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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 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 choose to 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?

Normal sleep behavior

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,1,2although by four months most infants have their longest sleep period at night.3 Therefore, it is normal for infants to wake frequently at night.
4 Many families also bed-share (adults and infants sharing the same sleep surface) and bed-sharing has been associated with increased breastfeeding duration.5,6

SIDS and sleep location

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 old7), although further studies with better definitions of bed-sharing are needed to give a better understanding of risk factors.

The safest location

There is evidence that the safest place for an infant to sleep is on a separate sleep surface in the same room as the care-giver. 8,9

When parents choose to bed-share

Information about safe sleeping environments for parents who wish to bed-share include the following points: 10 11 12

  • Bed-sharing is not recommended if either of the parents smoke, have consumed alcohol or drugs, are obese or extremely fatigued.
  • Sleeping on soft mattresses, waterbeds, couches, recliners or sofas is not safe for infants – use a firm mattress without soft bedding, doonas or pillows near the infant.
  • Ensure there are no gaps between the mattress and wall or headboard, or other gaps where the infant can get trapped or wedged.
  • Pets should not be on/in the bed with the infant. If other children are in the bed, there should be an adult between the child and the infant.
  • The infant should not be dressed too warmly,nor wrapped tightly – adult bed coverings and body heat provide significantly more heat than if the infant is sleeping alone.
  • Infants should always be placed supine to sleep, although they will usually be on their side to breastfeed.

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.

There is also some evidence that using a pacifier (dummy) while the infant is going to sleep reduces the risk of SIDS, although the protective mechanism is unknown. 13 For breastfeeding infants it is recommended that pacifiers not be introduced until breastfeeding is well-established (about 4 weeks of age). 14 If the pacifier falls out once the infant is asleep, there is no need to replace it. 15

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. # Jenni OG et al. (2007) Sleep behavior and sleep regulation from infancy through adolescence: normative aspects.
  4. # Armstrong K et al. (1994) The sleep patterns of normal children
  5. # Blair PS et al. (2010) Relationship between bed sharing and breastfeeding: longitudinal, population-based analysis.
  6. # Hauck FR et al. (2011) Breastfeeding and reduced risk of sudden infant death syndrome: a meta-analysis.
  7. # Horsley T et al. (2007) Benefits and harms associated with the practice of bed sharing
  8. # Moon RY et al. (2012) Sudden infant death syndrome: an update.
  9. # Blair PS et al. (2006) Sudden Infant Death Syndrome and the time of death: factors associated with night-time and day-time deaths.
  10. # UNICEF UK Baby Friendly (2012) Caring for your baby at night.
  11. # Blair P et al. (2012) The health professional\'s guide to \'Caring for your baby at night.\'
  12. # Brodribb W (ed) (2012) Settling and sleep. IN: Breastfeeding Management in Australia
  13. # Hauck FR et al. (2005) Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis
  14. # Section on Breastfeeding (2012) Breastfeeding and the use of human milk.
  15. # American Academy of Pediatrics (2011) Policy Statement - SIDS and other sleep-related deaths