Co-sleeping discussion omitted breastfeeding

Journal of Family Practice, Feb, 2007 by Debra Kyler, Michelle R. Adler, Abbas Hyderi

To the editor:

As a lactation consultant, I am always amazed by the omission of the vast amount of research done by James J. McKenna, PhD (www.nd.edu/~jmckenn1/lab/) that shows the beneficial aspects of co-sleeping to the newborn when discussing the co-sleeping issue ("What are safe sleeping arrangements for infants?" J Fam Pract 2006; 55: 1083-1087). Rarely do we hear about the physiological benefits to the baby, such as respiration regulation, heartbeat regulation, and temperature regulation when the baby is near her mother. Isn't a newborn more stable and at less risk of SIDS when near her mother and these physiological processes are in check?

Obviously, substance abuse (including tobacco), type of bed, and bedcovers need to be discussed with the parents. But in my view, these are secondary to the benefits of co-sleeping.

Debra Kyler, MS, RD, IBCLC

Board-Certified Lactation Consultant

The authors respond:

We can appreciate the concern over the omission of breastfeeding from our response to this question. A number of studies have been conducted demonstrating a significant association between bedsharing and breastfeeding. (1-5) A 1997 study by McKenna et al showed that infants who routinely bedshare breastfeed twice as much at night as infants who routinely sleep in a separate bassinette. The duration of breastfeeding episodes was also 39% longer. (1) A 2005 study by the International Child Care Practices Study Group showed that infants who bedshare with their mothers exclusively breastfeed longer than infants who do not bedshare (relative risk [RR] = 0.43; 95% confidence interval [CI], 0.30-0.61). (2)

While we do not dispute the potential benefits of bedsharing on breastfeeding, our task was to answer a question about the safety of various infant sleep arrangements. The outcomes we included were accidental asphyxiation, SIDS, injury, and death of unknown cause. We decided not to report on the relationship between breastfeeding and SIDS because breastfeeding did not meet inclusion criteria as a "sleep arrangement."

A 2006 trial conducted by Ball et al demonstrated that infants who sleep in sidecars attached to a mother's bed breastfeed as frequently as bedsharing infants and were observed in potentially adverse situations less frequently. (3) Given the potential benefits of bedsharing on breastfeeding, and the fact that side-cars are not a financially viable or culturally appropriate option for many families, it's fair to say that the question, "Does bedsharing improve breastfeeding?" probably deserves its own Clinical Inquiry.

Michelle R. Adler, MD MPH

Department of Family Medicine, Oregon Health & Science University

Abbas Hyderi, MD, MPH

Department of Family Medicine, University of Illinois at Chicago

REFERENCES

(1.) McKenna JJ, Mosko SS, Richard CA. Bedsharing promotes breastfeeding [see comment]. Pediatrics 1997; 100:214-219.

(2.) Nelson EA, Yu LM, Williams S, International Child Care Practices Study Group Members. Internstional child care practices study: Breastfeeding and pacifier use. J Hum Lact 2005; 21:289-295.

(3.) Ball HL, Ward-Platt MP, Heslop E, Leech SJ, Brown KA. Randomised trial of infant sleep location on the postnatal ward. Arch Dis Child 2006; 91:1005-1010.

(4.) Ball HL. Breastfeeding, bed-sharing, and infant sleep. Birth 2003; 30:181-188.

(5.) McCoy RC, Hunt CE, Lesko SM, et el. Frequency of bed sharing and its relationship to breastfeeding. J Dev Behav Ped 2004; 25:141-149.