James J. McKenna Ph.D Director, Mother-Baby Behavioral Sleep Laboratory - University of Notre Dame

All about Infant Sleep, Breastfeeding, Cosleeping, SIDS prevention, Safe CoSleeping, Safe Bedsharing, Dangerous Bedsharing, and the Development of Independence In Relationship to Sleeping Arrangements.

l.  My mom is worried that if my baby sleeps in my bedroom she will never go to her own room?  Does cosleeping mean co-dependence?
Cosleeping in the form of roomsharing, or the infant sleeping next to the parents' bed, but not in the bed, saves babies lives, as an infant's chances of dying from SIDS or from some other asphyxia event are reduced at least by one-half, according to current epidemiological studies. Interestingly, “co-dependence” is critical for human infants in the their younger years, of course. They are not yet able to be independent, in any sense.  Other research shows that infants who are the most reassured and experience the most close physical contact and proximity with their parents from birth actually become more independent at later ages, even during their toddler period. Independence is here defined as being able to be alone in a room by themselves without distress and being able to solve problems (as tested in psychological experiences) by themselves, compared with babies who slept alone from birth.

2.  My sister's baby died of SIDS when he was just 3 months old.  This has made me fearful as to what to do with my own new baby when she/he comes in January. What has your experience taught you in this regard? Does it run in families?
The four best things you can do are, not smoke during your pregnancy, breastfeed your infant exclusively, sleep close to the baby, within sensory range, in the same room (at least) and always lay your baby on his/her back for sleep, whether if sleeping alone or near of an adult.

3.  My husband has been deployed to Iraq three times. We are expecting our first baby and I want the baby to relate to his/her father - any ideas?
Nothing can substitute for the presence and physical proximity of the father except for perhaps hearing his voice on the phone or letting an older 4-6 month old infant see their father on screen such as in a video, or hearing his voice on the phone. or on a tape. Fathers are better able to bond with their babies as well if given as much sensory (visual and auditory) stimuli and exposure as is possible during their absence. 

4.  I have always been a very light sleeper. The smallest sound wakes me up and I can't go back to sleep. Am I wise to attempt cosleeping when my baby comes?
It depends on what your priority might be. Usually, parents do match the sleep patterns achieved before the arrival of their infant, Adjustments are necessary, You might be surprised, though,  about how much more willing you will be to sacrifice consolidated or uninterrupted sleep where and when it improves your infants' emotions or behavioral dispositions, and, seeing through your baby’s behavior, how much your sleeping close means to him or her. 

5.  Money is tight these days. Is it true that breast feeding is the economical way to go?  
Breastfeeding saves at least 5-10, 000 dollars in formula or milk costs, depending on the feeding patterns of your infant. It has enormous savings.

6.  Do you recommend cloth diapers or is it o.k. to go with disposables?
Whatever you and your infant prefers and /or what seems to work successfully, and avoids skin rashes and/or infant discomfort.  But think green!

7.  I'm a working mother of a 2 year old and a new 3 month old baby. Is it your best advice that I try find a nanny or am I better off to locate a day care center for both children?
If at all possible it is always better to keep especially young infants (less than four or five months old) in their own home with the babysitter or nanny coming to your home, rather than leaving young babies in daycare centers. According to Dr. Rachel Moon twenty percent of SIDS cases occur amongst infants being left in daycare centers with many dying on the first day or first week of being left there. Nobody knows why, or what it is in the home environment with mother being present, or father, that specifically protects the infants But protection, it is.  

8.  I have followed your advice in many articles you've written. My baby has always slept in our room in the CO-SLEEPER® brand bassinet you recommended. When would it be wise to start having the baby sleep in her own crib and how do I start this?

This is a question best answered by the parents and not by outside authorities as every infant, and with every set of parents, their parenting goals are different and the needs of all, including each unique infant, must be considered. I generally believe that infants in the first year of life should (especially when physiological factors  are considered) sleep close to the parents at least sleeping in the parent’s room, owing to the extreme neurological immaturity (25% of adult brain volume) at birth and the human infants' extremely slow development, compared with other species. 

9.  My son David was born very prematurely. The Arm's Reach® CO-SLEEPER® brand bassinet I bought was the best investment we ever made. There was enough room to hold his oxygen tank and other necessities for his care.  Is there any other device you would recommend that would add to his comfort and make life a bit less stressful for us?

