Original Article www.jpedhc.

org

Parent-Infant The practice of co-sleeping,

also known as bed-sharing, has
become a topic of much contro-
versy in the United States. Al-
Co-sleeping and Its though definitions for this term
vary throughout the literature, co-
sleeping usually involves parents

Relationship to and infants sleeping together in an

adult bed. Parents may cite numer-
ous reasons why they choose to

Breastfeeding co-sleep with their infants: to com-

fort a fussy infant, to attend quickly
to an ill infant, for enjoyment and
to increase time spent with the in-
Stephanie D. Buswell, RN, BSN, fant, to promote bonding, and be-
cause there is nowhere else for the
& Diane L. Spatz, PhD, RNC infant to sleep. Above all, how-
ever, breastfeeding has been
found to be the most prominent
reason for co-sleeping (Ball, 2002).
ABSTRACT The importance of breastfeed-
Co-sleeping can provide numerous benefits for both the parent(s) and the infant. ing should not be underestimated
Perhaps the greatest advantage lies in its promotion of breastfeeding, an act widely in terms of its nutritional, immuno-
recognized for its benefits to both the mother and infant. However, risks also are logical, and developmental bene-
associated with co-sleeping, prompting many researchers to examine the safety of fits to both the mother and infant.
its practice. Pediatric nurse practitioners need to be informed on issues related to
The American Academy of Pediat-
co-sleeping in order to educate parents regarding its risks and benefits, to assess
the safety of an established sleeping environment, and to be aware of its preva-
rics (AAP) recommends that moth-
lence in their patient populations. A review of the literature is presented to inform ers exclusively breastfeed their in-
pediatric nurse practitioners about varied definitions of co-sleeping, the reasons fants for the first 6 months of life
why some parents engage in the practice, cultural preferences for co-sleeping, and continue to breastfeed for at
associated risks and benefits, and its relationship to breastfeeding. J Pediatr Health least the first year of life or as long
Care. (2007) 21, 22-28. as mutually desired by the mother
and infant. It is also recommended
that the mother and infant sleep in
close proximity to one another to
facilitate breastfeeding (2005).
More specifically, co-sleeping has
been found to promote breastfeed-
ing (McKenna, Mosko, & Richard,
1997). Furthermore, co-sleeping
not only supports the ease and
Stephanie D. Buswell is Staff RN, Children’s Hospital and Regional Medical Center, convenience of nighttime breast-
Seattle, Wash. feeding, but it also may lessen ma-
ternal pain or discomfort following
Diane L. Spatz is the Helen M. Shearer Term Chair in Nutrition and Associate
Professor-Clinician Educator, University of Pennsylvania School of Nursing, birth (Ball, 2002). For example, a
Philadelphia, Pa, and Clinical Nurse Specialist-Lactation, Children’s Hospital of side-lying position for breastfeed-
Philadelphia, Philadelphia, Pa. ing is often more comfortable than
Reprint requests: Diane L. Spatz, PhD, RNC, University of Pennsylvania School of a cradle or cross-cradle hold for a
Nursing, 420 Guardian Drive, Philadelphia, PA 19104-6069; e-mail: mother recovering from a Cesar-
spatz@nursing.upenn.edu. ean section.
0891-5245/$32.00 Although co-sleeping has nu-
merous benefits, the controversies
Copyright © 2007 by the National Association of Pediatric Nurse Practitioners.
surrounding this issue stem from
doi:10.1016/j.pedhc.2006.04.006 the associated risks to the infant of
22 Volume 21 • Number 1 Journal of Pediatric Health Care
sharing a bed with another individ-
ual. These risks may include hy-
perthermia, overlying, smothering,
suffocation, entrapment, strangula-
tion, and sudden infant death syn-
drome (SIDS) (Baddock, Galland,
Beckers, Taylor, & Bolton, 2004;
Hauck et al., 2003; Nakamura,
Wind, & Danello, 1999).
