This is the current release of the guideline.

Academy of Breastfeeding Medicine protocols expire five years from the date of publication. Evidence-based revisions are made within five years or sooner if there are significant changes in evidence.

Newborn/infant health and nutrition

Counseling
Management
Prevention
Risk Assessment

Family Practice
Nursing
Nutrition
Obstetrics and Gynecology
Pediatrics

Advanced Practice Nurses
Allied Health Personnel
Dietitians
Nurses
Physician Assistants
Physicians

To facilitate optimal breastfeeding and safe parent-child co-sleeping practices

Nursing mothers and their newborn infants

1. Consider ethnic, socioeconomic, feeding, and other family circumstances when obtaining sleep history
   • Sensitivity to cultural differences
2. Parental counseling and education
   • Risks and benefits of parent-child co-sleeping
   • Unsafe co-sleeping practices
   • Safe sleeping environment for infant

• Infant mortality
• Mechanical asphyxiation
• Sudden infant death syndrome

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

An initial search of relevant published articles written in English in the past 20 years in the fields of medicine, psychiatry, psychology, and basic biological science is undertaken for a particular topic. Once the articles are gathered, the papers are evaluated for scientific accuracy and significance.

Not stated

Expert Consensus (Committee)
Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

I Evidence obtained from at least one properly randomized controlled trial

II-1 Evidence obtained from well-designed controlled trials without randomization

II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group

II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

III Opinions of respected authorities, based on clinical experience, descriptive studies and case reports; or reports of expert committees

Systematic Review with Evidence Tables

An expert panel is identified and appointed to develop a draft protocol using evidence based methodology. An annotated bibliography (literature review), including salient gaps in the literature, are submitted by the expert panel to the Protocol Committee.

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

Draft protocol is peer reviewed by individuals outside of lead author/expert panel, including specific review for international applicability. Protocol Committee's sub-group of international experts recommends appropriate international reviewers. Chair (co-chairs) institutes and facilitates process.

Reviews submitted to committee Chair (co-chairs).

Draft protocol is submitted to The Academy of Breastfeeding Medicine (ABM) Board for review and approval. Comments for revision will be accepted for three weeks following submission. Chair (co-chairs) and protocol author(s) amends protocol as needed.

Following all revisions, protocol has final review by original author(s) to make final suggestions and ascertain whether to maintain lead authorship.

Final protocol is submitted to the Board of Directors of ABM for approval.

1. Because breastfeeding is the best form of nutrition for infants, any recommendations for infant care that impede its initiation or duration need to be carefully weighed against the many known benefits to infants, their mothers, and society.
2. It should not be assumed that all families are practicing only one sleeping arrangement all night every night and during the daytime as well. Healthcare providers should consider ethnic, socioeconomic, feeding, and other family circumstances when obtaining a history on infant sleep practices (Blair et al., 1999; Flick et al., 2001; Ostfeld et al., 2006).
3. Parents need to be encouraged to express their views and to seek information and support from their healthcare providers. Sensitivity to cultural differences is necessary when obtaining sleep histories.
4. There is currently not enough evidence to support routine recommendations against co-sleeping. Parents should be educated about risks and benefits of co-sleeping and unsafe co-sleeping practices and should be allowed to make their own informed decision.

Bed sharing/co-sleeping is a complex practice. Parental counseling about infant sleep environments should include the following information:

