Bed-sharing among six-month-old infants in western Sweden

Infant Care Practices, Caregiver Awareness of Safe Sleep Advice and Barriers to Implementation: A Scoping Review

Modifiable infant sleep and care practices are recognised as the most important factors parents and health practitioners can influence to reduce the risk of sleep-related infant mortality. Understanding caregiver awareness of, and perceptions relating to, public health messages and identifying trends in contemporary infant care practices are essential to appropriately inform and refine future infant safe sleep advice. This scoping review sought to examine the extent and nature of empirical literature concerning infant caregiver engagement with, and implementation of, safe sleep risk-reduction advice relating to Sudden Unexpected Deaths in Infancy (SUDI). Databases including PubMed, CINAHL, Scopus, Medline, EMBASE and Ovid were searched for relevant peer reviewed publications with publication dates set between January 2000–May 2021. A total of 137 articles met eligibility criteria. Review results map current infant sleeping and care practices that families adopt, primary infant caregivers’ awareness of safe infant sleep advice and the challenges that families encounter implementing safe sleep recommendations when caring for their infant. Findings demonstrate a need for ongoing monitoring of infant sleep practices and family engagement with safe sleep advice so that potential disparities and population groups at greater risk can be identified, with focused support strategies applied.

Swedish survey of infant sleep practices showed increased bed-sharing and positive associations with breastfeeding

AIM

Many countries lack monitoring of infant sleep practices, despite associations with sudden infant death. We studied sleep positions, bed-sharing and breastfeeding in a new birth cohort.

METHODS

Data were obtained from a prospective, population-based cohort study of children born in western Sweden in 2018. The parents of 9,465 six-month-old infants, via postal questionnaires, were asked about their infants' sleeping positions at three and six months, including where they slept and any bed-sharing arrangements. The data were compared with our earlier 2003-2004 birth cohort.

RESULTS

Questionnaires were completed by the parents of 3,590 (38%) infants. At three months, 54% of the infants slept in a separate cot in their parents' room. A further 43% slept in their parents' bed: 42% in baby nests and 42% in close contact with their parents. At six months, 33% bed-shared, compared with 20% in 2003-2004 (p < 0.001). Bed-sharing was positively associated with breastfeeding (odds ratio at three months: 1.5-2.8, 95% confidence interval: 1.1-4.5).

CONCLUSION

Most infants slept in separate cots during the first three months. However, bed-sharing showed an increasing trend and baby nests were popular. Bed-sharing was positively associated with breastfeeding, but the association may not be causal.

The influence of bed-sharing on infant physiology, breastfeeding and behaviour: A systematic review

This review aimed to better understand the underlying physiology of the risks and benefits of bed-sharing. Eight databases were searched using terms relating to adult-infant/baby, bed-sharing/co-sleeping combined with outcome terms for physiology, sleep, cardiovascular, respiratory, temperature and behaviour. Of 836 papers identified, 59 papers representing 48 cohorts met inclusion criteria. Objective data using various methodologies were available in 27 papers and subjective data in 32 papers. Diverse measures were reported using variable definitions of bed-sharing. Identified physiological and behavioural differences between bed-sharing and cot-sleeping included increased behavioural arousals, warmer in-bed temperatures and increased breastfeeding duration in bedshare infants as well as differences in infant overnight sleep architecture, cardiorespiratory control and cortisol responses to stress. We concluded that many differences are context-specific, and dependent on the subjective view of the parents and their cultural values. Objective risk arises if the infant is unable to mount an appropriate physiological or behavioural response to their micro-environment. More studies in the bed-sharing setting are needed to identify infant risk, the potential benefits of a safer environment, and how bed-sharing interacts with infant care practices other than sleep.

Area-based study shows most parents follow advice to reduce risk of sudden infant death syndrome

Aim

Guidance on reducing the risk of sudden infant death syndrome (SIDS) was successfully introduced to a number of countries in the early 1990s. The most important recommendations were supine sleeping for infants and non‐smoking for mothers. This 2012–2014 study examined adherence to the national Swedish SIDS advice.

Methods

We asked 1000 parents with infants registered at child healthcare centres in western Sweden to complete a questionnaire on infant care from birth to 12 months of age.

Results

We analysed 710 responses and found that, in the first three months, 1.3% of the infants were placed in the prone sleeping position and 14.3% were placed on their side. By three to five months, this had risen to 5.6% and 23.6%. In the first three months, 83.1% were breastfed, 84.1% used a pacifier and 44.2% shared their parents' bed, while 5.8% slept in another room. Bed sharing was more likely if infants were breastfed and less likely if they used pacifiers. During pregnancy, 2.8% of the mothers smoked and the mothers who had smoked during pregnancy were less likely to bed share.

