ARTICLE #2 Co-Sleeping: Good for Parents, Good for Baby
ARTICLE #3 How to Make Sleep Sharing Work
ARTICLE #4 Rethinking Healthy Infant Sleep
ARTICLE #5 Sleeping Safely With Your Baby
ARTICLE #6 The Benefits of Co-Sleeping
People spend a third of their lives asleep. And we do not sleep in random ways. How we sleep, with whom we sleep, and where we sleep is molded both by culture and custom, traditions handed down through generations. For most of human history, babies and children slept with their mothers, or perhaps with both parents. Our distant ancestors lived in small groups that subsisted by hunting and gathering, and it is safe to assume that these bands did not have separate sleeping quarters for parents and children in their temporary shelters. It wasn't until 200 years ago that a few cultures began to construct dwellings with more than one room, and even today, such sleeping privacy is rare except in more affluent societies. The majority of people around the world still live in one-room shelters where all activities take place.
Anthropologist John Whiting also found a simple association between climate and parent-child cosleeping (among other behaviors). Evaluating 136 societies, Whiting outlined four kinds of typical household sleeping arrangements: mother and father in the same bed with baby in another bed; mother and baby together and father somewhere else; all members of the family in separate beds; and all members of the family together in one bed. The most prominent pattern across cultures, Whiting discovered, was mother with child and father in another place (50 percent of the 136 cultures). In another 16 percent, the baby slept with both mother and father. Many of these cultures, he wrote, were polygamous, so that fathers were moving among households and beds, and the stable unit was actually each mother with her children. Whiting also found a connection to cold weather. Men and women (that is, couples) routinely sleep together in places where the winter temperature falls below 50 degrees - presumably for warmth more than any other reason - but they often have separate sleeping arrangements where the climate is warmer. The sleeping place of babies, on the other hand, usually conforms to a different climatic situation - they usually stay with mother in areas with warm climates, but in colder climates, they are swaddled in blankets and strapped to cradleboards to minimize heat loss. These cultures, however, represent a small minority of the hu-man population.
In almost all cultures around the globe, babies sleep with an adult, while older children sleep with parents or other siblings. It is only in industrialized Western societies such as those in North America and some parts of Europe that sleep has become a private affair. The West, in fact, stands out from the rest of humanity in the treatment of its children during sleep. In one study of 186 nonindustrial societies, children sleep in the same bed as their parents in 46 percent of the nonindustrial cultures, and in a separate bed but in the same room in an additional 21 percent. In other words, in 67 percent of the cultures around the world, children sleep in the company of others. More significantly, in none of those 186 cultures do babies sleep in a separate place before they are at least one year old. In another survey of 172 societies, all infants in all cultures do some cosleeping at night, even if only for a few hours. The US consistently stands out as the only society in which babies are routinely placed in their own beds and in their own rooms.
Anthropologist Gilda Morelli compared the sleeping arrangements and nighttime habits of parents in the US with a group of Mayan Indians in Guatemala. The Mayan babies slept with their mothers in all cases for the first and sometimes the second year. In more than half the cases, the father was there as well, or he was sleeping with older children in another bed. Mayan mothers made no special note of feeding at night because they simply turned and made a breast available when the baby cried with hunger, probably while the mothers were still fast asleep. For the comparative US group, three babies were placed in a separate room to sleep from the time they were born, and none of the 18 subjects slept in the parents' bed on a regular basis. By three months of age, 58 percent of the babies were already sleeping in another room; and by six months of age, all but three had been moved out to a separate room. Not surprisingly, 17 of the 18 American parents reported having to stay awake for nighttime feedings.
Differences in attitude toward sleep in general were equally clear between the two cultures. American parents used lullabies, stories, special clothing, bathing, and toys to ritualize the sleep experience, whereas Mayan parents simply let their babies fall asleep when they did, with no folderol. When the researcher explained to the Mayan mother how babies were put to bed in the US, they were shocked and highly disapproving, and expressed pity for the American babies who had to sleep alone. They saw their own sleep arrangements as part of a larger commitment to their children, a commitment in which practical consideration plays no part. It did not matter to them if there was no privacy, or if the baby squirmed at night - closeness at night between mother and baby was seen as part of what all parents do for their children.
Conversely, the American parents who slept with their babies on a regular basis said they did so for "pragmatic" reasons (presumably for breastfeeding and comforting a fretful baby), although they acknowledged that cosleeping seemed to foster attachment. Unlike the Mayans, they often found this attachment to be worrisome and somehow emotionally or psychologically unhealthy. They moved their babies out of the parental room as soon as possible, usually by six months; and they expressed the need to guide the child down a path of independence, as well as a desire for their own privacy. They also felt such separation would be less traumatic if done early rather than later. As one mother put it, "I am a human being, and I deserve some time and privacy to myself." Many mothers also have been told by pediatricians or childcare experts that sleeping alone in a bassinet or crib is safer for the baby, and so they follow this advice, assuming they are doing the right thing.
