Sleep Like A Baby? What Does That Really Mean? (In Vermont) James J. McKenna Ph.D Edmund P.Joyce C.S.C. Chair in Anthropology..Director, Mother- Baby

Sleep Like A Baby? What Does That Really Mean?

(In Vermont)

James J. McKenna Ph.D Edmund P.Joyce C.S.C. Chair in Anthropology..Director, Mother-Baby Behavioral Sleep Laboratory

University of Notre Dame du Lac

What is “normal, healthy infant sleep”Do we answer from a biological or recent cultural point

of view? Does it matter? If so, How? • How and in what ways has

culture by way of social values and goals mediated and influenced not only the study and conceptualizing of infant sleep i.e. proper positioning, arrangement, nighttime feeding patterns, and appropriate parental responses

• but the biology of both maternal and infant sleep in complex urban western settings?

• Why do 20-40% of western babies have “sleep problems to solve”?

1.Disarticulated from mother…

No touch;

No smells;

No sounds

No movement;

No body heat’

No breadth exchange

Fact: The only object/surface/entity on

or around which the baby is “designed” to

sleep remains the mother’s body.

“There is no such thing as a baby, there is a baby and someone.”

D.Winnicott

...in our enthusiasm to view the human infant (culturally) as a

separable, autonomous organism, we have pushed too far the concept of

the infant’s physiological independence from the parent…

confusing the infant’s preparedness to adapt, with actual adaptation…

confusing the infant’s abilities to sleep alone with moral and scientific truths

and meanings

Hierarchy of value is imposed:– On moral grounds…– the “good” baby vs. the “bad” baby, – but also, the effective /strong parent vs. the

ineffective/weak parent;

– On scientific grounds…– The developmentally superior, competent

baby vs. the inferior, less competent (spoiled/indulged) baby

Limitations of Western Pediatric Sleep and SIDS Research

adult- centric;

non-evolutionary;

ethnocentric;

(a)theoretical (no theory around which to interpret clinical events or research

results) Who is the infant? What do infants need? What criteria should be

used to decide, that is... dominant cultural practices?

biological? species-wide? local? Western reductionist science methods have not served infants well.. Eliminated concept of “the

mother-infant dyad” as the unit of analysis

Western pediatric medicine suffers from what Professor

George Williams calls…

the “fallacy of medical normalcy..” if we do it, or practice it, or value it (in

western society)..it must be right and/or appropriate

Cultural

Scientific

Public Health

Family

Interacting factors-- (most and least relevant ?)From: Sally Baddock (New Zealand) Peter Blair and Helen Ball (Great Britain), Caroline

McQuillan (Australia) James McKenna and Lane Volpe (USA)

Where babies actually

sleep

Infant and Parental Biology Including Feeding Method

most relevant

least relevant

including economic status

“It’s not what we know that gets us into trouble….it’s what we know…that just ain’t so!

From: Everybody’s Friend (1874)

By Mark Twain

….culturally favored child care practices change independent of,

and much faster than,

infant biology….

(ideologies or goals that underlie recommendations are often historical and

ideological in origin but passed off as, if not confused for, scientific findings)

if...sleeping alone through the night is medically

“good” for babies then don’t “good” babies do so, and

“good parents” enforce it?

In the west solitary sleeping arrangements became entangled with, and one and the same with, “good” morals

Cascading Inter-connections Regarding Western Parent-infant Sleep Conflicts

• (Infants rarely have sleep problems, parents do..!)• Western parents suffer from a variety of damaging diseases not the least of

which is.. the disease of false and unrealistic expectations..a cultural and not a biological model of infant’s sleep patterns;

• the disease of confusing parental desires and wishes and “best interest” with that of their infants

• the “die”model of sleep--the only “good” sleep is an uninterrupted one;• that infant sleep behavior correlates with good moral character, and

general future social skills and competencies…in domains other than sleep;

• the presumption of an adversarial relationship existing between infants and parents as regards sleep..Consider the book title: “Winning Bedtime Sleep Battles”..and “Babywise” ;

• suffer from the disease of misinformed expectations • devoid of the “relational” familial factors (where baby sleeps

and feeds as regards parental emotions and goals;) • devoid of intrinsic (infant) factors (temperament, personality

, sensitivities);• categorizes infant’s inability to follow cultural model

as…”disease”, sleep disorder, immaturity, and, thus, infant becomes a “patient”;

• promotes one- size- should- fit- all; • promotes one sleeping arrangement as a moral issue and

gives it a specific set of inappropriate meanings;

Why Our Babies “Can’t” Sleep and Why Western Parents Are the Most Exhausted And

Disappointed Parents In The World

Why Do Parents Have Infant Sleep Problems To Solve?

