1. 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. 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

7. The Current Study

8. 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)

9. 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

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

11. Ethnicity –91% White –2.5% Black –1.4% Latina –1.5% Asian –0.6% Native American

12. Do others know where your baby sleeps?

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

14. Do people say negative things about where your baby ends the night? US Sample (N=4337) Χ 2 (2)=681.64 p<.0001 Infant Sleep Location

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

16. Reasons for Current Sleep Arrangements

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

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

19. How mothers handle nighttime feedings

20. Χ 2 (1)=163.08, p<.0001 Where Mothers Fall Asleep During Night Feedings US Sample (N=2103)

21. 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

22. 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

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

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

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

26. 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

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

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

29. 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

30. 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

31. 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