Differences in attitude among cultures can perhaps be most clearly seen in work on immigrants from one culture to another; infant sleep patterns, it turns out, are one of the last traditions to change under pressure from the adopted country. In England, Asian parents - that is, people of Indian, Pakistani, and Bangladeshi origin - continue to sleep with their babies even when this is not the accepted pattern or the one advocated by British health care. And in the US, where solitary sleep is advocated by pediatricians and the larger society, ethnic pockets remain in which sleeping with the baby is the accepted pattern; minorities that live by nonwhite rules also regularly cosleep. In one study of Hispanic-Americans in East Harlem in New York City, 21 percent of the children from six months to four years of age slept with their parents, as compared to 6 percent of a matched sample of white middle-class children. Eighty percent of the Hispanic children shared the same room with their parents, and this sharing was not due solely to space constraints.
Recent immigrants are not the only group that differs in their sleeping arrangements with their children. In a comparison of whites and African Americans, 55 percent of the white parents and 70 percent of the black parents said they coslept with their babies. For whites, cosleeping with their children took place primarily when babies were perceived to have sleeping problems - defined as waking during the night - or due to a mother's ambivalence toward the parenting role. In this and other studies, cosleeping in white families was usually a last-resort attempt to soothe a troubled child or fix a troubled parent-offspring relationship. For black parents, cosleeping was seen as a normal pattern and had nothing to do with fixing a troubled sleep history or a problematic relationship.
In Appalachia or eastern Kentucky, cosleeping in infancy and childhood is the norm, as it has been for hundreds of years. Although the people of this area are not an ethnic minority or recent immigrants, they do represent a cohe- sive population that has been resistant to change. Historians note that in colonial times on the eastern seaboard, several people slept in the same bed - it was the only way to sleep in such small houses. But when new ideas about privacy began to appear in the 19th century, housing reflected those changes, and suddenly there were private sleeping rooms, first in public houses and then in private homes. The people of Appalachia, descendants of that more colonial tradition, continued the communal sleeping arrangement and still refuse to place babies alone even when there is plenty of room. Contrary to the advice given by pediatricians in the area, these mothers place their babies in the parental bed because they believe in their particular parenting ideology.
As anthropologist Susan Abbott points out, "[Cosleeping] is not some kind of quaint hold-over from an archaic past, nor is it pathological in its constitution or outcome for the majority of those who experience it. It is a current, well-situated pattern of child rearing that is withstanding the onslaught of advice by contemporary childcare experts."
The point is to make a tightly knit family and keep children close. Seventy-five-year-old Verna Mae Sloane writes of motherhood in Appalachia: "How can you expect to hold on to them in life if you begin by pushing them away?"
Why is cosleeping important? Science is just now learning the answer to that question. No one yet knows why animals sleep, but we do have a pretty good idea how sleep occurs. Like most physical states, sleep involves a number of biological or physiological mechanisms. Sleep is controlled by the primitive brain stem, which sends messages to and from the heart, the lungs, muscles around the diaphragm and ribs, and hormone- producing organs - all systems that monitor and regulate the choreography of sleep. In sleep, just as during times of wakefulness, adult humans shift through periods of controlled neocortical-driven breaths and automatic brainstem-initiated breaths. Adults are able to manage the shift between these types, but infants do it less easily. Infants are born with neurologically unfinished brains. They don't develop the ability to easily navigate types of breathing until they are at least three to four months old, and the sleep patterns of newborns reflect this. As mentioned earlier, they are unable to consolidate periods of sleep and don't distinguish between day and night; they also spend more time in REM sleep than adults do.
When sleeping with her mother, a baby reacts to her movements and goes through any number of changes in sleep stages, far more than when the infant sleeps alone, practicing the transitions from one kind of breathing to another. Left alone, babies must steer through night sleep with little training, and no external environmental stimuli or cues. Most babies eventually develop the skill to shift between types of breathing as their brains develop. But for some infants, such shifts may be harder; they could benefit from the external metronome of parental breathing. Cosleeping, with all its entwined movements through various levels of sleep, and its physical checkpoints, may be exactly what nature intended to ensure babies survive through the night as well as learn how to sleep and breathe on their own.
Most parents in Western culture, by opting not to cosleep, have thus altered the physical parent-baby interaction during sleep hours. But it is important for parents who have done so to realize that they have opted for this arrangement because of cultural reasons, not out of biological appropriateness. What these well-meaning parents do not realize is that they might also be putting their babies unnecessarily at risk.
Infant needs and parental responses to those needs do, after all, constitute a dynamic, co-evolving system, a system that was, and is even now, being shaped by natural selection to maximize infant survival and improve parental reproductive success. Culture may change, and society might progress, but biology is modified at a much slower rate. Babies are still stuck with their Pleistocene biology despite our modern age, and no amount of technological devices or bedtime routines will change that. What babies need from parents is to be part of that interactive parent-baby system that evolved for good evolutionary reasons, and which is a biological necessity even today.
Meredith F. Small is a professor of anthropology at Cornell University. She is the author of Female Choices: Sexual Behavior of Female Primates and What's Love Got to Do with It? The Evolution of Human Mating. This article is excerpted from her most recent book, Our Babies, Ourselves (Anchor Books, 1998).
For more information on babies and sleep, see the following articles in past issues of Mothering: "In Support of the Family Bed," and "Sudden Infant Death Syndrome: Making Sense of Current Research," no. 81; "The Truth About Nightwaking," (ed) no. 76; and "Tossing and Turning Over 'Crying It Out,'" no. 74.
