Breastfeeding and Co-sleeping

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Definitions of terms used in this article1

  • Sudden Unexpected Death in Infancy (SUDI). The sudden, unexpected death of a baby, in which a cause of death is not immediately obvious. SUDI is a research classification which includes both SIDS and fatal sleeping accidents.
  • Fatal sleeping accident. Death of a baby occurring during sleep, as a result of an accident such as a fall, suffocation or overlaying.
  • Bed-sharing. Bringing baby onto a sleep surface when co-sleeping is possible, whether intended or not.
  • Room-sharing. The baby sleeps in a cot or other separate sleeping surface in the same room as the parents.
  • Sharing the same sleep surface. This includes the practices of bed-sharing and co-sleeping on the same sleep surface. This terminology allows differentiation of the risks associated with solitary sleeping (baby sleeping in a separate room), room-sharing and environments in which the baby and caregiver share the same sleep surface.
  • Sudden Infant Death Syndrome (SIDS). The sudden and unexpected death of a baby under 1 year of age, with onset of the lethal episode apparently occurring during sleep, that remains unexplained after a thorough investigation including performance of a complete autopsy and review of the circumstances of death and a clinical history.
  • Co-sleeping. A mother and/or her partner (or any other person) being asleep on the same sleep surface as the baby.
  • Solitary sleeping. The baby sleeps in a room separate to the parents or caregiver.

Breastfeeding has a protective effect against SIDS.2

There are several theories proposed as to why breastfeeding has a protective effect against sudden unexpected deaths in infancy. These include:

  1. Breastfed babies are more easily aroused from sleep than formula-fed babies at 2–3 months of age, which is within the 2–4 month peak age during which SIDS occurs.3
  2. Breastfeeding provides babies with important immune factors (eg antibodies and white blood cells). These immunological properties of breastmilk may help to protect babies from SIDS.4
  3. Some babies whose deaths are sudden and unexpected have had a minor infection in the days preceding death that was not considered sufficient alone to have caused death.5 Breastfed babies suffer fewer infections (eg respiratory and gastrointestinal infections) than formula-fed babies.6

Co-sleeping is common

Many parents find that bringing their baby into their bed helps them to care for their baby at night. Even when parents, prior to their baby’s birth, do not intend to co-sleep with their baby, it is still common for parents to do so at least at some point overnight.7 One Australian study found that 80% of babies spent some time co-sleeping in the first 6 months of life.8

Breastfeeding and co-sleeping

Babies need to be fed during the night and many new mothers fall asleep while feeding their baby. Co-sleeping helps to minimise disruption to sleep for both a mother and her baby.

Breastfeeding and co-sleeping mutually support each other. The convenience of co-sleeping for breastfeeding at night is the reason parents most commonly give for choosing to co-sleep.9 Mothers who bed-share with their baby tend to breastfeed longer and maintain exclusive breastfeeding longer than those who do not co-sleep.10–12

Breastfeeding is protective against SIDS. Further protecting her baby, a breastfeeding co-sleeping mother usually adopts a position that facilitates close physical contact and observation of her baby.13,14 She tends to keep her baby at the level of her breast with an arm between her baby’s head and the pillow. She also instinctively bends her legs completing the protective space around the baby, making it impossible for another person to roll onto the baby without first coming into contact with her legs.15,16 A breastfeeding mother who co-sleeps with her baby (and has not consumed alcohol, illegal or sleep-inducing drugs or extreme fatigue) also tends to be highly responsive to her baby’s needs.17,18 Studies show more frequent arousals in both mothers and babies when they co-sleep, and some researchers have suggested that this may be protective against sudden unexpected infant deaths.19–21 Babies are checked by their mother and breastfeed more frequently when co-sleeping than when room-sharing.22,23

Risk factors for SUDI when co-sleeping

Under certain circumstances, some studies have reported an increased risk of SUDI in co-sleeping babies. The following risk factors have been identified:

  • Smoking

A baby exposed to cigarette smoke (eg if the mother or father smokes, or the mother smoked during pregnancy) increases the risk of SIDS, regardless of where the baby sleeps. Smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby.24–26 Parents who smoke are encouraged to room-share as long as the room the baby sleeps in is kept smoke-free, as their babies have an increased risk of sudden infant death and therefore require closer observation.