The most recent data state that
in 2003, SIDS was the cause of
death in 2162 infant deaths (7.7%
of all infant deaths) in the United
States (Hoyert, Heron, Murphy, &
Kung, 2006). Numerous organiza-
tions and agencies have re-
sponded to the risk of SIDS by re-
leasing warnings and position
statements related to factors
known to increase the risk. In re-
sponse to these risks, the U.S. Con-
sumer Product Safety Commission
(CPSC) has issued a warning
against placing infants to sleep in
adult beds. This warning is based
on data reporting 515 infant deaths
over an 8-year period (1990-1997)
related to accidental smothering,
wedging, suffocation, or strangula-
tion of the infant in a co-sleeping
environment (Nakamura et al.,
1999). The CPSC currently recom-
mends that children younger than
2 years should sleep in cribs tai-
lored to federal safety standards
and that they should not be put to
sleep in adult beds (United States
Consumer Product Safety Commis-
sion, 1999).
The AAP echoes this statement
by recommending that a separate
crib, bassinet, or cradle approved
by the CPSC should be placed in
the same room as the parent(s)
and that the infant should not co-
sleep with other individuals
(2005). This statement may be con-
fusing to parents and health care
providers, because the AAP also
advises parents to sleep in close
proximity to the infant to facilitate
breastfeeding. To further add to
the debate and confusion, some
studies have suggested that co-
sleeping may even decrease the
risk of SIDS by increasing infant
arousals and increasing maternal
Journal of Pediatric Health Care
awareness of the infant (Horne,
Parslow, Ferens, Watts, & Adam-
son, 2003; Mosko, Richard, & McK-
enna, 1997). This seemingly con-
tradictory information has spurred
much of the uncertainty surround-
ing the safety of co-sleeping, and it
is especially frustrating for breast-
feeding mothers debating between
sleep safety and ease of nighttime
breastfeeding.
DEFINITIONS OF
CO-SLEEPING
Difficulties arise when compar-
ing the literature on co-sleeping
because a universal definition for
this term does not appear to exist.
Numerous factors may be taken
into account when defining this
practice. Whereas some authors
offer a very broad description,
such as “sharing the bed with any-
one” (Hauck et al., 2003), others
do not even provide a working
definition (Flick, White, Vemula-
palli, Stulac, & Kemp, 2001).
Within the literature, one vari-
ance is the length of time the bed is
shared each night. Some authors
specify this length of time, such as
a minimum of 5 hours per night on
a regular basis (Hunsley & Tho-
man, 2002), whereas others claim
that co-sleeping can occur for any
portion of the night (Ball, 2002;
Jenni, Zinggeler, Iglowstein, Moli-
nari, & Largo, 2005; Weimer et al.,
2002). Furthermore, the number of
nights per week that co-sleeping
occurs also is inconsistent, ranging
from at least once per week (Ball,
2003) to at least five nights per
week (McKenna, et al., 1997). Most
authors do not include length of
time per night or number of nights
per week in their definitions.
Discrepancies also exist regard-
ing the number of family members
or other individuals present in the
bed while co-sleeping. Most defi-
nitions include one or both parents
as co-sleepers with the infant (Ball,
2002, 2003; Brenner et al., 2003;
Jenni et al., 2005; Latz, Wolf, &
Lozoff, 1999; Valentin, 2005; Will-
inger, Ko, Hoffman, Kessler, &
Corwin, 2003). Some vaguely refer
to the co-sleeper as “another adult”
(Abel, Park, Tipene-Leach, Finau,
& Lennan, 2001; Blair & Ball, 2004;
Weimer et al., 2002) or “anyone”
(Hauck et al., 2003; Nelson & Tay-
lor, 2001). These definitions allow
for other family members such as
extended family or siblings to be
considered co-sleepers. Further-
more, even though the association
of co-sleeping and breastfeeding is
a maternal-infant activity, only one
author specified the term as such
(McKenna et al., 1997). Thus, it is
obvious that there is no universal
term for co-sleeping, and variances
undeniably exist between different
families. Even though a standard-
ized definition would help in re-
search comparisons, such consis-
tency is not useful in everyday
practice because each family may
define its own practices differently
from another’s.
