Why does breastfeeding help reduce the risk of cot death? 
On what research is your breastfeeding advice based?
I’ve heard that I’m more likely to breastfeed successfully if my baby has constant access to the breast even at night. Does this mean my baby should sleep in my bed at night-time? 

Is it risky if I fall asleep while breastfeeding my baby? 
Is it OK to smoke and breastfeed? 
Is it safe for me to have a few glasses of wine or beer and breastfeed?

How long should I breastfeed for?
Can I use a dummy while I’m also breastfeeding my baby? Won’t my baby get confused? 
I’m having difficulties with breastfeeding. Where can I get support and advice?

I haven’t been able to breastfeed. Does using infant formula increase the risk of cot death? 
I’ve been bottlefeeding my baby expressed breast milk? Will this still help reduce the risk of cot death? What if the milk has been frozen?


Why does breastfeeding help reduce the risk of cot death? 
Probably by more than one mechanism. There is strong evidence that infection is involved in at least some cot deaths. Breastfeeding certainly protects babies against infection because mother’s milk (especially the colostrum, the straw-coloured fluid produced during the first days of breastfeeding) contains protective antibodies against many common infectious organisms to which the mother herself has been exposed during her life. There are other properties of breast milk that also add to the protective effect. This is likely to explain part of the protective effect against cot death, but there may be other reasons as well. 

On what research is your breastfeeding advice based?
Mainly on a recent online publication by the American Agency for Healthcare Research and Quality. This is a very long and detailed report into many aspects of breastfeeding in developed countries, which includes a meta-analysis of 6 scientific publications from 5 countries on the effect of breastfeeding on the risk of cot death. (A meta-analysis is a technique for combining the results of different studies into a single analysis which increases the statistical power of the conclusions). 

Overall, babies who had been at least partly breastfed (received some breast milk but with formula accounting for the rest) were about one third less likely to die than those who had never been breastfed. 

Another study from the USA, not included in the meta-analysis, found that breastfeeding reduced infant mortality from all causes, not only from cot death. 

I’ve heard that I’m more likely to breastfeed successfully if my baby has constant access to the breast even at night. Does this mean my baby should sleep in my bed at night-time?
No. There is evidence that taking your baby into your bed to sleep through the night is a risk factor for cot death. This is especially true if you are a smoker or you are under the influence of alcohol or other sedative drugs; or if your baby was premature or of low birthweight or is aged less than three months. By all means take your baby into your bed for feeds, but the safest practice is to return him or her to the cot (which should be in your bedroom for the first six months). 

Is it risky if I fall asleep while breastfeeding my baby?
Probably yes. It is certainly very risky to fall asleep with your baby in a chair or sofa, as shown by several independent research studies. There is also evidence that taking the baby into your bed to sleep through the night is a risk factor for cot death. This is especially true if you are a smoker or you are under the influence of alcohol or other sedative drugs; or if your baby was premature or of low birth weight or is aged less than three months. By all means take your baby into your bed for feeds, but the safest practice is to return him or her to the cot (which should be in your bedroom for the first six months).

Is it OK to smoke and breastfeed?
If you smoke during pregnancy or after you've given birth, your baby is at increased risk of a cot death whether you breastfeed or not. The small protective effect of breastfeeding is not able to make any significant difference to the risk you are exposing your baby to by smoking. In addition the risks from bedsharing are greatly increased if you are a smoker. If you breastfeed at night in bed there is an increased chance that you fall asleep and endanger your baby.

Cut down and try to cut out smoking. Do breastfeed but make sure you put your baby back in the cot next to your bed. 

Is it safe for me to have a few glasses of wine or beer and breastfeed?
As far as is known, yes, provided that you do not sleep with your baby while under the influence of alcohol. If you’ve had a few glasses of wine (more than two units) and your baby sleeps in the same bed as you, this increases the risk of cot death 14 times. 

How long should I breastfeed for?
Any breastfeeding, even a few days, is better than none, but most authorities (including the Department of Health) now recommend breastfeeding for at least 6 months if possible. It is perfectly OK to continue longer than this if you wish to do so. 

Can I use a dummy while I’m also breastfeeding my baby? Won’t my baby get confused?
Yes you can, provided that the dummy is not introduced until breastfeeding has been established, typically after about 4 weeks. There is some evidence that starting dummy use in the first week of life may interfere with the establishment of breastfeeding, but not if it is delayed until after 28 days. 

I’m having difficulties with breastfeeding. Where can I get support and advice?
When you leave hospital with your baby, you should be given information on where to get help locally. You can contact your midwife, health visitor, local peer supporter or baby café. 

You could ring the national breastfeeding helpline 0844 20 909 20, or any of the lay counselors’ helplines:
National Childbirth Trust 0870 444 8708 
Association of Breastfeeding Mothers 08444 122 949
Breastfeeding Network 0844 412 4664
La Leche League 0845 120 2918

The Department of Health website will take you to your regional coordinator for the national network of breastfeeding coordinators, as well as other breastfeeding links. You can find your local baby café online as well. 

I haven’t been able to breastfeed. Does using infant formula increase the risk of cot death?
There is an increased risk of cot death for babies who were never breastfed compared with those who have had at least some exposure to breast milk. However, if you really can’t breastfeed there is really no alternative but to use infant formula (and do remember that, in the absence of other risk factors, the risk of cot death is still very low). 

I’ve been bottlefeeding my baby expressed breast milk? Will this still help reduce the risk of cot death? What if the milk has been frozen?
There is no direct evidence on which to base a scientific answer to this question and we don’t think any scientific study has ever addressed it. However, the answer is probably yes, because the protective effect of breastfeeding is almost certainly due to the composition of the milk and not to the method of administration.