What Every Health Professional Should Know

Top 12 List: What Every Health Professional and “Civil Authority” Should Know About “Sleeping With Baby” i.e. Mother-Infant Cosleeping With Breastfeeding

By James J. McKenna, Ph.D.

1. Co-sleeping for the breastfeeding mother is “normative” human behavior; it is not “surprising," unexpected, nor irresponsible nor child abuse nor neglect; it is not immoral nor inherently stupid nor ignorant parental behavior;

2. Sweeping public health recommendations must resonate emotionally and socially with the constituencies for whom they are intended; simplistic anti-co-sleeping messages do not;

3. Where infants sleep is often unplanned and very fluid; most babies sleep in more than one context, from solitary to social and back. Health brochures capturing social and solitary environments are critical.

4. Co-sleeping is biologically interdependent with breastfeeding and is associated with an underlying parental biology that motivates it;

5. Co-sleeping is diverse. There is a difference between the act of co-sleeping or co-sleeping in the form of bedsharing and the conditions within which it occurs (which can be safe or unsafe);

6. It is inappropriate to claim that co-sleeping is a SIDS risk factor.  Co-sleeping in the form of separate surface co-sleeping is protective, and there is no singular risk factor associated with bedsharing, as is often claimed, since how and by whom it is practiced makes an enormous difference in outcome. Breastfeeding mothers, for example, overwhelmingly bedshare and with positive outcomes, when all other adverse factors (modifiable factors) are absent.  Usually when the safety of bedsharing with crib sleeping is compared, and bedsharing is said to be 22-40 times more dangerous, none of the confounding factors that are known to increase risks while bedsharing are mentioned.  Indeed, some find it acceptable to disregard, for example, a baby sleeping prone in the bedsharing environment as explanatory of the death but rather prefer to say the infant died simply because of bedsharing. A double standard is employed to assess the causes and remedies of deaths in cribs vs. deaths in beds (see this)

7. For moral, political and ethical reasons PARENTS  (and not medical authorities) must remain the final arbiters of their infant’s nighttime needs and sleeping arrangements. It is an intrinsic civil right of the parent to decide where their infant will sleep. It is not the civil right of a medical authority to tell parents where their baby will sleep. Where and when it is implied that it is not the parent's right, this overreach must be challenged at every level, by moral, legal, scientific, and political communities and their constituencies.

8. Where babies sleep is NOT ultimately a medical issue at all, but is instead “relational,” often practical, and is supported by parental and infant biological systems, or by philosophies, and sometimes by economic factors;

9. No one-size-fits-all strategy as regards sleeping arrangements will work: there is more than one way to save babies' lives and promote the well being of families;

10.The push by health professionals for the early consolidation of  infant sleep is a recent socio-cultural construct associated with bottle-feeding cultures and has little to do with what is in an infant’s best interest, especially one that breastfeeds.  Indeed, pushing an "early consolidation of sleep"  threatens the best interests of infants psychologically and physically as it conflicts with the infant's ability to breastfed throughout the night, according to its own needs, which means arousing  frequently to feed, therein optimizing growth and development, immune function, and the proliferation of important neurological interconnections.

11. According to Sackett (2001) “evidence- based medicine” in the form of  public health recommendations  must meet the needs, desires, and possibilities of those for whom the recommendations are intended. Opinions of citizens do matter. Parents, lactation consultants, and legitimate researchers all have been inappropriately dismissed by agencies and organizations attempting to eradicate any and all forms of bedsharing.

Recommendations have to make sense in the context in which they are to find acceptance. (Simplistic arguments against all forms of cosleeping, in this case, do not make sense, nor are the recommendations “practical” for those for whom they are intended.)

12. Because of the powerful, legitimate, biological reasons and physiological systems that underlie it, co-sleeping in the generic (unspecified forms) will not be subject to cultural nullification. Also parents retain the right to learn what factors can make bedsharing unsafe, and how to maximize safety.