METHODS OF DATA
COLLECTION
The majority of the literature on
co-sleeping utilizes qualitative
methods for data collection. A
common approach is to analyze
parent-completed sleep logs (Ball,
2003; Blair & Ball, 2004; Buckley,
Rigda, Mundy, & McMillen, 2002;
McKenna et al., 1997). This
method relies heavily on the par-
ent’s ability to remember certain
circumstances, yet parental recall
may not always be reliable. More-
over, studies using parental recall
of events occurring the night be-
fore may have more credibility
than those asking parents to re-
member episodes from many
nights or weeks earlier.
Another approach is to utilize
only parental/caretaker interviews
to gather data (Abel et al., 2001;
Latz et al., 1999; Weimer et al.,
2002; Willinger et al., 2003). Inter-
views allow for elaboration or clar-
ification on certain aspects of the
conversation, and they are excel-
lent for presenting descriptive and
narrative data such as in case stud-
ies. Finally, many authors combine
January/February 2007 23
interviews, sleep logs, and/or
questionnaires for multidimen-
sional qualitative data collection
(Ball, 2002, 2003; Blair & Ball,
2004; Brenner et al., 2003; Clem-
ents, et al., 1997; Nelson & Taylor,
2001; Valentin, 2005). The use of
multiple methods for data collec-
tion incorporates parental experi-
ences and recall, as well as stan-
dardized questionnaires. No
articles were found to have used
questionnaires only.
Quantitative studies also have
been performed on related aspects
of co-sleeping, examining thermal
sleep environments (Baddock et al.,
2004), physical properties of bed-
ding (Flick et al., 2001), arousability
thresholds of breastfeeding infants
(Horne et al., 2003), nocturnal
breastfeeding behaviors using au-
diovisual recordings and polysom-
nographic measures (McKenna et
al., 1997), and dangers associated
with co-sleeping (Nakamura et al.,
1999). Thus, quantitative studies
tend to focus more on specific, mea-
surable variables in the sleeping en-
vironments or physiological re-
sponses, rather than on parental
experiences, practices, and/or rates
of co-sleeping.
INTERNATIONAL AND
UNITED STATES
LITERATURE
Out of the 21 research studies
analyzed, 12 (57%) were con-
ducted in countries other than the
United States. Of these 12 studies,
most were conducted in the United
Kingdom (five) or Australia and
New Zealand (five). To compare
and contrast international practices
in countries outside of the United
States, Nelson and Taylor pub-
lished the International Child Care
Practices Study in 2001. This study
collected comparative information
on child care practices, including
co-sleeping, from 4656 families in
17 different countries. It was found
that infants in Chongqing, China,
had the highest rate of co-sleeping
(88%), whereas those in Odessa,
Ukraine, had the lowest rate (19%).
24 Volume 21 • Number 1
Interestingly, the data were col-
lected during the coldest 2 months
of the year in each country. Be-
cause the Ukraine’s coldest
months may be colder than Chi-
na’s, the possibility exists that co-
sleeping with the intent to keep an
infant warmer may not be a signif-
icant factor. This finding echoes an
analysis by Blair & Ball (2004) sug-
gesting that co-sleeping rates are
not related to colder months.
Analyzing data from multiple
countries across the globe is ben-
eficial because it can reveal how
diverse cultural practices may af-
fect the selection of an infant’s
sleeping environment. Just as dif-
ferent cultures view breastfeeding
differently, so too may they view
co-sleeping differently. In general,
there appears to be a positive cor-
relation between co-sleeping and
breastfeeding reported in the inter-
national literature. Ball (2003)
found a significant relationship be-
tween co-sleeping and breastfeed-
ing persistence. Blair and Ball
(2004) noted that 46% of co-sleep-
ing mothers and infants in the
United Kingdom were still breast-
feeding at 3 to 4 months, twice as
many as non– co-sleepers. A simi-
lar study in the United Kingdom
found that a shortened duration of
breastfeeding was associated with
mothers who did not co-sleep
(Clements et al., 1997).
In New Zealand, Abel et al.
(2001) revealed that co-sleeping is
the norm of Pacific ethnic groups
there (i.e., Maori, Tongan, Sa-
moan, Cook Islands, Niuean, and
Pakeha). These communities view
co-sleeping as a safer, more fami-
ly-connected way to sleep with
many practical, psychological, and
spiritual benefits for the infant.