By Ruth Lockshin
Twenty years later, I still have vivid memories of my first year as a parent, dreading bedtime.
Our daughter would fall asleep with little trouble. That wasn't the problem, especially after my husband and I figured out that waiting for her to fall asleep when she was tired was easier than trying to "put" her to sleep when we were tired. But would she stay asleep for a few hours, or would she awaken to nurse after 45 minutes?
We approached every night with apprehension. Some nights she would sleep for a few hours and I would say triumphantly, "See, she's getting into a good pattern now!" But as the weeks went on, the pattern became harder to detect. Of course we got the usual contradictory advice - wean her, nurse her more often during the day, start solids, let her cry it out.
Several friends encouraged me to take our baby into bed with us, to make it easier to nurse her. But to me, that seemed counter-productive. If she were in bed with us, surely our movements would stimulate her to wake and nurse more often - not at all what we wanted.
Finally, when she was about five months old and I once again believed that she had settled into a "pattern," we joined my parents for a Florida vacation. The sun and sand were wonderful and relaxing, but in the mornings I cried to my sympathetic father that we had ruined her pattern by leaving home, and that I was exhausted. Everything was unfamiliar to our baby - no wonder she woke frequently at night to make sure that we were still there!
My father, a pediatrician, reminded me that many mothers he knew felt more rested when they took their babies into bed with them. Desperate, I decided to try it.
At first, it was hard for me to get used to sleeping with a noisy, active baby. (My husband didn't mind - he moved another bed into our room and if he couldn't fall back to sleep in our bed, he would move over.) But while I was just as tired, at least I was warmer, since I no longer had to get out of bed so many times.
The months wore on, until one morning a well-meaning friend asked me the dreaded question, "How many times does she wake at night?" I realized I didn't know the answer. I had slept through her nursing sessions so successfully that I wasn't even aware of how often she nursed! This was a milestone.
Another milestone occurred one night when we slept in a hotel room with two double beds. We slept better there than we had since our daughter was born, so we immediately invested in another double bed for our own room.
After that, we never used a crib again. Our three other children shared our bed(s) from the moment of their births, and my early family bed dread was a thing of the past. I changed my definition of "sleeping through the night." The baby slept through the night as long as she kept her eyes closed. If she woke up, nursed, and went back to sleep, that was sleeping through the night. By that definition, our babies all slept through the night by about 6 weeks! I slept through the nursing too and felt much more rested in the morning.
SEPARATE SLEEPING IS A NEW CUSTOM
Like any college-educated mother, I used our bedroom as a laboratory at night and I read the professional literature about our experiment during the day. Just because it was more restful, cozier and more comfortable, did that mean that it was the best thing for the baby?
I learned from Tine Thevenin's classic book, The Family Bed, that "separate sleeping is mainly a social custom" and has been the norm in the West only for a hundred years or so. Thevenin shows from her own studies and others that fears of "overlying," a term with a biblical ring, are not well grounded. These deaths are not caused by mothers sleeping with their babies, but are rather cases of SIDS, which consistently occur around the world at the rate of 2-3 per 1000 live births.
Thevenin's book was first published in 1976; since then there have been several studies on the topic. Dr. William Sears, in his popular 1990 book, Nighttime Parenting, advocates co-sleeping as a way for parents to actually lower the risk of SIDS in their babies. According to Dr. Sears, "anthropological studies have shown that the rate of SIDS is approximately three to four times higher in cultures where mothers do not sleep with their babies."
Dr. James McKenna, Professor of Anthropology at the University of Notre Dame, and the author of a sleep laboratory study of co-sleeping, said in a statement in September 1999 that special precautions need to be taken to minimize catastrophic accidents such as making sure that mothers do not smoke and are not desensitized by drugs or alcohol. "However, the need for such precautions is no more an argument against all co-sleeping...than is the reality of infants accidentally strangling...alone in cribs a reason to recommend against all solitary...infant sleep."
Even Penelope Leach, the world-famous child care expert, recently wrote in the New York Times: "Being close at night helps parents bond with their babies... As long as the parents don't drink, smoke, sleep with thick comforters or put babies on their stomachs, there is no real evidence against sleeping with a baby, as most people in the world do."
My husband and I also wondered about the psychological effects of sharing the marital bed. Our marriage seemed to be thriving, but what about others?
According to Sandra Rigazio-Digilio, PhD, professor in the Marriage and Family Therapy Program at the University of Connecticut, "In healthy families, this nighttime togetherness can be a bonding experience for children and parents. If...both partners agree this will make feeding easier and make a child feel bonded, then this can...increase the well being of family members. However, if cosleeping is being used as a way to keep parents apart...it is inappropriate."
On a recent 20/20 show, one parent said:
"The more we thought about it, and especially when you look down at this little tiny baby and people are starting to tell you, 'Oh, you've got to start to separate yourself. You've got to put that baby in this other room.' And you look down at this little baby, and it just doesn't make sense. You know, the baby needs someone with them all the time, and that's the way it really should be."
Ruth Lockshin is a former LaLeche League leader, freelance writer and mother of four.
