Should culture trump science onwhere breastfeeding dyads sleep?
Article Title: Physiological Infant Care—Managing Nighttime Breastfeeding in Young Infants
Journal: Breastfeeding Medicine
Article Highlights
Main Takeaway
In the absence of hazardous circumstances, dyads are healthier sleeping together. Research supports this, but it counters some cultural beliefs and expectations.
Why?
Babies need to breastfeed about 8 to 12 times per 24 hours. Continuous proximity with the mother helps their systems regulate. To avert involution mothers need to remove milk regularly, especially in the early weeks. Sleeping together supports this normal process.
Quotable Droplet with the most kCals per mL:
“… Young infants require frequent feedings day and night, particularly those who are breastfeeding. This can be a challenge...” (Zimmerman, et al., 2023)
A few more details:
Normal infant feeding patterns: Newborns need to be fed by their cues, “responsive feeding.” 1, 2
Normal infant sleeping patterns: Nighttime separation from the mother can cause elevated cortisol levels whether demonstrated by appearance or not. Further, while separation may provoke sleep consolidation, it may not be physiological or safe, thus explaining why sleeping in proximity to the mother is associated with a decreased risk of SIDS. Wherever infants sleep, there may be no marked lengthening of duration of sleep in the first 3-12 months. 5
Cultural expectations of sleeping through the night and/or alone: “Intentionally limiting nighttime feeding is associated with early cessation of exclusive breastfeeding 6 … Breastfeeding infants sleep as well as or better than their formula feeding counterparts.” 6 (p. 160) Hazardous conditions are few and most are within parental control.
Maternal depression: A comprehensive review and meta-analysis found ”a reduced risk of postpartum depression associated with breastfeeding.”
Recommendations: With a gauge of the quality of evidence and strength, recommendations are provided which support nighttime breastfeeding.
Citation details
Article Title: ABM Clinical Protocol #37: Physiological Infant Care—Managing Nighttime Breastfeeding in Young Infants
Authors: Deena Zimmerman, Melissa Bartick, Lori Feldman-Winter, and Helen L. Ball
Journal: Breastfeeding Medicine, vol 18, number 3
Publication Date: March 15, 2023
References noted:
World Health Organization. Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services: The Revised Baby-Friendly Hospital Initiative: Implementation Guidance. World Health Organization and UNICEF: Geneva; 2018.
Kent JC, Mitoulas LR, Cregan MD, et al. Volume and frequency of breastfeedings and fat content of breast milk throughout the day. Pediatrics 2006;117(3):e387-e395.
Middlemiss W, Granger DA, Goldberg WA, et al. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Hum Dev 2012;88(4):227-232.
Thompson JMD, Tanabe K, Moon RY, et al. Duration of breastfeeding and risk of SIDS: An individual participant data meta-analysis. Pediatrics 2017;140(5):e2071324.
Volkovich E, Ben-Zion H, Karny D, et al. Sleep patterns of co-sleeping and solitary sleeping infants and mothers: A longitudinal study. Sleep Med 2015;16(11):1305-1312.
Vieira TO, Vieira GO, de Oliveira NF, et al. Duration of exclusive breastfeeding in a Brazilian population: New determinants in a cohort study. BMC Pregnancy Childbirth 2014;14:175.
Doan T, Gardiner A, Gay CL, et al. Breast-feeding increases sleep duration of new parents. J Perinat Neonatal Nurs 2007;21(3):200-206.
Alimi R, Azmoude E, Moradi M, et al. The association of breastfeeding with a reduced risk of postpartum depression: A systematic review and meta-analysis. Breastfeed Med 2022; 17(4):290-296.
KEEPING UP-TO-DATE WITH BREASTFEEDING MEDICINE
Droplets of Knowledge: Helping practitioners stay up to date with the latest information on breastfeeding, as well as a look at some of the classic studies.
Prepared by Constance Pond
Email lll.denaduran@gmail.com or lllleader.constance@gmail.com with comments, questions, or suggestions for future Droplets.