Furthermore, among these ethnic
groups, breastfeeding was one of
the parental topics on which there
was highest consensus. Most
women chose to breastfeed be-
cause of the perceived physical
and emotional benefits for them-
selves and their infants.
Just as co-sleeping and breast-
feeding practices vary worldwide,
they also differ among geographic
regions within the United States.
Breastfeeding rates tend to be
highest in western states like
Washington and Oregon and low-
est in southeastern states such as
Mississippi and Louisiana (Centers
for Disease Control and Prevention
[CDC], 2004). Published rates of
co-sleeping in the United States
also vary depending on geograph-
ical region; however, data are lim-
ited to states in which specific
studies have occurred. In the Dis-
trict of Columbia, co-sleeping was
viewed as “normative behavior,”
with almost 50% reporting they
usually co-slept in the child’s first
year of life (Brenner et al., 2003). A
study of New Orleans parents
found a co-sleeping rate of 88%,
with 46% of caregivers co-sleeping
at least 22 days in the last month
(Weimer et al., 2002).
In a 7-year study of 8453 caregiv-
ers within all 48 contiguous states,
Willinger et al. (2003) reported that
overall, 45% of infants had spent at
least some time at night on an adult
bed within the past 2 weeks. Be-
tween 1993 and 2000, the propor-
tion of co-sleeping infants more
than doubled. Thus, it appears that
co-sleeping is growing within the
United States, despite warnings
against it from the AAP and CPSC.
Factors reported to be associated
with routine co-sleeping in the
United States include mothers
younger than 18 years of age, Black
or Asian race, annual household in-
come of less than $20,000, Southern
states, and an infant less than 8
weeks of age.
In addition, much of the litera-
ture on co-sleeping focuses on ur-
ban settings, often concentrating
on minority or socioeconomically
disadvantaged populations. These
communities tend to display con-
sistently lower breastfeeding rates
(CDC, 2004). In the aforemen-
tioned studies conducted by Wei-
mer et al. (2002) and Brenner et al.
(2003), the majority of subjects
Journal of Pediatric Health Care
were inner-city, African-American
mothers. Their results may suggest
that this population has more of a
tendency to co-sleep than other
populations, yet additional re-
search is needed to determine the
validity of this notion. Further-
more, sleeping practices in rural
communities also should be exam-
ined to present a more compre-
hensive picture of the rates of co-
sleeping within the United States.
EFFECTS OF CO-SLEEPING
ON BREASTFEEDING
Out of the 11 articles specifi-
cally investigating the relationship
between co-sleeping and breast-
feeding, eight showed a positive
correlation and three revealed a
negative correlation or no correla-
tion. Among the positive correla-
tions, McKenna et al. (1997) found
that infants who routinely co-slept
at home breastfed three times
longer during the night than did
infants who routinely slept sepa-
rately, when tested in their routine
conditions. Blair and Ball (2004)
demonstrated that almost half of
co-sleeping mothers and infants
were still breastfeeding at 3 to 4
months of age, twice as many as
solo sleepers. In addition, Clem-
ents et al. (1997) found that exclu-
sive breastfeeding at discharge
from the hospital was associated
with later co-sleeping, suggesting
that breastfeeding is the induce-
ment for co-sleeping. Finally, in
terms of benefits to the mother,
Glenn & Quillin (2003) reported
that breastfeeding mothers had
more overall sleep than did bottle-
feeding mothers if their infants co-
slept for any part of the night.
Conversely, in the District of
Columbia, Brenner et al. reported
that breastfeeding was not signifi-
cantly associated with co-sleeping
at either of two follow-up inter-
views; therefore, no association
existed between co-sleeping and
either initiation of or concurrent
breastfeeding. Interestingly, the
authors report that 50% of the sub-
jects claimed they usually co-slept
Journal of Pediatric Health Care
during the first year of the infant’s
life (2003). This study did not cite
breastfeeding initiation rates of its
subjects, but the CDC reports an
initiation rate of only 65% among
residents in the District of Colum-
bia. Similarly, Flick et al. (2001)
found that at 8 weeks of age,
breastfeeding was no more com-
mon among African-American in-
fants who co-slept than among
those who did not co-sleep. All
subjects were known to be Afri-
can-American women in St. Louis,
yet other demographic factors (i.e.,
maternal age, socioeconomic sta-
tus, education, employment, and
previous breastfeeding experi-
ence) were not accounted for.
