To review current knowledge of the association between bed-sharing and breastfeeding behaviors during infancy.
Methods:
A systematic review methodology was employed following the Preferred Reporting Items for Systematic reviews and Meta-Analyses method and utilizing the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies for quality assessment. Inclusion criteria were quantitative or mixed-methods studies published between 1993 and 2022 that provided data on the association between bed-sharing and breastfeeding for postpartum mothers of infants 0–12 months. We excluded studies that utilized breastfeeding as the independent variable and bed-sharing as the dependent variable.
Results:
A total of 24 studies met the inclusion criteria, 11 of which were prospective/longitudinal and 13 of which were cross sectional. Eight of the longitudinal studies found a significant positive association between bed-sharing and breastfeeding (73%), and nine of the cross-sectional studies (69%) found a positive association.
Conclusion:
Many postpartum women bed-share with their infants. Bed-sharing is associated with an increase in breastfeeding for most women. There does not appear to be such a relationship between bed-sharing and breastfeeding in U.S. African American women, who have overall lower rates of breastfeeding.
Policy Implications:
The public health principle of risk reduction could be applied to those who plan to bed-share such as recommending that health care providers educate women about bed-sharing without hazards. Bed-sharing without hazards may be considered one strategy to promote breastfeeding.
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References
1.
BrahmP, ValdesV. Benefits of breastfeeding and risks associated with not breastfeeding. Rev Chil Pediatr, 2017; 88(1):7–14; doi: 10.4067/S0370-41062017000100001
2.
MeekJY, NobleL. Technical report: Breastfeeding and the use of human milk. Pediatrics, 2022; 150(1):e2022057989; doi: 10.1542/peds.2022-057989
3.
SaloneLR, VannWFJr, DeeDL. Breastfeeding: An overview of oral and general health benefits. J Am Dent Assoc, 2013; 144(2):143–151; doi: 10.14219/jada.archive.2013.0093
4.
GalsonSK. Mothers and children benefit from breastfeeding. J Am Diet Assoc, 2008; 108(7):1106; doi: 10.1016/j.jada.2008.04.028
5.
MannionCA, HobbsAJ, McDonaldSW, et al.Maternal perceptions of partner support during breastfeeding. Int Breastfeed J, 2013; 8(1):4–7; doi: 10.1186/1746-4358-8-4
6.
SkafidaV. The relative importance of social class and maternal education for breast-feeding initiation. Public Health Nutr, 2009; 12(12):2285–2292; doi: 10.1017/S1368980009004947
7.
FlackingR, NyqvistKH, EwaldU. Effects of socioeconomic status on breastfeeding duration in mothers of preterm and term infants. Eur J Public Health, 2007; 17(6):579–584; doi: 10.1093/eurpub/ckm019
8.
HeckKE, BravemanP, CubbinC, et al.Socioeconomic status and breastfeeding initiation among California mothers. Public Health Rep, 2006; 121(1):51–59; doi: 10.1177/003335490612100111
9.
DunnRLK, KA, FedrizziR, et al.Barriers and contributors to breastfeeding in WIC mothers: A social ecological perspective. Breastfeed Med, 2015; 10(10):493–501; doi: 10.1089/bfm.2015.0084
10.
EagletonSG, HohmanEE, VerdiglioneN, et al.INSIGHT study maternal return to work and infant weight outcomes. Acad Pediatr, 2019; 19(1):67–73; doi: 10.1016/j.acap.2018.08.008
11.
TsaiSY. Impact of a breastfeeding-friendly workplace on an employed mother’s intention to continue breastfeeding after returning to work. Breastfeed Med, 2013; 8(2):210–216; doi: 10.1089/bfm.2012.0119
12.
BaddockSA, PurnellMT, BlairPS, et al.The influence of bed-sharing on infant physiology, breastfeeding and behaviour: A systematic review. Sleep Med Rev, 2019; 43:106–117; doi: 10.1016/j.smrv.2018.10.007
13.
HuangY, HauckFR, SignoreC, et al.Influence of bedsharing activity on breastfeeding duration among US mothers. JAMA Pediatr, 2013; 167(11):1038–1044; doi: 10.1001/jamapediatrics.2013.2632
14.
SmithLA, GellerNL, KellamsAL, et al.Infant sleep location and breastfeeding practices in the United States, 2011-2014. Acad Pediatr, 2016; 16(6):540–549; doi: 10.1016/j.acap.2016.01.021
15.