Approved by the BabyCenter Medical Advisory Board
By the BabyCenter editorial staff
• Establish mutual agreement
• Get a big bed
• Make sure your mattress is safe
• Keep bedding light and minimal
• Never sleep share on a waterbed or couch
• Keep him warm, not hot
• Don't let your baby sleep on a pillow or with his head covered
• Never let infants and toddlers sleep next to each other
• Put up a sleep guard if you leave the bed
• Don't sleep share if you have a sleep disorder
• Don't smoke if you sleep share
• Don't drink or take drugs if you sleep share
• Be flexible
• Related Links
Safe, successful sleep sharing involves more than clean sheets and pillowcases. The first step: You and your partner both must be emotionally ready to try this arrangement, even if you don't know how long you'll stick with it. Here are 13 steps to making your sleep-sharing environment safe and satisfying for your whole family.
Establish mutual agreement
If you have a regular sleeping partner, be sure that both of you want to sleep share. If one person feels ambivalent, try it for a set amount of time and then reassess. Remember, sleep sharing works only if it suits every member of your family.
Get a big bed
Sleep sharing isn't going to be as comfortable or enjoyable if your bed is too small. King-size is best, but if your budget doesn't stretch that far, consider buying a bedside bassinet or removing a side rail from your baby's crib and putting the crib up against the side of your bed. Although it's not crucial, you'll have an easier time touching or soothing your baby if you adjust his mattress to the same height as yours. What's even more important is that you firmly tie the crib to your bed frame so they don't separate and create a crevice for your baby to slip into. A bedside bassinet works well if your baby is a wriggler he's still at arm's length but not kicking you all night long.
Make sure your mattress is safe
Whether you have your baby in bed with you or in a bedside bassinet, be sure the mattress is firm. Your baby could suffocate if he sleeps on a soft mattress or is surrounded by pillows and loose bedding. If you keep your mattress in a bed frame, make sure it fits tightly against the headboard so your baby can't fall face down into the gap and smother.
Keep bedding light and minimal
If you're sleep sharing with a baby younger than 12 months old, use as few blankets as possible and make sure they're lightweight to reduce your baby's risk of smothering or overheating. (This is most likely to happen during his first three months of life; from 3 to 10 months, his biggest risk is slipping into a crevice between the mattress and the bed frame.) He could also get wedged against an extra pillow or a stuffed toy, so keep those out of your bed, too.
Never sleep share on a waterbed or couch
James McKenna, head of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, advises against sleep sharing in a waterbed. They're often too soft and may have deep crevices around the frame where your baby could get trapped. Plus, in a waterbed your adult body movements could be enough to send your baby flying off the bed. Don't sleep share on a couch or sofa, either, as your baby could get wedged in the cracks between the cushions or between the cushions and the back of the couch.
Keep him warm, not hot
Dress or swaddle your baby lightly for sleep because contact with other bodies elevates his skin temperature. Here's a good rule of thumb: If you're comfortable, then your baby probably is, too.
Don't let your baby sleep on a pillow or with his head covered
Never put your baby down to sleep on top of a pillow because he risks rolling off it or smothering in its soft folds. And periodically check on him to make sure he hasn't wriggled down so that his head is covered by the blanket or duvet. If that happens, he could have trouble breathing or even suffocate.
Never let infants and toddlers sleep next to each other
You can share a bed with both an infant and a toddler as long as they don't sleep next to each other. Toddlers don't understand that an infant can't protect himself from suffocation, and your older child could inadvertently roll over onto the infant, put an arm across his mouth or head, or otherwise crush or smother him. Toddlers tend to be big-time squirmers, too, which means your older child could accidentally hit or kick your infant. For the same reasons, you shouldn't let an infant and a toddler sleep alone together in the same bed. You or your partner should sleep between the children instead.
Put up a sleep guard if you leave the bed
While your baby may be safe sleeping between you and your partner, he can easily fall out of the bed if you get up to use the bathroom or if you get out of bed earlier in the morning. And he can just as easily roll off the foot of the bed as the sides. To prevent this, purchase a bed rail to attach to the side of the bed, place pillows on the floor at the foot of the bed or put a bedrail at the end of the bed, too, and check on your baby often when you're not in the room with him.
Don't sleep share if you have a sleep disorder
A sleep disorder, such as sleep apnea, may make you sleep so deeply that you're at risk of not awakening if you roll onto your baby.
Don't smoke if you sleep share
According to McKenna, parents who smoke should not co-sleep. "Nobody knows exactly why, but when smokers sleep with their babies, the risk of SIDS is higher," McKenna says.
Don't drink or take drugs if you sleep share
Drugs and alcohol can impair your memory and cause you to forget that your baby is in your bed. They can also cause you to sleep so soundly that you may not realize it if you roll over on your baby. To avoid these serious safety risks, don't drink or take drugs if you sleep share, and always make sure both you and your partner are aware that your baby is in the bed.
Is sleep sharing right for all children and all adults? Probably not, says McKenna. There's no one-size-fits-all model when it comes to sleeping arrangements for you and your child. Some parents like to sleep with their children and some don't. Some children need more nighttime comfort and companionship than others. Also, not every child wants to sleep all night, every night, with his parents. It may take some trial and error, but eventually you'll find a method that works for you, your partner, and your baby.
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James J. McKenna, PhD
Professor of Anthropology
from Breastfeeding Abstracts, February 1993, Volume 12, Number 3.
