Breastsleeping, SIDS, infant sleep (part deux of unpacking #APHA16)


This post started out as part of the  previous blog post about my overall star-struck, breastfeeding research fan girl experiences at APHA 2016, but as I wrote the breastsleeping component I realized that this likely deserves it's own post. Ta-da! I'm serious about my finals procrastination.

Cosleeping and bedsharing is a hot-button issue for many parents. Infant loss related to unsafe sleeping and SIDS is perhaps one of the most tragic losses that a parent can experience, and the guilt and grief can be overwhelming.

Dr. James "Breastsleeping" McKenna!!!
Let me first say that I was not the only fan girl to ask Dr. McKenna for a selfie (which I think has officially replaced the autograph, and I am probably dating myself by even making this comparison). Professor at Notre Dame, founder of the mother-baby behavioral sleep laboratory, Dr. McKenna is an authority on mother-infant sleep sharing in relation to breastfeeding and SIDS. He's so fire that he didn't even show up with slides. He strode up to the podium and proceeded to talk us through the recent research related to the 2015 Acta Paediatrica manuscript published by himself and Dr. Lee Gettler: There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping.  

Bedsharing/cosleeping mothers are more likely to continue breastfeeding past 6-9 months. This is because breastfeeding and sleeping is an involved system that is functionally interactive. There is a persistent preoccupation with getting babies to sleep like adults, and while a minority are able to achieve those long blocks of sleep, this is not the most desirable outcome when you consider that babies are fundamentally, physiologically different from adults. The frequent waking can be protective against SIDS because babies lack the nervous system development that allows adults and older children to be in deep sleep and rouse ourselves into wakefulness if they stop breathing or start choking. Babies that wake frequently and protest caregiver separation are the hallmark of robust health, and should be lauded as such.

The heterogeneity of the activity makes it difficult to measure. Many people conceptualize cosleeping as sleeping in the bed with the adult caregivers, but this is only one form. With appropriate education on safe sleeping surfaces (very firm mattresses, no fluffy bedclothes/pillows/blankets, no alcohol, tobacco, prescription or OTC drugs that cause sleepiness), the risk of infants dying due to unsafe sleeping practices can be greatly reduced. Indeed, many parents falsely believe that sleeping with a baby in a chair, recliner, or sofa is somehow safer when the reality is that these are cosleeping activities and these are the least safe ways to go about the behavior.

A recent manuscript in Pediatrics by Rachel Moon and Fern Hauck explored the possible confounds that prevent a direction association between reduction in SIDS and the "safe to sleep" infant sleeping campaign. Statistically, SIDS deaths have decreased over the past 20 years have decreased, while the rates of other types of infant sleeping-related deaths have increased (eg. accidental strangulation and suffocation in bed and "ill-defined deaths"). Overall, the rate of postneonatal mortality has not declined. Vulnerability to postneonatal death is not necessarily about where the baby is sleeping. Exposure in utero or postnatally to tobacco smoke blunts infant arousal responses, which can increase the risk of sleep-related death. Prenatal exposure to drugs or alcohol can also increase SIDS risk.

It's well established, both in the literature and anecdotally (ask any breastfeeding mom) that exclusively breastfed infants tend to wake more frequently, and indeed this may be part of what leads to the protective effect that breastfeeding has when it comes to SIDS. The protective effect of breastfeeding in regards to SIDS is stronger when breastfeeding is exclusive.

Dr. Wendy Middlemass and Dr. Kathy Kendall-Tackett co-edited The Science of Mother-Infant Sleep, which you can find here at Praeclarus Pres. If you're interested in reading more research on the topic, this book is a great place to start. 


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