Where does your baby sleep?

SADE OGUNTOLA, in this piece, examines the risks and benefits of mothers co-sleeping with  their babies and the positions of medical experts on this habit.


To sleep or to co-sleep? That is the question. And seemingly everyone, from the grandmother to friends has an answer they can swear to be the best option.

Experts have repeatedly warned against bed sharing, a popular type of co-sleeping when babies and parents sleep together in the same bed. Yet, a lot of parents, especially new ones still do it. But for older parents, it is not easy making endless trips to the baby’s room for changing and feeding, so they prefer room sharing.

Co-sleeping is the practice of sharing sleeping space as the baby. Many people associate it with sharing a bed with a child, but co-sleeping can also mean simply sleeping in the same room but separate beds.

Occurrence of bed-sharing varies widely among ethnic and social groups but, even in Caucasian societies where bed-sharing is often discouraged; it continues to be a common practice.

Historically, humans have followed the mammalian pattern: mothers sleep in direct proximity to their young. In many cultures around the world today, this practice persists and traditional wisdom condones and encourages it.

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A Korean proverb goes, “A baby must not sleep in an empty room alone, and an adult must keep watch next to it.” In Tokyo, putting babies alone in a nursery is considered ‘cold and cruel.’

The American Academy of Pediatrics (AAP) has repeatedly warned against bed-sharing, a popular type of co-sleeping where the baby is in bed with you. Yet lots of parents still do it.

Bed-sharing between infants and parents has been identified in some potentially adverse circumstances as increasing the risk of sudden unexpected death in infancy/sudden infant death syndrome (SUDI/SIDS) and other dangers during sleep, like suffocation.

Sudden infant death syndrome is the unexplained, sudden death of a healthy baby. While no one knows what causes SIDS, doctors do know that bed-sharing raises a child’s risk of dying from it.

However, bed-sharing is the norm in many cultures where there is a low rate of SIDS, also known as a cot or crib deaths.

Parents have identified ease of breastfeeding, having a settled baby, reduced parental tiredness, and a sense of security as bed-sharing benefits, while observational studies have demonstrated increased breastfeeding, increased mother–baby interactions and increased infant arousal.

Now, families co-sleep for many reasons; from living situations, a lack of sleeping spaces, and cultural beliefs and traditions.  And still other families, may not actually want to co-sleep but aren’t sure how to help their toddler sleep more independently.

But the teaching now is that baby and mother must stay together; that they sleep together is not a direct cause of sudden infant death syndrome, said Dr Adejumoke Ayede, a consultant  pediatrician at the University College Hospital (UCH), Ibadan, Oyo State.

According to Dr Ayede, “What is promoted now is that baby and mother should stay together because it enhances feeding, it increases bonding, the advantages are limitless. It promotes lactation; it supports emotional stability of the mother and improves bonding between the mother and the baby.

“We do not prescribe buying of baby cots again, since the baby and mother are to sleep on the same bed. Even within the hospital, we are promoting rooming and early initiation of breastfeeding. The baby sleeps on the same bed in the night with the mother, not inside a baby cot.

“During the day, a baby can sleep in the cot, but if the mother is also sleeping during the day, the baby should sleep with the mother on the same bed.”

Considerable evidence supports a significant positive relationship between bed-sharing and breastfeeding. The benefits include increased frequency of successful breastfeeds, increased attempts at breastfeeding, and longer total breastfeeding time during a given night, as well as later age of breastfeeding cessation.

Evidence suggests that the bed-sharing infant’s safety is dependent on both mother and infant being quick to respond to subtle cues during the night.

This may explain the increased risk when a mother’s responses are impaired by alcohol or over tiredness, or when the infant is impaired through infection or exposure to smoking while still inside the womb.

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Howbeit, experts say that infants wake more frequently during bed-sharing because of increased breast-feeding.   Newborns wake regularly during the night to feed. But as infants grow older, maternal tolerance of night waking may reduce.

Far back in 2009, a preliminary survey of infant sleeping place and sleeping position in South-Eastern Nigeria found that bed sharing, though common (66.9%), was more among the experienced and less educated mothers. Maternal age and baby’s sex were not significantly associated with baby’s sleeping place. It was in the Journal of Tropical Medicine.

This study included mother/ infant pairs that attended the well baby clinics at the Institute of Child Health of the University of Nigeria Teaching Hospital, Enugu (ICH-UNTH), Mother of Christ Specialist Hospital (MCSH), Enugu and the Ebonyi State University Teaching Hospital (EBSUTH), Abakaliki.

Lying on the side was the most common (51.1%) and the least stable sleeping position. Only 36.6% of infants who slept in that position were likely to be found in the same position the following morning; lying on the back was the most stable (74.1%).

Howbeit, many mothers are unaware that sleeping by infants has been associated with increased risk of sudden infant death syndrome (SIDS). Many child caregivers continue to be unaware of the association of SIDS and infant sleep position and/or are misinformed as to the risks and benefits of the various sleep positions.

In 2014, experts’ rated mothers of infants attending the Paediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Mothers in Port Harcourt very poor on their knowledge and practice of infant sleep position.

A total of 229(81.2%) respondents were unaware of any medically recommended sleep position. The study was published in the Nigerian Journal of Paediatrics.

Of those who were aware, the commonest source of knowledge was grandmothers. Baby’s comfort was the commonest reason for choice of position irrespective of whether it was side, supine or prone.

The study showed that close to half of the babies sleep in their tummy down (prone position). This is very worrisome as this position has been recognised as a risk factor for SIDS.

Although the cause of SIDS is unknown, placing the infant to sleep on the back (supine position) has been found to be significantly associated with a decrease in the rate of SIDS.

Moreover, a 2015-study looking at the risk factors associated with babies’ death in Nigeria listed this to include drinking alcohol, smoking or staying near a smoker, malaria in mother, obesity, feeding habit of a pregnant woman.

Factors associated with babies’ death also include postnatal factors such as over weight of a baby, place of delivery, birth attendant, pre-term birth, length of labour, placenta abnormalities and failure to have a wellness baby check.

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