Safe baby co-sleeping fact sheet

By Elizabeth Harrop

Updated October 2009

“Elizabeth’s fact sheet serves as a powerful reminder that parents are the best placed to make choices for their children, and not so called experts”.
Professor James McKenna, recognised as the world’s leading authority on mother-infant co-sleeping, in relationship to breastfeeding and SIDS

Babies sleeping through the night in their own room is a western model created since the industrial revolution. It devalues the role of mothers, the needs of their babies and the support of the father and extended family, placing a premium on forced independence.

Meanwhile, the huge benefits of safe co-sleeping with baby have been lost. Safe co-sleeping for example, actually helps protect against Sudden Unexplained Death in Infancy (SUDI, also known as SIDS or Cot Death).

Co-sleeping is surrounded by myth, with all co-sleeping branded as irresponsible, when it is actually unsafe forms of co-sleeping which lead to harm. Rather like wanting to ban all car driving because of the possibility of road deaths, without differentiating between safe and reckless driving. To quote an October 2009 study of SIDS in south west England: “Many of the SIDS infants had coslept in a hazardous environment … specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.”

Co-sleeping¹ is beneficial to mothers & babies and the children & adults they become:

• Protective against SIDS
• More frequent breastfeeding for a longer term
• Less crying
• Calmer and more soothing night time environment
• Increased understanding of baby’s cues
• Longer birth intervals
• More light and less deep sleep appropriate to infants
• More independent and secure children
• Better mental health as adults.

Always follow safety guidelines such as sleeping baby on their back, avoiding smoking (in and after pregnancy), being drug and alcohol free, using light bedding and a firm mattress. For full recommendations see Safe Cosleeping from The University of Notre Dame Mother-Baby Behavioral Sleep Lab and Attachment Parenting International – Infant Sleep Safety

It is ok

• to breastfeed your baby to sleep
• to breastfeed several times in the night
• if your baby doesn’t sleep through the night
• if your baby wants to be with you all night
• to bed/room share with your baby

Why it is ok

1. Human babies need to be close to their mothers 24 hours a day (not just from 7am to 7pm), and their biology reflects this. This biology is not subject to cultural influence, indeed human evolution has remained relatively unchanged for the past 10,000 years:²

• CAREGIVER ABSENCE: Human infants cry when their parents leave them, unlike the offspring of nested mammals, which expect to be left alone and therefore never cry spontaneously during the absence of their mother.³ Protesting against solitary sleep is an instinctive self-preserving mechanism.⁴ Meanwhile mothers are biologically programmed to give a nurturant response to her baby’s cries and not to restrain herself. Upon hearing her baby cry, the blood flow to a mother’s breasts increases, accompanied by a biological urge to “pick up and nurse.⁵
• MILK: Non primate mammals eg lions and deer, have milk with high fat and protein to sustain young which may be left alone for 4-12 hours. Human breast milk is low in fat (3%) and protein and high in lactose requiring regular feeding and closeness to the mother.⁶ A human infant is biologically designed to sleep next to its mother’s body and to breastfeed intermittently throughout the night, at least for the first year of its life.”
• BRAIN DEVELOPMENT: The human infant has only 25% of its brain developed at birth, the least of all primates, and relies on support and external regulation (eg of heart rate and breathing) especially for the first year⁷.
• DEFECATION: Mothers of baby mammals who are left alone for periods in the nest, lick their babies to stimulate defecation and urination. Human infants defecate spontaneously, as they do not expect to be left alone⁸.

2. Infant sleep physiology evolved under conditions of continual parental contact – so to remove external stimulus during sleep could have negative effect on infant sleep development, and co-sleeping facilitates development⁹.

3. Babies fall asleep at the breast because they are biologically programmed to do so¹⁰. “I am feeding, therefore I am with my mother, therefore I am safe, therefore I can sleep”.

4. Babies sleeping through the night in their own room is a western model created since the industrial revolution, which saw irrevocable changes in human labour, consumption, and family and social structure. Sadly many of these changes devalued the role of mothers, the needs of their babies and the support of the father and extended family. Instead placing a premium on a forced independence. As James McKenna says “Ideas on infant sleep are based on who we want our babies to become, not on who they are”.¹¹ 200 year old cultural changes are trying to override the biology of infants, which has taken 200,000 years to evolve.

5. When mothers are about to give their babies up for adoption, health care professionals assist them with a programme of “unbonding” from the baby. This includes physical separation of mother and baby. Society encourages separation by saying “you’re spoiling your baby” or “your baby’s just being manipulative” when we breastfeed our babies to sleep, pick them up at the first cry, or sleep with them.¹²

6. The expectation that babies sleep through the night is based on research done in the 1950s in the US, when less than 9% of babies were breastfed. The starting point for the research was solitary sleeping, formula fed babies.¹³ Similarly the 3-4 hour feed schedule is based on formula-fed and not breast-fed babies.¹⁴ New research by Prof James McKenna, looks at the sleep patterns of breastfed babies from an anthropological perspective (across all time and all cultures), shows that healthy functioning includes multiple wakings, light REM sleep, regular night feeding and proximity of the mother.

7. The Australian Association for Infant Mental Health say that controlled crying “is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences”.¹⁵ They advise that babies should not be left to cry until they can understand that their carer will return – at around 3 years of age.

