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Breastfeeding & Bedsharing: Still Useful (And Important) After All These Years - Page 3

Author // James J. McKenna, PhD

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Breastfeeding & Bedsharing: Still Useful (And Important) After All These Years
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The Cultural/Scientific Bias Against Co-sleeping

It has been easy for public officials to conclude that the problems associated with co-sleeping are not worth solving, in part because of our society’s unique cultural history. In popular parenting books and childcare magazines, co-sleeping may be (1) described as if it were a homogenous concept, (2) ignored completely, or (3) presented in terms of the likely or inevitable “problems” that could arise, especially the danger of suffocation. Sometimes co-sleeping is explicitly discouraged; at other times the message is subtler. The most frequently cited reasons for recommending separate sleeping quarters for parents and children include preservation of the marriage; promotion of the child’s individualism and autonomy; avoidance of incest and suffocation; promotion of the child’s social competence; and strengthening of the child’s gender and sexual identities.

Indeed, where a problem or potential problem with co-sleeping can be identified, rather than being considered simply something to be solved, it becomes an argument against the practice, as if all families who co-sleep will experience the same problem. Furthermore, problems associated with co-sleeping are presented as if they cannot be solved in the same manner as, for example, problems associated with solitary sleep.

Throughout the literature, co-sleeping is described as the cause of marital discord; although, data from Sweden refute this notion.50 Co-sleeping is also cited as the cause of sibling jealousy; while possibly true, it is probably only one of many causes. Parents are warned that co-sleeping creates a bad habit, one that is difficult to break. Co-sleeping is said to confuse the infant or child emotionally or sexually, or to induce over stimulation: “Sleeping in your bed can make your child feel confused and anxious rather than relaxed and reassured. Even a young toddler may find this repeated experience overly stimulating.”51 But no evidence is offered to show how, when, and under what circumstances this happens; nor is there any acknowledgment that perhaps under stimulation could be a more serious clinical and psychological problem.

A child needs to sleep alone, it is said, in order to establish a lifetime of good sleep hygiene, as well as to create a sense of self and comfort with aloneness, skills that presumably foster self-reliance and a strong sexual identity, all moral goods. Again, not only is no evidence presented that supports these statements, but also new evidence from a number of studies shows the opposite. In fact, when bed-sharing occurs in the context of ongoing healthy social relationships, toddlers and children are more independent, not less, and when they’re older, they have stronger sexual identities, not weaker ones, and are able to handle stress better.

Scientific paradigms do not change quickly or easily. The concept of infant–parent co-sleeping is not readily assimilated by those who have spent their scientific lives documenting the normality of solitary infant sleep and accepting uncritically the alleged deleterious consequences of co-sleeping. Probably few researchers, clinicians, and parents routinely co-slept with their own parents, a factor that would strongly influence their comfort with the practice. Perhaps an appreciation of diverse childcare practices, including co-sleeping, will come only with the growing populations of non- European immigrants in Western countries. As demographics on that score suggest, the question is not if the paradigm will change, but how soon.


Conclusions and Recommendations

The vast majority of scientific studies on infant behavior and development conducted in diverse fields during the last 100 years suggest that the question placed before us should not be “Is it safe to sleep with my baby?” but rather, “Is it safe not to do so?” An objective reading of the CPSC’s own database leads to a very different conclusion than the one it reached— namely, that no infant should sleep outside of the supervision and company of a responsible adult caregiver.

The issue is too complex to recommend in a sweeping way that all families should bed-share; still, any public safety campaign should recommend that at the very least every infant should be placed, preferably within arm’s reach, sleeping on a different surface, alongside a responsible adult caregiver. Room-sharing alone reduces the infant’s chances of dying from SIDS fourfold, according to the largest epidemiological study of SIDS yet undertaken.52

Recall that, until recent history, nighttime breastfeeding and infant and maternal co-sleeping functioned in tandem in all societies, and that both patterns remain an inevitable and inseparable system for most people today, including a growing number of Western parents. When practiced safely, co-sleeping with breastfeeding (whether bed-sharing or not) represents a highly effective, adaptive, integrated childcare system that can enhance attachment, communication, nutrition, and infant immune efficiency thanks to the increased breastfeedings and the increased parental supervision and mutual affection that accompany this practice. Moreover, bed-sharing and breastfeeding contribute indirectly to maternal and infant health by maximizing the intervals between succeeding births, therein lessening sibling competition for limited maternal resources. Co-sleeping infants appear more content than those who sleep (or try to sleep) by themselves. With increased maternal contact and feeding, crying is significantly reduced, and, contrary to conventional thinking, maternal and infant sleep can be increased. Consequently, less energy is siphoned away from essential infant activities such as growth and defense against infectious disease.

As renowned child psychotherapist D. Winnicott said half a century ago, “There is no such thing as a baby; there is a baby and someone.” Perhaps no childcare practice better reflects this truth than that of a human infant sleeping and breastfeeding next to its mother’s body, enjoying her loving and protective responses. For these reasons, neither governmental regulatory agencies, associations of crib manufacturers, nor medical authorities, many of whom confuse their personal preferences and ideologies for science, will ever be able to deny parents and infants what they want to do naturally— and that is to sleep and feed side by side.

