An International Consortium of Mother-Baby Sleep Experts Publishes White Paper Indicating that Bedsharing Does Not Increase the Risk of SIDS in Breastfed Infants

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A recent meta-analysis concluded that bedsharing increased the risk of SIDS even for breastfed infants. In contrast, SIDS: Risks and Realities, a new white paper by an international consortium of mother-baby sleep experts published by Praeclarus Press, indicates that bedsharing does not increase the risk of SIDS in breastfed infants, and in fact lowers the risk of SIDS because it helps sustain breastfeeding.

Bedsharing does not increase the risk of SIDS for breastfed infants.

Mother-infant bedsharing is a common behavior among new parents, one that persists even in the wake of dire public-health messaging telling parents to not sleep with their babies. In the Survey of Mothers' Sleep and Fatigue, approximately 60% of parents in the U.S. sample indicated that they sleep with their babies for at least part of the night. But many parents do not tell others, including healthcare providers, that their babies sleep with them.

One reason why bedsharing persists despite admonitions not to is because it facilitates breastfeeding, which is also reduces the risk of SIDS. Mothers who do not bedshare are significantly more likely to supplement with formula and/or stop breastfeeding altogether well before their babies' first birthdays. This early cessation of breastfeeding falls well short of recommended guidelines. For example, the American Academy of Pediatrics currently recommends that mothers breastfeed exclusively for the first six months, and continue breastfeeding with solid food for at least one year. The World Health Organization recommends exclusive breastfeeding for the first six months, and breastfeeding with solid food for at least two years for infants worldwide.

Mother-baby sleep researchers, such as Dr. Helen Ball in the U.K., and Dr. James McKenna in U.S., have repeatedly found in their studies that breastfeeding mother-infant dyads sleep differently than mother-infant dyads who are formula feeding. Breastfeeding mothers are attuned to their babies even while sleeping, and this maternal attunement protects the babies from SIDS. Dr. McKenna does not recommend that non-breastfeeding mothers bedshare.

In contrast to previous studies, a recent meta-analysis by Carpenter et al. (2013) concluded that bedsharing increases the risk of SIDS even when the infants are breastfeeding. In response, an international consortium of mother-baby sleep experts have issued a white paper, SIDS: Risks and Realities, specifically addressing the findings in the meta-analysis. SIDS: Risk and Realities is available at The mother-baby sleep experts highlight some of the specific limitations of the meta-analysis, and note that it did not control for important risk factors, such as unsafe bedding, infant sleep position, and infant vulnerability due to prematurity or low birthweight.

The white paper entitled, SIDS: Risks and Realities, states that the factors that increase risk of SIDS are those related to infant breathing and arousability. With regard to sleep, these include the following:

Respiratory obstruction (e.g., fluffy bedding)
Rebreathing expired gases (i.e., from cover on face)
Thermal stress through overheating (e.g., too many covers)
Physiological vulnerability of arousal (e.g., deep sleep from formula usage)

The authors of SIDS: Risk and Realities conclude by noting that:
"Despite a long history of efforts to reduce bedsharing, this nighttime-care practice remains to be the preferred practice for many, is increasing in some areas, and provides many protective or health-benefiting outcomes for mothers and infants...A focus on protection and a discussion of what underlies risk will be much more successful in reducing risk of SIDS—as well as improving the health context postnatally."

SIDS: Risk and Realities is authored by Sarah Ockwell-Smith, Wendy Middlemiss, Tracy Cassels, Helen Steven, and Darcia Narvaez. In addition to the white paper, the May 2013 issue of Clinical Lactation is also available at Praeclarus Press. This issue focuses on mother-infant sleep, sleep training, and the role of breastfeeding. There is also a detailed listing of resources available for both parents and professionals on mother-infant sleep location, safe sleep, and breastfeeding. Praeclarus Press is a small press dedicated to women's health.

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