I think you are doing just about the best infant care practice possible. It is not safe to have a very small, especially premature  baby sleeping next to a parent in the bed, but  very important to have them sleeping alongside the the bed on a different surface. The infant-parent sensory exchanges and the monitoring by the parent, coupled with breastfeeding are about as good as it gets for such an infant. 

10. What constitutes a "safe sleep environment" irrespective of where the infant sleeps?
Stepping aside from dangerous social factors, such as adult inebriation or adult bedsharing while under the influence of drugs, or with strangers, and ignoring for the moment the physical-structural-furniture and bedding  aspects of “safe infant sleep” infants always sleep most safely in the context of (and under the supervision of) a committed, sober adult caregiver who is in a position to respond to infant needs, crises, nutritional needs and to exchange sensory signals and stimuli. Infants should sleep on firm surfaces, clean surfaces, in the absence of smoke, under light (comfortable) blanketing with their heads never covered. Sleep suits are ideal for infants.  The bed should not have any stuffed animals or pillows around the infant, or other children in it, and never should an infant be placed to sleep alone on a bed, or on top of or around a pillow under mother's arm usually under her tricep, the usual universal position for a breastfeeding-cosleeping infant sleeping on a flat surface next to its mother. Sheepskins or other fluffy material and especially beanbag mattresses should never be used. Waterbeds can be dangerous, too, and always, if bed furniture or frames are used the mattresses should tightly intersect the bed-frame and no spaces or gaps should exist around circumference of the bed.  Infants should never sleep on couches or sofas, with or without adults where they can slip down (face first) into the crevice or get wedged against the back of a couch.

11. What makes for the safest possible bedsharing environment? 
To begin with, breastfeeding mothers exhibit more sensitivities to their babies movements, position and sound, than do bottle feeding moms so you might think about putting babies on a different surface, to sleep alongside, rather than have the baby in the bed, if bottle feeding.

But if breastfeeding, even if one uses a CO-SLEEPER® brand bassinet, the baby will often simply want to sleep next to you, to snuggle in physical contact,  and all parents should therefore be prepared for this contingency. Knowledge makes your baby safer. If a decision is made to bed-share, ideally, both parents should agree and feel comfortable with the decision and dads as well as moms should take responsibility for the safety, through the night, of his or her baby. In other words, reflect on that sticker stuck on  car bumpers which says:  “baby on board”. This suggests that  each bed-sharer should agree that he or she is equally responsible for the infant and acknowledge that the infant is present . My feeling is that both parents should think of themselves as primary caregivers.Moreover, infants a year or less should not sleep with other children siblings - but always with a person who can take responsibility for the infant being there. Obviously, persons on sedatives, medications or drugs, or if intoxicated --or excessively unable to arouse should not cosleep on the same surface with the infant. To be safe, long hair on the mother should be tied up to prevent infant entanglement around the infant's neck (yes, it has really happened and extremely obese persons, who may not feel where exactly or how close their infant is, may wish to have the infant sleep alongside but on a different surface.

It is important to realize that the physical and social conditions under which infant-parent cosleeping occur, in all its diverse forms, can and will determine the risks or benefits. What goes on in bed is what matters. 

It may be important to consider or reflect on whether you would think that you suffocated your baby if, under the most unlikely scenario, your baby died from SIDS while in your bed. Just as babies can die from SIDS in a risk-free solitary sleep environment, it remains possible for a baby to die in a risk-free cosleeping/bed sharing environment. Just make sure, as much as this is possible, that you would not assume, if the baby died, that either you or your spouse would think that bed-sharing contributed to the death, or that one of your really suffocated (by accident) the infant. It is worth thinking about.

12. Is there only one “best” sleeping environment for me and my infant? 
In a nutshell, no, of course not. And the assumption by pediatric sleep researchers that there is, explains why Western parents are the most exhausted, disappointed least satisfied, yet, most educated and well read than any other parents on the planet, as regards their infants' sleep. Mostly, where infants and children sleep is relational and not medical at all. Where babies end up sleeping reflects, among other things,  the special needs, temperaments,  and desires and/or nutritional needs of infants and children,  and, for parents, where infants sleep reflects their emotional needs and /or childrearing goals or philosophies. There is no one way to arrange your baby's sleep, before you retire for sleep, and how well one approach works is, as always, determined by factors pertinent to each family (what parents want , hope for, and see as reflecting the kind of relationship they want to share with each other and with their baby.