  • Alcohol, drugs or extreme fatigue

Babies are at increased risk of a fatal sleeping accident if they co-sleep with someone who is has consumed alcohol or illegal or sleep-inducing drugs or who is experiencing extreme fatigue.27,28 A parent should not co-sleep with their baby if they have consumed alcohol or illegal or sleep-inducing drugs, or when extremely fatigued.

  • Sharing a sleeping surface with a sibling(s) or a pet(s)

Babies are at increased risk of death if they co-sleep with more persons than their parents (eg other siblings)29 or with a pet.30 Co-sleeping with a sibling raises the risk.31 Babies should not co-sleep if anyone other than the parents is in the bed.

  • Obesity

Parents who are obese may not be able to feel exactly where or how close their baby is and so may wish to room-share with their baby.32 Obese parents should not co-sleep with their baby.

  • Formula-fed babies

Dr James McKenna recommends that formula-fed babies room-share with their parents rather than co-sleep, because mothers who formula feed their babies do not demonstrate the same responsive night-time parenting practices as breastfeeding mothers.33

  • Sofa-sharing

Using a sofa, couch, beanbag or armchair as a sleeping place for a baby increases the risk of a fatal sleeping accident.34,35 Caregivers should never co-sleep with a baby on a sofa, couch or armchair. Babies can suffocate against cushions or become wedged between the seat and the back of the sofa whether or not a sleeping adult is present.

  • Young baby and overheating or head covering

It has been thought that the risk of death in a young baby who co-sleeps with a parent may be increased if the baby overheats or if the baby’s head becomes covered.36 Some studies have reported a higher risk of death when a young baby (ie under the age of 12 weeks) shares a bed with a parent.37–40 These studies did not however consider all known risk factors such as alcohol or drug use, or multiple bed-sharers. In addition, the peak age for SIDS has always been within this range no matter where the baby sleeps.

  • Baby alone on an adult bed

Leaving a baby unattended on an adult bed also increases the risk of a fatal sleeping accident.41

  • Infant wrapping and swaddling

Do not wrap baby if sharing a sleep surface as this restricts arm and leg movement.42

Room-sharing

There is a lower risk of SIDS when a baby room-shares with parents as compared to a baby sleeping alone in another room (solitary sleeping).43 Sleeping in a room with other children has no protective effect. A 2004 European study reported that about 36% of SIDS cases in this study were attributable to the baby sleeping alone and 16% attributable to co-sleeping.44

Co-sleeping and non-smoking and sober parents

The main risks of co-sleeping with non-smoking and sober parents are thought to be overheating and head covering. Electric blankets should not be used. The bed should be arranged so that the baby is not near a pillow and nor is the head covered by a doona, blanket, sheet or pillow. Babies should always be placed on their back to sleep, never face down. They should not be swaddled or wrapped, but be free to move. The mattress should be firm and flat and there should be no chance for the baby to be trapped against a wall or another bed or between the sides of the bed and the mattress.

Summary

  • Most SUDI deaths occur when a baby is sleeping alone outside the supervision of a committed adult.45
  • Parents who co-sleep need to be aware of the risks and arrange the sleeping space to minimise these risks.
  • Co-sleeping with a parent who smokes increases the risk of SUDI including SIDS and smoking parents (or a mother who smoked during pregnancy) should never co-sleep with their baby.
  • Parents affected by alcohol, drugs or extreme fatigue should not co-sleep with their baby while under the influence of those conditions.
  • A sofa is not a safe sleeping place for a baby with or without a parent present as it increases the risk of infant death.
  • Co-sleeping has the potential to benefit babies in that it supports breastfeeding and therefore a baby’s health.
  • It also helps parents get more sleep.46
  • The challenge is to lower infant death rates without compromising breastfeeding.
  • It is unlikely that bed-sharing in itself is a risk factor for SUDI but rather the particular circumstances in which co-sleeping occurs.

For further information

Six ways to reduce the risk of sudden unexpected death in infancy and sleep baby safely (from Red Nose)

1. Sleep baby on the back from birth, not on the tummy or side

2. Sleep baby with head and face uncovered

3. Keep baby smoke free before birth and after

4. Provide a safe sleeping environment night and day

5. Sleep baby in their own safe sleeping place in the same room as an adult care-giver for the first six to twelve months

6. Breastfeed baby  

The information on this website does not replace advice from your health care providers.