Finally, an Australian article re-
ported that similar proportions of
infants were breastfeeding, regard-
less of their sleeping environment:
76% of co-sleeping infants were
breastfeeding, compared with 75%
of solo-sleeping infants (Buckley
et al., 2002). This finding may be
attributed to the fact that breast-
feeding is the cultural norm in Aus-
tralia, where breastfeeding initia-
tion rates are between 83% and
87% (Australian Bureau of Statis-
tics, 2001). Furthermore, this re-
search did not provide any defini-
tion of co-sleeping, so parental
subjects could have differed on
whether their practices were truly
considered co-sleeping.
IMPLICATIONS FOR
PEDIATRIC NURSE
PRACTITIONERS
Some parents may not be aware
of the recommendations from the
AAP or CPSC, whereas others may
be overwhelmed by all the contra-
dictory information on co-sleeping
with their infant(s). Breastfeeding
mothers, in particular, may be frus-
trated with the AAP’s conflicting
recommendations; although a
mother may desire to exclusively
breastfeed for 6 months, she may
find it difficult to be successful
when she is advised against night-
time breastfeeding in bed. Eidel-
man and Gartner (2006) argue that
mothers wary of breastfeeding in
bed may choose the even riskier
practice of breastfeeding infants in
an upholstered sofa or chair. This
practice may carry an even greater
risk of smothering or dropping the
infant. Finally, some parents may
not think to inquire about safe
sleeping practices at their infant
visits, especially if they believe
their chosen method is “wrong.”
Because client populations may
display a wide range of knowledge
on this topic, it is the responsibility
of the pediatric nurse practitioner
(PNP) to incorporate this discus-
sion into everyday practice.
A full assessment of the infant’s
sleep practices should occur not
only at the initial infant visit but
also at every visit thereafter, be-
cause infant sleep patterns, prac-
tices, and environments can
change over time. This assessment
should impart a nonjudgmental
approach so as not to suggest there
is a right or a wrong practice. An
open-ended question such as,
“Where does your infant sleep at
night?” allows for a more detailed
response. Probing questions in-
clude the location of the infant
(e.g., adult bed or separate crib),
hard or soft sleeping surface, pres-
ence of blankets or pillows, and
proximity of the infant to the par-
ents (e.g., in the same room or in a
separate nursery). By encouraging
the parent to provide more details
on the infant’s sleeping environ-
ment, PNPs can better assess the
safety of the chosen setting. For
instance, an infant co-sleeping in
an adult bed without covers or
blankets may be less likely to ex-
perience hyperthermia than a solo-
sleeping infant swaddled or cov-
ered in multiple blankets.
Despite the risks and the recom-
mendations by the AAP and CPSC,
automatically condemning co-sleep-
ing may not be appropriate in all
families. Instead, the individual
needs of the infant/child, the family
context, and the cultural back-
grounds need to be taken into con-
sideration. Some children may need
January/February 2007 25
close parental proximity during the
night as during the day depending
on their developmental level and at-
tachment behavior (Jenni et al.,
2005). Furthermore, different paren-
tal ideologies, beliefs, and styles
may emphasize certain aspects of in-
fant sleep that are of greater impor-
tance. For example, if parents
strongly desire the enhanced bond-
ing effects of co-sleeping, they may
believe that this benefit outweighs
the associated risk for SIDS. On the
other hand, if parents are incredibly
fearful of accidentally overlying the
infant while asleep, they may prefer
to place the infant in a separate bed
where this risk is eliminated. Thus, it
is the responsibility of the PNP to
inquire about and understand the
reason(s) why parents choose their
A full assessment of the infant’s sleep practices
should occur not only at the initial infant visit
but also at every visit thereafter, because infant
sleep patterns, practices, and environments can
change over time.
current sleeping environment and to
provide information on how each
method (co-sleeping or solo sleep-
ing) can be performed safely.
