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