Try to remember that you will come to know special things about your baby better than anyone. Become informed, but then make your own decision and trust your feelings and feel good about and not ashamed of your decision and try not to hide your decisions from others but educate them to the variety of decisions that parents make. How you and the other caregivers feel about privacy and separation, or being close to the baby even when the baby is sleeping but you are not, and the physical circumstances of your house, can make a difference as to what approach or practice might work best for you. For example, some parents who retire for bed much later than the baby feel more comfortable if the baby is kept within proximity where, for example, the baby can be easily seen or heard, or "checked on". In these cases, the baby may not be officially "put to bed" in the sense of being placed in a room where all contact is broken. Rather in these instances the parents might place the baby in an open hall in a bassinet, or let the baby sleep in a bassinet in the living room, or in a carrier seat close enough to permit a kind of informal monitoring. 

Interestingly, infants and older babies fall asleep more easily in the context of family noise, rather than in silence, as is generally thought. This is because the baby probably feels more secure hearing that a care giver - or perhaps that something-- is going on nearby. It is always possible that a loud TV or an active herd of siblings could make it impossible for the baby to sleep - but generally it is hard to keep a baby awake if he or she is sleepy. But you can be the judge of how "intrusive" the noise level might be. Some parents may choose to put the infant in a separate room with the door closed, where sensory access between the baby and the parents (and other family members) is not possible or likely. My preference is never to close the door to a baby's room since babies find sleep when they need it, and they were not designed biologically or psychologically to sleep in complete social isolation and sensory deprivation.  

Some parents find it comforting to put some kind of walkie-talkie in the room, which is fine, except that a more appropriate use of the walkie-talkie talkie would be to turn the amplifiers around. That is pump family noise into the baby's room, letting the baby monitor the parents and siblings, rather than the other way around. Fifty years (at least) of human developmental research shows that baby's respond positively to physical and psychological sensory signals (sounds, sights, smells, touches, movement) from others when they "feel" that they are not alone. We might presume that external social noise gives young children a sense of security -- or something akin to a baby thinking "it's nice to know someone is around, should I need them".

13. Will our baby sleep through the night sooner if he or she shares our bed?
There exists no longitudinal data that can answer this question. But a variety of scientific studies indicate that rather than it being completely controlled by the environment, the baby's own maturational rate as influenced by its unique internal needs to awaken, to feed, to find reassurance, or to oxygenate, are as much influencing factors in night waking and "sleeping through the night" as is sleep location. 

Years ago, Dr. Tom Anders observed that babies awaken for short periods throughout the night without parental knowledge, even where they sleep in a crib, alone. Some babies will simply go back to sleep while others, presumably with different needs and sensitivities, will awaken and "signal" their need for contact with the parent. Should infants do so i.e. signal parents, it is not necessarily a sign of immaturity, stubbornness or attempts to manipulate. Interestingly, laboratory studies reveal that the average duration of infant and maternal awakenings in the cosleeping environment are shorter on average than the awakenings mothers and babies experience when baby awakens in another room, and requires intervention before going back to sleep. 

One bit of information might help here: from a biological perspective, it is appropriate for babies to awaken during the night during the first year of life. In fact, although infants can be conditioned to sleep long and hard alone, and without intervention and, hence, fulfill the cultural expectation that the should sleep through the night, the fact remains that they were not designed to do so, and it may not be either in their best biological or psychological interest. As always, parental goals and needs lead parents to interpret their infant's behavior, including night awakenings, very differently. For example, many parents do not worry about night awakenings because especially where the babies sleep next to them, the infants are content and less likely to awaken and remain distressed.

14. What are the advantages of having our baby sleep with us?
Advantages can only be assessed in view of how parents feel about their infant being close or -- next to them, and calculated in a positive way only if parents are knowledgeable about how to cosleep safely. Some obvious advantages can include: the baby will know that you are there-and can respond emotionally and physiologically in potentially beneficial ways. Babies will breast-feed more often with less disruption to mother's sleep - and the baby will receive more sleep as will the mother compared with solitary sleeping breast feeding babies - as recent studies show. Babies arouse more frequently, but for shorter average durations than if the baby slept apart - and spend less time in deeper stages of sleep which may not be beneficial for babies with arousal deficiencies - as also shown in recently published referenced articles. Babies cry significantly less in the cosleeping environment which means that more energy (at least theoretically) can be put into growth, maintenance and protective immune responses. More breast-feeding which accompanies cosleeping also can be translated into less disease and morbidly, indeed, breast-feeding is enhanced. Proximity of the infant potentially permits the parents to respond to changes in the baby's status - such as if it were choking or struggling to breathe - and, of course, proximity makes it more likely that if a baby were fighting to rid itself of blankets over it's head, the parent might hear the event and intercede. Working mothers who feel guilty of not having enough time to be with their babies during the day - can feel better about nurturing and, hence, being in interaction with their baby during the night - and hence, further augmenting and cementing their relationships, as can dad. Given the right family culture, cosleeping can make mother, dad and baby feel very good, indeed.