Moreover, although no sleep
environment is completely safe,
many of the known risks associ-
ated with infant sleep environ-
ments are modifiable (Mesich,
2005). If a parent decides to co-
sleep with his or her infant, guide-
lines can be provided to increase
the safety of the experience (see
Box). PNPs can utilize these guide-
lines to evaluate the safety of an
established sleeping environment
and/or to provide education on
creating one. These guidelines also
can be offered to parents in a writ-
ten format. Furthermore, the PNP
should always assess for frequency
26 Volume 21 • Number 1
of parental drug or alcohol use on
a routine basis, regardless of the
sleeping environment.
Because research into the prac-
tice of co-sleeping is a relatively new
endeavor, there are numerous impli-
cations for expanding the knowl-
edge on this topic. The inclusion of
a definition for co-sleeping is imper-
ative for future research. This defini-
tion should include at least the
length of time per night, the number
of nights per week, and the number
and type of persons (e.g., mother,
father, and siblings) present in the
sleeping environment.
Rates of co-sleeping among all
geographic regions of the United
States (especially in rural areas) also
should be established. Furthermore,
little is known about co-sleeping
practices among Native American,
Asian-American, and Hispanic pop-
ulations. An awareness of this infor-
mation may help PNPs and re-
searchers better understand co-
sleeping trends in the United States
and be more aware of how families
of diverse cultural backgrounds may
perceive and practice co-sleeping.
Ideally, having national data on co-
sleeping would be advantageous so
that the relationship between breast-
feeding and co-sleeping could be
better understood.
The relationship of co-sleeping
and breastfeeding must be exam-
ined with use of multiple research
modalities. If parental recall is uti-
lized to gather data on co-sleeping
practices, the data should be col-
lected immediately after the event
BOX. Guidelines to
Increase the Safety of the
Co-sleeping Environment
1. Avoid the use of soft mat-
tresses or waterbeds and in-
stead place the infant to
sleep on a firm mattress.
2. Remove all cords, ties, or
other strangulation risks from
near the bed.
3. Always use a tightly fitting fit-
ted sheet on the sleeping
surface.
4. Never use fluffy comforters,
pillows, or quilts on top of or
under sleeping infants.
5. Always put infants to sleep
on their backs.
6. Parental smoking is a risk
factor for SIDS, so there
should be no smoking at all in
the home of an infant.
7. Mothers or fathers greater
than 175 pounds have been
shown to have a higher risk of
overlaying while co-sleeping.
8. Never co-sleep after using
any depressants, sedative
drugs, illegal drugs, or when
alcohol has been consumed.
Reprinted with permission from
Mesich, 2005.
occurred. For example, if one is ex-
amining how many times an infant
wakes to feed while co-sleeping, the
parent should report these occur-
rences immediately the next morn-
ing so as to minimize errors in recall.
Finally, especially among low-
income African-American fami-
lies—a group found to have rela-
tively high rates of co-sleeping but
low rates of breastfeeding—there
is a lack of knowledge as to why
families choose to co-sleep or not.
It is unclear whether the decision
to co-sleep is linked to a lack of
separate sleeping surfaces, to in-
sufficient blankets or other materi-
als for warmth, to a desire to be
physically closer to the infant, or to
other reasons. Focus groups
and/or case studies may be appro-
Journal of Pediatric Health Care
priate for expanding on this ques-
tion, yet the experiences of numer-
ous subjects would need to be
investigated in order to report ac-
curate trends.
CONCLUSION
Whether infants are safer in bed
with their parent(s) or alone in a
crib remains open for further ex-
ploration. Most likely, this multi-
faceted controversy will continue
to be contested until sufficient re-
search can support or undermine
the risks and benefits associated
with co-sleeping. At this point, the
literature lacks ample data on co-
sleeping rates both worldwide and
in the United States, especially
among distinct geographical and
racial/ethnic groups. Furthermore,
Because the opportunities to co-sleep with an
infant may arise multiple times each day, it is
essential that parents be informed of the risks
and benefits, as well as how to maximize safety
if they choose this practice.
although the data on its relation-
ship to breastfeeding is not conclu-
sive, the literature appears to sup-
port the notion that co-sleeping
promotes breastfeeding.
