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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 1
THE SAFE SLEEP 7: NAPTIME AND NIGHTTIME
STRATEGIES for the BREASTFEEDING Family
Linda J. Smith, MPH, IBCLC
Black Mothers Breastfeeding Association
7th Annual National Seminar
Beyond the Mom: Reframing the Approach to Maternal Care
October 14, 2016
Objectives
• Describe normal sleep for infants and their mothers
• Explain the Safe Sleep Seven
• Discuss baby‐proofing your bed and nap strategies
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What’s normal sleep?All new mothers have fragmented sleep
All babies wake frequently in first 6‐9 months
Frequent feeding is normal, babies are not ‘convenient’
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Infant sleep
• “A human infant is biologically designed to sleep next to its mother’s body and to breastfeed intermittently throughout the night, at least for the first year of its life.
• And however distant and removed contemporary western urban cultural environments are from the overall care and infant vulnerabilities… [of] hundreds of thousands of years ago, it still remains true that nothing a human neonate [newborn] can do or cannot do makes sense except in light of the mother’s body –
• James McKenna and Lee Gettler• McKenna, J. J., Ball, H. L., & Gettler, L. T. (2007). Mother‐infant cosleeping, breastfeeding and sudden infant death
syndrome: what biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Am J Phys Anthropol, Suppl 45, 133‐161.
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Infant Sleep
• Short 60‐90 minute cycles and feeding intervals• May combine two cycles occasionally, once a day
• Immature liver can’t sustain blood sugars till 6‐9 months
• Double birthweight in 4‐6 months
• Small stomach: size of a chicken’s egg from 2‐6 months
• Breastmilk digests quickly, fosters brain growth
• Breastfeeding & bedsharing are mutually reinforcing
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Mother’s sleep
• Postpartum mothers have fragmented sleep
• Many new moms take 1‐3 naps every day
• Body is recovering from pregnancy & birth
• Breastfeeding floods her & baby with oxytocin
• Expect mother to be drowsy during breastfeeding
• Mother often falls asleep while baby is still nursing
• Plan for safety EVERY time you nurse
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 2
the Safe Sleep Seven©
3 adult factors: nonsmoker, sober, breastfeeding mother
3 baby factors: healthy, on back, unswaddled in light clothing
Safe surface
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Safe Sleep Seven ©2014 La Leche League International
• No Smoking
• Sober Parents
• Breastfeeding Mother
• Healthy Baby
• On his/her back
• Lightly Dressed (not swaddled)
• Safe Surface
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No smoking
• Prenatal smoking = HIGHEST risk factor for SIDS (5‐fold)
• Any smoking in the home increases risk of SIDS • Dose‐related, up to 7‐fold higher
• It’s not enough to smoke outside the house• Smokers exhale carbon monoxide for >24 hours after every cigarette; CO is heavier than air
• How far away from the smoker’s mouth is ‘safe?’• Carbon dioxide dissipates within 8 inches
• No information on distance for carbon monoxide
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Sober Bedpartners
• Smothering (not SIDS) is HIGHLY related to alcohol use
• Drunk bedpartners are less aware of baby
• Alcohol appears in milk• About 1% of maternal dose transfers quickly to milk
• Milk levels same as blood (does not accumulate)
• Babies don’t nurse as well when alcohol is in milk
• Metabolizes (clears) at about 1 ounce per hour
• Reduces milk production somewhat
• Myths about beer
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Breastfeeding mother
• Nursing mothers sleep differentlywith their babies• Arm above or under baby’s head
• Legs bent, frequent touching & adjusting position
• Baby stays in en face position with mother
• Baby orients & moves toward breast
• Mother does not roll away and roll back
• Synchronized sleep cycles!
• Nursing mothers get the most sleep of any new parents
• Formula feeding more than doubles the risk of SIDS
• Formula may suppress arousal in vulnerable babies
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Cuddle Curl confirmed in infrared sleep studies
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https://www.dur.ac.uk/resources/isis.online/RMP‐15mid.jpg
Richard, C., Mosko, S., McKenna, J., & Drummond, S. (1996). Sleeping position, orientation, and proximity in bedsharing infants and mothers. Sleep, 19(9), 685‐690.
Ball, H. L. (2003). Breastfeeding, bed‐sharing, and infant sleep. Birth, 30(3), 181‐188.