Conclusion

Overall adherence to the SIDS advice was good, but both prone and side sleeping practices should be targeted.

Parent-child bed-sharing: The good, the bad, and the burden of evidence

The practice of parent and child sharing a sleeping surface, or 'bed-sharing', is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed 659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on 98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - anthropology, psychology/psychiatry, and pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children's social, emotional, and physical development.

Bed sharing is more common in sudden infant death syndrome than in explained sudden unexpected deaths in infancy

Aim

Despite its declining incidence, sudden infant death syndrome (SIDS) is still an important cause of death in infancy. This study investigated the environmental circumstances associated with SIDS, by analysing data from all sudden unexpected deaths in infancy (SUDI) in Sweden from 2005 to 2011.

Methods

All Swedish infants forensically autopsied up to the age of 365 days from 2005 to 2011 were included. Medical records were obtained from the hospitals and supplementary data from the Swedish Medical Birth Register.

Results

Of the 261 infants, 136 were defined as SIDS and 125 as explained SUDI. The documentation in the medical records was poor when it came to issues such as bed sharing, sleep position, smoking, breastfeeding and pacifier use. The main findings were a significantly higher prevalence of bed sharing in SIDS than in explained deaths (odds ratio 7.77, 95% confidence interval 2.36–25.57) and that prone sleeping was still overrepresented. Bronchopneumonia, other infections and congenital anomalies were the most common causes of explained SUDI.

Conclusion

Bed sharing and prone sleeping were more common in SIDS than in explained SUDI. Sparse data in medical records were a problem, and the authors are now working with the National Board of Health and Welfare on a project to establish new routines.

Application of a Socio-Ecological Model to Mother–Infant Bed-Sharing

Mother–infant bed-sharing has been associated with an increased risk of sleep-related infant deaths, and thus, health messaging has aimed to discourage this behavior. Despite this messaging, bed-sharing remains a common practice in the United States, especially among minority families. Moreover, rates of accidental suffocation and strangulation in bed (often related to bed-sharing) are on the rise, with Black infants at two to three times greater risk than Whites. Multiple studies have identified risk factors for bed-sharing, but a gap remains between findings and translation into interventions. The socio-ecological model (SEM) has been suggested as a way to study and design interventions addressing complex public health issues. This article reconceptualizes the literature on mother–infant bed-sharing using the SEM. PubMed, POPLINE, ERIC, and Psych Info were searched for articles that (a) included bed-sharing as the outcome variable, (b) were published between 2000 and 2013, (c) were conducted in the United States, and (d) included quantitative comparison of more than one factor. The following data were extracted: sample characteristics, bed-sharing definition, methods, factors examined, key findings, and conclusions. Data were summarized into five SEM levels—infant, maternal, family and household, and community and society, nested within the historical context of race. Sixteen studies met inclusion criteria. Significant factors associated with bed-sharing were present within each SEM level of influence. Educational interventions may increase efficacy by attending to multiple levels of the SEM, especially when implementing such interventions within minority subpopulations. Using a harm reduction approach to reducing the risk around bed-sharing may be one way to account for the multiple influences on bed-sharing. The science and practice of minimizing mother–infant bed-sharing may be advanced through use of the SEM.

Is "Bed Sharing" Beneficial and Safe during Infancy? A Systematic Review

Background. There is conflicting evidence regarding the safety and efficacy of bed sharing during infancy-while it has been shown to facilitate breastfeeding and provide protection against hypothermia, it has been identified as a risk factor for SIDS. Methods. A systematic search of major databases was conducted. Eligible studies were observational studies that enrolled infants in the first 4 weeks of life and followed them up for a variable period of time thereafter. Results. A total of 21 studies were included. Though the quality of evidence was low, bed sharing was found to be associated with higher breastfeeding rates at 4 weeks of age (75.5% versus 50%, OR 3.09 (95% CI 2.67 to 3.58), P = 0.043) and an increased risk of SIDS (23.3% versus 11.2%, OR 2.36 (95% CI 1.97 to 2.83), P = 0.025). Majority of the studies were from developed countries, and the effect was almost consistent across the studies. Conclusion. There is low quality evidence that bed sharing is associated with higher breast feeding rates at 4 weeks of age and an increased risk of SIDS. We need more studies that look at bed sharing, breast feeding, and hazardous circumstance that put babies at risk.