© Australian Breastfeeding Association August 2017

References

  1. Queensland Health 2008 Safe Infant Care to Reduce the Risk of Sudden Unexpected Deaths in Infancy Policy Statement and Guidelines. Queensland Government, Queensland Australia
  2. Alm, B., Wennergren, G., Mollborg, P., Lagercrantz, H 2015, Breastfeeding and dummy use have a protective effect on sudden infant death syndrome. Acta Paediatr 105(1),31–38. 
  3. Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., Vennemann, M.M 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 128(1),103-10.
  4. Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., Vennemann, M.M 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 128(1),103-10.
  5. Hauck, F.R., Thompson, J.M., Tanabe, K.O., Moon, R.Y., Vennemann, M.M 2011, Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis, Pediatrics, 128(1),103-10.
  6. Sankar, M.J., Sinha, B., Chowdhury, R., Bhandari, N., Taneja, S., Martines, J., Bahl, R (2015), Optimal breastfeeding practices and infant and child mortality: a systematic review and meta-analysis. Acta Paediatr 104(467),3-13.
  7. Ball HL, Hooker E, Kelly PJ 2000, Parent-infant co-sleeping: Fathers’ roles and perspectives. Inf. Child Dev 9: 67-74.
  8. Rigda RS, McMillen IC, Buckley P 2000, Bed sharing patterns in a cohort of Australian infants during the first six months after birth, J. Paediatr Child Health 36: 117-121.
  9. Ball, H.L 2002, Reasons to bed-share : why parents sleep with their infants, Journal of reproductive and infant psychology, 20 (4):207-222.
  10. Ball, H.L 2003, Breastfeeding, bed sharing and infant sleep. Birth. 30(3): 181-188.
  11. Blair, P.S., Heron, J., Fleming, P.H 2010, Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis Pediatrics 126(5): e1119-e1126.
  12. McCoy, R.C., Hunt, C.E., Lesko, S.M., Vezina, R., Corwin, M.J., Willinger, M., Hoffman, H.J., Mitchell, A.A 2004, Frequency of bed sharing and its relationship to breastfeeding Dev Behav Pediatr. 2004, 25(3),141-114.
  13. Young, J 1998, Bed-sharing with Babies: The Facts, RCM Midwives Journal, 1(11),338-341.
  14. Young, J 1999, Night-time behaviour and interactions between mothers and their infants of low risk for SIDS: a longitudinal study of room-sharing and bed sharing, PhD thesis: Institute of Child Health,University of Bristol.
  15. Baddock, S.A., Galland, B.C., Taylor, B.J., Bolton, D.P.G 2007, Sleep arrangements and behavior of bed-sharing families in the home setting Pediatrics. 119(1),e200-e207.
  16. Young, J 1999, Night-time behaviour and interactions between mothers and their infants of low risk for SIDS: a longitudinal study of room-sharing and bed sharing, PhD thesis: Institute of Child Health,University ofBristol.
  17. Baddock, S.A, Galland, B.C., Taylor, B.J., Bolton, D.P.G 2007, Sleep arrangements and behavior of bed-sharing families in the home setting Pediatrics. 119(1), e200-e207.
  18. McKenna, J.J., McDade, T 2005, Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding Paediatr Respir Rev. 2005, 6(2),134-52.
  19. Blair, P.S., Ward-Platt, M., Smith, I.J., Fleming, P.J and the CESDI SUDI Research Group 2006, Sudden infant death syndrome and the time of death: factors associated with night-time and day time deaths. International Journal of Epidemiology 35(6),1563-1569.
  20. Mosko, S., Richard, C., McKenna, J 1997, Maternal sleep and arousals during bedsharing with infants. Sleep. 20(2),142-150.
  21. Horne, R.S., Parslow, P.M., Harding, R 2004, Respiratory control and arousal in sleeping infants Paediatr Respir Rev. 5(3),190-198.
  22. Baddock, S.A., Galland, B.C., Bolton, D.P., Williams, S.M., Taylor, B.J 2006, Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting Pediatrics. 117(5),599-1607.
  23. Young, J 1999, Night-time behaviour and interactions between mothers and their infants of low risk for SIDS: a longitudinal study of room-sharing and bed sharing, PhD thesis: Institute of Child Health,University ofBristol.
  24. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191.
  25. Scragg, R., Mitchell, E.A., Taylor, B.J., Stewart, A.W., Ford, R.P.K., Thompson, J.M.D., Allen, E.M., Becroft, D.M.O on behalf of the New Zealand Cot Death Study Group 1993, Bed sharing, smoking, and alcohol in the sudden infant death syndrome. BMJ 307,1312-1318.
  26. Vennemann, M.M., Hense, H.W., Bajanowski, T., Blair, P.S., Complojer, C., Moon, R.Y et al 2012, Bed Sharing and the risk of sudden infant death syndrome: can we resolve the debate? Pediatr. 160(1),44-48.e2.
  27. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191.
  28. Vennemann, M.M., Hense, H.W., Bajanowski, T., Blair, P.S., Complojer, C., Moon, R.Y et al 2012, Bed Sharing and the risk of sudden infant death syndrome: can we resolve the debate? Pediatr. 160(1),44-48.e2.
  29. Hauck, F. R., Herman, S. M., Donovan, M., Iyasu, S., Moore, C., Donoghue, E., et al. (2003). Sleep environment and the risk of sudden infant death syndrome in an urban population: The Chicago Infant Mortality Study. Pediatrics, 111(5), 1207–1214.
  30. Red Nose 2017, Sharing a sleep surface with a baby. Accessed 6/8/17 from https://rednose.com.au/article/sharing-a-sleep-surface-with-a-baby
  31. McKenna, J 2012, Frequently Asked Questions, Accessed 6/8/17 from: http://cosleeping.nd.edu/frequently-asked-questions/
  32. McKenna, J 2012, Frequently Asked Questions, Accessed 6/8/17 from: http://cosleeping.nd.edu/frequently-asked-questions/
  33. McKenna, J 2012, Frequently Asked Questions, Accessed 6/8/17 from: http://cosleeping.nd.edu/frequently-asked-questions/

