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Controversies in Infant Sleeping

Controversies in Infant Sleeping. Rebecca B. Saenz, MD, IBCLC, RLC, FABM, LLLL Mississippi Breastfeeding Medicine Clinic, PLLC Madison, MS. #1: Co-Sleeping. What’s so controversial?. Who With whom Where Location Position When How long How to get to sleep. Sleeping Positions. Prone

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Controversies in Infant Sleeping

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  1. Controversies in Infant Sleeping Rebecca B. Saenz, MD, IBCLC, RLC, FABM, LLLL Mississippi Breastfeeding Medicine Clinic, PLLC Madison, MS

  2. #1: Co-Sleeping

  3. What’s so controversial? • Who • With whom • Where • Location • Position • When • How long • How to get to sleep

  4. Sleeping Positions • Prone • Side • Back

  5. Sleeping Locations • Crib (where?) • Bassinet / cradle • Co-sleeper • Parental bed • Sofa • Recliner • Swing • Infant seat • Parent’s arms / shoulder / chest / abdomen / lap • Sling

  6. “The mother herself is the baby’s natural habitat.” -- Nils Bergman, MD (pediatrician)

  7. What’s all the fuss about anyway? Sudden Infant Death Syndrome prevention

  8. SIDS - definition Sudden Infant Death Syndrome – the sudden death of an infant under one year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history. (Willinger et al, 1991).

  9. Incidence per 1,000 live birthsSource: CDC

  10. SIDS - research • Death certificate analysis • Retrospective interviews • Compared to “matched” control group • Age • Gestational age & birth weight • Gender • Logistic regression analysis

  11. What the AAP says(Please don’t shoot the messenger!) • Breastfeed • Back to sleep • In approved crib • In parents’ room or close proximity for first few months • Don’t co-sleep • Use pacifier after breastfeeding established

  12. What the ABM says • Breastfeed • Back to sleep • “Safe Co-Sleeping” OK • Firm surface – not waterbeds • Not too much cover • Parents not inebriated • Parents don’t smoke • Precautions against rolling out, etc. • Pacifiers aren’t necessary

  13. Resources • SIDS Resources, Inc. • http://www.sidsresources.org/professionals/proflinks.shtml • National SIDS Alliance • American SIDS Institute • Baby Friendly – UK statement • http://www.babyfriendly.org.uk/press.asp#20051209 • http://www.babyfriendly.org.uk/pdfs/sharingbedleaflet.pdf • La Leche League (www.llli.org) • Tear-off sheet #1486-27 “Safe Sleep”

  14. Resources Dr. James McKenna: http://www.nd.edu/~jmckenn1/lab/ McKenna JJ and McDade T. Why Babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews (2005) 6:134-152.

  15. #2: Sleeping Habits • How Long Should Babies Sleep • When “should” babies sleep “through the night”? • Nursing to sleep • Bottle to sleep • Pacifiers • Self-soothing • Security objects • Thumb-sucking • Cry-it-out

  16. People who say they “sleep like a baby” usually have never had one.

  17. Nursing to sleep • In bed vs. in rocking chair • Held by mom • Warmth • Heartbeat • Smell • Position: side-lying, then rolls to back

  18. Bottle to sleep • What’s in the bottle? • Breast milk vs. formula • Dental caries: “baby-bottle mouth” • Otitis media • GastroEsophageal Reflux Disease

  19. Self-soothing • Realistic expectations • Infant neurological immaturity • Infant psychological immaturity • Security objects • Familiarity / continuity • Smell • Feel • Thumb-sucking vs. pacifiers • Dental issues • GERD soothing • ?SIDS prevention

  20. “Cry-It-Out” • Psychology • Trust vs. Mistrust • Maternal Instinct • Anxiety • Physiology • Maternal • Effect on milk ejection reflexes • Effect on milk supply • Infant

  21. Mississippi Breastfeeding Medicine Clinic, PLLC Rebecca B. Saenz, MD, IBCLC, FABM, LLLL 111-A Depot Drive Madison, MS 39110 601-898-7979 Fax 601-898-7989 drbecky@msbfmedclinic.com Also on Facebook Follow on Twitter: @litldoc

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