Babies (and Toddlers) Wake Frequently at Night (Part Two)

As babies grow older and become toddlers, Western parents often start expecting them to sleep longer and more independently. This is especially true for first children, particularly if that child has a younger sibling. When a second baby is born, suddenly the toddler seems like a giant!

Yet, that 15 or 18 or even 24 month old is really still a baby. The move towards more adult like sleep happens on a child’s own individual schedule – some young toddlers adapt easily to sleeping longer stretches in another bed or room, while others aren’t ready until closer to three or four years old. In many cultures, no one really pays attention to the child’s age – the child decides when they are ready to move to another sleeping space (if there is one).

Nightime is scary

I distinctly remember not being allowed in my parent’s bed or room after a certain age. The dark, quiet house was so scary, even in elementary school. When I woke in the middle of the night, I sometimes spent hours reading comic books, trying to distract and calm myself enough to be able to go back to sleep. I didn’t really sleep well consistently until I met my husband and had someone to sleep with at night.

Many parents today are questioning why Western society considers it normal for adults to sleep together and for babies to sleep alone. Yet we sometimes forget that as babies turn into toddlers and then become older children, they often still need the comfort of another person at night. If room is an issue, a single mattress that can be pulled out from under a bigger bed or even a sleeping bag on the floor may be helpful for those times an older child needs to be close.

Sometimes, adjusting expectations is all that’s needed to adapt to frequent toddler wake ups. Parents can play “musical beds” and siblings older than 18 months or so are often happy to share a bed in another room, at least for part of the night. My three were in and out of our bed for between three and twelve years. The one who slept with us the longest hiked 2600+ miles on the Pacific Crest Trail and traveled around the world!

Source: United States Breastfeeding Committee

However, if you need more than just a change in attitude, other “nudging” ideas from Sweet Sleep can help. Often it’s easiest just to breastfeed a toddler back to sleep, but certain things may reduce the number of times a toddler wakes at night to nurse (if your toddler has weaned, a snack or a cup of water next to the bed can come in handy).

Nudging a toddler

You can start by patting and reassuring the toddler for a bit before nursing – eventually your child may accept that instead. Getting up to use the toilet first, assuring bubs that you will be right back, may buy you some time in which your child could fall back to sleep on their own. Try “spooning” your toddler after nursing or when they first start to rouse – it may be that a cuddle is all they need.

Sometimes a little distance from the breast can be useful. If possible, have your child sleep on the other side of your partner, or even just turn over yourself and sleep with your back to the toddler after nursing. Mumbling and turning over slowly towards them may eventually be all that’s needed when they stir – a simple reassurance of your presence.

Twiddling, scratching and other unwanted behaviors can make night nursing difficult. Holding the toddler’s hand and demonstrating how to stroke gently or giving them something else to pinch (a stuffed animal or doll) can be useful. It can also help to place your arm across your other breast or take a short break from nursing. Talking gently and empathetically while setting firm limits (“you really want to scratch, but it hurts mommy, pinch this instead; you feel frustrated, etc.”) helps your child learn appropriate breastfeeding manners.

Shortening breastfeeding/chestfeeding times can also make night wakings tolerable. It’s best to work on this during the day at first, when your toddler is likely to be more amenable. Some parents sing the ABC song or count to ten slowly – talking about it for a few days before starting helps the child get used to the idea.

Gentle night weaning

Parents sometimes feel they need to wean completely in order to get better sleep, but weaning doesn’t have to be all or nothing. Reading the children’s book Nursies When the Sun Shines is a wonderful way to introduce the concept of night weaning to your toddler. Talking with them in an age appropriate way and going slowly can make it a pleasant process for both of you. For more information, check out this article on gentle night weaning.

Photo by Tatiana Syrikova from Pexels

If you are ready to try starting your toddler out in another room at night, consider forgoing the crib and instead putting a mattress on the floor of a childproof room. You can bring the child into your bed when they first wake in the night, or one parent can go back to that room to lie down with them, cuddling, patting and soothing as needed.

At bedtime, when your child is older, you can try telling them that you have to leave for a few minutes to do something, always returning when you say you will. Eventually, your child will have fallen asleep by the time you get back. Of course, they may still crawl into bed with you in the middle of the night, but rest assured that they will someday sleep just fine without you in their college dorm room!

Two steps forward, one step back

Of course, “nudging” a toddler to sleep longer doesn’t always go smoothly. It’s important to remember that sleep is developmental and can often seem like two steps forward, one step back. If your child is truly upset with what you are doing, you may want to try something else or try the same approach again a few weeks later.

There may be times when you are dealing with particularly disrupted sleep and are feeling exhausted. In these cases, an emergency sleep break can help you cope. Give your baby or toddler to a trusted adult, pump if you need to, then sleep until you wake up naturally. This can make all the difference, even if it’s just once a week during the day on a weekend. Use an eye shade, breathe deeply and feel your body sinking into the bed. If anxiety and/or depression are affecting your sleep, get help here.

Of course, nightmares, illness, stress and other factors can also contribute to disrupted sleep – when a toddler is wound up or crying at night, soothing and empathy are often the best approach. Even after weaning, children frequently need the reassurance of a parent at night for many years. During the tough nights, try to remember that you are promoting secure and healthy sleep for your child – and it’s a gift that lasts a lifetime.

Sweet Sleep by Diane Wiessinger, Diana West, Linda J. Smith, and Teresa Pitman

Safe Infant Sleep by Dr. James McKenna

https://www.georginadowden.com.au/post/how-to-gently-stop-breastfeeding-your-toddler-to-sleep

https://www.psychologytoday.com/us/blog/freedom-learn/201110/why-young-children-protest-bedtime-evolutionary-mismatch

https://www.psychologytoday.com/us/blog/moral-landscapes/201303/understanding-and-helping-toddler-sleep

https://www.postpartum.net/

Babies (and Toddlers) Wake Frequently at Night (Part One)

Regressions. White noise machines. Charts of sleep needs by age. Wearable blankets. Sleep trackers. Today’s parents, at least those in WEIRD societies (yes, that’s an actual term in anthropology – Western, Educated, Industrialized, Rich and Democratic) are overloaded with information and choices about where and how much babies sleep. This obsession promotes so much unnecessary anxiety and stress – no wonder parents have trouble sleeping!