Dr. James J. McKenna is a professor of Anthropology and Director of the Mother- Baby Behavioral Sleep Laboratory at the University of Notre Dame. He also serves on the Health Advisory Board of La Leche League International. He has served on the Executive Committees of the American Anthropological Association and Society For Medical Anthropology and is a member of the American Academy of Pediatrics. He lectures nationally and abroad on the importance of re-conceptualizing what constitutes healthy childhood sleep, and along with his undergraduate students, continues to study family sleeping arrangements and the importance of breast feeding in promoting the health of mothers and infants.


Notes:

  1. For a review of scientific studies, see Touch in Early Development, T. Field, ed. (Mahway, New Jersey: Lawrence Earlbaum and Assoc., 1995).
  2. J. J. McKenna, "An Anthropological Perspective on the Sudden Infant Death Syndrome (SIDS): The Role of Parental Breathing Cues and Speech Breathing Adaptations," Med. Anthrop. 10 (1986): 9-53.
  3. J. J. McKenna and S. Mosko, "Mother Infant Cosleeping: Toward a New Beginning," in Sudden Infant Death Syndrome: Problems, Puzzles, Possibilities, R. Byard and H. Krous, eds. (New York: Arnold Publishing, 2001), 258-272.
  4. J. Young and P. J. Fleming, "Reducing the Risks of SIDS: The Role of the Pediatrician." Pediatrics Today 6, no. 2 (1998): 41-48
  5. D. A. Drago and A. L. Dannenberg, "Infant Mechanical Suffocation Deaths in the United States, 1980-1997," Pediatrics 103, no. 5 (1999): e59.
  6. S. Nakamura et al., "Review of Hazards Associated with Children Placed in Adult Beds," Arch. Pediat. Adolesc. Med. 153 (1999): 1018-1023.
  7. N. J. Scheer, "Safe Sleeping Environments for Infants: A CPSC Perspective," Program and Abstracts, Sixth International SIDS Conference, Auckland, New Zealand, February 8-11, 2000.
  8. See Note 1.
  9. C. Richard et al., "Sleeping Position, Orientation, and Proximity in Bedsharing Infants and Mothers," Sleep 19 (1996): 667-684.
  10. E. B. Thoman and S. E. Graham, "Self-Regulation of Stimulation by Premature Infants," Pediatrics 78 (1986): 855-860.
  11. M. W. Stewart and L. A. Stewart, "Modification of Sleep Respiratory Patterns by Auditory Stimulation: Indications of Techniques for Preventing Sudden Infant Death Syndrome?" Sleep 14 (1991): 241-248.
  12. A. F. Korner and E. B. Thoman, "The Relative Efficacy of Contact and Vestibular-Proprioceptive Stimulation on Soothing Neonates," Child Dev. 43 (1972): 443-453.
  13. A. F. Korner et al., "Reduction of Sleep Apnea and Bradycardia in Pre-Term Infants on Oscillating Waterbeds: A Controlled Polygraphic Study," Pediatrics 61 (1978): 528-533.
  14. A. H. Sankaran et al., "Sudden Infant Death Syndrome (SIDS) and Infant Care Practices in Saskatchewan, Canada," Program and Abstracts, Sixth SIDS International Conference, Auckland, New Zealand, February 8-11, 2000.
  15. M. A. Kibel and M. F. Davies, "Should the Infant Sleep in Mother's Bed?" Program and Abstracts, Sixth SIDS International Conference, Auckland, New Zealand, February 8-11, 2000.
  16. D. P. Davies, "Cot Death In Hong Kong: A Rare Problem?" The Lancet 2 (1985): 1346-1348.
  17. N. P. Lee et al., "Sudden Infant Death Syndrome in Hong Kong: Confirmation of Low Incidence," British Medical Journal 298 (1999): 72.
  18. S. Fukai and F. Hiroshi, "1999 Annual Report, Japan SIDS Family Association," Sixth SIDS International Conference, Auckland, New Zealand, 2000.
  19. E. Wilson, "Sudden Infant Death Syndrome (SIDS) and Environmental Perturbations in Cross-Cultural Context," Master's thesis, University of Calgary (Alberta), 1990.
  20. J. Yelland et al., "Explanatory Models about Maternal and Infant Health and Sudden Infant Death Syndrome among Asian-Born Mothers," in Asian Mothers, Australian Birth, Pregnancy, Childbirth, Child Rearing: The Asian Experience in an English-Speaking Country, P. L. Rice, ed. (Melbourne: Ausmeed Publications, 1996), 175- 189.
  21. E. A. S. Nelson et al., "International Child Care Practice Study: Infant Sleeping Environment," Early Hum. Dev. 62 (2001): 43-55.
  22. See Note 20.
  23. See Note 19.
