Safer Sleep & the Breastfed Baby

“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. 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 mothers¹ and breastfeed for longer.² If you choose not to bedshare, co-sleeping may give your baby the closeness he craves and make breastfeeding easier without sharing the same sleep surface as you.

It is possible to bedshare with twins, but co-sleeping rather than bedsharing is recommended if they were premature or low birth-weight.

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 research³ shows that mothers who bedshare with their breastfed babies adopt a naturally protective position, making overlaying difficult and smothering by pillows or bedding unlikely. This has been referred to as the ‘cuddle curl’ position.

SIDS

Sudden Infant Death Syndrome (SIDS), or cot death, is a sudden unexpected infant death (usually occurring during sleep) that can’t be explained by a medical condition, infection, intentional harm, or accidental causes.
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.
During daytime and nighttime, a baby’s risk of SIDS is lower if they sleep in the same room as you. 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.
Formula-feeding (including combi-feeding) imposes a statistically significant higher risk of SIDS.
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:

Not ill, premature, or low birth-weight (less than 2.5kg)
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. (See Sleep Safely. Never sleep with your baby on a sofa or armchair.

Make an informed decision
Use the information above along with our checklist below 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. At an LLL meeting you can find out how other mothers meet the sleep needs of their own family members in different ways and at different stages.
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 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 Further Reading for more details, or for more information on these definitions, see here.

Sleep safely

Sleep tips
Do
✔ Place your baby to sleep on his back.
✔ Keep your sleeping baby close day and night, not in a room alone.
✔ Avoid exposing your baby to cigarette smoke at any time as this increases the risk of SIDS.
✔ Place your baby with his feet to the foot of any cot, crib or pram.
✔ Sleep facing your baby in bed (your thigh should prevent him slipping under the covers).
✔ 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.

✔ 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.

When bedsharing do
✔ Sleep facing your baby in bed (your thigh should prevent him slipping under the covers)..
✔ 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.

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:
✘ On a sofa or armchair.
✘ If he is swaddled.

Don’t bedshare
✘ If any person in the bed is a smoker (even if they never smoke in bed).
✘ 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 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

You may find that different sleeping arrangements work at different times. Being inventive and focusing on how you and your family can get the most sleep tonight can help. Some of these ideas may work for you, 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 cardigan can keep your arms 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!
• Keeping a low light on.
• Going to a La Leche League meeting and learning from other mothers.
• Watching 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 Sue Cardus, Karen Butler, Sue Upstone & mothers of La Leche League GB.