“Is your baby sleeping through the night?” may be the most common question heard by Western parents. And when the answer is “no” or “for a while, but now they are waking up again,” parents often worry something is wrong with their baby. But here’s the thing – it’s biologically normal for babies to wake at night. Heck, it’s normal for adults – we get up to use the toilet, adjust blankets or even just roll over.

Waking at night is protective

For young babies, night waking is actually protective. Humans have the largest brains of any primate in relation to our size and our infants are born less mature so their heads fit through the birth canal. One result of this immaturity is an underdeveloped breathing system – and some SIDS researchers theorize that vulnerable babies may sleep so long and so deeply that they “forget” to breathe.

This may be why babies sleep less deeply and have shorter sleep cycles than adults – and why trying to “train” an infant to sleep more like an adult may be risky. It’s also why sharing sleep with a baby is important – a parent’s breathing and movements at night keep an infant from sleeping too deeply.

In addition, babies brains and bodies are growing incredibly fast, which sometimes makes it hard to stay asleep! The dreaded “sleep regression” is misnamed – it’s actually a developmental progression as an infant who had been sleeping longer stretches starts to wake more frequently. They may be becoming more aware of their surroundings or getting ready to crawl or any one of the other mental and physical milestones children progress through during the first few years of life.

But I’m tired!

So you may be thinking – ok, that’s fine, but I’m tired! How can I get a better night’s sleep?

First, don’t look at the clock or your phone and forget the sleep trackers – trust me, it helps not to know! And don’t worry if your child doesn’t sleep the average for their age – like adults, they all have individual sleep needs. Remember, you can’t make a baby sleep – you can only provide a calming atmosphere that is conducive to sleep. If your child truly seems sleep deprived (rubbing eyes constantly, looking dazed, etc.), try winding down earlier in the evening (see my post Bedtime is Overrated) or lying down with them in a quiet, childproof room during the day – even if they don’t nap, the rest time is restorative.

Second, share sleep with your baby (and toddler)! Make your bed a safe space (see How to Sleep Safely with your Baby) and work on getting comfortable in the cuddle curl so you can nurse without waking completely. An extra pillow under your head and one between your knees can make a world of difference. If baby likes to sleep with your nipple in their mouth all night and you find that uncomfortable, try easing it out (a finger in the corner of the mouth helps) when they are in a deep sleep and press up on their chin to keep their mouth closed for a minute or two.

Putting your top leg down on the bed and leaning over to nurse from the top breast sometimes can help stretch out your back. And don’t feel you need to sleep in one position the whole night – the cuddle curl is safest when infants are tiny, but even then many parents don’t stay like that the whole night. They roll on their backs for a while or turn over and stretch. For parents who bottle feed, having baby next to the bed in a co-sleeper or sidecar crib for at least the first four months makes it easier to put in a pacifier/dummy and pat baby’s back.

Stay horizontal

Are you sensing a pattern here? Staying horizontal is key! Some parents have heard that they shouldn’t let their baby fall asleep nursing or that they should put an infant down drowsy but awake. This may work for a few unicorn babies, but human milk contains melatonin, tryptophan and other substances that promote sleepiness. Nursing to sleep is biologically normal and often much easier than rocking or bouncing in the middle of the night.

If you already rock or bounce your little one to sleep, see if you can transition to back to nursing or something else you can do lying down. Patting or rubbing, shushing or humming, letting baby suck on your finger, or rocking baby’s bum may help. Patting and humming while breastfeeding can also be helpful if you will be going back to work or school and someone else will be helping baby sleep – your child will associate these other sleep cues with the comfort of nursing.

And remember – you don’t have to get baby back to sleep every time they wake. If they aren’t upset and don’t want to nurse, it’s fine to let bubs babble and roll around a bit until they are ready to doze off again. Take this time to breathe deeply and relax, which can be almost as restorative as sleep.

Many parents hardly notice when their babies rouse – they adjust covers, shift position, latch and drift off again without fully waking up. If this works for both you and your little one, there’s no need to change anything. But if frequent waking is disturbing either of you, Sweet Sleep has some great ideas on ways to “nudge” a baby into sleeping longer.

Try nudging

There isn’t much nudging that can be done in infants under six months old, but there are a few things to try. Breastfeeding more often during the day sometimes helps, especially in the evenings when babies often naturally cluster feed as they “tank up” for the night. Sleeping skin to skin – opening your shirt and cuddling bub close wearing just a diaper, or laying a hand on baby’s bare back – can encourage longer sleep sessions. Even just being held by an adult, whether it’s a contact nap with mom while she watches a movie or a snooze in an infant carrier as grandpa vacuums the floor, often stretches out the zzzs.

After about six months old, there are a few more “nudges” to try. Getting baby outside each day for some exercise and sunlight can encourage more restful sleep at night, even when it’s cold and overcast. Take a lesson from Scandinavian parents, who bundle up their infants in all kinds of weather for naps outdoors after a brisk walk in a stroller or pram.

A short bedtime routine, hopefully done as part of an evening wind down for the whole family (see Bedtime is Overrated), can include a relaxing massage if baby enjoys it. If bubs falls asleep before you, dream feeding (basically latching babe on in their sleep) right as you are turning out the lights and heading for slumberland yourself can stretch out your child’s first sleep interval.

Baths are traditionally done in the evening, but if they are stimulating rather than relaxing for your child, move it to a different part of the day. You may want to add Epsom salts to baby’s bath – magnesium is absorbed through the skin and can help calm restlessness.

