Expert recommendations around infant sleep fail to recognize the concept of “breastsleeping,” relying on an evolutionary anomaly of artificial feeding and solitary sleep as the norm for infant behavior. Breastfeeding comprises a sum total of human behavior that is more than just nutrition. With focus on the ingredients of milk, and the delivery of expressed milk, it is easy to overlook the importance of breastfeeding on proximity to mother and human contact. Recommendations for infant sleep and breastfeeding, including the “Baby Box,” are seen as risk reduction strategies, without regard to the evolutionary norms of human behavior. If “breastsleeping” were recognized as the evolutionary norm, we would be focusing on risks of separation, not risks of bedsharing. Such risks may potentially be profound, but are as yet little studied. The 2016 AAP safe sleep recommendations are critically reviewed here, as are updates in progress toward a more evolutionarily balanced model.
Learning Objectives:
Objective 1: Learn about the concept of “breastsleeping” as it relates to human evolutionary biology.
Objective 2: Describe the history of the rise of solitary sleep, and its relationship to use of cows’ milk.
Objective 3: Discuss the implications of failing to use the appropriate evolutionary framework when decisions around research, and public health recommendations.
Objective 4: Critically review current recommendations around safe sleep.
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