BovbjergML, HillJA, UphoffAE, et al.Women who bedshare more frequently at 14 weeks postpartum subsequently report longer durations of breastfeeding. J Midwifery Womens Health, 2018; 63(4):418–424; doi: 10.1111/jmwh.12753
16.
VolkovichE, Ben-ZionH, KarnyD, et al.Sleep patterns of co-sleeping and solitary sleeping infants and mothers: A longitudinal study. Sleep Med, 2015; 16(11):1305–1312; doi: 10.1016/j.sleep.2015.08.016
17.
LavalleeL, ScannellM. Infant bed-sharing: Supporting parents to make an informed decision. Nurs Stand, 2017; 31(30):42–51; doi: 10.7748/ns.2017.e10427
18.
EidelmanAI, SchanlerRJ, JohnstonM, et al;SECTION ON BREASTFEEDING. Breastfeeding and the use of human milk. Pediatrics, 2012; 129(3):e827–e841; doi: 10.1542/peds.2022-057988
19.
OyarzúnMA, VelosoPB. Sudden infant death syndrome. In: Pediatric Respiratory Diseases. Springer; 2020, pp. 495–500; doi: 10.1007/978-3-030-26961-6_49
20.
MoonRY, MindellJA, HonakerS, et al.The Tension Between AAP Safe Sleep Guidelines and Infant Sleep. Pediatrics, 2024; 153(4):e2023064675; doi: 10.1542/peds.2023-064675
BallHL, TaylorCE. Baby-box schemes in England: Parent and practitioner experiences, and recommendations. BMC Pediatr, 2020; 20(1):154–111; doi: 10.1186/s12887-020-02064-2
23.
BartickM, BoisvertME, PhilippBL, et al.Trends in breastfeeding interventions, skin-to-skin care, and sudden infant death in the first 6 days after birth. J Pediatr, 2020; 218:11–15; doi: 10.1016/j.jpeds.2019.09.069
24.
MarinelliKA, BallHL, McKennaJJ, et al.An integrated analysis of maternal-infant sleep, breastfeeding, and sudden infant death syndrome research supporting a balanced discourse. J Hum Lact, 2019; 35(3):510–520; doi: 10.1177/0890334419851797
BlairPS, BallHL, McKennaJJ, et al;Academy of Breastfeeding Medicine. Bedsharing and breastfeeding: The Academy of Breastfeeding Medicine Protocol # 6, Revision 2019. Breastfeed Med, 2020; 15(1):5–16; doi: 10.1089/bfm.2019.29144.psb
27.
ZimmermanD, BartickM, Feldman-WinterL, et al;Medicine AoB. ABM Clinical Protocol # 37: Physiological infant care—Managing nighttime breastfeeding in young infants. Breastfeed Med, 2023; 18(3):159–168; doi: 10.1089/bfm.2023.29236.abm
28.
ColeR, YoungJ, KearneyL, et al.Infant care practices and parent uptake of safe sleep messages: A cross-sectional survey in Queensland, Australia. BMC Pediatr, 2020; 20(1):27–13; doi: 10.1186/s12887-020-1917-5
29.
BartickM, SmithLJ. Speaking out on safe sleep: Evidence-based infant sleep recommendations. Breastfeed Med, 2014; 9(9):417–422; doi: 10.1089/bfm.2014.0113
30.
BunchMG, HutsonSP. A nursing perspective on infant bed-sharing using multidisciplinary theory integration. ANS Adv Nurs Sci, 2020; 43(4):338–348; doi: 10.1097/ANS.0000000000000326
31.
MoonRY, TASK FORCE ON SUDDEN INFANT DEATH SYNDROME. SIDS and other sleep-related infant deaths: Evidence base for 2016 updated recommendations for a safe infant sleeping environment. Pediatrics, 2016; 138(5); doi: 10.1542/peds.2016-2940
32.
LiberatiA, AltmanDG, TetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol, 2009; 62(10):e1–e34; doi: 10.1016/j.jclinepi.2009.06.006
33.
RasmussenKM, FeliceJP, O’SullivanEJ, et al.The meaning of “breastfeeding” is changing and so must our language about it. Breastfeed Med, 2017; 12(9):510–514; doi: 10.1089/bfm.2017.0073
34.
BaileyC, TawiaS, McGuireE. Breastfeeding duration and infant sleep location in a cohort of volunteer breastfeeding counselors. J Hum Lact, 2020; 36(2):354–364; doi: 10.1177/0890334419851801
35.
MiddlemissW, GlamanR, SeddioK, et al.Supporting lower-income working women to initiate breastfeeding: Learning who is breastfeeding and what helps. J Am Assoc Nurse Pract, 2018; 30(9):519–528; doi: 10.1097/JXX.0000000000000077
36.
