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Mother-infant Sleep Locations and Nighttime Feeding Behaviors U.S. Data from the Survey of Mothers’ Sleep and Fatigue. Kathleen Kendall-Tackett, Ph.D., IBCLC Thomas W. Hale, Ph.D. Department of Pediatrics Texas Tech University School of Medicine Zhen Cong, Ph.D.

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slide1

Mother-infant Sleep Locations and Nighttime Feeding BehaviorsU.S. Data from the Survey of Mothers’ Sleep and Fatigue

Kathleen Kendall-Tackett, Ph.D., IBCLC

Thomas W. Hale, Ph.D.

Department of Pediatrics

Texas Tech University School of Medicine

Zhen Cong, Ph.D.

Department of Human Development and Family Studies

Texas Tech University

slide3
AAP 2005 Task Force on SIDS
    • No bedsharing
    • No sleeping with baby on sofa or recliner
    • Baby in parents’ room for the first 6 months
aap task force on sids
AAP Task Force on SIDS
  • Infants should not bed share during sleep
  • Infants may be brought into bed for nursing or comforting but should be returned to their own crib or bassinet when the parent is ready to return to sleep
  • Parents should not bring a baby to bed when they are overly tired or using medications or substances that could impair his or her alertness
  • Infants’ cribs or bassinets should be placed in the parents’ bedroom
  • No one should sleep with an infant on a couch or armchair because this is very dangerous
slide5
In the wake of local infant “cosleeping” deaths, regional health departments have translated AAP Statement into “One Message”

Never Bedshare

slide8
Online survey of 6,410 mothers with infants aged 0-12 months (Mean infant age=6.96 months)
  • From 59 countries
    • U.S. (N=4,789)
    • European Union/Eastern Europe (N=545),
    • Canada (N=416)
    • Australia/New Zealand (N=186)
    • Middle East (N=56)
    • Central and South America (N=32),
    • Asia (N=30)
    • Africa (N=13)
slide9
Sample recruited with the assistance of lactation specialists
    • WIC State Breastfeeding Coordinators
    • U.S. State Breastfeeding Coordinators
    • La Leche League in the U.S., Canada, New Zealand, Great Britain
    • Australian Breastfeeding Association
slide11
Ethnicity
    • 91% White
    • 2.5% Black
    • 1.4% Latina
    • 1.5% Asian
    • 0.6% Native American
do people know where baby ends the night us sample n 4678
Do people know where baby ends the night? US Sample (N=4678)

Infant Sleep Location

Χ2(2)=17.64, p<.0001

do people say negative things about where your baby ends the night us sample n 4337
Do people say negative things about where your baby ends the night? US Sample (N=4337)

Infant Sleep Location

Χ2(2)=681.64 p<.0001

hcp does not know where baby ends the night us sample n 4360
HCP does not know where baby ends the night US Sample(N=4360)

Χ2(2)=132.75, p <.0001

right way to do it us sample n 2320
Right Way to Do It US Sample (N=2320)

Infant Sleep Location

Χ2(2)=6.90, p<.032

only way that worked us sample n 2082
Only Way that Worked US Sample (N=2082)

Infant Sleep Location

Χ2(2)=162.9, p<.0001

slide21
SIDS Cases in U.S.

0.56 per 1000 (0.0005%)

40% of these take place outside of cribs

0.0002%

Of mothers who feed at night on a chair, sofa or recliner

  • 44.4% sometimes fall asleep there
  • 24.7% of the entire sample
slide22
Bottom line
  • 25% of U.S. mothers in our sample are admitting to sometimes falling asleep in dangerous sleep locations, likely in an attempt to avoid bedsharing
slide23
Higher-income and highly educated mothers are the ones most likely to feed their babies in chairs/recliners at night
slide26
Take Away Message #1
  • The “Never-Bedshare” message does not work
  • These edicts are likely resulting in the highly dangerous behavior of sleeping with infants on chairs, recliners or sofas
slide27
Take Away #2
  • Bedsharing happens
    • Parents bedshare for cultural, ideological and practical reasons
    • Their behavior persists even when they are told not to
slide28
Take Away #3
  • Parents need individualized, culturally sensitive information about safe sleep regardless of where babies sleep
slide29
Conclusions
  • Bedsharing is common in the U.S. and persists despite considerable pressure
  • Edicts to never bedshare have encouraged a far more dangerous and risky behavior
slide30
Parents need guidance on safe sleep behaviors that are effective and meet mothers’ and babies’ needs
  • Sleeping on an adjacent surface is a possible and reasonable compromise
slide31
“As in most controversies, some value is found in both sides of the argument
  • One must weigh the relative risk and benefits and provide evidence-based information to fit the individual needs and complex social, economic, and cultural context of the family”

Morgan et al. JOGNN 2006; 35: 684-691