Academy of Breastfeeding Medicine issues co-sleeping and breastfeeding guidelines

Contrary to even the recommendations of its own section on breastfeeding, the American Academy of Pediatrics (AAP) released an statement from its Task Force on SIDS¹ (sudden infant death syndrome) the Academy of Breastfeeding Medicine has problems accepting.

Recommendations that advise against parent-infant bed-sharing and support the generic use of pacifiers imply a "truly astounding triumph of ethnocentric assumptions over commonsense and medical research," according to Nancy Wight, M.D., president of the Academy of Breastfeeding Medicine.

These issues will be addressed in the new peer-reviewed journal Breastfeeding Medicine, the journal of the Academy of Breastfeeding Medicine.

Current research from the CDC², as well as AAP’s existing policy statement on Breastfeeding and the Use of Human Milk³, note breastfeeding is associated with a lower risk of SIDS.

Since 1992, SIDS has decreased as both co-sleeping and breastfeeding have increased. Sleeping near one’s baby or in the same room has been shown to reduce the risks of SIDS and more broadly promote maternal and child health by facilitating breastfeeding.

As exclusively breastfed infants feed frequently through the night, breastfeeding is thought to reduce SIDS by the same proposed mechanism as supine sleep and pacifiers, namely less deep sleep and frequent brief awakenings.

Breastfed babies do not need artificial pacifiers to get stimulation since they already have the protective effect of suckling during the night. Pacifiers have been associated with increased risk of ear infections, later dental problems, and reduced breastfeeding.

As reduced breastfeeding increases infant mortality from infectious disease and several other causes, the ABM agrees with the AAP that a pacifier should not be introduced until breastfeeding is well established and never forced on an infant.

Pacifiers would only be of possible benefit to infants lacking the natural opportunity of breastfeeding.

Extensive research on infant sleep has revealed that infants are frequently aroused to lighter stages of sleep by parental movement when co-sleeping.

Dr. James J. McKenna, of the University of Notre Dame, was a consultant to the AAP on the new policy, but disagrees strongly with their conclusions.⁴ He points out there are many forms of co-sleeping, and that recommendations for safe co-sleeping need to be publicized.

Co-sleeping is defined as sleeping in close proximity to one’s infant, which can include but does not necessarily imply being in the same bed.

Infants should never co-sleep with other siblings, with smoking or substance-abusing parents, on sofas or waterbeds, with soft bedding materials, or adjacent to spaces that could trap the infant.

As with sleeping in a crib, infants should be placed on their backs, with only a thin blanket on a firm bedding surface.

Evidence-based recommendations regarding co-sleeping and breastfeeding may be found in Protocol #6 on the Academy of Breastfeeding Medicine’s site.

Citations

1. AAP Task Force on Sudden Infant Death Syndrome. The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding Sleeping Environment, and New Variables to Consider in Reducing Risk. Pediatrics November 2005; 116(5):1245-1255
2. American Academy of Pediatrics, Section on Breastfeeding, Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics 2005; 115(2):496-506
3. Chen A, Rogan WJ. Breastfeeding and the Risk of Post-neonatal Death in the United States. Pediatrics 2004; 113:e435-439 URL: http://www.pediatrics.org/cgi/content/full/113/5/e435
4. McKenna JJ, McDade T. Why babies should never sleep alone: A Review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Pediatric Respiratory Reviews 2005; 6:134-152

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