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LLLI Center for Breastfeeding Information

Journal Abstract and Review of the Month for December 2005

"Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding"

Authors: James J. McKenna and Thomas McDade

Paediatric Resp Revs (2005) 6:134-152.


In stark contrast to the recent 2005 AAP Policy Statement on sleep environment and the risk of Sudden Infant Death (SIDS), which condemned all co-sleeping and bedsharing as unsafe, the authors provide a clear picture of the anthropological and biological reasons why human beings are predisposed to co-sleep with their infants. They discuss how definitions of what constitutes a "normal" sleep pattern and sleep environment have changed during the last 100 years and how the science surrounding a definition of "normal"sleep has been manipulated in an attempt to prove itself through circular logic. He counters this modern concept that "safe sleep is alone sleep" with discussions of why, particularly for breastfeeding infants, sleeping with an attentive, unimpaired mother is not only safe but biologically sound.

Those who seek information on non-American cultures as it relates to co-sleeping will find a great deal here. Japanese, Chinese, and other Asian cultures that have both high co-sleeping and low SIDS rates are discussed, as are studies from Britain. The authors look deeply at how cultural attitudes toward both breastfeeding and co-sleeping influence parental decisions, pointing out that even in the nonsupportive American culture, many parents choose to co-sleep because they instinctively "feel" it is right.

Of particular interest are the annotated definitions for co-sleeping (mom and baby nearby but on separate surfaces) and bedsharing (mom and baby in the same bed) and why one is publicly supported while the other is not. The authors, unlike the authors of the AAP statement, recognize that all co-sleeping situations are unique, with multiple variables that prevent accurately extrapolating neither universal norms nor uniform replication. Instead, the authors refer repeatedly to the common sense guidelines for safe co-sleeping developed by Dr. McKenna and point out the various physiological processes that support the baby's safety in a co-sleeping environment. Of special note is the statement that one of breastfeeding's protective effects is that a baby in the prone position has significantly more control over its head, breathing, limbs, and environment and is also able to breastfeed, while a baby sleeping on its stomach cannot. This supports the authors' idea that breastfeeding and co-sleeping automatically provide the safest environment for the developing infant.

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

The full text of this article is available (for a fee) at:

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

LLLI additional information on the benefits of nighttime nursing, safe co-sleeping, 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 the AAP PolicyStatement Policy Statement.

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