15. What are the long term effects on my baby of sharing a bed?
While advocates of solitary infant sleeping arrangements have claimed any number of benefits of infant sleeping alone, the truth of the matter is, none of these supposed benefits have been shown to be true through scientific studies. The great irony is that, not only have benefits of solitary infant sleep NOT been demonstrated - simply assumed to be true, but recent studies are beginning to show the opposite that is, it is not, for example, solitary sleeping arrangements that produce strong independence, social competence, feeling of high self esteem,good comportment by children in school, ability to handle stress, strong gender or sex identities - but it is social or cosleeping patterns that might, indeed, contribute to the emergence of these characteristics. Consider, for example:

  • Heron's (1) recent cross-sectional study of middle class English children shows that amongst the children who "never" slept in their parents bed there was a trend to be harder to control, less happy, exhibit a greater number of tantrums. Moreover, he found that those children who never were permitted to bed-share were actually more fearful than children who always slept in their parents bed, for all of the night (1).
  • In a survey of adult college age subjects, Lewis and Janda (2) report that males who coslept with their parents between birth and five years of age had significantly higher self-esteem, experienced less guilt and anxiety, and reported greater frequency of sex. Boys who coslept between 6 and 11 years of age also had higher self-esteem. For women, cosleeping during childhood was associated with less discomfort about physical contact and affection as adults. (While these traits may be confounded by parental attitudes, such findings are clearly inconsistent with the folk belief that cosleeping has detrimental long-term effects on psycho-social development.
  • Crawford (3) found that women who coslept as children had higher self esteem than those who did not. Indeed, cosleeping appears to promote confidence, self-esteem, and intimacy, possibly by reflecting an attitude of parental acceptance (Lewis and Janda 1988).
  •  A study of parents of 86 children in clinics of pediatrics and child psychiatry (ages 2-13 years) on military bases (offspring of military personnel) revealed that cosleeping children received higher evaluations of their comportment from their teachers than did solitary sleeping children, and they were underrepresented in psychiatric populations compared with children who did not cosleep. The authors state: "Contrary to expectations, those children who had not had previous professional attention for emotional or behavioral problems coslept more frequently than did children who were known to have had psychiatric intervention, and lower parental ratings of adaptive functioning. The same finding occurred in a sample of boys one might consider "Oedipal victors" (e.g. 3 year old and older boys who sleep with their mothers in the absence of their fathers)--a finding which directly opposes traditional analytic thought" (4).
  • Again, in England Heron (1) found that it was the solitary sleeping children who were harder to handle (as reported by their parents) and who dealt less well with stress, and who were rated as being more (not less) dependent on their parents than were the cosleepers!
  • And in the largest and possible most systematic study to date, conducted on five different ethnic groups from both Chicago and New York involving over 1,400 subjects Mosenkis (5) found far more positive adult outcomes for individuals who coslept as a child, among almost all ethnic groups (African Americans and Puerto Ricans in New York, Puerto Ricans,, Dominicans, and Mexicans in Chicago ) than there were negative findings. An especially robust finding which cut across all the ethnic groups included in the study was that cosleepers exhibited a feeling of satisfaction with life,

But Mosenkis's main finding went beyond trying to determine easy causal links between sleeping arrangements and adult characteristics or experiences. Perhaps his most important finding was that the interpretation of "outcome" of cosleeping had to be understood within the context specific to each cultural milieu, and within the context of the nature of social relationships the child has with its family members! For the most part, therefore, it is probably true that neither social sleep (cosleeping) or solitary sleep as a child correlates with anything in any simple or direct way. Rather, sleeping arrangements can enhance or exacerbate the kind of relationships that characterize the child's daytime relationships and that, therefore, no one "function' can be associated with sleeping arrangements. Rather than assuming that sleeping arrangement produces a particular "type" person it is probably more accurate to think of sleeping arrangements as part of a larger system of affection and that it is altogether this larger system of attachment relationships, interacting with the child's own special characteristics that produces adult characteristics.

