“In most parts of the world… babies sleep close to their mothers, as they have through most of history.” – The Womanly Art of Breastfeeding
A baby is born expecting to stay in close contact with his mother night and day, in order to keep safe, warm and well-fed.
It is perfectly normal for babies—especially breastfed babies—to wake and feed at night throughout at least the first year. A baby may show a very strong preference for staying next to his mother at night.1 Parents who follow advice to never take their baby into bed with them may have difficulty getting enough sleep.
Bedsharing† when breastfeeding is a traditional way of caring for a baby at night—breastfeeding at night can be a whole lot easier when you take your baby into bed with you and feed lying down.
Breastfeeding mothers who bedshare† get more sleep than bottlefeeding mothers2 and breastfeed for longer.3 At least two-thirds of breastfeeding mothers bedshare at some point and those who follow advice not to bedshare may go to much riskier sofas and reclining chairs in the middle of the night.4
Infant sleep–what are the risks?
The Safe Sleep Seven
Meeting Everyone’s Needs
Sleep Safely
Easy Nights
Infant sleep–what are the risks?
Accidents Babies sleep in a variety of places at different times. Wherever a baby sleeps an accidental injury is possible. A baby could become wedged between furniture or against a parent’s body, fall off the sleep surface or risk suffocation or strangulation by pillows, cords or blankets.
Breastfed babies orient themselves near their mother’s breast in bed. Dr Helen Ball’s research5 shows that mothers who sleep in bed with their breastfed babies adopt a protective position, making overlaying difficult and smothering by pillows or bedding unlikely. This has been referred to as the ‘cuddle curl’ position.
SIDS A sudden unexpected infant death (usually occurring during sleep) that can’t be explained by a medical condition, infection, intentional harm, or accidental causes, is known as SIDS (Sudden Infant Death Syndrome). SIDS can happen in any sleep situation, but research has shown that some babies are more vulnerable than others, mainly during the first four months.
Managing SIDS risk Listed highest first, the following factors increase SIDS risk for a vulnerable baby, wherever he sleeps.
Exposure to smoke, particularly before birth, can affect a baby’s ability to rouse from sleep. The risk is related to how much exposure a baby has. It is always a good idea to reduce your baby’s exposure to smoke wherever he sleeps, but if you are a smoker you should not share a sleep surface with your baby.
Placing a baby on his front to sleep may affect his ability to arouse and to breathe. ‘Back to Sleep’ campaigns have reduced SIDS in many Western countries. Bedsharing breastfeeding mothers often nurse in a side-lying position—when a baby comes off the breast he naturally rolls onto his back. Once he can roll back and forth a baby can choose his own sleep position.
Being unattended. Since most SIDS incidents happen out of sight of adults, it makes sense to have your baby nearby and keep a watchful eye on him. Anything that reduces your alertness or ability to respond to your baby, such as alcohol, drugs or certain medications, can pose a risk and/or impair your judgement.6
Formula-feeding imposes a statistically significant higher risk of SIDS, so it’s sensible to avoid using formula unless you absolutely need it.
Overheating. If bedsharing, keep your baby lightly dressed and avoid heavy bedding. Swaddling increases the risk of overheating and reduces a baby’s ability to move and make you aware of his needs.
The Safe Sleep Seven
Breastfeeding mothers who meet the criteria below are statistically low risk and can bedshare with confidence.
You need to be:
- A non-smoker
- Sober (no drugs, alcohol, or medications that could make you drowsy)
- Breastfeeding
Your baby needs to be:
- Healthy (not ill or premature)
- Kept on his back when he’s not breastfeeding
- Unswaddled, wearing no more than a sleepsuit or light pyjamas
You both need to be:
- On a safe surface. Never sleep with your baby on a sofa or armchair.
Make an informed decision
Use the information above along with our checklist overleaf to evaluate your baby’s different sleeping places and your own personal family circumstances, to reduce the risk of an accident wherever you and your baby sleep.
Meeting Everyone’s Needs
If you are struggling to reconcile your own sleep needs with those of your baby, then talking with an LLL Leader may be helpful. Many mothers find attending an LLL meeting and hearing how other mothers meet their own families’ varying sleep needs can make a real difference.
Find local support here.
Call our helpline: 0345 120 2918
†Co-sleeping or bedsharing?
Bedsharing here implies a baby sharing an adult bed with one or both parents.
Co-sleeping implies a baby sleeping close to his parents but not necessarily in the same bed, eg in a bedside cot, or a sidecar cot attached to the bed. Some studies combine sofa sleeping with bedsharing, making it more difficult to separate the risk factors for each scenario. See https://tinyurl.com/ya4r42ck .
Sleep safely
Sleep tips
Do
✔ Place your baby to sleep on his back.
✔ Avoid exposing your baby to cigarette smoke at any time as this increases the risk of SIDS.
✔ Keep your sleeping baby close day and night, not in a room alone.
✔ Sleep facing your baby in bed (your thigh should prevent him slipping under the covers).
