The AAP has released the new infant sleep and sleep position guidelines. Some of us thought something huge was coming but the AAP really has made only one shifty little co-sleeping change since the 2011 recommendations, as I see it. 

While it does not specifically condone bed-sharing*, the new guidelines suggest that you should nurse the baby laying down in bed rather than in a soft chair if you might fall asleep. They are basically admitting that bed-sharing might be one safe option for breastfed babies. They are saying that bed-sharing is safer than the ONLY other option which is breastfeeding in a chair or sofa where you might fall asleep; hence the baby could get lodged or smothered. At night. Yep. Most of us fall asleep while nursing at night. So, given those options, and this new guideline, which will you choose? 

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The last part seems laughable to me. Now that the baby is in bed with you, when she wakes you up she will probably want to nurse again. You will probably nurse her and you will probably fall asleep again before you can get up and put her in her crib. Funny, most moms notice this goes on all night long. Actually, the part about no pillows, sheets or blankets in the bed is also laughable. Those items should not be near the baby which is a very important distinction since I don’t know anyone who sleeps in the winter without any covering or one pillow. In fact to nurse at night, many women side-lay with baby and need one pillow under mom’s head to prevent neck pain. The arm is usually between baby’s head and the adult pillow. 

Is this the AAP basically doing what I, myself, do in my sleep and lactation business when I talk about co-sleeping? I really cannot tell you to bed-share with baby because I am not going to be responsible for an accident, but I can tell you that sitting on your sofa with your baby on you at night is not safe. I can tell you about what the other risks for Sudden Unexplained Infant Sleep Death (SUID) are so that you can weight your risks and benefits yourself. (By the way, those include formula fed babies, nicotine in the home, moderate or major alcohol consumption, morbid obesity, overheating, smothering with too many blankets and pillows, siblings next to the baby, and parent sleep disorder.) I show you (in the featured photo above) what safe bed-sharing looks like, but the AAP does not do that. 

The real news here is that the AAP is NOT saying “Don’t Sleep With Your Breastfed Baby”. They aren’t telling you to plan for it, but they aren’t telling you not to do it under any circumstances the way they used to. I guess that’s a tiny itty bitty premature baby step in the right direction of actually supporting breastfeeding parents. 

Some of us in the field of breastfeeding and infant sleep were just praying that the AAP would say now, in 2016, that bed-sharing is a safe option for breastfed babies. We would surely prefer the American Academy of Pediatrics recommend it for sleep-deprived, breastfeeding parents and advise them of HOW to bed-share SAFELY as well as calling it the norm, rather than shaming parents for it. I personally have been swayed by the work of Dr. James McKenna at Notre Dame’s Mother-Baby Behavioral Sleep Lab and the work of the UK’s Dr. Helen Ball. 

But really, I am more swayed by the basic truth that with breastfeeding in infancy, bed-sharing is almost entirely unavoidable. In fact, a major 18 year study conducted by the National Institute of Health suggest that most families are bed-sharing with infants at some point, even when they don’t tell their health care providers and even though they were overwhelmed with Safe Sleep info advising otherwise. The AAP has had 6 years now to absorb that information and you would think they would have utilized it more by now to make life with infants safer and easier. How about spending some government dollars on showing what safe co-sleeping without extra pillows or blankets looks like rather than those failed absolutely insane and insulting knife campaigns. 

What else do the new guidelines say? 

  • The news that breastfed babies are at a much lesser risk for sudden infant death was from back in 2011.  
  • The recommendation that babies should room-in (co-sleep but in a crib) is also from 2011 but many people didn’t pay attention. This year they went further to specifically that rooming-in protects against SIDS and included the detail that rooming-in should last one year. 
  • Firm sleep surface is the same as before. Tight sheet. No bumpers or toys. Same.
  • Babies should not routinely sleep in swings or carseats. Also not new but very important. 
  • They recommend pacifiers in the beginning of the night as a possible SIDS protection, but the mechanism for this protection is something they cannot explain and the evidence is scarce. This is also not new, but I have not seen any much good evidence for this one and in my practice helping families sleep, a pacifier becomes a sleep association and the parent needs to help baby find it every time they come out of a short infant sleep cycle. So this is not my favorite recommendation on many ends. My guess is that pacifiers are more protective for formula fed babies sleeping in cribs because they are not sucking through the night like breastfed babies and sucking stimulates breathing. 
  • Side of bed Co-sleepers are safe. In-bed co-sleeping positioners are not considered safe- all same as before.  

Click Here for what the original SIDS researcher for the US Government says about Bed-sharing and actual risks for SIDS.

I am in field of helping parents and babies survive the challenges of sleep depravation and supporting them in healthy lactation. Families are simply still not seeing the reality of their sleep depravation reflected by the AAP or pediatricians. It has been suggested for so long that breastfeeding parents get out of bed and stay awake during each night nursing session. This feels like a cruel joke with the punchline being a feeling of shame in being a bad and unsafe parent. I will do my best in providing the new information while I sit here hoping that with the next round of sleep guidelines gets a little more real and much more clear on what safe bed-sharing looks like.

I think honesty will save a lot more babies. 

*A Note on Verbiage: Co-sleeping is any form or room-sharing including bed sharing. Bed-sharing is always co-sleeping. Co-sleeping is not always bed-sharing.

moorea

 

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