• Because no two people in any relationship have exactly the same “best’ interests..always trade-offs are involved…sleep is relational..not medical

• current one-size- must- fit- all model devoid of relational-emotional aspects including unique infant “intrinsic” factors

– such as infant sleep personality-temperament and how these articulate with unique needs of parents to respond to perceived infant needs, as well as the parents own needs for contact with their infants;

• Current models either ignore altogether the critical relationship between nighttime breastfeeding and sleep, or minimize its significance to infant-maternal health.. seeing breastfeeding as a threat and not added value

– wish nighttime feeding would just go away as it threatens the priority given to consolidated sleep (the predominant cultural

value) • Transition away from thinking of co-sleeping as pathology (psychology) to dangerous (medical)

Until recent, western historic periods, no human parents ever

asked:

Where will my baby sleep, how will I lay my baby down to sleep, and

how will I feed my baby?

most human parents still don’t!

For the human infant the three functionally inter-related (adaptive)

components of normal, healthy infant sleep include:

• Sleep location – (next to mother for social or co-sleeping behavior

involving on-going sensory exchanges, monitoring and mutual regulation)

• Nighttime feeding – exclusive breast feeding

• Sleep position– Back (supine)

The cultural-medical dismantling of this biological system led to the deaths of thousands of western infants from, SIDS, accidental

asphyxiations and/or other SUDI (i.e. from social sleep …to solitary infant

sleep--

from breast feeding …to bottle-formula feeding

from supine …to prone infant sleep position

THE UNDERMINING OF MATERNAL CONFIDENCE AND KNOWLEDGE

Benjamin Spock wrote to mothers in: Baby Care

“You know more than you think you do….

don’t be afraid to trust your common sense. Bringing up baby won’t be a complicated job if you

take it easy, trust your own instincts, and follow the directions your doctor gives you!

cited by tina thenevin,1993, mothering and fathering

To understand current debate/discourse over sleep must understand Bridget Jordan’s delineation of the

place of “authoritative medical knowledge” in our western culture.

• Decision -making hierarchy is distributed--physician at top, lactation consultant, nurses, parents at bottom;

• “the power of authoritative knowledge is not that it is correct but that it counts”

• “Standard Care” enforced by legal and institutional actions;– Examples: prosecution of Salt

Lake City couple whose infant died after co-sleeping (child abuse homicide); or lactation consultants fired if they give safety information on bedsharing.

• Invalidates other knowledge systems;

• Parental knowledge counts for nothing

• Parents must override instincts- as medical personnel always know best;

Modified from: Birth In Four Cultures by Bridget Jordan

Authoritative medical knowledge…

“…to legitimize one way of knowing as “authoritative” devalues, often totally dismisses, all other ways of knowing. Those who reject authoritative knowledge systems tend to be seen as backward, ignorant, or

naïve troublemakers…”

Socio-cultural and Historical Factors and Forces Leading to Erroneous Scientific Understandings

(Undermining Parental Confidences and Empowerment)

• rise of child care experts using moral judgments as a basis of recommending what infants “need’..what is worth “investing in” as a practice..

• belief in superiority of technology, rather than on maternal bodies to stimulate, hold and nurture;

• emphasis on “average expectable population outcomes” rather than on individual variability or potential.. per any given behavioral parenting strategy;

• emphasis on ethnocentric social values and ideologies (not biology) to guide research and conclusions..”fallacy of medical normalcy” (GWilliams)

• improper medicalization of relational (caregiving) issues ..assumed to be best understood by pediatricians (who generally have no training in human social development or human evolution…

• “Pathologizing” of normal behavior (crying when left alone) ..making infants into patients (blaming the victim for the crime) in need of correction when they fail to follow cultural scripts..”Never let a baby fall asleep at the breast” AAP Guidelines For Infant Sleep

• social constructions of infancy, not /biological- evolutionary based (influences of Freud, Klein, Watson..psychology in general);

• “Science” of infant feeding (bottle-formula feeding) and sleep pediatrics became one and the same with… mutually reinforcing moral ideas about who infant should be, or become, rather than who they are…and how husbands and wives should relate vis a vis distance, authority and separation from children…also, ideologies about the bedroom as a “sexual place..”

