Bedsharing, Breastfeeding, and Safe Infant Sleep Advice: The Caregiver's Dilemma

Laura A. Stokowski, RN, MS 


March 08, 2016

Infant Sleep Location and Breastfeeding Practices in the United States: 2011 - 2014

Smith LA, Geller NL, Kellams AL, et al.
Acad Pediatr. 2016 Feb 3.[Epub ahead of print]

Breastfeeding, Sleep Location, and Advice

To reduce the risk for sudden infant death syndrome (SIDS) and other types of infant sleep-related death, the American Academy of Pediatrics (AAP) issued updated recommendations in 2011 about safe sleep environments for infants, including the recommendation that infants be placed to sleep in their own cribs or bassinets within the mother's bedroom but not in the mother's bed (room sharing without bedsharing).[1] The AAP also recommends exclusive breastfeeding for the first 6 months of life. However, little is known about whether parents in the United States widely follow these recommendations after taking their babies home from the hospital, or whether advice against bedsharing has a negative impact on breastfeeding duration.

To describe the prevalence of breastfeeding and sleep location practices among US mothers and the factors associated with these behaviors, including advice received from outside sources, Smith and colleagues analyzed a nationally representative sample of 3218 mothers from 32 birth hospitals between January 2011 and March 2014. Mothers completed a follow-up survey when their infants were at least 60 days of age, which included questions about usual type of feeding (breast milk, formula) and sleep location (bedsharing, room sharing, separate room) and surface (type of infant bed, adult bed, sofa, infant seat, or co-sleeper) during the preceding 2 weeks. Mothers were also asked whether they had received advice from any of four sources: family, baby's doctor, hospital nurses, or media. If mothers had received advice, questions targeted whether that advice was in agreement with current AAP recommendations.

Exclusive breastfeeding was reported by 30.5% and partial breastfeeding by 29.5% of the mothers. Most mothers (65.5%) reported usually room sharing without bedsharing, and 20.7% reported usually bedsharing. Compared with mothers who room shared without bedsharing, mothers who bedshared were more likely to report exclusive breastfeeding or partial breastfeeding. The mothers who room shared without bedsharing included 58.2% of the exclusively breastfeeding mothers and 70% of the non-breastfeeding mothers. Receiving appropriate advice about sleep location or breastfeeding increased adherence to recommendations in a dose-response manner. Advice from multiple sources with the same message appears cumulative.

The investigators concluded that many mothers have not adopted AAP-recommended infant sleep location or feeding practices. Although breastfeeding was associated with higher rates of bedsharing, many breastfeeding women do not bedshare. Finally, providing advice to room share without bedsharing did not negatively affect the likelihood of breastfeeding among these mothers.


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