Mother-infant co-sleeping often accompanies nighttime breastfeeding. New research suggests that co-sleeping affects infant physiology and patterns of arousal, raising questions about currently accepted norms for "healthy" infant sleep.
Judging from the infant's biology and evolutionary history, proximity to parental sounds, smells, gases, heat, and movement during the night is precisely what the human infant's developing system "expects," since these stimuli were reliably present throughout the evolution of the infant's sleep physiology. The human infant is born with only 25 percent of its adult brain volume, is the least neurologically mature primate at birth, develops the most slowly, and while at birth is prepared to adapt, is not yet adapted. In our enthusiasm to push for infant independence (a recent cultural value), I sometimes think we forget that the infant's biology cannot change quite so quickly as can cultural child care patterns.
Infants sleeping for long periods in social isolation from parents constitutes an extremely recent cultural experiment, the biological and psychological consequences of which have never been evaluated. Most Americans assume that solitary sleep is "normal," the healthiest and safest form of infant sleep. Psychologists as well as parents assume that this practice promotes infantile physiological and social autonomy. Recent studies challenge the validity of these assumptions and provide many reasons for postulating potential benefits to infants sleeping in close proximity to their parents - benefits which would not seem likely with solitary sleeping. Current clinical models of the development of "normal" infant sleep are based exclusively on studies of solitary sleeping infants. Since infant-parent co-sleeping represents a species-wide pattern, and is practiced by the vast majority of contemporary peoples, the accepted clinical model of the "ontogeny" of infant sleep is probably not accurate, but rather reflects only how infants sleep under solitary conditions. I wonder whether our cultural preferences as to how we want infants to sleep push some infants beyond their adaptive limits.
To explore this possibility further, Dr. Sarah Mosko and I are studying the physiological effects of mothers and infants sleeping apart and together (same bed) over consecutive nights in a sleep lab. Our two pilot studies conducted at the University of California, Irvine School of Medicine, showed that the sleep, breathing, and arousal patterns of co-sleeping mothers and infants are entwined in potentially important ways. Solitary sleeping infants have a very different experience than social sleeping infants - although we do not know yet what our data mean.
Funded by the National Institutes of Child Health and Human Development, this research will help us to evaluate the idea that infant-parent co-sleeping may change the physiological status of the infant in ways that, theoretically, could help some (but not all) SIDS-prone infants resist a SIDS event (McKenna 1986; McKenna et al. 1991; McKenna et al., in press). One of the suspected deficits involved in some SIDS deaths is the apparent inability of the infant to arouse to reinitiate breathing during a prolonged breathing pause. Our preliminary studies show that mothers induce small transient arousals in their co-sleeping infants at times in their sleep when, had the infant been sleeping alone, arousal might not have occurred. We have suggested that perhaps co-sleeping provides the infant with practice in arousing. Before we can draw any conclusions, more work is needed.
Regardless of what our own research will reveal, there already exists enough scientific information to justify rethinking the assumptions underlying current infant sleep research, as well as pediatric recommendations as to where and how all infants should sleep. Especially needed are new studies which begin with the assumption that infant-parent co-sleeping is the normative pattern for the human species-and that our own recent departure from this universal pattern could have some negative effects on infants and children. We need to determine if unrealistic parental expectations, rather than infant pathology, play a role in creating parent-infant sleep struggles - one of the most ubiquitous pediatric problems in the country. It may well be that it is not in the biological best interest of all infants to sleep through the night, in a solitary environment, as early as we may wish, even though it is more convenient if they did so.
Co-sleeping is often discussed as if it were a discrete, all-or-nothing proposition (i.e., should baby sleep with parents?). Many parents fail to realize that infants sleeping in proximity alongside their bed, or with a caregiver in a rocking chair, or next to a parent on a couch, in a different room other than a bedroom, or in their caregiver's arms all constitute forms of infant co-sleeping. I studied the location of infants and parents in their homes between 6:00 PM and 6:00 AM and found more infant-parent contact than parents describe.
I prefer to conceptualize infant sleep arrangements in terms of a continuum ranging from same-bed contact to the point where infant-parent sensory exchanges are eliminated altogether, as, for example, infants sleeping alone in a distant room with the door closed. Nowadays, one-way monitors often broadcast infant stirrings to parents in these situations, compensating for the loss of sensory proximity.
I am amused by this baby monitor phenomenon, primarily because we Americans seem to have gotten it all backward. Rather than parents monitoring the infant, a great number of developmental studies suggest that it should be the other way around, with the infant processing parental stirrings (especially breathing sounds and vocalizations). Infant sleep, heart rate, breathing, and arousal levels are all affected by such stimuli, probably in adaptive ways to facilitate development and to maximize adjustment to environmental perturbations (Chisholm 1986). At the very least, monitors should be broadcasting sound in both directions!
Given the human infant's evolutionary past, where even brief separations from the parent could mean certain death, we might want to question why infants protest sleep isolation. They may be acting adaptively, rather than pathologically. Perhaps these infant "signalers," as Tom Anders calls them, have unique needs and require parental contact more than do some other infants, who fail to protest. It's worth considering.
Chisholm, James. Navajo Infancy: An Ethological Perspective. New York: Aldine de Gruyer, 1986.
Call, Justin. Commentary.Med Anthropol 1986; 10(l): 56-57.