8. Separation causes harmful changes in the body systems of infants. For example a one hour separation of mother and baby monkey young caused a compromised immune system, drop in temperature, cardiac arrhythmias and release of stress hormones in the infant. As a fellow primate, but with an even more dependent infant, the implications for human babies are worse.¹⁶

9. Babies which sleep without an adult caregiver in the same room are twice as likely to die from SIDS¹⁷ , which is suspected to relate to a breathing control error occurring during sleep¹⁸:

• Overheating is a risk factor in SIDS.¹⁹ Solitary sleeping infants cry more which leads to overheating, and they are not capable of regulating their thermal environment – unlike a bed-sharing mother who will wake to eg adjust bedding to cool a baby.
• Solitary sleepers may accelerate the maturation of deep sleep, before arousal mechanisms are mature.²⁰
• Their systems such as breathing and heart rate are not regulated by a nearby parent.
• Respiratory drive will be increased in infants who co-sleep due to the increased CO2 content of the room.
• The presence of a parent provides movement (breathing and bodily) which reduce apneic pauses (physical suspension of breathing) in infants.²¹
• In countries such as Japan and Hong Kong, bedsharing is common and SIDS is uncommon. The surface slept upon is usually very firm, & few mothers in these cultures smoke.²²

10. The first 6-9 months of life have rapid changes in sleep-awake patterns so you should not try to identify or correct ‘sleep problems’ before that time.²³

11. There are numerous studies showing the psychological benefits of bed sharing for babies into childhood and adulthood and its impact on positive adult mental health.²⁴

12. Infants which sleep with their mothers breastfeed more frequently and for a longer feed duration. And mothers who co-sleep are more likely to breastfeed for longer.²⁵

13. The suffocation risk of bed-sharing is exaggerated and fails to differentiate between unsafe and safe co-sleeping practices (see text box). When being warned off bed-sharing with examples of infant deaths, always ask for details, as they are likely to reveal unsafe co-sleeping practices. Did the mother smoke during her pregnancy, were siblings present in the bed, for example.

14. “If they sleep in your bed, they’ll never leave“. Anecdotal evidence from co-sleeping parents does not bear this out. Many co-sleeping parents report that their children become willing to leave, with little or no persuasion, around age two or three, as they mature physically, emotionally and cognitively. Co-sleeping families tend not to see things in terms of habits that need to be broken, but as patterns that can be established, but that continually evolve and change. For co-sleeping families, laying the foundation for security and closeness takes precedence over early independence.²⁶

A final thought

While co-sleeping may be ideal when seen in the context above, you have to find a balance between meeting your needs and those of your baby. Don’t feel bad if you can’t do it all, just feel good that you are trying to do some of it, some of the time.

References

1. Co-sleeping is defined as when “a primary caregiver … sleeps within … arms reach of the infant” and so could include room-sharing not just bedsharing. McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context

2. McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context

3. Blurton Jones (1974) in McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context

4. James McKenna, Infant-Parent Co-sleeping in an Evolutionary Perspective Sleep. Vol. 16, No. 3 (1993): 263-282

5. Dr William Sears

6. McKenna, “Infant-Parent Co-sleeping in an Evolutionary Perspective”

7. The small brain development evolved as a result of natural selection favouring bipedalism up to 6 million years ago and the resulting changes to the birth canal which required babies to have smaller heads. See McKenna “Infant-Parent Co-sleeping in an Evolutionary Perspective”.

8. McKenna Birth Breastfeeding and Beyond Conference, Christchurch 3 June 2008

9. McKenna, “Infant-Parent Co-sleeping in an Evolutionary Perspective”

10. Carol Bartle Birth Breastfeeding and Beyond conference, Christchurch 3 June 2008.

11. McKenna Birth Breastfeeding and Beyond conference, Christchurch 3 June 2008.

12. Research by Dr Sally Ruane and presentation by Carol Bartle at ‘Birth Breastfeeding and Beyond conference, Christchurch 3 June 2008.

13. James McKenna Why We Never Ask ‘Is It Safe for Infants to Sleep Alone? Academy of Breast Feeding Medicine News and Views 2001

14. Alison Barrett Birth Breastfeeding and Beyond Conference, Christchurch 3 June 2008

15. Australian Association for Infant Mental Health, Position Paper 1: Controlled Crying March 2004

16. McKenna, “Infant-Parent Co-sleeping in an Evolutionary Perspective” & McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context

17. Roomsharing, as one form of co-sleeping is now recommended by the American Academy of Paediatrics as a way to help reduce SIDS. Five studies referenced in McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context.

18. McKenna, Ball and Gettler “Mother-Infant Cosleeping, Breastfeeding and SIDS” Yearbook of Physical Anthropology 2007. There are differences in opinion as to the most at-risk age – from 11-15 weeks to 2-12 months

19. Sleeping Like a Baby: How Bedsharing Soothes Infants, By Miranda Barone

20. James McKenna Sudden Infant Death Syndrome in Cross-Cultural Perspective: Is Infant- Parent Cosleeping Protective?

21. Vicki L Schechtman “Infant-Parent Co-sleeping in an Evolutionary Perspective”

22. McKenna, “Infant-Parent Co-sleeping in an Evolutionary Perspective”

23. McKenna, “Infant-Parent Co-sleeping in an Evolutionary Perspective”

24. For some examples please see Sleeping Like a Baby: How Bedsharing Soothes Infants By Miranda Barone & McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context

25. McKenna & Gettler Mother-Infant Co-Sleeping with Breastfeeding in the Western Industrialized Context

26. Attachment Parenting International see also Centre for Attachment