LLLI Center for Breastfeeding Information

Journal Abstract of the Month for January 2007

“The controversy about what constitutes safe and nurturant infant sleep environments”

Authors: KH Morgan, MW Groer, LJ Smith

J Obstet Gynecol Neonatal Nurs. 2006 Nov-Dec;35(6):684-91.

Abstract:

Where Should Infants Sleep?

This question is at the center of an on-going controversy that encompasses emotional, physiological, practical, and even liability issues. It is a universal question, one that touches every mother, whether she consciously considers options or not. This article addresses some of the key issues at stake in answering this question, especially in light of recent attention given to the matter by such organizations as the American Academy of Pediatrics (AAP) and the media.

The article distinguishes between 3 forms of infant sleep locations:

Bedsharing, in which mother and baby sleep together in the same bed
Crib-sleeping, in which baby sleeps alone in a crib
Cosleeping, or “any practice in which the baby sleeps in the same room as the parents”

Cosleeping is a broad term that includes bedsharing, and may include crib-sleeping if the crib is in the same room as the parents.

The authors are very clear that wherever an infant sleeps, safety must be a major concern. Media reports of babies being smothered in their parents’ beds, or even warnings that they MIGHT be smothered, have led to the unsubstantiated notion that cribs provide the safest sleeping location for small infants. In fact, research indicates that the opposite may be true.

The Whys and Wherefores About Bedsharing

Babies were sleeping with their mothers long before cribs were invented. Not only is this convenient, especially for the breastfeeding mother, but it is also physiologically sound. A mother can respond immediately to the needs of her infant, and often in physiological ways she is unaware of. Her body temperature, breathing, and even posturing helps the immature regulatory systems of the infant maintain stability. Bedsharing, practiced safely, has been linked to lower risk of Sudden Infant Death Syndrome.

These are important benefits to the survival of young babies. Safety concerns cannot be ignored however. There are unsafe forms of bedsharing that could lead to overlaying, smothering, etc. Risk factors for bedsharing, as reported by the Academy of Breastfeeding Medicine, include:

Parental or environmental smoke exposure
Alcohol and/or drug use (including prescription medications which may cause drowsiness)
Exhaustion/sleep deprivation
Non-parental bed partners (babysitters, siblings, etc., who are not as in tuned with the infant as the parents)
Unsafe sleep surfaces: soft surfaces, couches, pillows near the infant, and overheating

The Risks of Crib-Sleeping (especially in a separate room)

The infant who sleeps alone must regulate heart rate, breathing, and body temperature on his own. He must also withstand the emotional trauma of separation from his mother. And his mother may no longer be physically close enough to detect the early feeding cues to prevent the agitation of a crying baby, which, in turn, affects everybody’s sleep. Having the crib in the same room with the parents can alleviate some of the potential problems of separate sleeping.

Cosleeping—Tailoring the Infant Sleep Location to Individual Situations

The authors recommend that health care professionals offer guidance to new parents based on discussion of lifestyles and potential benefits and risk factors of the various sleep locations. No location should be summarily dismissed, nor automatically recommended.

The authors list online guidelines from various sources, including the Academy of Breastfeeding Medicine’s “Protocol #6: Guidelines on Co-Sleeping and Breastfeeding,” http://www.bfmed.org/ace-files/protocol/cosleeping.pdf

Keywords:

Breastfeeding,
Bedsharing,
Cosleeping,
Evidence-based medicine

The full text of this article is available for a fee at:
http://www.nlm.nih.gov/loansomedoc/loansome_home.html

PubMed Link to abstract:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus &list_uids=17105632&itool=iconabstr&query_hl=5&itool=pubmed_docsum

For More Information:
LLLI FAQ: Should I sleep with my baby?
http://www.llli.org/FAQ/cosleep.html

LLLI Media Release:
LLLI Responds to AAP Policy Statement on Sudden Infant Death Syndrome
http://www.llli.org/Release/sids.html

Dr. James McKenna’s Mother-Baby Behavioral Sleep Laboratory
http://www.nd.edu/~jmckenn1/lab/

Past Journal Abstracts of the Month