References Cited
1. Heron P. Nonreactive cosleeping and Child Behavior: Getting a Good Night's Sleep All Night Every Night. Masters Thesis, University of Bristol, Bristol, United Kingdom , 1994.
2. Crawford, M. Parenting practices in the Basque country: Implications of infant and childhood sleeping location for personality development. Ethos 1994, 22;1:42- 82.__3. Lewis RJ, LH Janda. The relationship between adult sexual adjustment and childhood experience regarding exposure to nudity, sleeping in the parental bed, and parental attitudes toward sexuality. Arch Sex Beh 1988; 17:349-363.. Crawford, M. Parenting practices in the Basque country: Implications of infant and childhood sleeping location for personality development.
4. Forbes JF, Weiss DS, Folen RA. The cosleeping habits of military children. Military Medicine 1992; 157:196-200.
5. Mosenkis, J The Effects of Childhood Cosleeping On Later Life Development 1998._Masters Thesis. University of Chicago. Department of Human Development _James McKenna

16. Cosleeping and Overlaying/Suffocation: Is there a chance I'll roll over and crush my child?
To claim that there is NO chance of an adult overlaying a baby would be irresponsible, but so would it be irresponsible to claim that an infant could never be killed while traveling in an automobile, or while sleeping alone in a crib which has an overly soft mattress, or crib slats which do not prevent the infant's head from passing between them. In each case, the dangers are significantly reduced - and the potential benefits of car travel or infants sleeping alone (where this is what parents want) can be realized -- when the safety precautions unique to each choice of behavior are regarded. In the case of automobile travel, strapping infants correctly into a consumer safety approved car seat, and not driving while under the influence (of drugs or alcohol) makes car transportation worth the relatively small risk such travel imposes.
No infant sleep environment is risk-free. As regards cosleeping (in the form of bed-sharing) what we know to be true scientifically is that for nocturnal infant breast feeding and nurturing throughout the night both mothers and babies were designed biologically and psychologically to sleep next to one another. And while beds per se did not evolve mother-infant cosleeping most assuredly did-and not maximize infant and maternal health and infant survival! Infant-parent cosleeping with nocturnal breastfeeding takes many diverse forms, and it continues to be the preferred "normal" species-wide sleeping arrangement for human mother-baby pairs. In the worldwide ethnographic record, mothers accidentally suffocating their babies during the night is virtually unheard of, except among western industrialized nations, but here there are in the overwhelming number of cases, explanations of the deaths that require reference to dangerous circumstances and not to the act itself.
Let me expand a bit on what we know to be true scientifically. Anthropological and developmental studies suggest that mothers and infants are designed to respond to the presence of the other, and no data have ever shown that among mother-baby pairs who cosleep for breast-feeding in a safe cosleeping/bed-sharing environment that mothers are unable to sense the proximity of their babies in order to avoid smothering them. Our own laboratory sleep studies of cosleeping/bed-sharing mothers infant pairs (2 to 4 month olds) reveal that both breast-feeding mothers and their infants are extremely sensitive throughout the night - across all sleep stages - to the movements and physical condition of the other. The healthy infant, which includes most infants, are able to detect instances, where for example, their air passages are blocked. They can respond very effectively to alert the mother to potential danger, and they have the physical skills to maneuver out of danger, under normal circumstances. That being said, modern societies and the objects on which we sleep and the social and physical conditions within which bed-sharing can and often does occur especially among the urban poor forces professionals to be very guarded when discussing bed-sharing and/or cosleeping. The truth is that there is no one outcome (good or bad) that can be associated with cosleeping in the form of "bed-sharing, but rather a range of outcomes (from potentially beneficial to dangerous and risky) depending on the overall circumstances within which the cosleeping takes place.
For example, the condition of the sleeping surface - the bed (in Western cultures) and the condition and frame of mind of the adult cosleeper (s), and the purposes for cosleeping --are very important in assessing the relative safety, dangers or potential benefits of sleeping with your infant or child. During my many years of studying infant-parent cosleeping/bed-sharing, I am unaware of even one instance in which, under safe social and physical conditions, a mother, aware that her infant was in bed with her, ever suffocated her infant. But just as is true for other aspects of infancy or childhood important precautions need to be taken if families elect to bed-share For example, bed-sharing should be avoided entirely if the mother smokes (either throughout her pregnancy or after) as maternal smoking combined with bed-sharing increases the chances of SIDS.
While there is evidence that accidental suffocation can and does occur in bed-sharing situations, in the overwhelming number of cases (sometimes in 100% of them) in which a real overlay by an adult occurs, extremely unsafe sleeping condition or conditions can be identified including situations where adults are not aware that the infant was in the bed, or adult sleeping partners who are drunk or desensitized by drugs, or indifferent to the presence of the baby. In these cases often the suffocation occurs while the parent and infant sleep on a sofa or couch together.
In my own work I stress that a distinction must be made between the inherently protective and beneficial nature of the mother-infant cosleeping/breast feeding context, and the conditions (of the mother and the physical setting including equipment) within which it occurs - which can range from extremely safe to unsafe and risky.
While mother-infant cosleeping evolved biologically, it is wise to recall that beds did not; whether sleeping in a crib or in the adult (parental) bed, the mattress should be firm and it should fit tightly against the headboard so that an infant cannot during the night fall into a ledge face down and smother. Since contact with other bodies increases the infant's skin temperature, babies should be wrapped lightly in the cosleeping environment especially, and attention should be given to the room temperature. Obviously if the room temperature is already warm (say above 70 degrees F, the baby should not be covered with any heavy blankets, sheets or other materials A good test is to consider whether you are comfortable; if you are, then the baby probably is as well.
Avoid cosleeping with a baby on a couch as too many that I know of slipped face down into the cracks between the pillow seats and were compressed against the back wall of the couch, or fell face down into the back part of the couch and suffocated. Personally, I would also avoid cosleeping on waterbed, although there may be some instances they are firm enough and lack deep crevices (around the frame) that could be deemed safe.
Under no circumstances should the baby sleep on top of a pillow, or have his/her head covered by a blanket. Moreover, if another adult is in the bed, the second adult should be aware (made aware of) the presence of the baby, and it should never be assumed that the other adult knows that the baby is present. Parents should discuss with each other whether they both feel comfortable with the baby being in the bed and with them. I always suggest that if parents elect to cosleep in the form of bed-sharing each parent (and not just one) should agree to be responsible for the baby. Such a decision, by both sleeping adults, maximizes attention to the presence of the infant.
Toddlers or other little children should not be permitted to sleep in the adult bed next to an infant as toddlers are unaware of the dangers of suffocation. Moreover, it is safer not to permit an infant and a toddler to sleep alone together in the same bed.
Finally, it is not a pleasant thought to consider, but I always think that it is important to consider if, by chance, an infant died from SIDS while sleeping next to you, would you assume that you suffocated the infant, or would you know that you did not, that the infant died independently of your presence? If you are unable to believe that SIDS could occur independent in the bed-sharing or bed-sharing/breast feeding context, just as it can under perfectly safe solitary sleeping conditions, then perhaps it might be best to have the your infant cosleep next to you on a separate surface, rather than actually in your bed. Regardless of what you decide, it is important to consider the possibility, no matter how remote and unlikely such a scenario may be. That SIDS can, indeed, occur, where safe bed-sharing, breast feeding and complete nurturing and care for the infant has occurred, makes this question worth discussing amongst you and your partner.

