Commenting on co-sleeping and bed sharing, in response to media reports today, Rosemary Dodds, Policy Research Officer for the National Childbirth Trust (NCT) and Andrew Radford, Programme Director of UNICEF UK's Baby Friendly Initiative said:

"Parents need to be given clear, accurate information on risk factors so that they can make their own decisions. No one really knows what causes cot death but research shows that there are a few simple precautions that can be taken to help your baby sleep safely."

This information is outlined in the joint UNICEF/FSID leaflet, Sharing a bed with your baby

"There is evidence that mothers who breastfeed and share a bed with their babies are more likely to continue breastfeeding. As not breastfeeding is associated with increased short and long term health risks, we are worried that telling women not to co-sleep may reduce the duration of breastfeeding."

The UNICEF/FSID leaflet is designed to promote safety while protecting breastfeeding and giving parents the full information so they can make informed choices. It includes information on the benefits of and contra-indications to bed sharing and the safety issues related to it.

At present, UNICEF UK and the National Childbirth Trust do not support blanket recommendations against bed sharing in the early weeks for the following reasons:

• The evidence used to support the existence of an increased risk of bed sharing with non-smoking parents in the absence of other known risk factors is weak and ambiguous. No study which has properly recorded and controlled for all known risk factors (including smoking, drug and alcohol consumption) has found that bed sharing increases the risk of death.
• Research conducted in the UK indicates that it is very common for parents to take their baby into bed for short periods at night, particularly for breastfeeding, comforting and settling babies. Clear and full information is therefore necessary to support these parents to make informed choices.
• Simply advising parents against bed sharing without giving practical information about how to cope with a very young baby at night may in fact increase risk. Breastfed babies often feed frequently and for long periods in the first few weeks after delivery. Breastfeeding can also have a soporific effect on the mother (this is nature's way of allowing her to rest). If mothers feel that they must not bed share there is at least a theoretical risk that they will sit on a sofa or chair and fall asleep there, putting their babies in far more danger than if they had shared a bed. There is an additional concern that the sleep deprivation caused by sitting up for large parts of the night will drive mothers to eventually either ignore the recommendation and take their baby into bed when they are excessively tired (a known risk factor) or to give up breastfeeding.

Bottle-fed babies are significantly more likely to suffer infections and respiratory illness, both of which put young babies at risk. 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. The health benefits of breastfeeding to mothers and babies are considered so great that targets for increasing breastfeeding have been set in the UK and health professionals all over the country are working hard to achieve them.

If the government or health professionals simply advise parents against bed sharing, they deny parents a full discussion about important topics such as the benefits, contraindications and safety issues.

UNICEF and the NCT therefore recommend that:

• Parents be given full information appropriate to their needs about the benefits, risks and alternatives to bed sharing in order to encourage safe practice and to protect breastfeeding, both in the antenatal and early postnatal period.
• All NHS Trusts should develop guidelines for staff in order to ensure safe and appropriate practice both in hospital and at home.
• Trusts should provide all relevant health care staff with adequate education to allow them to discuss this issue with all parents as appropriate to their needs.

UNICEF and the NCT recommend 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 and the NCT further recommend that all future research into infant death and sleeping environments should unambiguously record data on all important factors, which must include 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 should be adjusted to control for them.