Tag Archives: SIDs

Should bedsharing/ co-sleeping only be for breastfed babies?

I think it’s time to look at this issue a little more, of all the things I write about unbelievably the most contentious is my suggestion that only mothers who are breastfeeding should share a bed with their baby. In fact I have received a fair deal of angry backlash in response to this, mostly by mothers who think I am being “anti formula feeding” and spreading incorrect information, so I think the time has come for this idea to have it’s own blog post.

So – why do I believe that mothers should only share a bed with their baby if they are breastfeeding? Particularly when most of the safe co-sleeping/bedsharing guidelines omit this point.

Let me start by saying I believe this is an area that is in desperate need of further research, I am still saddened that bedsharing research misses the most important points, it is VITAL that well constructed research is undertaken accounting for all of these variables, but most importantly accounting for feeding method.

Before I go further I would like to quickly point out the following:

Bedsharing – sharing a bed with your infant

Co-Sleeping – sharing a room with your infant

I have used the term co-sleeping in the title of this post purely for SEO purposes.

cosleep

The following are reasons you may want to think again if you you formula feed and share a bed with your baby:

1) Formula fed babies are at greater risk of SIDS than breastfed babies (wherever they sleep). See here for more. It makes sense to me then to be warier of introducing anything that may further compound this risk, with this in mind alone it is vital that if sharing a bed with a formula fed baby every single safety recommendation for bedsharing is followed exactly.

breastisbestor1

2) Formula fed babies are in general less arousable than breastfed babies during certain phases of sleep, this means that babies who are formula fed tend to awaken less readily than those who are breastfed if there is a threat to their life during certain sleep phases (this may be in part a reason for point 1 above). In particular this difference is seen the most during active sleep states at 2-3mths, which is the peak SIDS risk period.

bfsleep1

3) Mothers who breastfeed experience different sleep to those who formula feed and awaken more regularly than formula feeding mothers during the night. Breastfeeding mothers seem to be more in tune with their baby during the night and as such may be more arousable than mothers who formula feed and may be more likely to awaken if there baby stops breathing/falls etc.

I guess the problem comes when we feed our babies via another method than nature intended – nature understandably does not then provide the same protection and it is important we respect that.

To quote from University of Notre-Dame’s Sleep Lab’s website:

“all else being safe, bed-sharing among nonsmoking mothers who sleep on firm mattresses specifically for purposes of breast feeding, may be the most ideal form of bed-sharing where both mother and baby can benefit by, among other things, the baby getting more of mother’s precious milk and both mothers and babies getting more sleep – two findings which emerged from our own studies.”

Here’s a great video interview with Dr. James McKenna where he speaks more about breastfeeding mothers bedsharing and SIDS:

4) Mothers who breastfeed are far more likely to adopt a cradling/side laying position with their baby (the advised position to adopt when sharing a bed with your baby) and are more responsive to their baby’s movements in the night – this is currently being researched by two centres – Durham University sleep lab in the UK and James McKenna’s sleep laboratory in the University of Notre Dame.

bedshare

For all of the reasons above I personally only feel confident in advocating bedsharing if the mother is breastfeeding, however unpopular my opinion may be, it has nothing to do with my opinions on breastfeeding V formula feeding (for the record I don’t have one – I have 4 kids, one was breastfed for 4mths, then moved onto formula, one was breastfed for 8wks, then moved onto formula, one was breastfed until 6mths and the last I breastfed for 4yrs!) and everything to do with keeping babies safe.

by:

Sarah (Founder of BabyCalm)

You can read more of Sarah’s articles HERE.

 

References.

  1. Horne RSParslow PMHarding R. Respiratory control and arousal in sleeping infants. Paediatr Respir Rev. 2004 Sep;5(3):190-8.
  2. McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev. 2005 Jun;6(2):134-52.
  3. http://www.nd.edu/~jmckenn1/lab/articles/USBC-SIDS-PR-10-17-2005.pdf
  4. Parslow PMFerens DWatts AMAdamson TM. Comparison of evoked arousability in breast and formula fed infants. Arch Dis Child. 2004 Jan;89(1):22-5.
  5. http://pediatrics.aappublications.org/content/100/2/214.abstract
  6. http://jhl.sagepub.com/content/16/1/13.short
  7. Kahn AGroswasser JFranco PScaillet SSawaguchi TKelmanson IDan B. Sudden infant deaths: stress, arousal and SIDS. Early Hum Dev. 2003 Dec;75 Suppl:S147-66.
  8. http://www.ibreastfeeding.com/content/newsletter/nighttime-breastfeeding-and-maternal-mental-health
  9. http://www.nd.edu/~jmckenn1/lab/articles/Canada%20safe%20Sleep.pdf

Are you a Dummy Mummy?

Dummy = pacifier to my overseas readers!

I’ve been asked twice this week if I know of any evidence on the pros and cons of dummy use, naturally being the science geek that I  am, I do indeed know of an embarrassingly large collection of trials for both camps of the debate. I thought it might be handy to pop a quick post together to summarise the evidence.

One thing is for sure and that’s dummy use is highly prevalent in the UK.  The Avon Longitudinal Study found that nearly 60% of the 10,950 babies in the sample had used a dummy by four weeks of age!