The Complex History of Infant Sleeping Arrangements In Western Industrial Societies Is Reduced To Simple

Understandings Congruent With Present Cultural Beliefs:

• inevitable suffocation/overlying/SIDS• inevitable psychic damage to infant• inevitable rupture to conjugal (husband/wife) relationship• inevitable prolonged dependency of infant/ child• inevitable lack of autonomy in infant/child

– NOTE: not one controlled scientific study documents the benefits of solitary infant sleep, or the alleged deleterious social/psychological/physiological consequences of safe cosleeping with breast feeding

How A Folk Myth (normal, healthy babies sleep alone) Achieved Scientific Validation

“Scientific” validation of solitary

infant sleep as “normal” and

“healthy”

#1: Initial test condition—infant sleeps alone, is bottle fed, and has little or no parental contact

#2: Derive measurements of infant sleep

under these conditions

#3: Repeat measurements across ages, creating an “infant sleep model”

#4: Publish clinical model on what constitutes desirable, healthy infant sleep.

#5: To produce “healthy” infant sleep, replicate the test condition

Changing perceptions….of what’s good for baby…

“The constant handling of an infant is not good for him. The less he is lifted, held and passed from one pair of hands to another, the better, as while he is young his bones are soft and constant handling does not tend to improve their development nor the shapeliness of his

little body. the newborn infant should spend the greater

portion of his life on the bed” FROM: THE BABY

MARIANNA WHEELER 1901

HARPER BROS: NEW YPRK LONDON

CHANGING PERCEPTIONS OF WHAT INFANTS NEED...

THE MOTHERHOOD BOOK (1935)

“Babies should be trained from their earliest days to sleep regularly and should never be woken in the night for feeding….”

“Baby should be given his own bedroom from the very beginning. he should never be brought into the living room at night”

Richard Ferber, M.D.

Director,

Center for

Pediatric

Sleep Disorders, Children’s

Hospital, Boston

slide courtesy of Meret Keller and Wendy Goldberg

Dr. Richard Ferber “changes his mind”..?? But the larger and more important question is…What is it about our culture that makes us care, or makes it important what someone who has no familiarity with our baby or our family thinks about this very personal issue?

• “If you find that you actually prefer to to sleep with your baby you should consider your own feelings very carefully”.

• “Whatever you want to do , whatever you feel comfortable doing, is the right thing to do, as longs as it works….. most problems can be solved regardless of the philosophical approach chosen” (Ferber: 2006: 41)

1976

2006

(1976, 1999)“…Sleeping in your bed can make an infant confused and anxious

rather than relaxed and reassured. Even a toddler may find this repeated experience overly stimulating”

(2006)“Children do not grow up insecure just because they sleep

alone or with other siblings, away from their parents; and they are not prevented from learning to separate, or from

developing their own sense of individuality simply because they sleep with their parents” (Ferber 2006:41).

Changing concepts related to where babies can or should sleep..the beat goes on…

“Sleeping With Baby: An Internet -based Sampling of Parental Experiences, Choices, Perceptions, and

Interpretations In A Western Industrialized Context

J.J. McKenna and L.E. Volpe in press Inf. Child Dev.

Based on self-selected sample of 200 mostly middle class mothers

from Canada, United States, Australia, and Great Britain….

400 pages of narrative “ethno histories” in response to nine

questions…

“Sleeping With Baby: An Internet -based Sampling of Parental Experiences, Choices, Perceptions, and

Interpretations In A Western Industrialized Context”

• How did you, do you, co-sleep?• How long did you/have you co-slept?• Why are you co sleeping, or, why did you co-sleep?• If you already have children who moved on from co-sleeping, what do you think

of your experience?• If you are still co-sleeping, what do you think of it now (i.e. as opposed to your

attitude when you began?• How well do your children sleep now?• Are you breast feeding or did you breast feed? If so, for how long? • Do you and/or your partner smoke? • By co-sleeping, do you think you ever saved your child’s life?