BuswellSD, SpatzDL. Parent-infant co-sleeping and its relationship to breastfeeding. J Pediatr Health Care, 2007; 21(1):22–28; doi: 10.1016/j.pedhc.2006.04.006
37.
TollenaarMS, BeijersR, JansenJ, et al.Solitary sleeping in young infants is associated with heightened cortisol reactivity to a bathing session but not to a vaccination. Psychoneuroendocrinology, 2012; 37(2):167–177; doi: 10.1016/j.psyneuen.2011.03.017
38.
BaddockSA, Tipene-LeachD, WilliamsSM, et al.Wahakura versus bassinet for safe infant sleep: A randomized trial. Pediatrics, 2017; 139(2); doi: 10.1542/peds.2016-0162
39.
MillerJ, ScottJ. Newborn and infant (0–12 months). In: Food and Nutrition Throughout Life. Routledge; 2020:117–140; doi: 10.4324/9781003115670
40.
ThomasBH, CiliskaD, DobbinsM, et al.A process for systematically reviewing the literature: Providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs, 2004; 1(3):176–184; doi: 10.1111/j.1524-475X.2004.04006.x
41.
BaddockSA, GallandBC, BoltonDP, et al.Differences in infant and parent behaviors during routine bed sharing compared with cot sleeping in the home setting. Pediatrics, 2006; 117(5):1599–1607; doi: 10.1542/peds.2005-1636
42.
BallHL. Reasons to bed-share: Why parents sleep with their infants. J Reproduct Infant Psychol, 2002; 20(4):207–221; doi: 10.1080/0264683021000033147
43.
BallHL, HowelD, BryantA, et al.Bed‐sharing by breastfeeding mothers: Who bed‐shares and what is the relationship with breastfeeding duration? Acta Paediatr, 2016; 105(6):628–634; doi: 10.1111/apa.13354
44.
BlairP, BallH. The prevalence and characteristics associated with parent–infant bed-sharing in England. Arch Dis Child, 2004; 89(12):1106–1110; doi: 10.1136/adc.2003.038067
45.
BlairPS, HeronJ, FlemingPJ. Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis. Pediatrics, 2010; 126(5):e1119–e1126; doi: 10.1542/peds.2010-1277
46.
BrennerRA, Simons-MortonBG, BhaskarB, et al.Infant-parent bed sharing in an inner-city population. Arch Pediatr Adolesc Med, 2003; 157(1):33–39; doi: 10.1001/archpedi.157.1.33
47.
ClementsMS, MitchellEA, WrightSP, et al.Influences on breastfeeding in southeast England. Acta Paediatr, 1997; 86(1):51–56; doi: 10.1111/j.1651-2227.1997.tb08831.x
48.
ColeR, YoungJ, KearneyL, et al.Reducing sleep-related infant mortality through understanding factors associated with breastfeeding duration: A cross-sectional survey. Breastfeeding Review, 2020; 28(1).
49.
FlickL, WhiteDK, VemulapalliC, et al.Sleep position and the use of soft bedding during bed sharing among African American infants at increased risk for sudden infant death syndrome. J Pediatr, 2001; 138(3):338–343; doi: 10.1067/mpd.2001.111428
50.
FordRPKM, EA, ScraggR, et al.Factors adversely associated with breast feeding in New Zealand. J Paediatr Child Health, 1994; 30(6):483–489; doi: 10.1111/j.1440-1754.1994.tb00717.x
51.
KadakiaA, JoynerB, TenderJ, et al.Breastfeeding in African Americans may not depend on sleep arrangement: A mixed-methods study. Clin Pediatr (Phila), 2015; 54(1):47–53; doi: 10.1177/0009922814547565
52.
KuralB, GökçayG. Association between infant sleep location and breastfeeding. Breastfeed Med, 2022; 17(4):305–310; doi: 10.1089/bfm.2021.0188
53.
LahrMB, RosenbergKD, LapidusJA. Maternal-infant bedsharing: Risk factors for bedsharing in a population-based survey of new mothers and implications for SIDS risk reduction. Matern Child Health J, 2007; 11(3):277–286; doi: 10.1007/s10995-006-0166-z
54.
Landa-RiveraJL, Pérez-PérezJ, González-NúñezM, et al.Population-based survey showing that breastfed babies have a lower frequency of risk factors for sudden infant death syndrome than nonbreastfed babies. Breastfeed Med, 2022; 17(2):182–188; doi: 10.1089/bfm.2021.0113
55.