Things to check

Anemia can also contribute to restless sleep, so have your child’s iron levels checked if he or she thrashes about and can’t seem to get comfortable. If babe sleeps with their mouth open (especially if they snore), check with your doctor in case sleep apnea could be keeping baby up or see an IBCLC if you suspect a tongue tie.

Allergies are another common culprit and sometimes eliminating certain foods or taking up carpet (in the case of dust allergies) can be helpful. Teething, reflux, colds and ear infections also keep babies awake at night. This quiz is a quick way to discover these and other possible reasons for sleep disturbances so you can follow up with the right health professional.

One frequent frustration for parents is the baby who wakes up in the middle of the night and simply refuse to go back to sleep for an hour or two – or even more. This is especially common between the ages of six and twelve months. Children are busy practicing new skills during this period – no time for sleep!

Two shift sleeping

They also may be doing two shift sleeping, something that was once typical for many of us. When mine were little I played dead (we had a floor bed in a childproof room) – they babbled and played (and yes, would head butt me and stick their fingers in my nose) and eventually went back to sleep while I did my best to snooze. Keep your eyes closed and model sleep with lots of turning over, grumbling and saying shhhh. 

Sleep patterns in babies – shorter sleep cycles, a larger percentage of light sleep – become more adultlike as your child grows, but this happens for each individual on his or her own timeline. Often parents expect toddlers over one to stop waking at night, but many still wake well into the second and third year of life. We will explore this in Part Two.

Sweet Sleep by Diane Wiessinger, Diana West, Linda J. Smith, and Teresa Pitman

Safe Infant Sleep by Dr. James McKenna

https://www.pinkymckay.com/the-myth-of-baby-sleep-regressions-whats-really-happening-to-your-babys-sleep/

https://www.sciencealert.com/humans-used-to-sleep-in-two-shifts-maybe-we-should-again

Bedtime is Overrated

In Spain, babies and children stay up until after 10 p.m., sometimes joining their parents and other families on a stroll around town in the evening. Contemporary foraging cultures (hunter-gatherers) like the !Kung in Botswana have no set schedule – both adults and children sleep when they are tired.

In the Philippines, toddlers often fall asleep in a hammock in the main living area and are carried to bed when their parents are ready to join them. In France, many children do their own thing until they put themselves to bed.

Bedtime struggles

However, parents in predominantly English speaking countries like the US, the UK and Australia constantly hear about the importance of a routine and an early bedtime, even when the sun doesn’t go down until late. But this often becomes a struggle – it’s scary at night and children don’t want to be alone. Parents worry their babies and toddlers aren’t getting enough sleep, which leads to more stress – and less sleep.

Even some co-sleeping parents lie in the dark for hours waiting for their babies to fall asleep. But does it have to be this way? The authors of Sweet Sleep instead suggest front-loading – getting more work done earlier in the day so everyone can wind down earlier in the evening.

With front-loading, parents and kids brush teeth and slip into pajamas (or whatever routine you prefer), then relax in a dimly lit, childproof room, often on a floor bed. Parents can read (or read to each other), watch TV with closed captions, answer emails, snooze, listen to podcasts and so on while baby/toddler nurses or plays nearby and eventually falls asleep. With bedtime pressure off, everyone gets more rest.

A modified version can even work for school age kids. The expectation that the hour or two before sleep is reserved for reading and relaxing – together – can decrease battles over video games and other screen time before bed.

Customized front-loading

Front-loading looks different for different families. Some families may pile the dishes in the sink so the first one up in the morning can wash them. Other couples may work together to clean up, prep for the next day and get children ready for bed so everyone can wind down together afterwards. Single parents or those whose partners aren’t often available may need to find creative ways to cut back on chores, like pulling clean clothes out of baskets instead of folding them.

I remember many evenings lying in the dark nursing my oldest to sleep, feeling frustrated that I couldn’t be downstairs watching TV with my husband or getting a chore done. Some nights I was able to unlatch and ninja roll away, only to have her wake up after an hour or two, or sometimes only twenty minutes later.

Once we let go of a fixed bedtime, things became so much easier. We all got the rest we needed and everyone felt more relaxed. Of course, if an early bedtime works for your baby or toddler, that’s wonderful! If not, you may want to give front-loading a try.

Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family by La Leche League International

Our Babies, Ourselves by Meredith Small

 “Don’t Tell The Kids, But Bedtime Is A Social Construct” by Maggie Koerth-Baker, July 12, 2017, fivethirtyeight.com

https://www.psychologytoday.com/us/blog/freedom-learn/201110/why-young-children-protest-bedtime-evolutionary-mismatch

How to Sleep Safely with your Baby

In today’s technological society, it’s easy to lose sight of the fact that humans are mammals. We give birth to live young and feed our infants milk from our bodies.

More specifically, we are primates, a “carry” species that is biologically programmed to keep our babies close day and night. Humans have slept next to their children on the ground or on mats for millions of years. Bedsharing is biologically normal.

However, modern comforts like soft mattresses and fluffy pillows have introduced hazards to the nighttime environment. So how can Western parents safely meet our children’s biological sleep needs?

Read Sweet Sleep

There are some great sleep books out there, but if you can only read one, be sure it’s Sweet Sleep. If you have a partner, read it out loud to each other. You will learn the details of the Safe Sleep Seven for bedsharing (no smoking, stay sober, breastfed baby, no sweat/no swaddle, healthy full term baby, safe surface, baby on back) and so much more.

If you don’t meet these requirements, you can still cosleep – just be sure to use a commercial cosleeper or “sidecar” a crib to the bed.  And research has shown that by four months old, a healthy baby can share sleep on a safe surface with any responsible nonsmoking adult.

Learn to nurse in the “cuddle curl”

During the day, babies love to nap on a reclining parent’s chest. Tummy sleeping is fine in this case and it’s a great time to catch up on reading or binge watching! But at night, mothers around the world instinctively curl around their babies to nurse and sleep.

