over the past 30 years, but around 300 babies still die every year in the UK. These deaths cluster among the most vulnerable families where babies are also at risk of neglect and abuse.
It is recommended that SUDI prevention for families who may be unable to implement safer sleep guidance should use a multi-agency approach. This involves staff across multiple services trained in infant sleep safety who can then support parents to implement it. We are working with Durham County Council and Durham & Darlington NHS Trust to implement and evaluate a multi-agency approach to SUDI prevention for vulnerable families in County Durham. This will soon be extended to Northumberland.