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

Kathleen Kendall-Tackett, Ph.D., IBCLCThomas W. Hale, Ph.D.

Department of PediatricsTexas Tech University School of Medicine

Zhen Cong, Ph.D.Department of Human Development and

Family StudiesTexas Tech University

• Maternal-infant bedsharing is a practice that continues to be mired in controversy

• 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

• 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

• In the wake of local infant “cosleeping” deaths, regional health departments have translated AAP Statement into “One Message”

Never Bedshare

The Current Study

• 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)

• 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

Average age of mothers (M=31.16)

Range=13-50 years

• Ethnicity– 91% White– 2.5% Black– 1.4% Latina– 1.5% Asian– 0.6% Native

American

• Do others know where your baby sleeps?

Do people know where baby ends the night? US Sample (N=4678)

0

10

20

30

40

50

60

Crib In Room In Bed

Χ2(2)=17.64, p<.0001

Infant Sleep Location

Do people say negative things about where your baby ends the night?

US Sample (N=4337)

0

10

20

30

40

50

60

70

80

90

Crib In Room In Bed

Χ2(2)=681.64 p<.0001

Infant Sleep Location

HCP does not know where baby ends the night

US Sample (N=4360)

0

10

20

30

40

50

60

70

% Mothers

Crib In Room In Bed

Baby Sleep Location

Χ2(2)=132.75, p <.0001

• Reasons for Current Sleep Arrangements

Right Way to Do It US Sample (N=2320)

0

10

20

30

40

50

60

70

Crib In Room In Bed

Χ2(2)=6.90, p<.032

Infant Sleep Location

Only Way that Worked US Sample (N=2082)

0

10

20

30

40

50

60

70

Crib In Room In Bed

Χ2(2)=162.9, p<.0001

Infant Sleep Location

• How mothers handle nighttime feedings

0

10

20

30

40

50

60

70

80

% Mothers

In Bed On Chair/sofa

Feeding LocationΧ2(1)=163.08, p<.0001

Where Mothers Fall Asleep During Night

FeedingsUS Sample (N=2103)

SIDS Cases in U.S.0.56 per 1000 (0.0005%)40% of these take place outside of cribs0.0002%

Of mothers who feed

at night on a chair, sofa or recliner

• 44.4% sometimes fall asleep there

• 24.7% of the entire sample

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

• Higher-income and highly educated mothers are the ones most likely to feed their babies in chairs/recliners at night

Education by Night Feeding Location

4045505560

HighSch

ool

Some

CollBA

MA Dr

Pe

rce

nta

ge In

Bed

Chair,Sofa

X2(4)=12.465, p<.014

Night Feeding Location by Income

3540455055606570

Per

cen

tag

e

Bed

Chair

X2(4)=29.558, p<.0001

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

Take Away #2

• Bedsharing happens– Parents bedshare

for cultural, ideological and practical reasons

– Their behavior persists even when they are told not to

Take Away #3

• Parents need individualized, culturally sensitive information about safe sleep regardless of where babies sleep

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

• 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

• “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