Let me end on a positive note: all else being safe, bed-sharing among nonsmoking mothers who sleep on firm mattresses specifically for purposes of breast feeding, may be the most ideal form of bed-sharing where both mother and baby can benefit by, among other things, the baby getting more of mother's precious milk and both mothers and babies getting more sleep - two findings which emerged from our own studies.

 17. Why do babies wake up so often and so easily? Why do they seem to sleep longer/more profoundly when mommy is lying beside them?
If infants do wake up easily, then it's likely biologically appropriate and dependent on method of feeding and general comfort level (condition of diaper and/or satiation-hunger status). Recall that breastfed infants wake up much more frequently and at shorter intervals than do bottle fed infants since cows milk is designed for cow brain growth (much less volume compared with human brains) and body growth rates while breast milk has just the right composition which means fast burning sugars and much less protein and fat for that ever-growing human infant brain which triples in size in the first year. All human beings including infants have their own unique sleep personalities and no two human infants (adults or infants) are the same. Mostly infants wake up because it is in their best interest to do so as their neurobiology is not designed for sustained, deep and consolidated sleep at young ages, before six months of age. They appear not to wake up as much next to their mothers but actually in terms of small arousals and even larger ones they wake up more, but they do not necessarily alert the mother because they sense their own safety (or whatever emotion or physical sense that reduces stress or anxiety) which comes with smelling her milk and feeling her body, hearing her breath and feeling her movements and rhythms. 

