This post has been updated in November 2016
As usual, the media recently succeeded in increasing the fear of new parents, in relation to infant sleeping and bed sharing with baby. Oh my word. Those of us working or who have worked in field sigh with frustration, but the flurry of panic amongst those with babes in arms is almost palpable. In addition, the Department of Health has instructed the National Institute for Clinical Excellence (NICE) to undertake an extraordinary review of the section of the postnatal care guideline (CG 37) on reducing the risk of sudden infant death syndrome (SIDS). As I was on the original postnatal care guideline development group, my opinion is being sought.
Thank goodness we have sensible experts in the field, who are able to shed light on the real facts behind the print. You are about to meet one!
I have been fortunate enough to hear Professor Helen Ball speak about the topic of safe bed sharing and SIDS on a few occasions at conferences, and I am delighted that she agreed to be interviewed for my blog.
Hi Helen, thanks for agreeing to chat to me here! Could you introduce yourself?
Hi Sheena, I am Professor of Anthropology at Durham University and Director of the Parent-Infant Sleep Lab. This is my 24th year at Durham!
When did you first become interested in infant sleep patterns?
I started reading academic research about infant sleep in 1992 while I was pregnant with my first child. I didn't start thinking about researching infant sleep myself then, however. At the time I had recently finished my PhD in primatology and was living in the US and lecturing part-time. A few years later, after I had been appointed as a lecturer at Durham, and I was pregnant with my 2nd child, I decided I wanted to switch to a research field that didn't require overseas fieldwork, and could be done closer to home — and the idea to study infant sleep was born!
What does your average working day consist of?
This year I have ‘Research Leave’ to catch up on all of the research I didn’t have time to do over the past 3 years while I was Head of the Anthropology Dept in Durham. So, this at the moment my work day consists of writing academic papers and grant applications, meeting with my lab manager Charlotte about PhD student projects, updates to the ISIS (Infant Sleep Info Source) website, or training sessions we might be running. I also have time to speak at conferences and travel, so in September I went to Uruguay to the SIDS International Conference, in October I was invited to speak at a national conference in Lisbon, and I have just come back from the UNICEF UK Baby Friendly Conference.
Has much changed regarding cosleeping and SIDS since we last spoke?
Yes, there have been some quite significant changes – principally around the ways in which health professionals engage with parents on this issue. For the past decade or more there has been a tendency to avoid conversations about cosleeping/bed-sharing with parents, and to issue ‘one size fits all’ advice to avoid bed-sharing under any circumstances. However in 2014 NICE reviewed all the evidence pertaining to SIDS and cosleeping and came to the conclusion that the research data was not strong enough to say cosleeping causes SIDS, but that there were some circumstances in which there is (or may be) an association between co-sleeping (bed and sofa-sharing) and SIDS. The NICE guidance recommends that health professionals discuss with parents the fact that cosleeping happens, both deliberately and unintentionally, and inform them of the associations between smoking, drug and alcohol use, prematurity and low birth weight infants with cosleeping and SIDS. The key message was to empower parents with information so they can make their own informed choices about cosleeping.
One issue that NICE did not draw out in their evidence review, was the difference between sofa and bed-sharing (hence their use of the catch-all term ‘co-sleeping’). A SIDS case-control study conducted in the South-West of England clarified the dangers of sofa-sharing and other hazardous forms of bed-sharing (with tobacco, alcohol or drug consumption) and found that in the absence of these hazards, there was no association between bed-sharing and SIDS. To clarify these factors UNICEF UK have now produced an infographic and guide for health professionals.
As a midwife, I find some of the information for parents on infant sleep and SIDS confusing, and frequently scary. What are your thoughts?
It is very difficult to understand how you might keep babies safe from something that appears to cause them to die with no apparent explanation. The prospect of your baby dying unexpectedly in their sleep is very scary — but there is a lot of research evidence now to help us pinpoint what might increase the risk of this happening, and how it might be avoided. The biggest success has been with sleep position — when parents were advised to sleep their babies on their back, the SIDS rates plummeted. People are now hoping for another simple piece of advice to be equally effective, but it doesn't seem as though there are any other 'magic bullets'. The remaining risks are far more complex and difficult to change (such as smoking). Some fears around the risks associated with bedsharing have caused authorities in different locations to promote scary campaigns aimed at frightening parents away from bed-sharing. These have been heavily criticised for being insensitive to bereaved parents, for fear-mongering, and for creating a climate in which parents lie to their health care providers about bedsharing, and health care staff avoid discussing bedsharing safety and contraindications with parents. These campaigns have also proved ineffective in reducing SIDS. I am pleased to see that (at least in the UK) we are now moving towards more tailored education for parents that can allow them to consider the risks that may affect their baby and make relevant care decisions.
The media obviously has great influence on behaviours. How best do you think we can steer the information to support parents?
One of the reasons we created the ISIS website was to ensure there was a reliable source of research info on infant sleep that parents and health professionals could refer to, and where they could find information explaining the controversies and things they should consider in weighing up the evidence. It would be much less confusing for parents if the media hype around parenting stories did not try to polarise issues around infant care such as infant feeding and sleep behaviour. There is far more agreement among the 'experts' in this field than disagreement, but one wouldn't know this from reading some of the media stories!
Another thing parents find confusing is when media illustrate stories about infant sleep with images of babies sleeping prone or in other situations that to not reflect SIDS-reduction guidance. For this reason we recently created a professional quality image-bank to illustrate what the safest bed-sharing arrangements look like. This can be found at HERE.
What are your plans for the future Helen?
I have just been appointed as (Honorary) Chair of the Scientific Committee for the Lullaby Trust. We are currently writing the Trust’s 10-year research strategy, which will be implemented in January 2017. Our goal is to foster research that will discover ways to lower the SIDS rate in the UK down to 150 per year.
And lastly….what motivates to continue to champion the cause?
I believe strongly that parents should be provided with information they can use to make their own decisions about infant care. So many parents and health professionals contact me to ask questions and seek clarification that I am very aware there is an unmet need for information and education on infant sleep. Many of their questions address issues we don't presently have research to base answers on. I have always felt that as an academic it was important to conduct research that was useful to others, addressed questions that were relevant to non-academics, and would be used by the real world. With our infant sleep research we are achieving this, which makes it worthwhile!
Thank you so much Helen for taking time out of your busy and important schedule to feature here. AND CONGRATULATIONS ON YOUR NEW POST and massive achievement! Wonderful and much deserved success. I wish you lots of luck and send best wishes for the future, and enormous gratitude for the advice and support you give to us all, as health professionals and parents.
You can find Helen on Twitter @IsisOnline1
UPDATED NOVEMBER 2016