This “cuddle curl” creates a safe space for baby at the breast with mom’s arm above and legs pulled up below. If this position doesn’t come naturally at first, keep working at it – you may need to move baby down so their head tips back, pull their legs into your tummy or elevate your breast with a small folded towel.

Baby Sleep Info Source website – image courtesy of Kathryn O’Donnell

Some parents, even those with small breasts, move their upper leg over on to the bed so they can lean over to nurse with the top breast (stomach sleepers often really like this) or hold baby on their chest while they roll to their other side. Back sleepers sometimes find that a pillow behind them allows them to partly roll on to their backs.

Work on getting comfortable so both you and baby can drift back to sleep while nursing. Firm pillows are ok as long as they are kept away from baby, anchored under your head or between your knees. Dr. James McKenna has found that bedsharing mothers and babies naturally synchronize their sleep patterns, often barely waking together to latch or adjust position before falling back asleep.

Your mattress should be firm – and big

Ditch your waterbed, pillowtop or other soft sleeping surface. If your pillowtop mattress is two sided, turn it over! Or invest in a firm mattress topper – there are quite a few on the market. Futons are a great option for a firm sleeping surface that can be used on the floor or on a low frame.

If you are buying a new mattress, get a king size (or larger!). If you aren’t, consider getting a single mattress and attaching it tightly to your full or queen to make a bigger sleep surface. Pack the crack firmly with a towel if necessary.

Make it safe

For the most part, Western culture views solitary infant sleep as “normal,” so accidents in cribs result in making cribs safer – not getting rid of them. The same should be true for bedsharing – and bedsharing IS biologically normal.

Public health warnings about bedsharing often frighten new parents so much that many end up falling asleep with their babies on far more dangerous surfaces than beds, such as sofas and recliners. Make your bed a safe space and relax knowing that bedsharing while following the Safe Sleep Seven is no more risky than putting baby in a crib nearby.

Tie up dangling cords, strings and even long hair at night. Get rid of extra pillows, stuffed animals and fluffy comforters – use several layers of thin blankets instead and keep them down around your waist. If you are cold, try wearing a soft cardigan sweater and an old shirt with holes cut out for your breasts.

Dockatots and other sleep positioners are not necessary and in fact may pose a suffocation hazard – use them during the day on the floor for naps when an adult is awake in the same room. Babies don’t need silent, dark rooms – in fact, sleeping too deeply is a risk factor for SIDS and ambient noise is thought to be protective.

Check for cracks between the mattress and other parts of the bed – if you find any, pack them tightly with towels or blankets. Do the same if you use a bedrail.

Some parents put a pool noodle at the edge of the bed under the fitted sheet to make a simple guardrail before baby becomes mobile – however, this could also post a suffocation hazard. Pushing your bed against a wall isn’t recommended, as a crack could appear as the mattress shifts.

Put your mattress on the floor

Families around the world sleep on the floor and some doctors even recommend it for back problems. It may take a little getting used to, but this is often the safest option, particularly when baby starts crawling.

If you have solid surface floors, a blanket or quilt underneath that extends out around the sides can cushion the short drop if baby crawls off. With carpet, be sure to vacuum around the mattress regularly to remove dust. Lift up the mattress every week or so to air it out and prevent mold. Be sure to childproof the rest of the room.

Don’t worry – it won’t be long before you can have an elevated bed again. Older toddlers can be taught to get down feet first. When my children were young, we took apart our bedframe and stored it in another room with the box spring for a few years. They are now in their early twenties and I have a hard time remembering what it was like to sleep on the floor!

Try to relax

This is probably the hardest part for modern parents. The internet is full of conflicting information and dire warnings about bedsharing. Remember that our species is biologically programmed to sleep with our babies – if it were inherently dangerous, we wouldn’t be here today.

Follow the Safe Sleep Seven, make your bed a safe space and enjoy cuddling with your baby. In my interview with Dr. James McKenna on the Attachment Parenting podcast, he says, “…one of the greatest joys you can have (is) knowing you are protecting and nurturing your baby in a most healthy way, which is to sleep next to it and, if mothers can, to breastfeed through the night.”

It’s also important to turn your clock around, don’t look at your phone at night and stop using sleep tracking apps. Knowing how often you and your baby wake just leads to more stress and less sleep.

Some parents swear by expensive physiological trackers like the Owlet, but these gadgets are meant for babies sleeping alone, which itself is a risk factor for SIDS. In fact, the American Academy of Pediatrics says not to use these monitors as a SIDS reduction strategy.

The authors of an article in the Journal of the American Medical Association note that healthy babies can have temporary drops in oxygen levels and 80% of these are harmless. Research has shown that when these drops happen, the breathing and movements of an adult sleeping nearby help rouse babies from deep sleep so they breathe normally again.

Is my baby getting enough sleep?

The latest source of worry for new parents are recent articles claiming that children need a certain amount of sleep for normal brain development. But remember that these give the average amount needed – and to be an average, some must sleep more and some must sleep less!

Contrary to popular belief, sleep training doesn’t necessarily result in more or better sleep. Babies and toddlers still wake at night – they just learn not to protest, since no one will respond. And the stress of biologically ABNORMAL separation is likely to do more harm to a child’s brain development than any supposed lack of sleep.

Many kids do just fine with a late bedtime. The authors of Sweet Sleep recommend “front loading” – getting things done early in the day (leave the dinner dishes for morning!) so the family can relax on their floor bed in the evening.

Turn the lights low, read or listen to podcasts, let baby or toddler play and nurse until they are ready to fall asleep. If they wake up in the middle of the night ready to party, play dead until they nod off again. Sweet Sleep also has great ideas on how to “nudge” a baby to sleep longer when they are ready.

Occasionally, very frequent night waking can be caused by ear infections, allergies or other medical concerns. Here’s a screening quiz that can help you decide if your child’s night waking is normal or if a trip to the doctor might be indicated.

Sleep coaches, programs and schools have become big money makers recently in several Western countries. Most are based on cultural (rather than biological) norms of separate infant sleep and encourage sleep training.