18. How recommendable are “apnea monitors“ like “Angel Care”?
It depends on what the apneas are thought to be useful for, who recommended them, and whether the problem they are attempting to eliminate has been shown by good science to be effectively improved or prevented by that particular monitor. My opinion is that their usefulness is highly limited. Apnea monitors are not recommended to prevent SIDS, though I understand why parents of potentially ill infants might feel more secure by using them. Many mothers that start out using apnea monitors give them up and rely on their own capacities to stabilize their infants  Mother's proximity and monitoring coupled with the infants capacity to sense mothers sensory stimuli should prove extremely effective in most cases.

19. Many parents are afraid of practicing cosleeping, as their pediatrician tells them that it has been considered to increase the risk of SIDS. What is the truth about cosleeping and SIDS?
First of all, the question must be first responded to by asking…what kind of Cosleeping are you referring to? It is scientifically fallacious to say that cosleeping increases the chances of SIDS especially in light of the fact that hundreds of different cosleeping patterns exist which vary in degrees of safety and benefits enormously and outcomes associated with them. Room-sharing is a form of cosleeping and it is known that room-sharing decreases an infants' chances dying by one half!  But perhaps more importantly no human infant (meaning no present living human beings) would or could be alive today had our ancestral mothers not all slept next to their infants for physiological regulation, management, protection and to be breastfed throughout the night. It is one thing to delineate which kinds of "cosleeping" in diverse settings are safer or less safe or not safe at all, therein acknowledging the diverse types of cosleeping and the need to educate parents to the known factors which increase suffocation risks or some types of SIDS (say, evoked by overheating or the covering an infant’s head or sleeping on a couch with an infant or letting other children sleep next to a baby ); but it is an altogether different and immoral strategy to claim in an unqualified way that mother's bodies, no matter what, cannot safely sleep next to their infants, or that  these bodies are inherent lethal weapons, no matter what. Most cosleeping cultures either have never heard of SIDS or have the lowest infant mortality or SIDS rates in the world, These cosleeping cultures are characterized by mothers who breastfeed and do not smoke suggesting that it is not cosleeping that is the problem at all, but how it is practiced. 

Saying without qualification that "cosleeping causes SIDS" is the equivalent of saying that the mother's body and capacities are inherently deficient, the very body against which everything an infant can or cannot do biologically, or needs to do, is explained including infant survival itself.  This strategy and comment presently being used by medical institutions not only gets the science wrong, ignores contrary evidence, and dismisses any critiques of that science that claims to show that all bedsharing is dangerous, but they attempt to pass on to the public social judgments for science. They assume, and present their statements, as if they are backed up by systematic studies that prove that  parents are not intelligent nor capable enough to take care of the sleep environment within which they "cosleep" and that during sleep parents all become insensitive to their infants' needs, and are incapable of responding to their infants needs or conditions when scientific studies published in the best medical scientific journals contradict and refute their claims. They use a double standard of assessing the causes and solutions for solitary sleeping crib sleeping infant deaths, and any and all forms of cosleeping infant deaths.

20. One thing parents fear about cosleeping is that their child will never learn to sleep alone. What do you tell these parents?
All infants eventually learn to sleep alone and follow the patterns of their families. This is not a skill that requires teaching. It is an inevitable skill. Cosleeping babies decide to learn to sleep alone, later than do routinely solitary sleeping infants, this is true..but they do learn to sleep alone, for sure.  It’s a matter of timing and not whether they ever learn how. In fact, I am not even sure it is something the cosleeping children cannot do as early as solitary sleeping children. It may be that they just don’t want to and why should they when sleeping with mom and dad feels so safe and good. This is a cultural concept being afraid that children will never learn to sleep alone. 

21. Why do babies wake up when they fell asleep in your arms and you try and “put them down”?
Because infants are biologically designed to sense that something dangerous has occurred, separation from the caregiver…and they feel, through their skin, that something is different such as a missing the softness of the mother’s touch, the heat of mother’s body, the smells of mother’s milk, the gentleness of mother’s moving –breathing chest and the feeling of being protected. Infants are alerted because their own body is concerned they are about to be abandoned and it is therefore time to awaken to call the caregiver back; the very caregiver on whose body the infant’s survival depends.