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LLLI Center for Breastfeeding Information

Journal Abstract and Review of the Month for October 2005

American Academy of Pediatrics Policy Statement: "The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk"

Authors: AAP Task Force on Sudden Infant Death Syndrome: John Kattwinkel, Fern R. Hauk, Maurice E. Keenan, Michael Malloy, and Rachel Y. Moon

Abstract and Review:

The AAP Task Force on Sudden Infant Death Syndrome has recommended that infants (including breastfeeding infants older than one month) be put to sleep while sucking a pacifier. According to an article on the subject written by one of the members of the Task Force, pacifier usage at the beginning of every sleep period triggers some unknown physiological mechanism that seems to promote a lower arousal threshold in the infant. It may also promote a more open airway through the forward position of the tongue. Both of these positives are already apparent in the breastfed infant, whose arousal threshold may already be lowered through safe co-sleeping and whose tongue must be forward in order to nurse efficiently. The Task Force recognizes the value of non-nutritive sucking, but states that such sucking on a pacifier does not significantly impact the breastfeeding relationship or the mother's milk supply, a statement that cannot be considered well founded in the light of the supply-and-demand nature of breast milk production. It also fails to comment on the fact that nonnutritive sucking can and does occur at the mother's breast, where it does not endanger the sustaining of the mother's milk supply at all. The Task Force acknowledges that pacifier usage increases the baby's risk of developing ear, gastrointestinal and oral Candida (thrush) infections, all of which pose threats to the baby's health.

Those knowledgeable about breastfeeding recognize that maternal-infant co-sleeping where the mother is neither a smoker, nor under the influence of substances that interfere with normal mental activity; promotes a lower arousal threshold in both mother and baby, creating an atmosphere in which each is more sensitive to the other's movements, noises, and distress than is true when they sleep separately. When cosleeping/bedsharing occurs under safe conditions, it can serve to benefit mother, baby, and the family at large.

Mothers who breastfeed their infants naturally produce hormones that encourage them to become calm and fall easily into sleep. This is why many mothers who breastfeed choose to cosleep in the first place: so they do not have to remain awake throughout the nursing period to return their babies to a separate sleeping space, as the Task Force recommends. For working mothers, who must have sufficient nipple stimulation during the limited hours they are with their babies to compensate for that lost during the work day, a nighttime situation which maximizes both enough nursing time to ensure an adequate milk supply and sufficient sleep time is imperative. Without safe co-sleeping as an option, many working mothers may be forced to choose between continuing the physically and emotionally healthy benefits of breastfeeding their children and maintaining their livelihoods.

Dr. James McKenna of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame has published extensively on ways to safely cosleep/bedshare with an infant. The Task Force cites his work in their bibliography and many of their recommendations mimic his, but they do not utilize his research. The Task Force's suggestions on areas to target for improvement disregard both the positives of bedsharing/cosleeping for both infant and parent and the potentially negative effects of those suggestions on breastfeeding management, particularly with regard to milk production and pacifier usage.

This paper is categorized by the following keywords:
Sudden Infant Death
Sleep Behavior
NonNutritious Suck

The full text of this policy statement is available at:

Dr. James McKenna's guidelines for safe co-sleeping:

Suggested Links to Professional Breastfeeding Organizations

AAP Section on Breastfeeding Policy Statement;115/2/496%20

LLLI additional informationon the benefits of nighttime nursing, safe cosleeping, and SIDS prevention from LLLI's publication for Leaders, LEAVEN ; and Members' publication, NEW BEGINNINGS

LLLI Media Releases

View the October 2005 Media Release from LLLI about this Policy Statement.

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