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3.2 Risk of SIDS

Key Points - Case Study C

Joanne is discharged early on day three and comes to see you for a follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?

Topic 3.1: Early problems
There is a difference between breast fullness and engorgement. Early frequent feeding and good breast drainage helps prevent and manage engorgement.

You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?

Topic 3.2: Risk of SIDS
It is normal for breastfed infants to feed frequently and wake at night in the first few weeks of life. Some continue to wake for a longer period. Many parents will co-sleep (where the infant is in close physical and/or social relationship with another person) and/or bed-share (adults and infants sharing the same sleep surfaces) during this time. Safe sleeping guidelines should be followed to reduce the risk of SIDS.

You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?

As well as needing to breastfeed frequently, in the first few weeks of life infants have short sleep cycles and do not have a distinct day–night pattern (1,2). Therefore, it is normal for infants to wake frequently at night. Some studies have found that nearly two-thirds of infants aged 10–12 months continued to wake regularly at night3. Many families also bed-share (adults and infants sharing the same sleep surface) and bed-sharing has been associated with increased breastfeeding duration (4,5).

Studies investigating risk factors for SIDS have often not clearly defined the sleep environment with no distinction made between safe bed-sharing and co-sleeping (where the infant is in close physical and/or social relationship with another person), and unsafe practices. A recent meta-analysis suggests that there may be a relationship between SIDS and bed-sharing with mothers who smoke and also for young infants (less than eight to eleven weeks old4), although further studies with better definitions of bed-sharing are needed to give a better understanding of risk factors.

There is evidence that infants sleeping on a separate sleep surface in the parents' room have a reduced risk of SIDS compared with infants sleeping in another room6. Some authorities suggest placing the infant's cot alongside the mother's bed so that she can easily communicate with and access the infant.

Information about safe sleeping environments for parents who wish to bed-share include the following points (7,6):

Most families will bed-share with their infant or child at some time, even though it may not be on a regular basis. Therefore, all parents should be aware of how to make the sleep environment as safe as possible.

Notes

  1. # Peirano P et al. (2003) Sleep-wake states and their regulatory mechanisms throughout early human development
  2. # de Weerd AW et al. (2003) The development of sleep during the first months of life
  3. # Armstrong K et al. (1994) The sleep patterns of normal children
  4. # Horsley T et al. (2007) Benefits and harms associated with the practice of bed sharing
  5. # Ball HL (2003) Breastfeeding, bed-sharing, and infant sleep
  6. # McCoy R et al. (2008) Clinical protocol #6: Guideline on co-sleeping and breastfeeding
  7. # Brodribb W (2004) Breastfeeding Management