Dummy Positives:

1) Dummy use may reduce SIDs risk

dummyMitchell, Blair and L’Hoir at the University of Auckland, New Zealand carried out a trial in 2006 which found “a remarkably consistent reduction of SIDS with pacifier use. The mechanism by which pacifiers might reduce the risk of SIDS is unknown, but several mechanisms have been postulated. ” Ditto researchers Moon, Tanabe, Yan, Young and Hauck at the Goldberg Center for Community Pediatric Health recently conducted a population based case-control study of 260 SIDS deaths and 260 matched living controls. Finding that dummy use decreased SIDs risks and that “pacifier use decreased SIDS risk more when mothers were ≥20 years of age, married, nonsmokers, had adequate prenatal care, and if the infant was ever breastfed. Pacifier use also decreased the risk of SIDS more when the infant was sleeping in the prone/side position, bedsharing*, and when soft bedding was present.”  A further study published in the BMJ in 2006 and conducted at Kaiser Permanente Northern California also found once again that dummy use “was associated with a reduction in risk in every category of sociodemographic characteristics and risk factors examined”.

It has been postulated that dummy use helps to keep infants in a back lying position and that this is what contributes to reduced SIDs levels although follow up research did not find this to be the case.

This research has led to the American Academy of Pediatrics & FSIDs recommending using a dummy at every sleep to reduce the risk of SIDS (and waiting  until 1mth in the case of introducing a dummy to  breastfed babies so that breastfeeding can become established).

*note I cannot find any information on whether this was all bedsharing lumped together or co-sleeping following safety guidelines.

2) Dummies can help to calm a fractious baby

dummy3Suckling is nature’s best comforter, if the mum is breastfeeding she has all she needs – although many choose to use dummies to help partners calm the baby or when she needs time alone, but bottle feeding mums are often helped greatly by the addition of a dummy which gives their baby a chance to suck when they are not being fed. Interestingly, there are marked differences in dummy use around the world – as I’ve already mentioned above the Avon Longitudinal study found 60% of British babies used dummies, whereas in their study “Soothing methods used to calm a baby in an Arab country” by Abdulrazzaq, Al Kendi and Nagelkerke which analysed data from  702 mothers from the UAE nationality, other Arabs, other Muslims, Indians and Philippinos in 2009 found that whilst 99.1% used breastfeeding as a soothing method, less than 10% used dummies to soothe their babies!

3) Dummies may help cranial bones re-align.

During labour the baby’s cranial bones move and overlap (think of a cone headed newborn!), this is normal and the bones usually return to their normal position over a few days after the birth, mostly via the process of the baby sucking (and the movement of the upper and lower jaw) which stimulates the base of the skull via the palate. Sometimes however things don’t return to normal and often abnormal skull compression becomes noticeable via the baby’s feeding habits and need to suck much more than usual. If the baby’s vagus nerve (the nerve directly linked to digestion) is compressed this can also have noticeable effects on a baby’s digestive system causing pain. All of this is more likely to happen if the labour is long, the baby is malpresented, I often notice babies who laid in an asynclitic presentation during labour are more sucky. For bottle fed babies in particular dummies can be very useful for a baby who needs to suck a lot. Sadly I cannot find evidence to support (or refute!) these claims although anecdotally many chiropractors and cranial osteopaths around the world agree and a recent literature review of “The chiropractic care of infants with colic” by Alcantara in June 2011 published in the International Chiropractic Pediatric Association reported that  “Our findings reveal that chiropractic care is a viable alternative to the care of infantile colic and congruent with evidence-based practice, particularly when one considers that medical care options are no better than placebo or have associated adverse events.”

Dummy Negatives

1) Dummy use increases the risk of Otitis Media (ear infections)

dummy2Science suggests there is a definite link between dummy use and paediatric ear infections. A Finnish study by Niemala, Pihakari, Pokka and Uhari published in Pediatrics  in 2000 found the occurrence of Acute Otitis Media  (AOM) was 29% lower amongst children whose parents had been told to limit dummy use. A Dutch cohort study published in Family Practice in 2008 by Rovers et al found once again that dummy use was a risk factor for ear infections. In their study of the 216 children that used a dummy 35% developed at least one episode of AOM, and of the 260 children that did not use a dummy a smaller percentage of 32% developed at least one AOM episode and for recurrent AOM, these figures were 16% versus 11% respectively.

2) Dummy use causes orthodontic damage

Research suggests that dummy use can cause orthodontic changes, however the research seems to suggest that this happens with long term (2yrs+) dummy use only *. A 1994 study by Ogaard B, Larsson E & Lindsten R entitle “The effect of sucking habits, cohort, sex, intercanine arch widths and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year old children” found that ther was a high prevalence of posterior crossbite in dummy users, however their analyses of covariance revealed that at least 2 years of dummy use was necessary to produce a significant effect in the upper jaw and 3 years in the lower jaw.

* note – I am unable to discover whether the research looked at regular  or orthondic type dummies.

Dummy use has an adverse effect on breastfeeding

breastisbestor1A study published last month by Gerd, Bergman, Dahlgren, Roswall and Alm entitled “Factors associated with discontinuation of breastfeeding before 1 month of age.” found that there was a negative correlation between breastfeeding and use of a dummy, however the famous 2011 Cochrane review into “pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding”  found that dummy use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants’ health is lacking.
I wonder if you’re now feeling like me? non the wiser! non of this research seems particularly compelling to me and could be used to support either “pro” or “anti” dummy use (and indeed it is!). For the record I don’t really have a position on dummies, I think they work for some families/babies and not for others – I’ve suggested them to some of the parents I’ve worked with and have suggested to others they might want to stop using them. One thing is for sure though there are a few basic guidelines to follow when using dummies:
  • wait until breastfeeding is well established (FSID suggest breastfeeding mums don’t use a dummy for the first 4wks).
  • only give your baby a dummy when they really need it (i.e: to calm crying, or help a fractious baby sleep) but take the dummy away when the baby is calm to prevent the dummy use becoming habitual.
  • try to get rid of the dummy by 6 months, by this time the benefits have pretty much served their purpose – longer use can take you more into the negative camp.
  • Always be led by your baby! if your baby won’t take a dummy – don’t persevere, listen to them!