– questions originally posted on

Recurrent parental themes

• awareness of comments concerning “warnings” against bedsharing and knowledge of bedsharing risks;

• relationship between breast feeding and bedsharing;• emotional bases of and correlates to co-sleeping for mothers

(parents) and infants alike;• transition to separate beds;• co-sleeping and effects on child’s socio-emotional development;• potential life saving experiences

ON RESPONDING TO INFANT CRIES...

“A RAPID AND SYMPATHETIC RESPONSE TO OUR BABIES CRIES IS THE FOUNDATION OF STRONG

FAMILY VALUES, NOT THE UNDERMINING OF THEM”...

FROM: HARVEY KARP…HAPPIEST BABY ON THE BLOCK (2002)

Ahhh… The question of promoting infant “independence”

(three questions)1) what exactly is “independence

for a 2-3 month old infant?

2) does it really correlate with solitary infant sleep practices?

3) is “independence of children” what parents really want?

But, is “independence” really best in the long run.. that is, is “independence” from parental intervention at 13 or 14 years of

age as desirable as it is, say, at 2 months?

Does sleeping alone actually correlate with autonomy, competence, and/or confidence, or happiness or to any other desirable personality attribute not obtainable through some

other arrangement or other childhood socialization experiences?

According to Daniel Stern (1985)

• “..the emotionally disturbed patient is one whose early experiences lacked attunement…..the tracking and attuning--which permits one person to be with another in the sense of sharing likely inner experience on an almost continuous basis”

“Autonomy in the sense of psychotherapy, implies taking control of one’s life…emotional autonomy does not mean isolation or avoidance of dependency. On the contrary, the lonely schizoid individual who preserves his “independence” at all cots may well be in a state of emotional heteronomy, unable to bear closeness with another person because of inner dread and confusion.

When dependence IS autonomy

A similar state of emotional heteronomy affects the psycho- path who is unaware of the feelings of others. The emotionally autonomous individual does not suppress her feelings, including the need for dependence, but takes cognizance of them, ruling rather than being ruled by them” (Homes and Lindley 1989)*

dependency AS autonomy

* The Value of Psychotherapy (1991) J.Holmes and R.Lindley. Oxford University Press

Crying

Chimps have….

..bad days, too!

Recent cultural ideologies place BOTH infants and parents at odds

with their biology (emotions)

• Western Caregiving:– Child is not in contact with mother

most of the time (crib, stroller)– Baby is kept supine – Scheduled separated feedings– Social pressures not to respond to

infant crying for fear of “spoiling”– Separation, minimal feedings, is

thought to be “good for baby”

Function of Crying

• primary form of pre-verbal communication;

• evolved maximize chances of infant survival and parental reproductive success.

• signals infant distress, fear, hunger, pain and/or discomfort..

• crying ensures proximity to parent, protection from predators.. (Bowlby)

• Though crying is not the normal way by which infants receive breast milk…crying is a late sign of infant hunger signals …

Evolutionary Adaptedness• “A number of studies in human

infants have confirmed the potential importance of both contact and nutrients as regulators of infant behavioral state…increasing carrying from 3 to more than 4 hours a day reduces duration…of crying/fussing behavior by 43% at 6 weeks of age” (41).

Controlled crying (or controlled comforting..or sleep training)

1. a technique to manage infants and young children who do not settle alone or who wake at night, or who settle only if held or if permitted to sleep in proximity or contact with their parents….