Many sleep “problems” go away when parents adjust their expectations and sleep environment to be more biologically normal. Books like Sweet Sleep, Good Nights, Sleeping With Your Baby, The Gentle Sleep Book, Sleeping Like a Baby and The No-Cry Sleep Solution can help (see below for details).

What about older babies and toddlers?

As babies grow into young children, most still need the comfort of a parent’s presence at night. Nighttime is scary! Families often play musical beds, with one parent lying down with an older child in one room while the other nurses a toddler in another.

Some parents find night nursing challenging as babies turn into toddlers. Night weaning is usually not without tears, but talking to your child about it gently for several weeks beforehand can help. So can a wonderful children’s book called Nursies When the Sun Shines. Many families have been successful with Dr. Jay Gordon’s method for night weaning – however, it’s important to keep any night weaning technique gentle and to try again later if your toddler doesn’t seem ready.

Every family finds their own way – older children may come into the parent’s bed in the middle of the night or one parent may go back into their room or siblings may share a bed. Many parents have found that children leave (or stop coming into) the family bed in their own time, be that 2, 12 or anything in between. Rest assured that no college student has ever needed to be nursed to sleep in their dorm room!

Sleeping with your baby is biologically normal. Humans have done it for thousands of years. It’s what babies – and parents – need at night. With a few precautions, Western parents can enjoy this species specific experience – and get plenty of rest too.

Bonafide, C. et al, “The Emerging Market of Smartphone-Integrated Infant Physiologic Monitors,” JAMA, January 24/31, 2017

BASIS – Baby Sleep Info Source

Brief Toddler and Infant Sleep Screening (BTISS)

Good Nights by Dr. Jay Gordon

Dr. James McKenna’s Mother-Baby Sleep Lab at the University of Notre Dame

Dr. Jay Gordon – Changing Sleep Patterns in the Family Bed

How to Side Car Your Crib

Nursies When the Sun Shines: A little book on nightweaning by Katherine Havener and Sara Burrier

Sleeping With Your Baby: A Parent’s Guide to Co-sleeping by Dr. James McKenna

Sleeping Like a Baby: Simple Sleep Solutions for Infants and Toddlers by Pinky McKay

Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family by Diane

Weissinger, Diana West, Linda J. Smith and Teresa Pitman

The Gentle Sleep Book by Sara Hockwell-Smith

The No-Cry Sleep Solution by Elizabeth Pantley

Is it Healthy and Safe for Babies to Sleep Alone?­­­­­­­­­­­­­­

Every few months it seems there’s another headline proclaiming “Cry-It-Out Doesn’t Hurt Babies” or “The Dangers of Co-Sleeping.” Doctors warn parents that their child will “never” leave their bed once they let the child sleep there. One public health campaign even compared bed sharing with putting a baby to bed with a butcher knife. All of this can be very upsetting and confusing for parents.

Babies instinctually want to do the natural thing – sleep with someone – and protest when they are put down alone. But Western culture promotes the belief that infants and toddlers “should” sleep alone and frightens parents into thinking that they will harm their children (physically and psychologically) by sharing a bed with them.

Is there any evidence of this? In a word, no – as long as it is done safely and in a biologically normal way (see the Safe Sleep Seven). But really, is that even the right question?

Leading sleep researcher, Dr. James McKenna, explains that many infant sleep studies are backwards, looking at cultural beliefs instead of scientific paradigms. They start with the assumption that solitary infant sleep is normal (it’s not – see my last three posts). These studies usually ask “is co-sleeping/bedsharing safe?” or “does sleep training reduce infant waking and crying?” rather than “is it healthy and safe for babies to sleep alone?”

In fact, McKenna believes that not asking the correct question resulted in a vast cultural experiment that contributed to many babies dying of Sudden Infant Death Syndrome (SIDS). In years past, the untested cultural belief that babies should sleep alone led to doctors telling parents to put infants down on their tummies so they would stay asleep longer. This resulted in huge spikes in SIDS rates that have since fallen with “back to sleep” campaigns.

Artificial (formula) feeding, which made it easier for baby nurses and others to care for infants as night, has also emerged as a major SIDS risk factor. Even solitary sleeping is no longer recommended – a parent’s breathing and other factors help prevent SIDS by stimulating the immature infant respiratory system.

Biologically normal infant sleep components include breastfeeding, sleeping next to the mother and varied sleep positions including side and back. In traditional cultures, sharing sleep takes place on a firm surface, usually the floor (these cultures also have very low SIDS rates).

In Western societies, parents are told to keep infants in their rooms, but never in their beds. Yet, because babies are biologically programmed to seek human contact, warnings against bedsharing often lead to parents falling asleep with their infants on unsafe surfaces such as couches or recliners.

Infant sleeping on unsafe surfaces (which can also include hazards such as mattresses that don’t fit tightly in the frame) is often lumped together with other forms of co-sleeping and even bedsharing in many studies. Unsafe surfaces are also confused as a risk factor for SIDS, rather than for suffocation. But as McKenna and his colleague Lee Gettler note, “…(with) careful and complete examination of death scenes, the results revealed that 99% of bedsharing deaths could be explained by the presence of at least one and usually multiple independent risk factors…such as maternal smoking, prone infant sleep, use of alcohol and/or drugs by the bedsharing adults.”

The authors of Sweet Sleep researched this topic extensively and concluded that there is no greater risk of SIDS when infants under four months old bedshare safely (again, the Safe Sleep Seven) than when they sleep nearby in a crib. And why should there be? Sleep sharing is the biological norm for our species and evolution would have stopped it long ago if it wasn’t safe. Sweet Sleep also states that a baby over four months can safely bedshare with any responsible, sober, non-smoking adult.

In addition to sleeping alone, Western parents are told that infants should be trained to sleep through the night as early as possible. These methods all involve varying amounts of crying to sleep – something that is not biologically normal for our species.