Because the opportunities to
co-sleep with an infant may arise
multiple times each day, it is essen-
tial that parents be informed of the
risks and benefits, as well as how
to maximize safety if they choose
this practice. PNPs have the re-
sponsibility to question clients
about their infant’s sleeping loca-
tions and to provide accurate, evi-
dence-based information on this
topic. In addition, as breastfeeding
advocates, PNPs should be re-
minded of how co-sleeping could
positively affect breastfeeding
among their patient populations.
Journal of Pediatric Health Care
REFERENCES
Abel, S., Park, J., Tipene-Leach, D., Finau,
S., & Lennan, M. (2001). Infant care
practices in New Zealand: A cross-cul-
tural qualitative study. Social Science &
Medicine, 53, 1135-1148.
American Academy of Pediatrics. (2005).
Breastfeeding and the use of human
milk [electronic version]. Pediatrics,
115, 496-506.
Australian Bureau of Statistics. (2001).
Breastfeeding in Australia: Electronic
delivery. Retrieved November 26,
2005, from http://www.abs.gov.au/
Ausstats/abs@.nsf/525a1b9402141235
ca25682000146abc/8e65d6253e10f80
2ca256da40003a07c!OpenDocument.
Baddock, S. A., Galland, B. C., Beckers,
M. G., Taylor, B. J., & Bolton, D. P.
(2004). Bed-sharing and the infant’s
thermal environment in the home set-
ting. Archives if Disease in Childhood,
89, 1111-1116.
Ball, H. L. (2003). Breastfeeding, bed-shar-
ing, and infant sleep. Birth, 30,
181-187.
Ball, H. L. (2002). Reasons to bed-share:
Why parents sleep with their infants.
Journal of Reproductive and Infant Psy-
chology, 20, 207-221.
Blair, P. S., & Ball, H. L. (2004). The preva-
lence and characteristics associated
with parent-infant bed-sharing in En-
gland. Archives of Disease in Child-
hood, 89, 1106-1110.
Brenner, R., Simons-Morton, B., Bhaskar,
B., Revenis, M., Das, A., & Clemens,
J. D. (2003). Infant-parent bed sharing
in an inner-city population. Archives of
Pediatric and Adolescent Medicine,
157, 33-39.
Buckley, P., Rigda, R., Mundy, L., & Mc-
Millen, I. (2002). Interactions between
bed sharing and other sleep environ-
ments during the first six months of life.
Early Human Development, 66,
123-132.
Centers for Disease Control and Prevention.
(2004). Breastfeeding practices—results
from the 2004 National Immunization
Survey. Retrieved January 28, 2006,
from http://www.cdc.gov/breastfeeding/
data/NIS_data/data_2004.htm
Clements, M. S., Mitchell, E. A., Wright,
S. P., Esmail, A., Jones, D. R., & Ford,
R. P. (1997). Influences on breastfeed-
ing in southeast England. Acta Paediat-
rica, 86, 51-56.
Eidelman, A. I., & Gartner, L. M. (2006).
Bedsharing with unimpaired parents is
not an important risk factor for sudden
infant death syndrome: To the editor.
Pediatrics, 117, 991-992.
Flick, L., White, D. K., Vemulapalli, C., Stu-
lac, B. B., & Kemp, J. S. (2001). Sleep
position and the use of soft bedding
during bed sharing among African
American infants at increased risk for
sudden infant death syndrome. The
Journal of Pediatrics, 138, 338-343.
Hauck, F. R., Herman, S. M., Donovan, M.,
Iyasu, S., Moore, C. M., & Donoghue,
E., et al. (2003). Sleep environment and
the risk of sudden infant death syn-
drome in an urban population: The Chi-
cago infant mortality study. Pediatrics,
111, 1207-1214.
Horne, R. S., Parslow, P. M., Ferens, D.,
Watts, A., & Adamson, T. M. (2003).
Comparison of evoked arousability in
breast and formula fed infants. Archives
of Disease in Childhood, 89, 22-25.
Hoyert, D. L., Heron, M., Murphy, S. L., &
Kung, H. C. (2006). Deaths: Final data
for 2003. Health E-Stats. Retrieved
March 31, 2006, from http://www.cdc.
gov/nchs/products/pubs/pubd/hestats/
finaldeaths03/finaldeaths03.htm
Hunsley, M., & Thoman, E. B. (2002). The
sleep of co-sleeping infants when they
are not co-sleeping: Evidence that co-
sleeping is stressful. Developmental
Psychobiology, 40, 14-22.