Ball, H.L 2006, Parent-infant bed-sharing behavior : effects of feeding type, and presence of father. Human nature : an interdisciplinary biosocial perspective, 17(3),301-318.

34. Blair, P.S., Fleming, P.J., Smith, I.J., Ward, Platt, M., Young, J., Nadin, P., Berry, P.J., Golding, J., CESDI SUDI Research Group 1999, Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ 319,1457-1461.

35. Byard, R.W., Beal, S., Blackbourne, B., Nadeau, J.M., Krous, H.D.F 2001, Specific dangers associated with infants sleeping on sofas. J Paediatr Child Health 37,476-478.

36. Vennemann, M.M., Hense, H.W., Bajanowski, T., Blair, P.S., Complojer, C., Moon, R.Y., et al 2012, Bed Sharing and the risk of sudden infant death syndrome: can we resolve the debate? Pediatr. 160(1),44-48.e2.

37. Blair, P.S., Fleming, P.J., Smith, I.J., Ward, Platt, M., Young, J., Nadin, P., Berry, P.J., Golding, J., CESDI SUDI Research Group 1999, Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ 319,1457-1461.

38. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191.

39. McGarvey, C., McDonnell, M., Hamilton, K., O’Reagan, M., Matthews, T 2006, A 8 year study of risk factors for SIDS: bed-sharing versus non-bed-sharing. Arch Dis Child 91.318-323.

40. Ruys, J.H., de Jonge, G.A., Brand, R., Engelbert,s A.C., Semmekrot, B.A 2007, Bed-sharing in the first four months of life: a risk factor for sudden infant death. Acta Paediatr 96,1399-1403.

41. McKenna, J.J., McDade, T 2005, Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding Paediatr Respir Rev 6(2),134-152.

42. Red Nose 2017, Sharing a sleep surface with a baby. Accessed 6/8/17 from https://rednose.com.au/article/sharing-a-sleep-surface-with-a-baby

43. Scragg, R.K.R., Mitchell, E.A., Stewart, A.W., Ford, R.P.K., Taylor, B.J., Hassall, I.B., Williams, S.M., Thompson, J.M.D 1996, Infant room-sharing and prone sleep position in sudden infant death syndrome. Lancet 347,7-12.

44. Carpenter, R.G., Irgens, L.M., Blair, P.S., England, P.D., Fleming, P., Huber, J., Jorch, G., Schreuder, P 2004, Sudden unexplained infant death in 20 regions in Europe: case control study. Lancet. 363,185-191.

45. McKenna, J.J., McDade, T 2005, Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding Paediatr Respir Rev 6(2),134-152.

46. McKenna J.J., Mosko, S.S 1997, Bedsharing promotes breastfeeding, Pediatrics. 100(2 Pt 1),214-219.

Last reviewed: 
Aug 2017