The phenomenon of “extinction” sleep training (a holdover from the discredited psychological theory of behaviorism) is another vast social experiment currently being conducted without evidence that it is healthy and safe for babies. In fact, one study found a disturbing rise in the stress hormone cortisol in infants “crying it out” (chronically elevated cortisol can harm a baby’s developing brain). Even studies that claim the practice is harmless demonstrate no benefits for either parents or babies – and sleep training does shorten breastfeeding duration (again, a SIDS risk factor).

Of course, sometimes babies cry no matter how responsive we are as parents, but holding and comforting babies seems to mitigate the negative effects of this stress. Studies that have looked at social sleeping with one or more parents have found multiple benefits, including increased breastfeeding (more antibodies and other benefits for baby), more rest for both infants and parents and a stronger emotional bond.

In biologically normal sleep, infant and mother often stir without fully waking – baby latches on and both fall back asleep. The parent’s body helps babies wake frequently during the night so they don’t sleep too deeply and stop breathing.

Photo by Sidharth Sircar from Pexels

Advocates of sleep training start with the Western cultural belief that solitary sleep is normal and babies should not disturb their parents at night. Infant night wakings are seen as problematic, rather than protective. Researchers test whether sleep training leads to less crying and fewer awakenings – NOT if this is good for babies.

Again we need to ask – is it healthy and safe for babies to sleep alone? Do parents have to teach their babies to fall asleep? Do parents get more rest if they wean from the breast and sleep train? Does it lead to happier, more independent children? Do sleep trained infants cry less? There is little evidence for any of this and some evidence of the opposite.

There is another way – a way that is normal for our species and has proven benefits, including more sleep for parents and babies. We don’t have to sleep on the ground in the woods, but we do need to avoid hazards associated with our comfortable Western lifestyles. We will look at this in the next What Babies Need.

 

Douglas PSHill PS. Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review. J Dev Behav Pediatr. 2013 Sept.

McKenna, Ball, and Gettler. Mother–Infant Cosleeping, Breastfeeding and Sudden

Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Pediatric Sleep Medicine. Yearbook of Physical Anthropology, 2007

Middlemiss W, Granger DA, Goldberg WA, Nathans L. Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep. Early Human Development. 2012

McKenna & Gettler. Co-Sleeping, Breastfeeding and Sudden Infant Death Syndrome. Encyclopedia on Early Childhood Development. 2010 (online)

Narvaez, D. The Ethics of Early Life Care: The Harms of Sleep Training, Clinical Lactation, 2013

Kendall-Tacket, K.A., Cong, Z., & Hale, T.W. Mother-infant sleep location and nighttime feeding behavior: U.S. data from the Survey of Mothers’ Sleep and Fatigue. Clinical Lactation. 2010

Bartick, M. and Smith, L.J. Speaking Out on Safe Sleep: Evidence-Based Infant Sleep Recommendations. Breastfeeding Medicine. 2014

Whittingham, K. and Douglas, P. Optimizing Parent–Infant Sleep From Birth To 6 Months: A New Paradigm. Infant Ment. Health J., 2014

Middlemiss & Kendall-Tackett, The Science of Mother-Infant Sleep. 2013

McKenna, J. (2007) Sleeping with Your Baby: A Parent’s Guide to Cosleeping.

Pitman, T., Smith, L., West, D., Wiessinger, D. (2014) Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family. La Leche League International.

https://www.isisonline.org.uk/

http://cosleeping.nd.edu/

http://evolutionaryparenting.com/bed-sharing-and-co-sleeping-research-overview/

News report featuring Dr. McKenna: https://www.youtube.com/watch?v=e3YXRf59TGs

Babies Share Sleep in Many Cultures

When my first child was two and a half, she crawled up onto the couch and fell asleep. I was shocked. Really? She can do that? She had never fallen asleep without nursing before.

Western culture tells parents to train children to sleep alone or they will “never” learn to fall asleep by themselves. Even those of us who keep our babies close at night sometimes wonder if they will ever stop needing us.

In many cultures, this isn’t even a question. Sleep is a social event where families sleep together in one room for many years, even in large homes. These societies assume that babies will grow into children, who will eventually fall asleep without nursing or rocking, as of course they do.

Anthropologists often observe contemporary foraging cultures (hunter-gatherers) to determine what is biologically normal for humans. Societies like the !Kung in Botswana (Africa), the Ache in Paraguay (South America), and the Agta in the Philippines (Asia) provide clues into the behavior of our ancient ancestors.

In these cultures, babies sleep next to their mothers at night and nap on someone – a grandparent’s lap, a father’s arms, a cloth tied around their mother’s back – during the day. As the child grows older and perhaps gains a sibling, they might move to sleeping closer to a grandparent or other relative. Only when they reach puberty is there any thought that the child might choose to sleep alone at times.

With these infants and toddlers, no one worries about bedtime rituals or if they are getting enough sleep. These children nurse and fall asleep when they are tired. They snooze in someone’s arms or are put down on a mat or hammock while the family finishes evening activities, then are carried to bed when mom is ready for sleep.

For contemporary foraging cultures, there are generally no separate rooms or heat other than a fire, which could account for these arrangements. But many other industrialized societies around the world have similar childcare practices.

In Korean (and likely other languages as well), there is no word for co-sleeping (sleeping in the same room) or bed-sharing (sharing a mat or bed). It’s assumed that everyone sleeps together on floor mats in the same room, although today mattresses are sometimes added on top of the mats.

Other Asian cultures use similar arrangements. Often the sleeping room serves several purposes – mats and bedding are simply folded up and put away during the day. Floor beds and mats have the added benefit of avoiding hazards such as babies falling out of bed or becoming trapped between a bed frame and mattress.

Interestingly, cultural practices have also contributed to differences in Eastern and Western bedroom furnishings. A preference for carpeted floors and wearing shoes in the house may have led to lifting mattresses off the dirty floor and on to a bed frame in Western houses.