Sweet Sleep and the Safe Sleep Seven 9/9/2016
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Healthy Baby
• SIDS risk is higher if baby has a respiratory illness
• Formula fed children have higher rates of sickness
• Formula fed babies are more likely to die, even in the USA
• No evidence that safe bedsharing increases risk to baby
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On his back (supine)
• “SIDS” = no reason found for a baby’s death
• Prone position increases SIDS risk • Prone (face‐down) position causes deeper sleep
• Some babies go into bradycardia (slow heart rate)
• A few can’t arouse out of that deep sleep / bradycardia
• No known warning signs for which babies are at risk• Possibly a brainstem defect
• Face‐up assures open airway, no smothering/suffocation
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Lightly dressed
• Same layers/thickness of clothing as adults• Whether bedsharing or in own sleep space
• No heavy covers or quilts
• Blanket sleeper or light blanket
• NO SWADDLING • Swaddling is an independent SIDS risk
• Overheating is a SIDS risk
• Arms and legs must be free to move
• “Skin to Skin” or Kangaroo Mother Care are GREAT
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Safe Surface Checklist©2014 La Leche League International
• Avoid smothering risks:• Sofas & recliners
• Softness & sagginess
• Spaces between mattress & headboard, walls, side rails
• Bedpartner who thrashes or sleeps exceptionally soundly
• Other children
• Pets that could interfere
• Clear your bed of:• Unused pillows
• Stuffed toys
• Heavy covers & comforters
• Anything that dangles or tangles
• Check for possible hazards• Distance to the floor
• Landing surface
• Sharp, poking or pinching places
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Close to you day and night
• Within sight and sound of responsible adult• Family noises do NOT disrupt infant sleep
• Family smells (aromas) may be improve arousals
• Wear‐carriers provide passive movement, convenience• Slings: “TICKS” for safety (Tight, In view, Close enough to kiss, Keep chin off chest, Supported back)
• Other tie‐on soft carriers for babies <6 months
• Side‐car devices attached to family bed
• Portable “Moses Baskets” kept near you
• NO sleeping in car seats except during car rides
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baby‐proofing your bed and nap strategiesBaby‐proof your bed ANYWAY because sleep happens
Side‐car devices are good options
Avoid couches and recliners
Safety on unplanned surfaces – secure baby to your body
Don’t be tempted by sleep training – highly stressful
Bedsharing and breastfeeding are mutually reinforcing
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 4
Sleep training: BAD IDEA
• Long history of adult control of children – bad outcomes
• Babies need human contact – we’re mammals!
• Montagu: “External Gestation” of 9‐12 months
• Kind touch is remembered deep in the brain
• Early care has lifelong implications – positive or negative
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NO NO NO!
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This would be safer if baby was secured on dad’s chest
Maybe – if near adult
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Babywearinghttp://babywearinginternational.org
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YES yes yes
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https://www.isisonline.org.uk/image‐archive/
Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 5
Bottom line:
“Baby‐proof the bed because sleep happens.”
Linda J. Smith, MPH, IBCLC
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Breastfeeding is at risk when mothers and babies don’t share sleep Santos 2009
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courtesy La Leche League– Hong Kong
Babies are at risk when mothers and babies don’t share sleep safely
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Greatest sleep comes with exclusive breastfeeding and bedsharing
Doan et al 2007
Ball &Blair 2004
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Greatest sleep comes with exclusive breastfeeding and bedsharing
Mothers and babies need to know how to do it safely
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Bottom line:
“Baby‐proof the bed because sleep happens.”
Linda J. Smith, MPH, IBCLC
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Sweet Sleep and the Safe Sleep Seven 9/9/2016
© Linda J. Smith / BFLRC 2016 6
Resources and references
• http://www.isisonline.org.uk/ ISIS provides information about normal infant sleep based upon the latest UK and world‐wide research
• Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family (2014). www.llli.org/sweetsleepbook
• University of Notre Dame Mother‐Baby Behavioral Sleep Laboratory http://www.nd.edu/~jmckenn1/lab
• Durham University Parent‐Infant Sleep Lab http://www.dur.ac.uk/sleep.lab/
• Academy of Breastfeeding Medicine Protocol on Co‐Sleeping www.bfmed.org
• McKenna, James. Sleeping with Your Baby.Washington, DC: Platypus Media 2007 http://www.platypusmedia.com/node/70
• Ball H, Inch S, Copeland M. The Benefits of Bedsharing (video) http://www.markittelevision.com/breastfeeding_titles.html
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Resources
•www.llli.org/sweetsleepbook•https://www.isisonline.org.uk/•http://cosleeping.nd.edu/
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The Safe Sleep Seven and Sweet Sleep book©2014 La Leche League International
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Diane WiessingerDiana WestLinda J. SmithTeresa Pittman
http://www.llli.org/sweetsleepbook
Thank you!
Linda J. Smith, MPH, IBCLC
937‐438‐8458
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