Keeping babies close and safe: a risk minimisation policy approach to practicality support breastfeeding while promoting safe infant sleeping

Background: The message Breastfeed baby has been reinstated into the Australian Sleep Safe, My Baby public health campaign in 2012 following a review of the evidence which demonstrated breastfeeding is an independent protective factor in reducing SUDI risk. Bed-sharing and co-sleeping with a baby supports increased frequency and duration of breastfeeding, however has become controversial as co-sleeping has been associated with infant deaths occurring in hazardous circumstances. This has led to some countries issuing blanket statements for all parents never to bed-share under any circumstances and inconsistency in the advice provided by health professionals relating to this practice, despite the acknowledgement that many parents may choose to; don’t intend to, but do; or have no option but to, share sleep with their baby. There is also concern that many parents will not disclose their parenting strategies if they believe it to be an unsupported practice, and that opportunities for health promotion to facilitate informed decision making and safe sleep action to suit individual family circumstances, will be lost. Aim: The presentation will share an evidence-based risk minimisation approach to shared sleeping arrangements with infants, which values and respects cultural norms, supports breastfeeding and continued close contact with a caregiver, and acknowledges the practical implications of breastfeeding babies during the night faced by parents. Methods: Safe infant sleeping guidelines developed in Queensland specifically chose risk minimisation (reduce risks) over a risk elimination (never) approach to co-sleeping, the principles of which have been adopted by several state health departments and SIDS and Kids. Active consultation and collaboration between key national stakeholder organisations which support parents with young infants has been integral to facilitating a consistent approach to providing parent support. Stakeholder groups include, but are not limited to, SIDS and Kids, Australian Breastfeeding Association and the Australian College of Midwives. Results: An evidence-based risk minimisation approach which provides the risks and benefits of co-sleeping, highlights circumstances in which shared sleep is not recommended, and provides strategies for reducing risk in all infant sleeping environments, especially for parents who choose to, or find themselves, sharing sleep as they breastfeed or settle their infant, has been adopted by key organisations. Organisational position statements and parent resource literature have been developed and this approach is progressively making its way into guidelines for hospital service provision in some states. Conclusion: To further reduce SUDI, innovative policy approaches which allow for co-sleeping benefits, respect cultural norms and infant care practices, whilst enabling safe sleep environments are necessary to ensure evidence based information is delivered in a consistent way. Implications for policy, practice and education: The principles of risk minimisation have utility in the development of useful and realistic state and local hospital guidelines relating to safe infant sleeping and are necessary in order to support health professionals to appropriately role model safe sleeping and provide consistent advice to parents about practical strategies to reduce risk in all sleep environments