Clean, heated floors, and even a heated sleeping platform called a kang in some parts of China, make floor sleeping comfortable in most Eastern homes. Western houses generally have cold floors, since the air is heated through fireplaces and furnaces.

Even some cultures that do use elevated beds often embrace social sleeping, such as parts of the Middle East and southern Europe. Family interconnectedness is highly valued in these societies. My son spent a semester studying in Barcelona, Spain and often posted videos of late night parades enjoyed by entire families, including young children and babies sleeping in carriers.

Interdependence (rather than independence) and kinship are common values in Eastern societies as well, which also contribute to sleep preferences. In traditional Japanese culture, co-sleeping on tatami mats is compared to a river. The parents are banks on either side, containing, protecting and guiding the water – their child – in the middle.

In fact, this belief in security and comfort for children at night is key for many co-sleeping cultures. Mayan parents in Latin America consider it abusive and unkind to put a baby to sleep in another room. Infants and young children generally fall asleep in someone’s arms and are carried to bed when the rest of the family is ready for sleep.

Parents in Kenya and other parts of Africa believe that it’s dangerous for babies to sleep alone in a separate room. Infants are cuddled, carried and breastfed frequently day and night. Anthropologists note that it’s rare to hear African babies cry, since they are comforted at the breast any time they stir.

It may be time for those of us who live in Western countries to question whether forcing early sleep independence in children really makes sense. If you have ever met an adult immigrant from Africa or Asia or Latin America, you have met someone who probably slept with their parents for years – and became confident and self-reliant enough to travel thousands of miles from home.

So, if shared sleep with babies and children is biologically normal for humans and common in other cultures, why are Western parents so scared to do it? Why do medical professionals and public health officials warn against it? What does the research literature really say? We will look at this in the next What Babies Need.

Ball, H., McKenna, J., Gettler, L. (2007) Yearbook of Physical Anthropology. “Mother–Infant Cosleeping, Breastfeeding and Sudden Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Pediatric Sleep Medicine.”

Biologically Normal Infant Sleep (closed Facebook group), personal communication, May 2018.

Fuentes, A., Gray, P., Narvaez, D., McKenna, J., Valentino, K. eds. (2014) Ancestral Landscapes in Human Evolution: Culture, Childrearing and Social Wellbeing.

Konner, M., Worthman, C. (1980) Nursing frequency, gonadal function, and birth spacing among !Kung hunter-gatherers.  Science. Feb 15;207(4432):788-91. https://www.ncbi.nlm.nih.gov/pubmed/7352291

Liedloff, J. (1986) The Continuum Concept: In Search of Happiness Lost.

McKenna, J. (2007) Sleeping with Your Baby: A Parent’s Guide to Cosleeping.

McKenna, J., Smith, E., Trevathan, W. eds. (2008) Evolutionary Medicine and Health: New Perspectives.

Seockhoon Chung, Hoyoung An. Cultural Issues of Co-Sleeping in Korea. Sleep Med Res. 2014;5 (2): 37-42. Publication Date (Web): 2014 December 30 (Review Article). doi:https://doi.org/10.17241/smr.2014.5.2.37

Shimizu, M., Park, H., & Greenfield, P. M. (2014). Infant sleeping arrangements and cultural values among contemporary Japanese mothers. Frontiers in Psychology, 5, 718. http://doi.org/10.3389/fpsyg.2014.00718

Small, M. F. (1999). Our babies, ourselves: How biology and culture shape the way we parent.

Worthman, C. M., & Brown, R. A. (2007). Companionable sleep: Social regulation of sleep and co-sleeping in Egyptian families. Journal of Family Psychology : JFP : Journal of the Division of Family Psychology of the American Psychological Association (Division 43), 21(1), 124–135. http://doi.org/10.1037/0893-3200.21.1.124

Guest Post: The gentle African way to your baby sleeping through the night

https://www.isisonline.org.uk/

https://cosleeping.nd.edu/

What Happened to Infant Sleep?

Photo via https://www.isisonline.org.uk/image-archive/images/

In many societies around the world, babies sleep next to their mothers. There are no cribs, sleep coaches, sleep training books, baby monitors, swings or other devices to manage a baby’s sleep. They aren’t needed. So what happened to infant sleep in Western culture?

It’s complicated. Sleep in general has undergone a radical transformation over the last two hundred years or so, primarily in response to the availability of artificial light and industrialization. Instead of being guided by the rhythms of the sun and the seasons, many people now stay up late into the night either for entertainment or work.

In times past, sleep was often not the straight through the night phenomenon Western culture considers normal today. There was a “first” and a “second” sleep, broken by a period of quiet wakefulness when people might read or pray, tend the fire, make love, talk quietly or the like before going back to sleep. Daytime naps were common.

However, this sort of rhythm did not suit the demands of factory owners or slaveholders. Industry demanded a long, sometimes irregular work schedule and working slaves to exhaustion served the plantation system.

Emancipation and labor laws have resulted in vast improvements to people’s lives in Western society. Yet sleep is still expected to take place during a single period, usually at night, for those lucky enough to have access to safe, comfortable housing.

In addition, sleep was once a social event not just for families – even total strangers would share beds when they traveled. Less desirable were tenements and slave cabins, where many people crowded together at night made comfortable sleep difficult. Eventually, though, both central heating and a middle class with a higher standard of living made separate bedrooms possible for many.

Other factors also contributed to the rise of separate sleep. Doctors warned of health risks from breathing the air of others and Victorian religious leaders preached of moral dangers (even today, sex is still equated with “sleeping together”), insisting on the privacy and sanctity of the marital bed.

These and other “experts,” who were overwhelmingly white and male, began to assert authority over the traditional wisdom of women in raising children. Most valued independence and self-sufficiency, and warned of the dangers of spoiling children with too much affection. Authorities on childcare also favored formula feeding, a technological innovation that not only allowed parents to feed their infant “scientifically,” but also allowed someone other than the mother to care for a baby at night.

