There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping
Venue: Acta paediatrica

Recently Mobbs et al. 2015 describe the need for, and benefits of, immediate and sustained contact, including cosleeping, to establish an appropriate foundation for optimal human infant breastfeeding, neonatal attachment and brain growth. To further support this model, we propose a new concept, 'breastsleeping' aimed to help both resolve the bedsharing debate and to distinguish the significant differences (and associated advantages) of the breastfeeding bedsharing dyad when compared with the nonbreastfeeding bedsharing situations, when the combination of breastfeeding bedsharing is practiced in the absence of all known hazardous factors. Breastfeeding is so physiologically and behaviourally entwined and functionally interdependent with forms of cosleeping that we propose the use of the term breastsleeping to acknowledge the following: (i) the critical role that immediate and sustained maternal contact plays in helping to establish optimal breastfeeding; (ii) the fact that normal, human (species wide) infant sleep can only be derived from studies of breastsleeping dyads because of the ways maternal infant contact affects the delivery of breastmilk, the milk's ingestion, the infant's concomitant and subsequent metabolism and other physiological processes, maternal and infant sleep architecture, including arousal patterns, as well as breastfeeding frequency and prolongation; and (iii) that breastsleeping by mother infant pairs comprises such vastly different behavioural and physiological characteristics compared with nonbreastfeeding mothers and infants, this dyadic context must be distinguished and given its own epidemiological category and benefits to risk assessment. Incorporating evolutionary theory and natural selective processes as a powerful explanatory frame, Mobbs et al. (1) revisit a model of what attachment theorist John Bowlby (2) might have called the optimal 'environment of evolutionary adaptedness' within which breastfeeding evolved. Ironically, one major weakness in Bowlby's otherwise polymathic formulation and explanation of 'attachment' was his seeming de emphasis of the role that human breastmilk and breastfeeding delivery actually played in its aetiology. Instead, Bowlby emphasised the more critical consequences of an infant convincing its mother to invest in its survival, with natural selection operating to exaggerate both neonatal facial attributes (big eyes situated on the midline of the face, surrounded by round, nonangular or nonthreatening cheeks) and emotionally attractive, reflexive infantile behavioural responses such as high pitched cooing infantile gaze, as well as infant affectional responses such as terminating cries when soothed, and infant smiling. According to Bowlby, these evolved human infantile traits, which expanded on our related suite of phylogenetic characteristics as primates, coalesced to help motivate mothers (and others) to not only breastfeed and carry but to also protect their infants from predators. In contrast, Mobbs et al. assign different priorities than did Bowlby to the initial mechanisms promoting attachment and stress the absolute centrality of breastfeeding, and, specifically, they argue for a necessary, sequential unfolding of it. Mobbs et al. argue that human neonates need from the start unhindered and immediate sustained maternal contact, including maternal infant cosleeping, to assure maximum lactogenesis. While many other factors contribute along the way, they posit that the absence of unhindered mother infant contact, from the outset, is a significant hindrance to breastfeeding beyond three months (3)