Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019

Peter S. Blair, Helen L. Ball, James J. McKenna, Lori Feldman-Winter, Kathleen A. Marinelli, Melissa C. Bartick, and the Academy of Breastfeeding Medicine

BREASTFEEDING MEDICINE Volume 15, Number 1, 2020

ª Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2019.29144.psb

Review by: dr. Ranti A Hannah, SpA, IBCLC


To address the controversy after American Academy of Pediatrics 2016 recommendation against bedsharing in relation to Suddent Infant Death Syndrome (SIDS) risk, ABM updated the Bedsharing and Breastfeeding Protocol based on current evidence. The evidence-based recommendation promotes breastfeeding and sleep safety, which consists of:

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  1. Researches around the world show that bedsharing promotes initiation, duration, and exclusivity of breastfeeding. (Level of evidence /LOE : 2-3)
  2. Breastsleeping is a biologically based model of sustained contact between the mother and infant, starting immediately after birth, in which sleeping and breastfeeding are inextricably combined, assuming no hazardous risk factors.
  3. Researches show that bedsharing for breastfeeding dyads pose no significant risk of SIDS in absence of hazardous risk factors such as:
    1. Prematurity or low birth weight
    2. Soft sleeping surfaces other than proper beds (including sofa, pillow, etc)
    3. Bedsharing with adults who smoke or under alcohol/drugs influence
    4. Supine sleeping
    5. Not breastfeeding (LOE:3)
  4.  The occurrence of accidental strangulation with breastsleeping is extremely rare without the risk factors stated above. (LOE:2-3)
  5. There are consequences of not bedsharing for breastfeeding dyads, including early weaning, low milk supply, and mother exhaustion. (LOE:1-3)


Medical practitioners should advice parents about sleep safety and still promote breastfeeding. The recommended sleeping position for breastsleeping is the “cuddle curl” pictured below.

If safe bedsharing is not possible, risk minimization by using these equipments should be considered.


Conclusion: Bedsharing on breastfeeding dyads without risk factors who apply sleep safety procedures is safe and promotes successful breastfeeding.



  1. Huang Y, Hauck FR, Signore C, et al. Influence of bedsharing activity on breastfeeding duration among US mothers. JAMA Pediatr 2013;167:1038–1044.
  2. Blair PS, Heron J, Fleming PJ. Relationship between bed sharing and breastfeeding: Longitudinal, population-based analysis. Pediatrics 2010;126:e1119–1126.
  3. Ball HL, Howel D, Bryant A, et al. Bed-sharing by breastfeeding mothers: Who bed-shares and what is the relationship with breastfeeding duration? Acta Paediatr 2016;105:628–634.
  4. Moon RY, 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:e20162940.
  5. Carpenter R, McGarvey C, Mitchell EA, et al. Bed sharing when parents do not smoke: Is there a risk of SIDS? An individual level analysis of five major case–control studies. BMJ Open 2013;3:e002299.
  6. Blair PS, Sidebotham P, Pease A, et al. Bed-sharing in the absence of hazardous circumstances: Is there a risk of sudden infant death syndrome? An analysis from two case–control studies conducted in the UK. PLoS One 2014;9:e107799.
  7. Lullaby Trust, Baby Sleep Info Source (Basis), Public Health England, UNICEF UK Baby-Friendly Hospital Initiative. Safer sleep for babies: A guide for parents. London, 2019.
  8. Crenshaw JT. Healthy Birth Practice #6: Keep mother and baby together: It’s best for mother, baby, and breasfeeding. J Perinatal Edu 2014;23:211–217.
  9. Drever-Smith C, Bogossian F, New K. Co-sleeping and bed sharing in postnatal maternity units: A review of the literature and critique of clinical practice guidelines. Int J Childbirth 2013;3:13–27.
  10. Ostfeld BM, Schwartz-Soicher O, Reichman NE, et al. Prematurity and sudden unexpected infant deaths in the United States. Pediatrics 2017;140:e20163334.
  11. Zhang K, Wang X. Maternal smoking and increased risk of sudden infant death syndrome: A meta-analysis. Leg Med (Tokyo) 2013;15:115–121.
  12. Erck Lambert AB, Parks SE, Cottengim C, et al. Sleeprelated infant suffocation deaths attributable to soft Bedding, overlay, and wedging. Pediatrics 2019;143: e20183408.
  13. Ball HL. The Atlantic Divide: Contrasting U.K. and U.S. recommendations on cosleeping and bed-sharing. J Hum Lact 2017;33:765–769.
  14. Howick J, Chalmers I, Glasziou P, et al. The Oxford 2011 Levels of Evidence. UK: Oxford, 2011.

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