2. involves leaving the infant to cry for increasingly longer periods of time before providing comfort…

3. the goal is to condition infants or young children to “sooth” themselves back to sleep and to stop them from crying or calling out during the night

Australian Association of Infant Mental Health Position Paper…

• “It is normal and healthy for infants and young children not to sleep through the night and to need attention from parents. This should not be labeled a disorder except where it is clearly outside the usual patterns”;

• “Parents should be reassured that attending to their infants needs/crying will not cause a lasting “habit”..Waking in older infants and young children may be due to separation anxiety, and in these cases sleeping with or next to a parent is a valid option. This often enables all to get a good nights sleep”

Australian Association of Infant Mental Health

“The AAIMHI is concerned…

“controlled crying” is not consistent with what infants need for their optimal emotional and psychological health, and may have

unintended negative consequences”

From “Controlled Crying: AAIMHI Position” Paper November 2002

Traditional Western Pediatric and Clinical Approaches and assumptions to Infant

Sleep:

• perpetuate the very environmental conditions that give rise to the parent-infant sleep problems they are asked to solve…

Controlled crying and or sleep training techniques and philosophies

…reflect social ideologies

not scientific findings about who infants are and what infants need based on empirically-based, scientific- biological studies;

techniques reflect who we think we want infants to be (convenient) or become or should become (autonomous/independent) as early in life as is possible;

First Question

What cultural assumptions about infants and their sleep and

developmental needs, lead to caregiving practices which induce

infants to cry in the first place, which in turn make “controlled crying” techniques seemingly

necessary?

Second Question (there is a choice) :

• What exactly needs to be changed? – should babies be changed… can they be

changed (biologically? -or-

– should the ideas and assumptions which underlie and justify recent western infant

care recommendations be changed ?– who gets to decide?

It’s one thing to ask if some infants can be conditioned or trained to sleep alone,

unattended.. “through the night” (unsupervised, unfed and unintended)

It’s altogether a different and more serious matter to ask if they should be, or if it is not nice,

dangerous or injurious in either the long or short run…

Misunderstandings by parents often motivate the use of “controlled

crying” techniques….

Parents are led to believe infants will be cognitively or socially handicapped--no scientific

studies support such predictions..

“

Infant crying…is it normal or necessary, or an expectable

behavioral expression found in daily life ? or

an alarm signal reserved for critical circumstances involving..

pain, hunger, fear (separation from the caregiver)--all or some of

these?

Evidence that it is neither expectable nor beneficial, but deleterious..

• requires considerable physiological effort with…

• increase heart and lung activity (Rao et al. 1993; Lester et al 1985),

• increased energy loss through..• Heart rate increases (Pillai and Jane 1990);• Augmented plasma cortisol levels;• Decreased blood oxygenation (Anders et al.

1970;Levesque et al. 1994);

And , yet, from a western cultural medical (clinical) perspective

protesting infants are considered to be developmentally inferior, immature, or “spoiled” compared with infants who comply or acquiesce passively to the cultural model of separation-----which actually endangers infants…..

And parents of such infants assume either that their infants are deficient, or that they lack good parenting skills…

Evidence -Based Science:

Infants sleeping alone in a room by themselves are at least twice as likely to

die from SIDS than are infants sleeping in the company (same room) as a

committed adult caregiver…

Sources: Great Britain (Blair et al 1999), New Zealand (Mitchell and Scragg 1995), and European Collaborative Study (Carpenter

et.al.in press, Lancet)

With respect to crying …and smiling

• Both these “perceptuo-motor mechanisms” according to Bowlby…promotes maternal “attachment”..

• turning on , and turning off , of each--- become socially and psychologically mediated as the infant’s neocortex myelinates (baby decides whether or not or if, to cry or smile…and to whom or for whom…and when to do so….

AAIMHI.. recommends that parents should be told….

• The method has not been assessed in terms of stress on the infant or the impact on the infant’s emotional development;

• A full professional assessment of the child’s health, and child and family relationships should be undertaken before initiating a controlled crying program…

• ….this should include an assessment of whether the infant’s crying is outside the normal levels

Clinical Application

• Inform parents that early infant crying is normal and “makes sense” from an evolutionary standpoint

• Possible “solution” to reduce the prolonged crying of colic: change “normative caregiving, rather than treating intrinsic or extrinsically induced pathology in the infant”

• Maintain contact and proximity to infant.

Infant and Child Development (Special Issue)

(2007) Vol16, Issue 4: 331-469

“Co-sleeping during infancy and early childhood: Key findings and

future directions (457-467)

Wendy Goldberg and Meret Keller

***Next few slides modified from and/or courtesy of…Meret Keller and Wendy Goldberg….UC Irvine Dept of

Psychology

Modeling “co-sleeping” as a medical disorder

Co-sleeping = Night wakings

Night wakings = Sleep problems

THEREFORE

Co-sleeping = Sleep problems

However…

Cross-cultural samples…China, India Southeast Asia, Japan… and others

U.S. co-sleeping sub- groups such as African -Americans, Hispanics, La Leche League-Breastfeeding mothers populations..

