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      <h1 id="top">3.2 Risk of SIDS</h1>
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            <td class="body"><img src="images/key_icon.gif" class="icon" alt="" /><h3>Key Points - Case Study C</h3>
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			Joanne is discharged early on day three and comes to see you for a follow-up on day five. The day following discharge her breasts became painful and hard and Rosie is again having difficulty latching on to the breast. Is this normal? What would you suggest Joanne do?
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		<dl><dt><a href="topic_3-1.html"><cite>Topic 3.1: Early problems</cite></a></dt><dd class="topic-paragraph">There is a difference between breast fullness and engorgement. Early frequent feeding and good breast drainage helps prevent and manage engorgement.</dd></dl>
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			You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?
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		<dl><dt><a href="topic_3-2.html"><cite>Topic 3.2: Risk of SIDS</cite></a></dt><dd class="topic-paragraph">It is normal for breastfed infants to feed frequently and wake at night in the first few weeks of life. Some continue to wake for a longer period. Many parents will co-sleep (where the infant is in close physical and/or social relationship with another person) and/or bed-share (adults and infants sharing the same sleep surfaces) during this time. Safe sleeping guidelines should be followed to reduce the risk of SIDS.</dd></dl>
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			You see Joanne and Rosie again at 10 days. Joanne's breasts have settled and Rosie is feeding well. However, she has been feeding frequently at night and Joanne's husband, Tom, has suggested bringing the baby to bed with them. Joanne has heard that this increases the risk of SIDS. What would you tell her?
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		As well as needing to breastfeed frequently, in the first few weeks of life infants have short sleep cycles and do not have a distinct daynight pattern (<sup><a href="#note1">1</a>,</sup><sup><a href="#note2">2</a></sup>). Therefore, it is normal for infants to wake frequently at night. Some studies have found that nearly two-thirds of infants aged 1012 months continued to wake regularly at night<sup><a href="#note3">3</a></sup>. Many families also bed-share (adults and infants sharing the same sleep surface) and bed-sharing has been associated with increased breastfeeding duration (<sup><a href="#note4">4</a>,</sup><sup><a href="#note5">5</a></sup>).
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		Studies investigating risk factors for <abbr title="Sudden Infant Death Syndrome">SIDS</abbr> have often not clearly defined the sleep environment with no distinction made between safe bed-sharing and co-sleeping (where the infant is in close physical and/or social relationship with another person), and unsafe practices. A recent meta-analysis suggests that there may be a relationship between <abbr title="Sudden Infant Death Syndrome">SIDS</abbr> and bed-sharing with mothers who smoke and also for young infants (less than eight to eleven weeks old<sup><a href="#note4">4</a></sup>), although further studies with better definitions of bed-sharing are needed to give a better understanding of risk factors.
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		There is evidence that infants sleeping on a separate sleep surface in the parents' room have a reduced risk of <abbr title="Sudden Infant Death Syndrome">SIDS</abbr> compared with infants sleeping in another room<sup><a href="#note6">6</a></sup>. Some authorities suggest placing the infant's cot alongside the mother's bed so that she can easily communicate with and access the infant.
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		Information about safe sleeping environments for parents who wish to bed-share include the following points (<sup><a href="#note7">7</a>,</sup><sup><a href="#note6">6</a></sup>):
		<ul><li>Bed-sharing is not recommended if either of the parents smoke, have consumed alcohol or drugs, are obese or extremely fatigued.</li><li>Sleeping on soft mattresses, waterbeds, couches, recliners or sofas is not safe for infants – use a firm mattress without soft bedding, doonas or pillows near the infant.</li><li>Ensure there are no gaps between the mattress and wall or headboard, or other gaps where the infant can get trapped or wedged.</li><li>Pets should not be on/in the bed with the infant. If other children are in the bed, there should be an adult between the child and the infant.</li><li>The infant should not be dressed too warmly – adult bed coverings and body heat provide significantly more heat than if the infant is sleeping alone.</li><li>Infants should always be placed supine to sleep, although they will usually be on their side to breastfeed.</li></ul>
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		Most families will bed-share with their infant or child at some time, even though it may not be on a regular basis. Therefore, all parents should be aware of how to make the sleep environment as safe as possible.