  24. C. Carroll-Pankhurst and A. Mortimer, "Sudden Infant Death Syndrome, Bed- Sharing, Parental Weight, and Age at Death," Pediatrics 107, no. 3 (2001): 530-536.
  25. Ibid.
  26. F. Hauck and J. Kemp, "Bedsharing Promotes Breastfeeding, and the AAP Task Force on Infant Positioning and SIDS," Pediatrics 102, no. 3 (1998): 662-663.
  27. E. A. Mitchell and J. Thompson, "Cosleeping Increases the Risks of the Sudden Infant Death Syndrome, but Sleeping in the Parent's Bedroom Lowers It," in T. Rognum, Sudden Infant Death Syndrome in the Nineties (Oslo: Scandinavian University Press, 1995), 266-269.
  28. See Note 19.
  29. V. Lummaa et al., "Why Cry? Adaptive Significance of Intensive Crying in Human Infants," Evolution of Human Behavior 19 (1998): 193-202.
  30. T. Pinilla and L. L. Birch, "Help Me Make It through the Night: Behavioral Entrainment of Breast-Fed Infants' Sleep Patterns," Pediatrics 91, no. 2 (1993): 436-444.
  31. A. B. Godfrey and A. Kilgore, "An Approach to Help Young Infants Sleep through the Night," Zero To Three 19, no. 2 (1998): 15-21.
  32. J.-L. Flandrin, Families in Former Times: Kinship, Household, and Sexuality (New York: Cambridge University Press, 1979).
  33. L. Stone, The Family, Sex, and Marriage in England, 1500-1800 (New York: Harper and Row, 1977).
  34. J. J. McKenna, "Cultural Influences on Infant and Childhood Sleep Biology and the Science That Studies It: Toward a More Inclusive Paradigm," in Sleep in Development and Pediatrics, J. Loughlin et al., eds. (New York: Marcel Dekker, 2000).
  35. R. Ferber, Solve Your Child's Sleep Problems (New York: Simon and Schuster, 1985).
  36. G. Cohen, ed., AAP Guide to Infant Sleep (New York: Villard, 1999).
  37. P. Heron, "Non-Reactive Cosleeping and Child Behavior: Getting a Good Night's Sleep All Night, Every Night," Master's thesis, Department of Psychology, University of Bristol, 1994.
  38. M. Crawford, "Parenting Practices in the Basque Country: Implications of Infant and Childhood Sleeping Location for Personality Development," Ethos 22, no. 1 (1994): 42-82.
  39. R. J. Lewis and L. H. Janda, "The Relationship between Adult Sexual Adjustment and Childhood Experience regarding Exposure to Nudity, Sleeping in the Parental Bed, and Parental Attitudes toward Sexuality," Archives of Sexual Behavior 17 (1988): 349-363.
  40. J. F. Forbes et al., "The Cosleeping Habits of Military Children," Military Medicine 157 (1992): 196-200.
  41. J. Mosenkis, "The Effects of Childhood Cosleeping on Later Life Development," Master's thesis, Department of Cultural Psychology, University of Chicago, 1998.
  42. J. J. McKenna et al., "Bedsharing Promotes Breastfeeding," Pediatrics 100 (1997): 214-219.
  43. J. J. McKenna et al., "Mutual Behavioral and Physiological Influences among Solitary and Cosleeping Mother-Infant Pairs: Implications for SIDS," Early Hum. Dev. 38 (1994): 182-201.
  44. J. Young, "Night-Time Behavior and Interactions between Mothers and Their Infants at Low Risk for SIDS: A Longitudinal Study of Room Sharing and Bedsharing," PhD thesis, University of Bristol, 1999.
  45. H. Hoffman et al., "Risk Factors for SIDS: Results of the Institutes of Child Health and Human Development SIDS Cooperative Epidemiological Study," in Sudden Infant Death Syndrome: Cardiac and Respiratory Mechanisms, P. Schwartz, D. Southall, and M. Valdes-Dapena, eds. (New York: Annals of the New York Academy of Sciences, 1988), 13-30.
  46. D. D. Fredrickson et al., "Relationship of Sudden Infant Death Syndrome to Breast-Feeding Duration and Intensity," Am. J. Dis. Child 147 (1993): 460.
  47. S. Mosko et al., "Maternal Sleep and Arousals during Bedsharing with Infants," Sleep 20, no. 2 (1997): 142-150.
  48. See Note 34.
  49. See Note 34.
  50. G. Klackenberg, "Sleep Behaviour Studied Longitudinally," Acta Paediatr. Scand. 71 (1982): 501-506.
  51. R. Ferber, Solve Your Child's Sleep Problems (New York: Simon and Schuster, 1985).
  52. P. S. Blair, P. J. Fleming, D. Bensley, et al. "Where Should Babies Sleep-Alone or With Parents? Factors Influencing the Risk of SIDS in the CESDI Study," BMJ 319 (1999): 1457-1462.




Pathways Issue 9 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #09.

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