Arms Reach® News

Why Babies Should Never Sleep Alone January 01 2006

by James J. McKenna and Thomas McDade, University of Notre Dame, Pediatric Respiratory Review

A review of the Cosleeping controversy in relation to SIDS, bed sharing and breast-feeding.

There has been much controversy over whether infants should cosleep or bed share with an adult caregiver and over whether such practices increase the risk of SIDS or fatal accident. However, despite oppositions from medical authorities or the police, many western parents are increasingly adopting nighttime infant care giving patterns that include some cosleeping, especially by those others who choose to breast-feed. This review will show that the relationships between infant-sleep patterns, infant sleeping arrangements and development both in the short and long term, whether having positive or negative outcomes, is anything but simple and the traditional habit of labeling one sleeping arrangement as being superior to another without an awareness of family social and ethnic context is not only wrong but possibly harmful. We will show that there are many good reasons to insist that the definitions of different types of cosleeping and bed sharing be recognized. We will examine the conceptual issues related to the biological functions of mother-infant cosleeping, bed sharing and the relationship each has to SIDS. At very least, we have that the studies and data described, will show that cosleeping at least in the form of room sharing especially with an actively breast-feeding mother saves lives, is a powerful reason why the simple, scientifically inaccurate and misleading, statement. "Never sleep with your baby" needs to be rescinded, wherever and whenever it is published.

One recent survey in the United States found that during the 1990's the numbers of mothers sharing their bed with their infants for part or all of the night doubled and may have reached as many as 50%. That same survey involving over 10,000 families revealed that breast-feeding mothers were three times more likely than bottle feeding mothers to bed share. Similar findings have been documented in Great Britain, Australia and New Zealand.

It appears that the biology-underlying breast-feeding behavior, the new western feeding norm – acts as a hidden regulator increasing nighttime mother-infant proximity whether sleeping in the same bed or within arms reach on a different surface.

If anthropological evidence on infant sleep and development were integrated and used as a starting point to inform infant sleep research, there is no doubt that the question we would be asking if it is safe for an infant to sleep next to its breast feeding mother, rather is it safe not to!

Born with only 25% of its adult brain volume the human infant is neurologically the most immature infant primate of all, the slowest developing and the most reliant on its mother for the longest period of time for physiological regulation and support. Indeed, what a human infant can or cannot do makes sense except in the light of the mother's body. Human infant milk composition, characterized by its low protein and fat content and high lactose, necessitates short intervals between breast feeds making human mother-infant cosleeping not only expectable but also biologically necessary. Moreover, mammal infants whose mothers leave them to sleep alone in nests neither cry nor defecate until she returns (to lick them) so as not to attract predators. Human infants cry and defecate spontaneously when their mothers leave, indicating that the constant physical association between them is evolutionarily stable and appropriate.

Recent studies suggest that supine infant sleep in the breast-feeding bed sharing context maximizes the chances that the baby will be able to respond to its mother's movements, sounds and touches. It further promotes easy and constant communication that reportedly serves as he basis of the growing mutual attachment between the mother and infant – a prerequisite for healthy infant development.

While infant sleeping arrangements vary enormously from culture to culture, the potentially beneficial psychological effects that nighttime maternal contact asserts on the human infant are not.

Many studies show that infant mammals, including human infants, appear to be re-sensitized to receive sensory signals linking them to cosleeping partner. All have been shown to change infant physiology – including heart rate and breathing patterns and including the cessation of excessive nighttime crying.

Recent studies show that increased cosleeping behavior, far from diminishing a child's ability to be alone or inhibit their abilities to innovate, appears to enhance such characteristics.

The American Academy of Pediatrics Guide to Your Child's Sleep moves from science to social opinion when they inform parents that infants should never be permitted to fall asleep at the breast or in the mother's arm's following a breast feed the very context within which the infant's falling asleep evolved and it is practically impossible to prevent. Parents are taught 'need" and "should" be "trained" to sleep alone. Yet, according to the 2000 National Sleep Foundation Survey in the United States, 62% of American adults whose parents followed these Dr. Spock-inspired recommendations currently report difficulties falling and staying asleep: 60 % of children under the age of 18 have complained to their parents about being tired during the day and 15% of children admit to falling asleep in school. These data suggest that there is either no simple correlation between early infant or childhood sleep patterns and adulthood, or that the solitary infant and childhood sleep training model, aimed at creating healthy sleep habits and advocated over 60 years, appears not only to have failed miserably, but may have produced the opposite effects that were promised. In spite of these statistics, childhood sleep guides continue to maintain that infants need to be taught to soothe themselves back to sleep with minimal or no parental involvement.

Again it is precisely this cultural context that helps to explain the simplistic recommendations against cosleeping made by the Consumer Product Safety Commission in the USA. Yet, it would appear that strong biologically based, emotional connections between breast feeding mothers and their infants, which predate recent cultural ideologies, might also explain why parents appear to be rejecting the recommendation always to place infants in cots to sleep and never to "sleep with a baby".

Children who 'never' slept in their parents' bed show a trend toward being rated 'harder to control', less happy, less innovative and less able to be alone and in several studies they exhibit a greater number of tantrums. Children who were never permitted to bed were actually more fearful than children who always slept in their parents' bed for all of the night, finding that is exactly the opposite of what is popularly understood.

Mother-infant cosleeping represents the preferred and obligatory arrangement for most contemporary people. In many instances there is no other choice for families and, still even in industrialized western countries, without the intense breast feeding and physical monitoring that accompanies cosleeping, the survival of an infant is threatened.

The terms cosleeping and bed sharing should not be used interchangeable since the generic practice of cosleeping wherein mothers and infants sleep on a different surface can be recommended, but due to its complete diversity of expression, bed sharing cannot.

Specific illustrations of cosleeping include infants sleeping next to their mothers on floor-based futons, or infants sleeping along side but not on the same surface as the mother – such as in a crib, or bassinet next to the mother's bed – within arm's reach.

Breast Feeding and cosleeping including breast-feeding in the context of bed sharing are often mutually reinforcing and constitute an integrated system. That is, the choice to breast feed leads in many cases to increased bed sharing behavior, which, in turn, increases the number of breast feeds per night, while facilitating decisions by mothers to breast feed for a greater number of months.

Breast-feeding promotes bed sharing which increases breastfeeding frequency and extends duration of breast-feeding in months, a mutually re-enforcing system.

In Northern England they found that they would have missed half of the routine cosleepers had the researchers not asked if the baby was moved from crib to bed sharing. "Bringing the baby into their bed to sleep was described as an 'intuitive' strategy by many new parents." The research raises the possibility that the true frequency of cosleeping has been grossly underestimated in western countries where parents traditionally confront social criticisms for bed sharing.

Regardless of what some may decide for themselves, sleeping with one's baby is not bad, irresponsible or criminal behavior but, the most part, it is merely normal and expectable and for the overwhelming number of parents, can be a good choice based on emotions and affectionate parental behavior toward which all healthy parents are at some point inclined.

We believe it is inappropriate to fundamentally condemn the practice of bed sharing by professional advice. In parental counseling, the individual child's needs, the family context and cultural background need to be taken into account.

The studies and data described in this paper, which show that cosleeping at least in the form of room sharing especially with an actively breast feeding mother saves lives, is a powerful reason why the simplistic, scientifically inaccurate and misleading statement 'never sleep with your baby' need to be rescinded wherever and whenever it is published.