Jenni, O. G., Zinggeler, F., Iglowstein, I.,
Molinari, L., & Largo, R. H. (2005). A
longitudinal study of bed sharing and
sleep problems among Swiss children
in the first 10 years of life. Pediatrics,
115, 233-240.
Latz, S., Wolf, A. W., & Lozoff, B. (1999).
Cosleeping in context: Sleep practices
and problems in young children in Ja-
pan and the United States. Archives of
Pediatric and Adolescent Medicine,
153, 339-346.
McKenna, J. J., Mosko, S. S., & Richard,
C. A. (1997). Bedsharing promotes
breastfeeding. Pediatrics, 100, 214-
219.
Mesich, H. M. (2005). Mother-infant co-
sleeping: Understanding the debate
and maximizing infant safety. The
American Journal of Maternal/Child
Nursing, 30, 30-37.
Mosko, S., Richard, C., & McKenna, J.
(1997). Infant arousals during mother-
infant bedsharing: Implications for in-
fant sleep and sudden infant death
January/February 2007 27
 syndrome research. Pediatrics, 100,
841-849.
Nakamura, S., Wind, M., & Danello, M. A.
(1999). Review of hazards associated
with children placed in adult beds. Ar-
chives of Pediatric and Adolescent
Medicine, 153, 1019-1023.
National Institute of Child Health and Human
Development. (2003). SIDS rate and
sleep position, 1988-2003. Retrieved
March 31, 2006, from http://www.
nichd.nih.gov/sids/SIDS_rate_backsleep
_03.pdf
Nelson, E. A., & Taylor, B. J. (2001). Inter-
national child care practices study: In-
fant sleeping environment. Early Hu-
man Development, 62, 43-55.
Quillin, S. I., & Glenn, L. L. (2003). Interac-
tion between feeding method and co-
sleeping on maternal-newborn sleep.
Journal of Obstetric, Gynecologic, and
Neonatal Nursing, 33, 580-588.
United States Consumer Product Safety
Commission. (1999). CPSC warns
against placing babies in adult beds;
study finds 64 deaths each year from
suffocation and strangulation. Re-
trieved October 4, 2005, from
http://www.cpsc.gov/cpscpub/prerel/
PRHTML99/99175.html
Valentin, S. R. (2005). Commentary: Sleep
in German infants—the ‘cult’ of inde-
pendence. Pediatrics, 115, 269-271.
Weimer, S. M., Dise, T. L., Evers, P. B., Or-
tiz, M. A., Welldaregay, W., & Stein-
mann, W. C. (2002). Prevalence, pre-
dictors, and attitudes toward
cosleeping in an urban pediatric center.
Clinical Pediatrics, 41, 433-438.
Willinger, M., Ko, C., Hoffman, H. J.,
Kessler, R. C., & Corwin, M. J. (2003).
Trends in infant bed sharing in the
United States, 1993-2000: The national
infant sleep position study. Archives of
Pediatric and Adolescent Medicine,
157, 43-49.

NOW AVAILABLE:
THE NAPNAP HEALTHY EATING AND ACTIVITY
TOGETHER (HEATSM) INITIATIVE’S IDENTIFYING AND
PREVENTING OVERWEIGHT IN CHILDHOOD CLINICAL
PRACTICE GUIDELINE AND RESOURCE KIT
NAPNAP’s HEAT Initiative is pleased to present
Identifying and Preventing Overweight in Childhood
Clinical Practice Guideline. NAPNAP is working to
prevent overweight and obesity through the HEAT
Initiative’s new clinical practice guideline and resource
kit. NAPNAP strongly values prevention and believes r: g
that healthy habits in nutrition and physical activity are rde p.or 0
o a 0
critical to good health for all children at every age. To napn 7-97
Developers of the Guideline offer a HEAT Resource kit .
w -85
that contains supporting materials and customized HEAT ww 56
handouts; including a Family History, Assessment 8
Checklists and Educational Tip Sheets, that can help or
practitioners apply the recommendations with patients
and families.

28 Volume 21 • Number 1 Journal of Pediatric Health Care