Sadly, one additional factor that may have contributed to the rise of solitary infant sleep were confessions from starving mothers of smothering their infants at night so they would have enough food for their other children. In sermons, horrified priests urged banning infants from the parents’ bed.

So, for a variety of reasons, much of modern Western society has come to believe that solitary infant sleep is normal and beneficial. Parents are told to use cry it out or other extinction sleep training methods to enforce this cultural construct.

Photo by Min An from Pexels

Yet other cultures consider putting a baby in a separate room – or even in a separate bed – not only strange, but akin to child abuse. Contrary to warnings from Western sleep “experts,” these cultures generally produce independent, well-adjusted children and young adults. We will explore the family sleep habits of some of these cultures in the next What Babies Need.

 

 

Ball, H., McKenna, J., Gettler, L. (2007) Yearbook of Physical Anthropology. “Mother–Infant Cosleeping, Breastfeeding and Sudden Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Pediatric Sleep Medicine.”

 

Ekirch, A. Roger. (2005) At Day’s Close: Night in Times Past.

 

McKenna, J. (2007) Sleeping with Your Baby: A Parent’s Guide to Cosleeping.

 

McKenna, J., Smith, E., Trevathan, W. eds. (2008) Evolutionary Medicine and Health: New Perspectives.

 

Pitman, T., Smith, L., West, D., Wiessinger, D. (2014) Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family. La Leche League International.

 

Reiss, Benjamin. (2017) Wild Nights: How Taming Sleep Created Our Restless World.

 

 

https://www.isisonline.org.uk/

 

https://cosleeping.nd.edu/

Babies Need to Sleep with Someone

“It is a primitive need of the child to have close and warm contact with another person’s body while falling asleep…. The infant’s biological need for the caretaking adult’s constant presence is disregarded in our Western culture, and children are exposed to long hours of solitude owing to the misconception that it is healthy for the young to sleep … alone.”
-Anna Freud, daughter of Sigmund Freud

Photo via https://www.isisonline.org.uk/image-archive/images/

Where should babies sleep? In Western cultures, like those in the US and Europe, the answer is usually in a crib, by itself, often in another room. But why? Two adults in a romantic relationship often share a bed – how does it make sense that a tiny, vulnerable person has to sleep alone?

In other parts of the world, this is not even a question – babies sleep with someone. Even in Western cultures the idea of solitary infant sleep has only become expected during the last hundred years or so.

Photo via Good Free Photos

To understand biologically normal sleep for human babies, we need to first look at our cousins in the animal kingdom. Some mammals give birth to atricial infants after a short gestation – deaf, hairless and sightless, they develop rapidly in nests or a pouch. Others are precocial, well developed and able to stand or hold on to their mothers almost immediately after birth.

Like many primates, humans are mostly precocial, but also have atricial traits like not being able to walk or cling, mainly due to being born with only 25% of their brain capacity (for more information, see Babies Need to Be Held, 10-14-17). Primate infants even rely on contact with their caregivers to regulate their heart rate, temperature and breathing.

All land mammal mothers sleep close to their babies, although some, like deer and rabbits, have high fat milk that allows them to hide their babies for long periods while they forage for food. The young of these “feed and leave” species don’t cry or defecate in mother’s absence so as not to draw the attention of predators.

Photo via Good Free Photos

However, contact/carry species like marsupials and primates (including humans) do eliminate spontaneously and cry when separated from their mothers. This, along with low fat milk that necessitates frequent feeding, means that these babies need to be kept close at all times, including at night. A human baby who wakes up and cries to protest being alone does so for a very good reason – survival!

In addition to physical regulation, primate infants also need contact for psychological wellbeing. This was first demonstrated by Harry Harlow with his famous experiment in which rhesus monkey babies separated from their mothers clung to a cloth covered “surrogate mother” rather than a wire one that dispensed food. More recent research points to a spike in cortisol in babies left to cry without being comforted, which could effect an infant’s developing brain.

From studying primates and the few remaining hunter-gatherer cultures, anthropologists have concluded that it is biologically normal for a human baby to sleep next to another person, usually it’s mother. So how did solitary infant sleep come to be considered normal and desirable in Western societies? We will explore that in the next What Babies Need.

Liedloff, J. (1986) The Continuum Concept: In Search of Happiness Lost.

McKenna, J. (2007) Sleeping with Your Baby: A Parent’s Guide to Cosleeping.

Pitman, T., Smith, L., West, D., Wiessinger, D. (2014) Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family. La Leche League International.

Small, M. F. (1999). Our babies, ourselves: How biology and culture shape the way we parent.

 

Ball, H., McKenna, J., Gettler, L. (2007) Yearbook of Physical Anthropology. “Mother–Infant Cosleeping, Breastfeeding and Sudden Infant Death Syndrome: What Biological Anthropology Has Discovered About Normal Infant Sleep and Pediatric Sleep Medicine.”

Freud, A. (1965). Normality and Pathology in Childhood.

Fuentes, A., Gray, P., Narvaez, D., McKenna, J., Valentino, K. eds. (2014) Ancestral Landscapes in Human Evolution: Culture, Childrearing and Social Wellbeing.

Gettler, L, McKenna, J. (2007) Textbook of Human Lactation. “Mother-Infant Cosleeping with Breastfeeding in the Western Industrialized Context: A Bio-Cultural Perspective.”

Kendall-Tackett, K., Middlemiss, W. (2014) The Science of Mother-Infant Sleep: Current Findings on Bedsharing, Breastfeeding, Sleep Training, and Normal Infant Sleep.

McKenna, J., Smith, E., Trevathan, W. eds. (2008) Evolutionary Medicine and Health: New Perspectives.

Tomori, C. (2017) Nighttime Breastfeeding: An American Cultural Dilemma.

 

https://www.isisonline.org.uk/

https://cosleeping.nd.edu/

Bed-Sharing and Co-Sleeping: Research Overview