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        <h3>Notes</h3>
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          <li id="note1"><a href="references.html#peir03" title="See full details">#</a> Peirano P et al. (2003) Sleep-wake states and their regulatory mechanisms throughout early human development</li>
          <li id="note2"><a href="references.html#dewe03" title="See full details">#</a> de Weerd AW et al. (2003) The development of sleep during the first months of life</li>
          <li id="note3"><a href="references.html#arms94" title="See full details">#</a> Armstrong K et al. (1994) The sleep patterns of normal children</li>
          <li id="note4"><a href="references.html#hors07" title="See full details">#</a> Horsley T et al. (2007) Benefits and harms associated with the practice of bed sharing</li>
          <li id="note5"><a href="references.html#ball03" title="See full details">#</a> Ball HL (2003) Breastfeeding, bed-sharing, and infant sleep</li>
          <li id="note6"><a href="references.html#mcco08" title="See full details">#</a> McCoy R et al. (2008) Clinical protocol #6: Guideline on co-sleeping and breastfeeding</li>
          <li id="note7"><a href="references.html#brod04a" title="See full details">#</a> Brodribb W (2004) Breastfeeding Management</li>
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      <h1>Breastfeeding Essentials</h1>
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        <li>0.1 <a href="topic_0-1.html">Introduction</a></li>
        <li>1.0 <a href="topic_1-0.html">Case Study A (Joanne)</a><ol><li>1.1 <a href="topic_1-1.html">Discussing breastfeeding</a></li><li>1.2 <a href="topic_1-2.html">What information to give</a></li><li>1.3 <a href="topic_1-3.html">Effects of Breastfeeding alternatives</a></li><li>1.4 <a href="topic_1-4.html">Common breastfeeding concerns</a></li><li>1.5 <a href="topic_1-5.html">Breast examination</a></li><li>1.6 <a href="topic_1-6.html">Contraindications to breastfeeding</a></li><li>1.7 <a href="topic_1-7.html">Conditions related to lactation outcomes</a></li><li>1.8 <a href="topic_1-8.html">Medications</a></li></ol></li>
        <li>2.0 <a href="topic_2-0.html">Case Study B (Joanne)</a><ol><li>2.1 <a href="topic_2-1.html">Preparation Before Birth</a></li><li>2.2 <a href="topic_2-2.html">Birthing Factors that Affect Breastfeeding</a></li><li>2.3 <a href="topic_2-3.html">Management After Birth</a></li><li>2.4 <a href="topic_2-4.html">Poor Attachment</a></li><li>2.5 <a href="topic_2-5.html">Hypoglycaemia</a></li><li>2.6 <a href="topic_2-6.html">Relationship between Jaundice and Breastfeeding</a></li></ol></li>
        <li>3.0 <a href="topic_3-0.html">Case Study C (Joanne)</a><ol><li>3.1 <a href="topic_3-1.html">Early problems</a></li><li class="current">3.2 <img src="design/bullet_arrow_right.png" alt="*" title="You are here" /><a href="topic_3-2.html">Risk of SIDS</a></li><li>3.3 <a href="topic_3-3.html">Contraception</a></li><li>3.4 <a href="topic_3-4.html">Milk composition</a></li><li>3.5 <a href="topic_3-5.html">Slowing of growth</a></li><li>3.6 <a href="topic_3-6.html">Introducing solids</a></li><li>3.7 <a href="topic_3-7.html">Weaning</a></li></ol></li>
        <li>4.0 <a href="topic_4-0.html">Case Study D (Sally)</a><ol><li>4.1 <a href="topic_4-1.html">Initial assessment</a></li><li>4.2 <a href="topic_4-2.html">Milk production</a></li><li>4.3 <a href="topic_4-3.html">Causes of inadequate infant growth</a></li><li>4.4 <a href="topic_4-4.html">Increasing milk supply</a></li></ol></li>
        <li>5.0 <a href="topic_5-0.html">Case Study E (Anna)</a><ol><li>5.1 <a href="topic_5-1.html">Sore nipples</a></li><li>5.2 <a href="topic_5-2.html">Factors causing nipple damage</a></li><li>5.3 <a href="topic_5-3.html">General treatment for sore nipples</a></li><li>5.4 <a href="topic_5-4.html">Further causes of nipple pain</a></li><li>5.5 <a href="topic_5-5.html">Mastitis – diagnosis</a></li><li>5.6 <a href="topic_5-6.html">Mastitis – treatment and complications</a></li></ol></li>
        <li>6.0 <a href="topic_6-0.html">In conclusion</a><hr /></li>
        <li class="appendix"> <a href="references.html">List of references</a></li>
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