McKenna, James. An anthropological perspective on the sudden infant death syndrome (SIDS): The role of parental breathing cues and speech breathing adaptations. Med Anthropol 1986; 10(1) Special Issue.
MeKenna, J., S. Mosko, C. Dungy, and J. McAnninch. Sleep and arousal patterns among co-sleeping mother-infant pairs: Implications for SIDS. Am J Physical Anthropol 1991; 83:331-47.
McKenna, J., E. Thoman, A. Sadeh, T. Anders et al. Infant-parent co-sleeping in evolutionary perspective: Implications for infant development and the sudden infant death syndrome. Sleep. In press.
There has been a lot of media lately claiming that sleeping with your baby in an adult bed is unsafe and can result in accidental smothering of an infant. One popular research study came out in 1999 from the U.S. Consumer Product Safety Commission that showed 515 cases of accidental infant deaths occurred in an adult bed over an 8-year period between 1990 and 1997. That's about 65 deaths per year. These deaths were not classified as Sudden Infant Death Syndrome (SIDS), where the cause of death is undetermined. There were actual causes that were verified upon review of the scene and autopsy. Such causes included accidental smothering by an adult, getting trapped between the mattress and headboard or other furniture, and suffocation on a soft waterbed mattress.
The conclusion that the researchers drew from this study was that sleeping with an infant in an adult bed is dangerous and should never be done. This sounds like a reasonable conclusion, until you consider the epidemic of SIDS as a whole. During the 8-year period of this study, about 34,000 total cases of SIDS occurred in the U.S. (around 4250 per year). If 65 cases of non-SIDS accidental death occurred each year in a bed, and about 4250 cases of actual SIDS occurred overall each year, then the number of accidental deaths in an adult bed is only 1.5% of the total cases of SIDS.
There are two pieces of critical data that are missing that would allow us to determine the risk of SIDS or any cause of death in a bed versus a crib.
How many cases of actual SIDS occur in an adult bed versus in a crib?
How many babies sleep with their parents in the U.S., and how many sleep in cribs?
The data on the first question is available, but has anyone examined it? In fact, one independent researcher examined the CPSC's data and came to the opposite conclusion than did the CPSC - this data supports the conclusion that sleeping with your baby is actually SAFER than not sleeping with your baby (see Mothering Magazine Sept/Oct 2002). As for the second question, many people may think that very few babies sleep with their parents, but we shouldn't be too quick to assume this. The number of parents that bring their babies into their bed at 4 am is probably quite high. Some studies have shown that over half of parents bring their baby into bed with them at least part of the night. And the number that sleep with their infants the whole night is probably considerable as well. In fact, in most countries around the world sleeping with your baby is the norm, not the exception. And what is the incidence of SIDS in these countries? During the 1990s, in Japan the rate was only one tenth of the U.S. rate, and in Hong Kong, it was only 3% of the U.S. rate. These are just two examples. Some countries do have a higher rate of SIDS, depending on how SIDS is defined.
Until a legitimate survey is done to determine how many babies sleep with their parents, and this is factored into the rate of SIDS in a bed versus a crib, it is unwarranted to state that sleeping in a crib is safer than a bed.
If the incidence of SIDS is dramatically higher in crib versus a parent's bed, and because the cases of accidental smothering and entrapment are only 1.5% of the total SIDS cases, then sleeping with a baby in your bed would be far safer than putting baby in a crib.
The answer is not to tell parents they shouldn't sleep with their baby, but rather to educate them on how to sleep with their infants safely.
Now the U.S. Consumer Product Safety Commission and the Juvenile Products Manufacturer's Association are launching a campaign based on research data from 1999, 2000, and 2001. During these three years, there have been 180 cases of non-SIDS accidental deaths occurring in an adult bed. Again, that's around 60 per year, similar to statistics from 1990 to 1997. How many total cases of SIDS have occurred during these 3 years? Around 2600 per year. This decline from the previous decade is thought to be due to the "back to sleep" campaign - educating parents to place their babies on their back to sleep. So looking at the past three years, the number of non-SIDS accidental deaths is only 2% of the total cases of SIDS.
A conflict of interest? Who is behind this new national campaign to warn parents not to sleep with their babies? In addition to the USCPSC, the Juvenile Products Manufacturers Association (JPMA) is co-sponsoring this campaign. The JPMA? An association of crib manufacturers. This is a huge conflict of interest. Actually, this campaign is exactly in the interest of the JPMA.
What does the research say? The September/October 2002 issue of Mothering Magazine presents research done throughout the whole world on the issue of safe sleep. Numerous studies are presented by experts of excellent reputation. And what is the magazine's conclusion based on all this research? That not only is sleeping with your baby safe, but it is actually much safer than having your baby sleep in a crib. Research shows that infants who sleep in a crib are twice as likely to suffer a sleep related fatality (including SIDS) than infants who sleep in bed with their parents.
Education on safe sleep. I do support the USCPSC's efforts to research sleep safety and to decrease the incidence of SIDS, but I feel they should go about it differently. Instead of launching a national campaign to discourage parents from sleeping with their infants, the U.S. Consumer Product Safety Commission should educate parents on how to sleep safely with their infants if they choose to do so.
