1. Prevalence of Infant Bed-sharing in Breastfeeding Mothers
Kristen Slaymaker, TCOM 20171; Deep Shah, MD, MPH2; Amy Raines-Milenkov, DrPH3; W. Paul Bowman, MD2
1Texas College of Osteopathic Medicine, UNT Health Science Center, Fort Worth, TX; 2Department of Pediatrics, UNT Health Science Center, Fort Worth, TX; and 3Department of Obstetrics & Gynecology, UNT Health Science Center, Fort Worth, TX
Chart 1. Reasons for choosing baby's sleep location among breastfeeding mothers who bed-share (n=22)
Research has shown that bed-sharing is a risk factor for Sudden Infant Death Syndrome (SIDS) and infant suffocation. SIDS is one of the leading causes of infant mortality in Tarrant County. At 6.87 deaths per 1,000 live births, Tarrant County has the highest infant mortality rate among the most populated Texas counties. While the UNTHSC Pediatric Clinic is located in a zip code with infant mortality rate similar to the national average (6.6 per 1000 live births), zip code areas less than five miles from the clinic have the highest infant mortality rates in the county: 2 times higher than the national average (13.95 per 1000 live births).
Several studies have shown a strong relationship between breastfeeding and bed-sharing. One study found that 72% of mothers who continue to breastfeed for more than four weeks incorporate bed-sharing into their nocturnal feeding and sleep routine early in infant’s life for minimal disruption of night-time breastfeeding. American Academy Of Pediatrics (AAP) Task Force on SIDS defines bed-sharing as a specific type of cosleeping when the infant is sleeping on the same surface with another person. Cosleeping is when parent and infant sleep in close proximity, on the same surface or different surfaces, as to be able to see, hear, and/or touch each other. Information reported on the poster is taken from a larger survey of infant sleep practices among patients of the UNTHSC Pediatric Department.
Objective: The purpose of this poster is to explore the relationship between breastfeeding and infant sleep practices among mothers attending the UNTHSC Pediatric Clinic
Chart 2. Reasons for choosing baby's sleep location among non-breastfeeding mothers who bed-share (n=16)
Mothers’ ≥ 18 years who had an infant between ages of 2 weeks and 3 months visiting UNTHSC Pediatric Outpatient Clinic were asked to participate in a written survey. The questionnaire collected information about demographics, breastfeeding and infant sleep routine, among other variables.
Out of 103 mothers surveyed, 28 were Caucasian, 18 were African-American, and 46 were of Hispanic/Latino origin. Among all mothers, 55 were currently breastfeeding or feeding their infants pumped milk. Thirty-eight respondents reported that baby sleeps in mother’s bed at some point during night, i.e. bed-sharing. When broken down by race and ethnicity, 20 Hispanics, 11 Caucasians and 6 African-Americans bed-share. Overall, Caucasian mothers were more likely to breastfeed (19 out of 28 mothers or 68%) and Hispanic mothers were more likely to bed-share at some point in the night (20 out of 45 or 44%). Out of all women (n=55) who reported to breastfeed/pump milk, 58% reported that their infants also spent time in mother’s bed at night.
Overall, 71 mothers practiced breastfeeding,
bed-sharing or both. The remaining 27 mothers from our study did not breastfeed or bed-share.
The top four rationales for choosing baby’s sleep location differed between breastfeeding and non-breastfeeding mothers
An interesting finding in our study is that among mothers who bed-share, more than half of mothers chose their baby’s sleep location based on the rationale that it seemed safer for their baby. This was the most frequently reported choice among non-breastfeeding mothers who bed-share and the 3rd most cited option among breastfeeding mothers who bed-share. This suggests that mothers are not engaging in safe sleep practices while breastfeeding. A national study found that the predominant risk factor for sleep-related deaths in younger infants is bed-sharing, whereas in older infants, death is more often associated with prone position or objects (blankets, toys) in sleep area. While the majority of infant deaths in the study were non-Hispanic Whites, we have found similar risk factors in our patient population, which is predominantly Hispanic.
As more mothers chose to breastfeed for the proven health benefits provided to baby, it is important that we remind mothers of the importance of safe sleep routines during the first vulnerable months of life. More research is needed to determine if this is consistent among mothers in other regions as well as to determine how the risks of bed-sharing compare to the benefits of breastfeeding.
Venn-diagram of Mothers who breastfeed, mothers who bed-share, and mothers who engage in both practices
Breastfeed
Bedshare 32 22 16 27
*Information on 6 mothers is not depicted due to non-response on breastfeeding and/or bed-sharing practices
Tarrant County Infant Health Network, Infant Mortality by Zipcode Distribution
Ball, H. (2003). Breastfeeding, Bed-Sharing, And Infant Sleep. Birth, 30(3),
Sleep Environment Risks for Younger and Older Infants, Pediatrics, July 2014
Taskforce on Sudden Infant Death Syndrome. (2011). SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment. Pediatrics.
AAP recommendations:
Room sharing without bed-sharing is recommended. Devices designed to make bed-sharing safe are not recommended. The crib should be free of soft objects and loose bedding. Bumper pads are not recommended.
Texas Pediatric Society Electronic Poster Contest