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

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

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  1. 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

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

  3. 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

  4. 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

  5. In the wake of local infant “cosleeping” deaths, regional health departments have translated AAP Statement into “One Message” Never Bedshare

  6. The Current Study

  7. 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)

  8. 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

  9. Average age of mothers (M=31.16) Range=13-50 years

  10. Ethnicity • 91% White • 2.5% Black • 1.4% Latina • 1.5% Asian • 0.6% Native American

  11. Do others know where your baby sleeps?

  12. Do people know where baby ends the night? US Sample (N=4678) Infant Sleep Location Χ2(2)=17.64, p<.0001

  13. 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

  14. HCP does not know where baby ends the night US Sample(N=4360) Χ2(2)=132.75, p <.0001

  15. Reasons for Current Sleep Arrangements

  16. Right Way to Do It US Sample (N=2320) Infant Sleep Location Χ2(2)=6.90, p<.032

  17. Only Way that Worked US Sample (N=2082) Infant Sleep Location Χ2(2)=162.9, p<.0001

  18. How mothers handle nighttime feedings

  19. Where Mothers Fall Asleep During Night FeedingsUS Sample (N=2103) Χ2(1)=163.08, p<.0001

  20. 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

  21. 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

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

  23. X2(4)=12.465, p<.014

  24. X2(4)=29.558, p<.0001

  25. 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

  26. Take Away #2 • Bedsharing happens • Parents bedshare for cultural, ideological and practical reasons • Their behavior persists even when they are told not to

  27. Take Away #3 • Parents need individualized, culturally sensitive information about safe sleep regardless of where babies sleep

  28. 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

  29. 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

  30. “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

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