Safe Sleep for Breastfeeding Babies

Sleeping with our babies is an instinct as old as motherhood itself. Yet today, some authorities say it’s risky. What are the facts?

Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS), Crib Death, or Cot Death is the unexpected and unexplainable death of a baby. The highest risk is during the first six months. The greatest SIDS risk factors are smoking during your pregnancy and placing your baby face-down for sleep.1 Formula-fed children have double the risk of SIDS.2 Parents who smoke and share a bed with their infant also increase the risk, regardless of where or when the parent smokes. One in five SIDS deaths occurs in daycare.3

Suffocation

Suffocation isn’t SIDS. It almost always involves either prone (face-down) sleeping or a baby becoming wedged, for instance in a couch4 or recliner. Sharing sleep with an adult who smokes or is impaired by drugs or alcohol is risky. Using pillows, props, or soft bedding to “help the baby sleep” increases risks.5 When a breastfeeding mother sleeps in bed with her baby, she tends to curve her body around her baby in a “cuddle curl” that keeps the infant at breast level and keeps her from rolling onto him.6 (And of course he would wriggle and yell if she did!) Her sleep cycles tend to synchronize with his, often increasing sleep time and lowering stress for both. Unfortunately, some mothers, mistakenly believing their bed is a SIDS risk, move to a couch or recliner with the baby – a much greater risk than the bed they left.7

“Cuddle Curl”

“All bedsharing,” “all babies,” and “all bed partners” are not the same, just as “all drivers” are not the same. Anything that interferes with breastfeeding puts a baby at higher risk.8 There is no known increased risk when a sober, non-smoking, breastfeeding mother sleeps with her baby on a safe surface.

Here’s what our babies have always “expected” at night:
During sleep, babies “expect”… What you can do
AN ADULT WITHIN REACH.
When they’re alone, babies’ temperature and breathing are less stable, and they have less practice in rousing – important practice! They also have more periods of apnea (no breathing) – all risk factors for SIDS.17
Keep your baby within his arm’s reach, not yours. Breathing on your baby is actually good for him. If you don’t share a bed, be sure to keep your baby in proximity (within arm’s reach) during sleep such as in a bassinet, crib, or ”sidecar” (which attaches to the bed), for at least the first 6 months.
A COMFORTABLE TEMPERATURE; overheating increases the risk of SIDS.18 Dress your baby the way you dress yourself. No extra covering or swaddling for sleep.
FREE ACCESS TO SUCKLING AT BREAST. There’s no evidence that a sleeptime pacifier helps protect a bedsharing, breastfed baby.19-21 Learn to breastfeed lying down during the day. Then, at night, you’ll already know how.
   

 

What do mothers expect at night? And how can they get it?
UNBROKEN SLEEP Babies usually double their weight by six months and triple it by a year; no wonder they breastfeed at night! Of all mothers, those who bedshare and breastfeed exclusively tend to get the most sleep.22, 23

Expect your baby to feed at night, so you won’t resent it.

If your baby doesn’t stay in your bed full-time, put him on a thin blanket or pad next to you, or in a ‘sidecar’ attached to your bed, and move baby and blanket/pad to the other surface to keep him settled during the switch.

A COMFORTABLE POSITION Practice during the day. Leaning back with your baby facing your chest is not a risk.

Because breastfeeding hormones make you relaxed and drowsy, breastfeed where your baby will be safe if your arms relax.

Lying on your side? Remember that babies tend to skootch up; you may need to slide her down for easy latching. To breastfeed from the top breast, use the bottom breast first so you can roll onto it somewhat.

A DRY BED A large towel or absorbent pad can protect sheets from both mother and baby leaks. Or use a waterproof mattress pad. Leaking milk usually subsides after the early weeks.
EASY DIAPER CHANGES Keep diapers and wipes at bedside. Once she stops pooping at night, she can probably use the same diaper all night.
ENOUGH ROOM Many families play musical beds at night. The parent without the baby can sleep anywhere, leaving mother and baby in their familiar, safe place.
A LITTLE TIME WITHOUT THE BABY Babies need lots of touch. In the beginning, life will be simpler if you don’t try to get away from the baby. And letting her sleep alone “until she wakes up the first time” can mean that she sleeps too deeply to rouse – not good for either of you and a risk for SIDS.

As she develops, you’ll find patterns that work for you and your family.