Here are some ways to educate parents on how to sleep safely with their baby:
Take precautions to prevent baby from rolling out of bed, even though it is unlikely when baby is sleeping next to mother. Like heat-seeking missiles, babies automatically gravitate toward a warm body. Yet, to be safe, place baby between mother and a guardrail or push the mattress flush against the wall and position baby between mother and the wall. Guardrails enclosed with plastic mesh are safer than those with slats, which can entrap baby's limbs or head. Be sure the guardrail is flush against the mattress so there is no crevice that baby could sink into.
Place baby adjacent to mother, rather than between mother and father. Mothers we have interviewed on the subject of sharing sleep feel they are so physically and mentally aware of their baby's presence even while sleeping, that it's extremely unlikely they would roll over onto their baby. Some fathers, on the other hand, may not enjoy the same sensitivity of baby's presence while asleep; so it is possible they might roll over on or throw out an arm onto baby. After a few months of sleep-sharing, most dads seem to develop a keen awareness of their baby's presence.
Place baby to sleep on his back.
Use a large bed, preferably a queen-size or king-size. A king-size bed may wind up being your most useful piece of "baby furniture." If you only have a cozy double bed, use the money that you would ordinarily spend on a fancy crib and other less necessary baby furniture and treat yourselves to a safe and comfortable king-size bed.
Some parents and babies sleep better if baby is still in touching and hearing distance, but not in the same bed. For them, a bedside co-sleeper is a safe option.
Here are some things to avoid:
Do not sleep with your baby if:
You are under the influence of any drug (such as alcohol or tranquilizing medications) that diminishes your sensitivity to your baby's presence. If you are drunk or drugged, these chemicals lessen your arousability from sleep.
You are extremely obese. Obesity itself may cause sleep apnea in the mother, in addition to the smothering danger of pendulous breasts and large fat rolls.
You are exhausted from sleep deprivation. This lessens your awareness of your baby and your arousability from sleep.
You are breastfeeding a baby on a cushiony surface, such as a waterbed or couch. An exhausted mother could fall asleep breastfeeding and roll over on the baby.
You are the child's baby-sitter. A baby-sitter's awareness and arousability is unlikely to be as acute as a mother's.
Don't allow older siblings to sleep with a baby under nine months. Sleeping children do not have the same awareness of tiny babies as do parents, and too small or too crowded a bed space is an unsafe sleeping arrangement for a tiny baby.
Don't fall asleep with baby on a couch. Baby may get wedged between the back of the couch and the larger person's body, or baby's head may become buried in cushion crevices or soft cushions.
Do not sleep with baby on a free-floating, wavy waterbed or similar "sinky" surface in which baby could suffocate.
Don't overheat or overbundle baby. Be particularly aware of overbundling if baby is sleeping with a parent. Other warm bodies are an added heat source.
Don't wear lingerie with string ties longer than eight inches. Ditto for dangling jewelry. Baby may get caught in these entrapments.
Avoid pungent hair sprays, deodorants, and perfumes. Not only will these camouflage the natural maternal smells that baby is used to and attracted to, but foreign odors may irritate and clog baby's tiny nasal passages. Reserve these enticements for sleeping alone with your spouse.
Parents should use common sense when sharing sleep. Anything that could cause you to sleep more soundly than usual or that alters your sleep patterns can affect your baby's safety. Nearly all the highly suspected (but seldom proven) cases of fatal "overlying" I could find in the literature could have been avoided if parents had observed common sense sleeping practices.
The bottom line is that many parents share sleep with their babies. It can be done safely if the proper precautions are observed. The question shouldn't be "is it safe to sleep with my baby?", but rather "how can I sleep with my baby safely." The data on the incidence of SIDS in a bed versus a crib must be examined before the medical community can make a judgment on sleep safety in a bed.
Harvard psychiatrist Michael Commons and his colleagues recently presented the American Association for the Advancement of Science with research that suggests that babies who sleep alone are more susceptible to stress disorders.
Notre Dame anthropology professor and leading sleep researcher, James McKenna, has long held that babies who sleep with their mothers enjoy greater immunilogical benefits from breastfeeding because they nurse twice as frequently as their counterparts who sleep alone.
In his book on Sudden Infant Death Syndrome, pediatrician William Sears cites co-sleeping as a proactive measure parents can take to reduce the risk of this tragedy. McKenna’s research shows that babies who sleep with parents spend less time in Level III sleep, a state of deep sleep when the risk of apneas are increased. Further, co-sleeping babies learn to imitate healthy breathing patterns from their bunkmates.
Every scientific study of infant sleep confirms that babies benefits from co-sleeping. Not one shred of evidence exists to support the widely held notion that co-sleep is detrimental to the psychological or physical health of infants.
If science consistently provides evidence that the American social norm of isolating babies for sleep can have deleterious effects, why do we continue the 150-year crib culture in the United States? Why do parents flock to Toys R’ Us to purchase dolls that have heart beats, sing lullabies and snore when they can do the same for free?
McKenna suggests that there are several factors that maintain this cultural norm. Foremost is the American value of self-sufficiency. Independence is an important characteristic for a successful person in our society. We take great pride in watching our babies pick themselves up by their own bootie straps. But the assumption that co-sleeping inhibits independence is pure cultural mythology. In fact, the opposite it true.
