October is SIDS Awareness Month. Longtime readers of my blog, and those who have attended any of my courses, know that the advice has changed quite a bit over the years, especially as that advice relates to the breastfed baby’s risk for SIDS. Let’s take a look at the facts.
What is SIDS?
SIDS is the sudden death of an infant less than 1 year old, that cannot be explained after a thorough investigation. That includes a complete autopsy, examination of the death scene, and a review of the medical history. It is different from Accidental Suffocation and Strangulation in Bed (ASSB). ASSB is the sudden death of an infant less than 1 year old due to suffocation by soft bedding or pillows, overlay by another person, wedging or entrapment, or strangulation.
For decades, the medical community lumped SIDS together with ASSB. Doctors advised mothers not bring their babies into bed with them — at any time, for any reason. Recent studies have shown that advice is a myth — at least for breastfeeding mothers.
What’s the link between breastfeeding and SIDS?
My favorite source of information about breastfeeding-related health is the multidisciplinary and international Academy of Breastfeeding Medicine (ABM). In its 2019 revision of its “Bedsharing and Breastfeeding” protocol, the ABM states quite plainly:
“Existing evidence does not support the conclusion that bedsharing among breastfeeding infants … causes sudden infant death syndrome (SIDS) in the absence of known hazards.”
In other words, if you’re a mother who breastfeeds your baby, he’s not automatically at risk of SIDS by sleeping next to you in bed.
Note, however, that the American Academy of Pediatrics (AAP) isn’t as warmly accepting of bedsharing as the ABM.
The AAP, in its latest SIDS recommendations (published in 2011 and reaffirmed in 2015), does acknowledge that breastfeeding mothers may bring their babies into bed for feeding. This advice is given primarily out of concern for the danger posed by falling asleep while breastfeeding on a sofa or in a chair. However, the group urges parents to return the baby to their crib once feeding is done.
When should you not bedshare?
Your breastfed baby’s risk for SIDS is related to his sleep environment. If you’re thinking about bedsharing, review these risk factors. These can increase an infant’s risk of SIDS and ASSB:
- Sleeping on a sofa or chair with a sleeping adult
- Sleeping on soft bedding (including infant positioners)
- Sleeping with an adult impaired by alcohol/drug use
- Sleeping with an adult who smokes
- Sleeping in the prone (tummy-down) position
- Never being breastfed
- Being preterm at birth, or having low birthweight
You can change some of these hazards. For example, you can avoid sleeping on a chair or sofa, you can remove any soft bedding from your bed. You can stop smoking, avoid using drugs or alcohol, breastfeed your baby, and put him to sleep on his back. Others you can’t — including have a baby who is born preterm or with a low birthweight.
Consider the benefits
Some studies have shown that bedsharing is beneficial for breastfeeding, at least when it comes to exclusive breastfeeding. It may be, in part, due to the physiologically different experience of mother-baby pairs that are “breastsleeping” versus those that are formula-feeding.
Research by James McKenna, PhD, of Notre Dame’s Mother-Baby Behavioral Sleep Laboratory (and co-author on the ABM’s Bedsharing guidelines) shows that, bedsharing between mother-baby pairs without risk factors for SIDS leads to optimal infant breastfeeding (both exclusivity and duration), neonatal attachment, and brain growth.
At the very least, room-share
I’m not suggesting that all breastfeeding mothers should sleep with their babies all night long.
If you have the risk factors listed above, bedsharing may increase breastfed baby’s risk for SIDS or ASSB. Also, if you are a very sound sleeper, or if your partner is a very sound sleeper, even if you don’t have any other risk factors, it may not be right for you.
But do you know how breastfed baby’s risk for SIDS can be reduced? Room-sharing!
The AAP and ABM agree that room-sharing, with the baby sleeping in a crib in the parents’ room, should be emphasized with every family. Room-sharing should occur for at least the first six months or, ideally, for the first year.
Following these recommendations will help to ensure safer, better sleep for everyone in the family, during the first year, and beyond.
For more information on safe sleep, see the AAP’s HealthyChildren guidance for parents.
For more on safe sleep while bedsharing, listen to my podcast with Dr. McKenna here.
How did you reduce your breastfed baby’s risk for SIDS? Tell us in the comments below!