 

References

1. Fleming P, Blair PS. Sudden Infant Death Syndrome and parental smoking. Early Hum Dev. Nov 2007;83(11):721-725.
2. Vennemann MM, Bajanowski T, Brinkmann B, et al. Does Breastfeeding Reduce the Risk of Sudden Infant Death Syndrome? Pediatrics. March 1, 2009 2009;123(3):e406-410.
3. Moon RY, Sprague BM, Patel KM. Stable Prevalence but Changing Risk Factors for Sudden Infant Death Syndrome in Child Care Settings in 2001. Pediatrics. October 1, 2005 2005;116(4):972-977.
4. Blair PS, Sidebotham P, Evason-Coombe C, Edmonds M, Heckstall-Smith EM, Fleming P. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. Bmj. 2009;339:b3666.
5. Ball H. Parent-infant bed-sharing behavior. Human Nature. 2006;17(3):301-318.
6. McKenna JJ, Ball HL, Gettler LT. Mother-infant cosleeping, breastfeeding and sudden infant death syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys Anthropol. 2007;Suppl 45:133-161.
7. Blair PS, Sidebotham P, Berry PJ, Evans M, Fleming PJ. Major epidemiological changes in sudden infant death syndrome: a 20-year population-based study in the UK. Lancet. Jan 28 2006;367(9507):314-319.
8. Ball HL, Ward-Platt MP, Heslop E, Leech SJ, Brown KA. Randomised trial of infant sleep location on the postnatal ward. Arch Dis Child. Dec 2006;91(12):1005-1010.
9. Vennemann MM, Bajanowski T, Brinkmann B, et al. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics. Apr 2009;123(4):1162-1170.
10. Lahr MB, Rosenberg KD, Lapidus JA. Bedsharing and Maternal Smoking in a Population-Based Survey of New Mothers. Pediatrics. October 1, 2005 2005;116(4):e530-542.
11. Dwyer T, Ponsonby AL. Sudden infant death syndrome and prone sleeping position. Ann Epidemiol. Apr 2009;19(4):245-249.
12. Academy of Breastfeeding Medicine Protocol C. ABM clinical protocol #6: guideline on co-sleeping and breastfeeding. Revision, March 2008. Breastfeed Med. Mar 2008;3(1):38-43.
13. American Academy of Pediatrics Task Force on Sudden Infant Death S. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. Nov 2005;116(5):1245-1255.
14. IP S, Chung M, Raman G, et al. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Rockville: Agency for Healthcare Research and Quality; 2007. AHRQ Publiction # 07-E007.
15. Gerard CM, Harris KA, Thach BT. Spontaneous arousals in supine infants while swaddled and unswaddled during rapid eye movement and quiet sleep. Pediatrics. Dec 2002;110(6):e70.
16. Richardson HL, Walker AM, Horne RS. Minimizing the Risks of Sudden Infant Death Syndrome: To Swaddle or Not to Swaddle? J Pediatr. Jun 19 2009.
17. Arnestad M, Andersen M, Vege A, Rognum TO. Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984-1998: implications for future prevention and research. Arch Dis Child. Aug 2001;85(2):108-115.
18. Baddock SA, Galland BC, Beckers MG, Taylor BJ, Bolton DP. Bed-sharing and the infant’s thermal environment in the home setting. Arch Dis Child. Dec 2004;89(12):1111-1116.
19. Pollard K, Fleming P, Young J, Sawczenko A, Blair P. Night-time non-nutritive sucking in infants aged 1 to 5 months: relationship with infant state, breastfeeding, and bed-sharing versus room-sharing. Early Hum Dev. Dec 1999;56(2-3):185-204.
20. O’Connor NR, Tanabe KO, Siadaty MS, Hauck FR. Pacifiers and Breastfeeding: A Systematic Review. Arch Pediatr Adolesc Med. April 1, 2009 2009;163(4):378-382.
21. Karabulut E, Yalcin SS, Ozdemir-Geyik P, Karaagaoglu E. Effect of pacifier use on exclusive and any breastfeeding: a meta-analysis. Turk J Pediatr. Jan-Feb 2009;51(1):35-43.
22. Doan T, Gardiner A, Gay CL, Lee KA. Breast-feeding Increases Sleep Duration of New Parents. J Perinat Neonatal Nurs. Jul-Sep 2007;21(3):200-206.
23. Quillin SI, Glenn LL. Interaction between feeding method and co-sleeping on maternal-newborn sleep. J Obstet Gynecol Neonatal Nurs. Sep-Oct 2004;33(5):580-588.