Night wakings not perceived

as problematic by all mothers!

Courtesy of Meret Keller and Wendy Goldberg

How such nighttime arousals by infants are evaluated depends on…

Begin in infancy?

OR

Begin in toddlerhood/ preschool?

A preferred parental

practice?

OR

Perceived as a

“necessary evil?”

Courtesy of Meret Keller and Wendy Goldberg

Sleep Groups (UCI Family Sleep Research Project; Keller & Goldberg, 2004)

• Solitary Sleepers:

Slept alone from 6 months through 3 years

• Reactive Co-Sleepers:

Slept alone by 6 months; began co-sleeping during second or third year

• Early Co-Sleepers: Bedsharers for at least the first year

Powerpoint Courtesy of Meret Keller and Wendy Goldberg

Meret Keller and Wendy Goldberg: Objective and Hypotheses

The primary objective of this study was to provide empirical data on co-sleeping in relation to reported sleep problems and preschool children's independence and autonomy. A secondary aim of this study was to investigate sub-types of co-sleeping.

(1)Early co-sleeping mothers view solitary sleeping more negatively and co-sleeping more positively than either solitary sleeping or reactive co-sleeping mothers.

(2) Reactive co-sleeping mothers report more child-related sleep problems and perceive these problems as more intense than do solitary sleeping and early co-sleeping mothers.

(3)Solitary sleeping children exhibit greater independence in sleep and other domains at preschool age compared to early and reactive co-sleeping children.

Results

Mothers of co-sleepers were least supportive of solitary sleeping.

Reactive co-sleepers had the most sleep problems (e.g., night wakings) and their mothers perceived them as problematic.

Solitary sleepers were the most independent in the sleep domain.

As preschoolers, early co-sleepers were most independent with peers and in self-care skills.

Measures

Sleep Practices Questionnaire (items adapted from Crowell et al.,

1987; Greenberger & Goldberg, 1989; Lee, 1992; Lozoff, et al.,

1984; Stillman, 1999).

Independence (“not relying on others,” Deci et al., 1993; Deci & Ryan, 1985) in domains of sleep, self-reliance, and social behavior

with peers.

Sample and Sleep Groups DefinedMeret Keller and Wendy Goldberg

The sample consisted of 83 preschool-aged children (54% female) and their mothers, who were well-educated, middle to upper middle-class, 71% Caucasian, 18% Asian American, and 5% Latina.

SOLITARY SLEEPERS SLEPT ALONE BY 6 MONTHS AND CONTINUED THAT ARRANGEMENT TO AGE 3

REACTIVE CO-SLEEPERSSLEPT ALONE AT 6 MONTHS; BEGAN CO-SLEEPING DURING SECOND OR THIRD YEAR FOR AT LEAST A 6- MONTH PERIOD

EARLY CO-SLEEPERS BEDSHARERS AT 6 MONTHS WHO CONTINUED CO-SLEEPING AT LEAST UNTIL 12 MONTHS

For example…Reactive Co-Sleeping:

Unwanted, unplanned co-sleepingDefinitions

– Children who start out as solitary sleepers in infancy and share the parents’ bed as toddlers or preschoolers

– Children who co-sleep (regardless of age) because they have difficulty sleeping alone even though the parents prefer separate sleeping arrangements (i.e., unplanned, unwanted co-sleeping)

Reactive co-sleeping families emerge as a distinctgroup from early/intentional co-sleeping families.


