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7 Priorities for Counseling Parents About Nighttime Breastfeeding

For years, I’ve felt silly directing breastfeeding mothers that according to expert opinions, that they should not take their baby into their bed with them for nighttime breastfeeding.

First, it seems to strike at one of the main reasons for breastfeeding: convenience! Second, it seemed that not being in the bed invited the likelihood of sprawling out and falling asleep with the baby on the sofa — a well-recognized suffocation risk! Finally, it didn’t seem to matter what I said. According to mothers’ sheepish confessions, as well as medical journals, breastfeeding mothers would end up taking their babies to bed with them.

I’m not the only healthcare provider who has felt bound to speak the “party line” on this business with sleeping and feeding, regardless of our own thinking on the matter. Fortunately, the American Academy of Pediatrics (AAP) recently changed its tune about sleeping and breastfeeding. As you prioritize care and communicate safe practices, here are what I believe to be the 7 top priorities:

Spread the good news!

Proclaim the American Academy of Pediatrics’ new statement as exactly that: NEW! Parents often feel confused when they hear one thing from one source, and something different from another source. By making sure they understand that this is new, they will be more likely to understand why they are hearing other “old” messages from other sources.

Restate what the AAP says and doesn’t say

Restate what the AAP says, and what it doesn’t say. Specifically, the AAP says that breastfeeding mothers may take their babies into the bed for “feeding or comforting.” BUT they should return to the baby to their own sleep space when the parent is ready to return to sleep.

The AAP also acknowledges that parents often fall asleep with their babies in bed, and that it is less hazardous to do so with the infant in an adult bed than a sofa or armchair. However, the AAP urges parents to ensure their bed is a safe space for infant sleep. It should be a firm mattress free of pillows and extra blankets which might suffocate or entrap the infant.

Emphasize safe sleep habits

Emphasize that the AAP encourages parents to have their baby’s crib, bassinet, or other safe sleep space in the parents’ bedroom for the first year of life (or at least the first 6 months). Being able to respond to the baby throughout the night helps to reduce the risk of SIDS.

Set parents straight on what’s fact, and what’s fiction.

Reduce any “bed-scaring” language

Parents have so long been told that they may NOT take their baby to bed that you need to be clear in explaining the risks of bed-sharing as needed versus sleeping on a sofa, armchair, or other too-soft surface. Explain what needs to happen to make the parents’ bed “safe” for the baby to share.

Also, assure them that studies show that babies are at lower risk for SIDS when they sleep in the parent’s room. Also point out that breastfed babies have a lower risk for SIDS than formula-fed babies.

Assume parents are going to co-sleep

Sometimes, you just have to get real. Assume that there is a high likelihood that the parents will fall asleep with their babies. In a recent conversation with me, Dr. Cecilia Tomori confirmed and expanded upon the research that I’ve read, and the stories I’ve heard from parents, that they inevitably do sleep with their babies sometimes.

Try to convey to parents that they can share with you what really happens in their homes, not what they think they “should” say.

Recognize and encourage honest dialogue

Recognize that candid, honest dialogue allows you to address the factors that contraindicate bedsharing (such as smoking, soft surfaces, substance abuse, being overtired) and increase the baby’s risks for Sudden Infant Death Syndrome (SIDS). For reference, check out my discussion with author lactation consultant and author Diana West, which included the “Safe Sleep Seven” from her popular book about “Sweet Sleep.”

Help parents to take the longer view

Help parents to take the longer view. Awakening every 2-3 hours for a feeding can seem like a struggle for a mother who wishes to exclusively breastfeed. However, it’s only a few months or so before most babies begin to have at least one 5-hour stretch of sleep. Knowing that “every 2-3 hour” wake-ups are temporary can make it easier for mothers to meet the goal for exclusive breastfeeding 6 months.

As Dr. Tomori and I note, new parents rarely have a plan for nighttime parenting. By focusing the conversation, we can begin to help parents to develop a plan that will, hopefully, work for them and their baby.

What tips do you have for talking with parents about nighttime parenting, feedings, and sleep?

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