McCoyRC, HuntCE, LeskoSM, et al.Frequency of bed sharing and its relationship to breastfeeding. J Dev Behav Pediatr, 2004; 25(3):141–149; doi: 10.1097/00004703-200406000-00001
56.
MitchellEA, HutchisonBL, ThompsonJMD, et al.Exploratory study of bed‐sharing and maternal‐infant bonding. J Paediatr Child Health, 2015; 51(8):820–825; doi: 10.1111/jpc.12833
57.
TaylorN, DonovanW, LeavittL. Consistency in infant sleeping arrangements and mother–infant interaction. Infant Ment Health J, 2008; 29(2):77–94; doi: 10.1002/imhj.20170
58.
VieiraGO, de Oliveira VieiraT, da Cruz MartinsC, et al.Risk factors for and protective factors against breastfeeding interruption before 2 years: A birth cohort study. BMC Pediatr, 2021; 21(1):310–310; doi: 10.1186/s12887-021-02777-y
59.
WennergrenG, Strömberg CelindF, GoksörE, et al.Swedish survey of infant sleep practices showed increased bed‐sharing and positive associations with breastfeeding. Acta Paediatr, 2021; 110(6):1835–1841; doi: 10.1111/apa.15719
TanKL, GhaniSN, MoyFM. The prevalence and characteristics associated with mother-infant bed-sharing in Klang District, Malaysia. Med J Malaysia, 2009; 64(4):311–315.
62.
TanKL. Factors associated with exclusive breastfeeding among infants under six months of age in peninsular Malaysia. Int Breastfeed J, 2011; 6(1):2; doi: 10.1186/1746-4358-6-2
63.
HauckFR, SignoreC, FeinSB, et al.Infant sleeping arrangements and practices during the first year of life. Pediatrics, 2008; 122(Suppl 2):S113–S20; doi: 10.1542/peds.2008-1315o
64.
BallHL. Bed‐sharing practices of initially breastfed infants in the first 6 months of life. Infant Child Dev, 2007; 16(4):387–401; doi: 10.1002/icd.519
65.
BallHL, MoyaE, FairleyL, et al.Bed-and sofa-sharing practices in a UK biethnic population. Pediatrics, 2012; 129(3):e673–e681; doi: 10.1542/peds.2011-1964
66.
Strömberg CelindF, WennergrenG, MöllborgP, et al.Area‐based study shows most parents follow advice to reduce risk of sudden infant death syndrome. Acta Paediatr, 2017; 106(4):579–585; doi: 10.1111/apa.13711
67.
LuijkMP, Mileva-SeitzVR, JansenPW, et al.Ethnic differences in prevalence and determinants of mother–child bed-sharing in early childhood. Sleep Med, 2013; 14(11):1092–1099; doi: 10.1016/j.sleep.2013.04.019
68.
MerskyJP, JanczewskiCE, Plummer LeeC, et al.Home visiting effects on breastfeeding and bedsharing in a low-income sample. Health Educ Behav, 2021; 48(4):488–495; doi: 10.1177/1090198120964197
69.
AteahCA, HamelinKJ. Maternal bedsharing practices, experiences, and awareness of risks. J Obstet Gynecol Neonatal Nurs, 2008; 37(3):274–281; doi: 10.1111/j.1552-6909.2008.00242.x
70.
BroussardDL, SappenfieldWM, GoodmanDA. The black and white of infant back sleeping and infant bed sharing in Florida, 2004–2005. Matern Child Health J, 2012; 16(3):713–724; doi: 10.1007/s10995-011-0768-y
71.
FuLY, ColsonER, CorwinMJ, et al.Infant sleep location: Associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations. J Pediatr, 2008; 153(4):503–508; doi: 10.1016/j.jpeds.2008.05.004
72.
GilmourH, Ramage-MorinPL, WongSL. Infant bed sharing in Canada. Health Rep, 2019; 30(7):13–19; doi: 10.25318/82-003-x201900700002-eng
73.
HussainS, LowellGS, RoehlerDR, et al.You can have your breastmilk and safe sleep too: A preliminary analysis of infant safe sleep data in a Midwestern home visiting program. Inj Epidemiol, 2018; 5(Suppl 1):14; doi: 10.1186/s40621-018-0138-y
74.
MeighanKA, BovbjergML, BenyshekDC, et al.Prevalence and predictors of postpartum cosleeping practices after midwife-led births in the US. J Pediatr, 2022; 248:46–50. e1; doi: 10.1016/j.jpeds.2022.05.048
75.
