Caring for twin infants: sleeping arrangements and their implications

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Author: Helen L. Ball
Date: June 2006
From: Evidence-Based Midwifery(Vol. 4, Issue 1)
Publisher: Redactive Media Group
Document Type: Article
Length: 5,229 words
Lexile Measure: 1510L

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Aim. The study aimed to assess sleeping arrangements used by parents for twin infants and to determine what information might be useful for health professionals and parents regarding twin infant sleep.

Method. A self-selected sample of 60 families recruited via Tamba (Twins and Multiple Births Association), local health professionals and newspapers maintained sleep logs and participated in telephone interviews when their twin infants were one, three and five months of age.

Results. The authors found significant associations between home sleeping arrangements and sleeping arrangements on the postnatal ward (chi-square=9.5, df=1, p=0.002), infant age (chi-square=5.45, df=1, p=0.0195), and sleep furniture used in the home (chi-square=36.13, df=1, p<0.0001). At one month of age, 60% of twins were co-bedded, 92% of which shared a cot while 86% of twins sleeping apart were in separate Moses baskets. Co-bedded twins were initially positioned side-by-side (68%), however eight co-bedding configurations were documented over the first three months. Sleep duration was the primary reason given by parents for sleeping twins either apart or together, but no significant differences were found for parental or infant sleep duration. Co-bedded twins were less likely to be moved from their parents' room than those who slept apart (9% versus 33%), however a few parents of co-bedded twins introduced unnecessary hazards into their twins' sleeping environments with the inappropriate use of bedding and make-shift barriers between the babies.

Conclusions. Department of Health advice to parents on reducing the risk of sudden infant death syndrome (SIDS) recommends sleeping infants in their parent(s) room for the first six months of life. Co-bedding appears to facilitate compliance with this recommendation via the use of a single cot. The strong association between hospital and home sleeping arrangements suggests that co-bedding twins on the postnatal ward may encourage parents to do so at home. By discussing sleeping arrangements for twin babies with parents, both hospital and community midwives could help to educate parents about the most appropriate ways of co-bedding twin infants and avoidance of unsafe practices.

Key words: Twins, multiple births, co-bedding, sudden infant death syndrome, SIDS, infant sleep, sleep safety

Key points

* Parents of newborn twins may prioritise nighttime coping over optimum care strategies, and may benefit from support and advice regarding twin infant sleeping arrangements

* How twin infants are slept in hospital predicts sleeping arrangements at home. Hospital midwives therefore have an opportunity to inform parents about twin infant sleeping arrangements

* Twin infants separated for sleep from birth were more frequently removed from their parents' room before three months of age than co-bedded twins, despite Department of Health advice to keep infants in their parents' room for six months

* Parents devised at least eight different configurations for co-bedding twin infants

* A small proportion of parents employed hazardous co-bedding practices--the use of barriers and covers, and the positioning of co-bedded infants, are issues that should be discussed by hospital and community midwives with parents of twin infants.


UK national guidelines on sleeping environments for newborn infants recommend they should sleep in a supine...

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Gale Document Number: GALE|A167108893