Criteria for Sleep Groups

6

12

18

24

30

36

Age (months)

Early BedsharersSolitary Sleepers Reactive Co-Sleepers

Bedshare part/all night Own room Co-sleeping for at least 6 months (otherwise solitary sleeping)


FINDINGS:Support for Reactive Co-Sleeper

Group

• Early and reactive co-sleeping children awakened more frequently than solitary sleepers

• Reactive co-sleeping mothers perceived their children’s night wakings as more problematic than other mothers

THEREFORE – Early co-sleeping mothers did not perceive their child’s night wakings as problematic


Child Outcomes

Early co-sleeping children, as preschoolers, reportedly more independent in non-sleep domains


Independence in Sleep Domain

Solitary sleepers most independent in sleep domain:– Solitary sleepers fell asleep on own at earlier age

• Solitary sleepers (M=5.0 months)• Reactive co-sleepers (M=11.0 months)• Early co-sleepers (M=26.9 months)

– Solitary sleepers slept through the night at earlier age• Solitary sleepers (M=6.2 months)• Reactive co-sleepers (M=13.6 months)• Early co-sleepers (M=25.5 months)


Independence in Non-Sleep Domains

As preschoolers, early co-

sleepers were mostindependent in

– Social relations with peers

– Self-care/daily living skills 6

12

18

24

30

36

42

Solitary Sleepers Reactive Co-Sleepers Early Co-SleepersExtent of Independence in Non-Sleep Domins


Maternal and Family Outcomes

• Maternal autonomy support:

Early co-sleeping mothers more supportive of their child’s autonomy and less controlling than mothers in other groups

• Marital intimacy:No differences in marital intimacy across sleep groups


Additional Child Outcomes Research

No differences in behavioral problems at 2 and 3 years of age for co-sleepers and solitary sleepers (except difficulty getting to sleep and night wakings) (Madansky and Edelbrock, 1990)

No differences, at age 6, in behavioral difficulties, emotional maturity, mood and affect, or creativity (Okami et al., 2002)

No differences, at age 18, on child’s ability to relate to parents, adults in general, other family members or peers. No link between bedsharing history and child’s likelihood of using alcohol/tobacco/hard drugs; having problems with self-acceptance; engaging in vandalism, fights or serious crimes; being sexually active; or having either positive or negative sexual experiences (Okami et al. 2002)


Three In A Bed: Where Do Fathers Fit In?

New Research Summer 2008: underlying hormonal basis of social bond formation and attachment during nighttime care amongst fathers and their infants and children..Lee Gettler and James McKenna

Photo Idea Courtesy of Meret Keller and Wendy Goldberg

http://contests.fotki.com/contests/50/5712.html

Fathers…

• In British sample, most fathers shared bed with infant 3-5 months post-birth, at least occasionally, even when had not expected to bedshare

• Fathers responded positively to bedsharing at 3-5 months post-birth, even when it was not anticipated prior to the birth of their child

• Fathers (particularly first-time fathers) had fears of rolling over on their infant and of disrupted sleep due to the infant’s presence in the bed, but once they adjusted to bedsharing, these fears were alleviated.

• Most fathers appeared to enjoy the experience, and did not consider the presence of their infant in bed as an intrusion on their marital relationship (Ball et al., 2000)


More on Fathers…

• Fathers and mothers endorsed similar reasons for their families’ sleep arrangements, although reasons differed by type of sleep arrangement

• Satisfaction with sleep arrangements was more likely for fathers and mothers whose attitudes coincided with their actual sleep practices

• A similar, highly satisfied, stable pattern was apparent for fathers and mothers of solitary sleepers and early co-sleepers, but satisfaction for mothers and fathers of reactive sleepers waned over time.


Will They Ever Leave…?


WHEN To Move Child To Own Room?

• Depends on family and cultural values• Does child kick and move around too

much?• Is child getting too big (not enough

room?)• Are parents feeling support or pressure

from family/friends/culture?• Does child feel comfortable/ready to move

out?Powerpoint Courtesy of Meret Keller and Wendy Goldberg

HOW To Move Child To Own Room?

• As many ways as there are families…– When child is ready– Move into room with older sibling– Parent sleeps temporarily in child’s room until child is

comfortable sleeping on own– Buy new bunk beds with CARS or DORA THE

EXPLORER bedsheets and blankets– Futon on floor of parents’ room until child feels

comfortable sleeping on own– Part-night in own room; part night with parents


Documents

Sleep Like A Baby? What Does That Really Mean? (In Vermont) James J. McKenna Ph.D Edmund P.Joyce C.S.C. Chair in Anthropology..Director, Mother- Baby