OsbergS, KalstadTG, Stray‐PedersenA. Norwegian parents avoid placing infants in prone sleeping positions but frequently share beds in hazardous ways. Acta Paediatr, 2021; 110(7):2119–2125; doi: 10.1111/apa.15797
76.
WardTCS, NguiEM. Factors associated with bed-sharing for African American and white mothers in Wisconsin. Matern Child Health J, 2015; 19(4):720–732; doi: 10.1007/s10995-014-1545-5
77.
HillAB. The Environment and Disease: Association or Causation? Sage Publications; 1965; doi: 10.1177/003591576505800503
78.
McKennaJJ, VolpeLE. Sleeping with baby: An internet‐based sampling of parental experiences, choices, perceptions, and interpretations in a western industrialized context. Infant Child Development, 2007; 16(4):359–385; doi: 10.1002/icd.525
79.
ThomanEB. Co-sleeping, an ancient practice: Issues of the past and present, and possibilities for the future. Sleep Med Rev, 2006; 10(6):407–417; doi: 10.1016/j.smrv.2005.12.001
80.
BartickM, TomoriC, BallHL. Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Matern Child Nutr, 2018; 14(2):e12544; doi: 10.1111/mcn.12544
81.
HinsonTD, SkinnerAC, LichKH, et al.Factors that influence breastfeeding initiation among African American women. J Obstet Gynecol Neonatal Nurs, 2018; 47(3):290–300; doi: 10.1016/j.jogn.2018.02.007
82.
SpencerBS, GrassleyJS. African American women and breastfeeding: An integrative literature review. Health Care Women Int, 2013; 34(7):607–625; doi: 10.1080/07399332.2012.684813
83.
ParkerMGK, ColsonER, ProviniL, et al.Variation in safe sleep and breastfeeding practices among non-Hispanic black mothers in the United States according to birth country. Acad Pediatr, 2017; 17(8):887–892; doi: 10.1016/j.acap.2017.07.003
84.
McKinneyC-H, Chase-LansdaleJ, Lindsay; RameyP, et al;Community Child Health Research Network. Racial and ethnic differences in breastfeeding. Pediatrics, 2016; 138(2):1–11; doi: 10.1542/peds.2015-2388
85.
MoskoS, RichardC, McKennaJ. Maternal sleep and arousals during bedsharing with infants. Sleep, 1997; 20(2):142–150; doi: 10.1093/sleep/20.2.142
86.
KingLS, RangelE, SimpsonN, et al.Mothers’ postpartum sleep disturbance is associated with the ability to sustain sensitivity toward infants. Sleep Med, 2020; 65:74–83; doi: 10.1016/j.sleep.2019.07.017
87.
WardTCS. Reasons for mother–infant bed-sharing: A systematic narrative synthesis of the literature and implications for future research. Matern Child Health J, 2015; 19(3):675–690; doi: 10.1007/s10995-014-1557-1
88.
ChianeseJ, PloofD, TrovatoC, et al.Inner-city caregivers’ perspectives on bed sharing with their infants. Acad Pediatr, 2009; 9(1):26–32; doi: 10.1016/j.acap.2008.11.005
89.
DoeringJ, DurforSL. The process of” persevering toward normalcy” after childbirth. MCN Am J Matern Child Nurs, 2011; 36(4):258–265; doi: 10.1097/NMC.0b013e31821826e7
90.
HärdelinG, HoldingBC, ReessT, et al.Do mothers have worse sleep than fathers? Sleep imbalance, parental stress, and relationship satisfaction in working parents. Nat Sci Sleep, 2021; 13:1955–1966; doi: 10.2147/NSS.S323991
91.
BallHL. The latest on bed sharing and breastfeeding. Community Practitioner, 2012; 85(1):29–32.
92.
ChuangC, ChangP, ChenY, et al.Maternal return to work and breastfeeding: A population-based cohort study. Int J Nurs Stud, 2010; 47(4):461–474; doi: 10.1016/j.ijnurstu.2009.09.003
93.
OgbuanuC, GloverS, ProbstJ, et al.The effect of maternity leave length and time of return to work on breastfeeding. Pediatrics, 2011; 127(6):e1414–e1427; doi: 10.1542/peds.2010-0459
94.
GalballyM, LewisAJ, McEganK, et al.A. Breastfeeding and infant sleep patterns: An Australian population study. J Paediatr Child Health, 2013; 49(2):E147–E152; doi: 10.1111/jpc.12089
95.
McKennaJJ, GettlerLT. There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping. Acta Paediatr, 2016; 105(1):17–21; doi: 10.1111/apa.13161
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