✔ Place your baby with his feet to the foot of any cot, crib or pram.
✔ Check your baby’s sleeping place for hazards:
✔ Choose a firm, flat, clean, well-fitting mattress and cover with a close-fitting sheet.
✔ Check for gaps he might get trapped in.
✔ Ensure he can’t fall out.
✔ Choose nightclothes without strings or ties that might strangle.
✔ Keep pillows and your covers away from your baby.
✔ Ensure anyone in the bed knows your baby is there.
✔ Keep an adult between any older children and your baby in bed.
✔ Check your baby does not get too hot or too cold whilst sleeping. In hot weather, open a window or use a fan.
✔ Keep pets out of your baby’s bed.
Don’t leave your sleeping baby:
✘ Near a fire or radiator, or in full sun.
✘ Wearing warm outdoor clothing when indoors.
Don’t sleep with your baby:
✘ If he is swaddled or in a sleeping bag.
✘ On a sofa or armchair.
✘ On a soft mattress. It isn’t known whether memory foam mattresses are a problem.
✘ If any person in the bed has drunk alcohol, taken drugs (legal or illegal) that could make them extra sleepy, or is too exhausted to be aware of your baby.
✘ If any person in the bed is a smoker (even if they never smoke in bed).
✘ If any person in the bed has an illness or condition that affects their awareness of your baby.
“Once you can feed the baby while comfortably stretched out, you’ve eliminated much of the work of mothering for eight of the 24 hours in a day.”
– The Womanly Art of Breastfeeding
Easy Nights
Many mothers have found that being inventive with their sleeping arrangements can help make nights easier with a baby. Some of these ideas might make nights easier for you too. But because only you know your own circumstances, always keep safety in mind.
Extra space can help. Try:
• Using a cot designed for co-sleeping.
• Pushing your baby’s cot right up to your bed. Lower the side and raise the base for easy access at night; tie the cot to your bed if you can.
• Using a king-size bed.
• Putting a single bed at the side for your partner, if you have one, to sleep on—keep your baby away from the gap in the mattresses.
Avoid tumbles by:
• Using a guard rail.
• Taking the legs off the bed or putting the mattress on the floor.
Keep comfortable by:
• Perhaps having separate bedding for each sleeper—but keep your own bedding away from your baby.
• A front opening cardigan can help your arms stay warm.
• Dressing your baby in light nightclothes to avoid overheating.
• Putting an extra thick nappy on your baby to avoid unnecessary changes in the night.
• Keeping a towel handy in case of damp nappies or leaking milk.
Learn to feed lying down by:
• Practising in the daytime!
• Going to a La Leche League meeting and learning from other mothers.
• Watch our video on breastfeeding while lying on your side:
These safety tips apply to healthy full-term breastfed infants. Preterm and low birth weight babies are more vulnerable. If your baby seems unwell, seek medical advice promptly. Remember that safety tips can help reduce the risk of SIDS and accidents wherever your baby sleeps, but cannot eliminate the risk altogether.
Written by mothers of LLLGB.
Further Reading
Dummies & Breastfeeding
Rhythms & Routines
I need some sleep
Letting Babies Cry – the Facts Behind the Studies
The Reasons Why Night Waking is the Biological Norm
LLLI Resources
Infant Sleep by Professor Helen Ball
Books
Sweet Sleep: Nighttime & Naptime Strategies for the Breastfeeding Family Wiessinger, West, Smith, Pitman, LLLI London: Pinter & Martin, 2014
The Womanly Art of Breastfeeding, LLLI. London: Pinter & Martin, 2010.
Sleeping With Your Baby McKenna, JJ. Washington DC: Platypus Media, 2007.
Helping Your Baby to Sleep: Why Gentle Techniques Work Best. Gethin, A. & Macgregor, B. Lane Cove AU: Finch, 2011.
Other websites
Infant Sleep Information Source
UNICEF: Caring for your baby at night. (link to UNICEF PDF)
University of Durham sleep lab
The Safe Sleep 7
References
1 Wailoo, M. & Ball, HL. et al. Infants bed-sharing with mothers. Arch Dis Child 2004; 89(12):1082–83.
2 Blair, PS. et al. Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England. BMJ 2009; 339:b63666.
3 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. Paediatr Respir Rev 2005; 6(2):134–52.
4 Ball, HL. The latest on bed sharing and breastfeeding. Community Practitioner 2012; 85(1):29–31.
5 Hrdy, SB. Mother Nature: A History of Mothers, Infants and Natural Selection. New York: Ballantine Books, 1999.
6 Ball, HL. Parent-infant bed-sharing behaviour: Effects of feeding type, and presence of father. Human Nature 2006; 17(3):301–18.
7 Hauck, FR. Et al. Breastfeeding and reduced risk of sudden infant death syndrome: A meta-analysis. Pediatrics 2011; 128: 103–110. http://pediatrics.aappublications.org/content/128/1/103.full
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Copyright LLLGB November 2017