Children who share sleep with their parents are actually more independent than their peers. They perform better in school, have higher self esteem, and fewer health problems. After all, who is more likely to be well-adjusted, the child who learns that his needs will be met, or the one who is left alone for long periods of time? McKenna suggests that it is confusing for a baby to receive cuddles during the day while also being taught that the same behavior is inappropriate at night.
The Commons report states that when babies are left alone to cry themselves to sleep, levels of cortisol, a stress hormone, are elevated. Commons suggests that the constant stimulation by cortisol in infancy causes physical changes in the brain. "It makes you more prone to the effects of stress, more prone to illness, including mental illness, and makes it harder to recover from illness," he concludes.
The best-selling book on infant sleep is frighteningly misdirected and offers absolutely no scientific grounds for its thesis. Richard Ferber suggest that the best way to solve your child’s "sleep problems" is to isolate them in another room, shut the door, and let them cry for ten minutes without interruption. Then parents may enter the room and verbally soothe the baby, but are warned against making physical contact with their baby. Shortly after, they are advised to leave the infant to cry for another timed interval a la "Mad About You."
Most sleep disorders are not biologically based, but rather, created by well-intended parents. Making oneself available by intercom is simply not meeting the nighttime needs of an infant.
Many parents argue that they tried "Ferberizing" their baby and enjoyed great success with the technique. Indeed, the infant may stop crying and learn to go to sleep on his own, but this is a short-term pay off for parents. The baby has not suddenly discovered quiet content. He simply is exhausted from his futile efforts to be nurtured. Fifteen years later, the same parents shrug their shoulders and wonder why their kids are shutting them out.
Though co-sleeping is common in most parts of the world, many American parents would not consider it because they fear it will cause them sleep deprivation. Every scientific study concludes that parents who bring their babies to bed sleep longer and better.
A few parents do experience difficulty sleeping with a baby in their bed. For them, a "sidecar" or bedside sleeper is an ideal way to meet their needs for rest and their baby’s need for co-sleep. Keeping a crib or bassinet in the parents’ room is another option. A "family bed" is not for everyone, but creative solutions for co-sleep are abundant in our consumer-friendly culture.
The most common question co-sleepers are asked is about maintaining a sexual relationship with one’s partner. The answer is simple. Go someplace where the baby is not. Enough said.
For those who consider unlimited access to their sexual partner more important than meeting the needs of their baby, cat ownership is a wonderful alternative to parenthood. You can just toss a bowl of Nine Lives on the floor and frolic around the house whenever the mood hits you.
Co-sleeping is not right for everyone. Heavy drinkers and drug addicts should avoid sleeping with their babies. Of course, these folks should probably avoid parenthood altogether.
If scientific research consistently demonstrates that co-sleeping offers tremendous benefits for babies and has no deleterious effects, it’s time Americans join the rest of the world and parent our babies 24 hours a day.
By Melissa Marino
Health and Science
December 28, 2003
Babies who share beds with their mothers are better off physically and mentally than those who don't and may even be better protected against SIDS, according to an infant specialist.
Professor James McKenna, the director of the mother-baby sleep laboratory at Indiana's University of Notre Dame in the United States, said the Western model of separating babies from their parents at night had failed.
"Western parents are the most unhappy parents in the world and they are the least satisfied with their children's sleep," he said.
Professor McKenna, who will speak as part of the World Association for Mental Health's 9th World Congress in Melbourne next month, said research at the sleep laboratory found that babies slept more and cried less if they shared beds with their mothers.
The crying time of solitary breastfeeding babies was three times greater than that of those who slept with their mothers. Also, those who co-slept had about an hour and 10 minutes more sleep than those who slept alone, Professor McKenna said. Mothers also benefitted from more sleep if they shared a bed with their child, he said.
"In all the traditional measurements about babies' health - breathing patterns, sleep patterns, the amount of time they spent crying, weight gain, their stress hormone levels . . . you would argue that the co-sleeping baby was clinically healthier than the baby that was sleeping apart," Professor McKenna said.
Research indicated that babies sleeping in the same room as a committed caregiver were half as likely to die of sudden infant death syndrome as a baby sleeping alone in a room, he said.
Babies who shared beds had fewer and shorter apnoeas, or suspensions of respiration, in the deepest stages of sleep than those who slept alone.
Jan Carey, the spokeswoman for SIDS and Kids in Australia said babies were at lower risk of SIDS if they shared the same room as their parents, providing the parents did not smoke. But the organisation did not recommend that babies should share their beds.
Professor McKenna said safety factors must be heeded for co-sleeping to be safe. Sleeping areas must be safe without gaps, soft mattresses or heavy blankets, and parents must not be affected by alcohol or drugs.
He said there was no scientific evidence that babies were better off sleeping alone. Instead, the practice had become the norm because of ideological and cultural ideas.
These included an 18th century clergy ban on poor mothers sleeping with their children in a bid to curb rates of infanticide.
Professor McKenna said studies now showed that children who shared rooms or beds with their parents were more independent and confident than solitary sleeping children. "They have stronger sexual gender identities and are much more comfortable with affection and touch as adults," he said.
Professor McKenna said in other cultures most babies slept either in the same bed or in the same room as their mothers, with feeding provided on demand.
"The question should never have been 'is it safe or normal to sleep with your baby'?" he said. "The question should always have been, and still is, 'is it safe not to'?"