1. Some potentially unsafe practices related to bed sharing/co-sleeping have been identified either in the peer-reviewed literature or as a consensus of expert opinion:
   • Environmental smoke exposure and maternal smoking (Blair et al., 1999; Mitchell et al., 1992; Mitchell et al., 1996; Mitchell et al., 1997; Scragg et al, 1993; Scragg et al., 1995; Scragg et al., 1998; Mitchell et al., 1994; Horsley et al., 2007)
   • Sharing sofas, couches, or daybeds with infants (Blair et al., 1999; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005)
   • Sharing waterbeds or the use of soft bedding materials (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005)
   • Sharing beds with adjacent spaces that could trap an infant (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005)
   • Placement of the infant in the adult bed in the prone or side position (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005)
   • The use of alcohol or mind-altering drugs by the adult(s) who is bed sharing (Blair et al., 1999)
   • Infants bed sharing with other children (American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005)
   • Bed sharing with younger babies <8–14 weeks of age may be more strongly associated with SIDS (Blair et al., 1999; Carroll-Pankhurst & Mortimer, 2001; Horsley et al., 2007; Tappin, Ecob & Brooke, 2005; Carpenter et al., 2004).
2. Families also should be given all the information that is known about safe sleep environments for their infants, including:
   • Place babies in the supine position for sleep (American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Use a firm, flat surface and avoid waterbeds, couches, sofas, pillows, soft materials, or loose bedding (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • If blankets are to be used, they should be tucked in around the mattress so that the infant's head is less likely to be covered (American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Ensure that the head will not be covered. In a cold room the infant could be kept in an infant sleeper to maintain warmth (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Avoid the use of quilts, duvets, comforters, pillows, and stuffed animals in the infant's sleep environment (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Never put an infant down to sleep on a pillow or adjacent to a pillow (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Never leave an infant alone on an adult bed (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Inform families that adult beds have potential risks and are not designed to meet federal safety standards for infants (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Ensure that there are no spaces between the mattress and headboard, walls, and other surfaces, which may entrap the infant and lead to suffocation (Byard, Beal & Bourne, 1994; Drago & Dannenberg, 1999; Kemp et al., 2000; Nakamura, Wind & Danello, 1999; U.S. Consumer Products Safety Commission, 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005).
   • Placement of a firm mattress directly on the floor away from walls may be a safe alternative. Another alternative to sharing an adult bed or sharing a mattress is the use of an infant bed that attaches to the side of the adult bed and provides proximity and access to the infant but a separate sleep surface. There are currently no peer-reviewed studies on the safety or efficacy of such devices.
   • Room sharing with parents appears to be protective against SIDS (Blair et al., 1999; American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, 2005; Tappin, Ecob & Brooke, 2005; Carpenter et al, 2004).

None provided

The type of evidence supporting the recommendations is not specifically stated.

The recommendations were based primarily on a comprehensive review of the existing literature. In cases where the literature does not appear conclusive, recommendations were based on the consensus opinion of the group of experts.

Optimal breastfeeding and safe parent-child co-sleeping practices

The concerns regarding the bed sharing and increased infant mortality have been centered around mechanical suffocation (asphyxiation) and sudden infant death syndrome (SIDS) risks.

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.

An implementation strategy was not provided.

Staying Healthy

Effectiveness
Patient-centeredness
Safety

Not applicable: The guideline was not adapted from another source.

2008 Mar

Academy of Breastfeeding Medicine - Professional Association

Academy of Breastfeeding Medicine

A grant from the Maternal Child Health Bureau, U.S. Department of Health and Human Services

Academy of Breastfeeding Medicine Protocol Committee

Committee Members: Caroline J. Chantry, MD, FABM Co-Chairperson; Cynthia R. Howard, MD, FABM, Co-Chairperson; Ruth A. Lawrence, MD, FABM; Kathleen A. Marinelli, MD, FABM, Co-Chairperson; Nancy G. Powers, MD, FABM

Contributors: *Rosha McCoy, MD, FABM; *James J. McKenna, PhD; *Lawrence Gartner, MD, FABM

*Lead authors

Not stated

This is the current release of the guideline.

Academy of Breastfeeding Medicine protocols expire five years from the date of publication. Evidence-based revisions are made within five years or sooner if there are significant changes in evidence.

None available

This NGC summary was completed by ECRI Institute on March 20, 2009. The information was verified by the guideline developer on September 10, 2009.