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Sharing Sleep with Babies: The Benefits of Safe Nighttime Slumbers

Barbara Higham
Great Britain
From NEW BEGINNINGS, Vol. 24 No. 6, November-December 2007, pp. 244-249

When I was expecting a baby for the first time, I spent ages researching which crib mattress was considered the safest and most ergonomic on the market. The costly mattress I eventually chose boasted every advantage; even claiming to prevent the pooling of exhaled carbon dioxide that might be re-inhaled by the baby. I felt reassured by all I'd read and thought that the safety of my baby was virtually guaranteed; yet, as it turned out, the safety factor was not put to the test as he never spent a night on this precious mattress.

When Felix was born he was rushed away from me because he wasn't breathing. When we were reunited several hours later, I never wanted to let him out of my sight again. We spent four days in the hospital. During this time I struggled to initiate breastfeeding and worried constantly while my baby underwent many intrusive tests. We were discharged "fully breastfeeding" although Felix had received a fair amount of formula through a naso-gastric tube. On returning home, the thought of putting him in a crib was simply unbearable. I spent every waking minute holding or watching him and I wasn't going to abandon my guard in the night! I was keenly aware that my baby needed comfort and company at night as well as in the day, and, along with a growing number of parents (as I later discovered), I wasn't going to let social conditioning stand in the way of meeting his needs.

A baby needs to breastfeed during the night for many months and may need parental attention at night for years. It's the rare baby who will sleep for more than a few hours at a stretch in the early weeks. It's important for parents to find ways of meeting their child's nighttime needs while getting sufficient sleep themselves. Worldwide and throughout history, mothers have found that breastfeeding has been made easier at night if they take baby into bed and feed lying down. It is not at all unusual for both mother and baby to sleep better this way.

Breastfeeding with bedsharing is one of the traditional ways of caring for an infant at night. (The term "bedsharing" implies a baby sharing an adult bed with one or both parents. The term "cosleeping" implies a baby is sleeping in close proximity to an adult caregiver, not necessarily in the same bed.)

However, sleeping with a young baby may not suit every family. Some mothers prefer keeping a crib by the bed and bringing their babies into the bed when it's time for a feeding. Some find that sitting up in bed to breastfeed works best for them in the early weeks. Proximity is what seems to make mothering at night easier because if baby is near by, a mom can respond to his needs quickly and with the minimum amount of disruption to her rest.

Babies often show strong preferences about where they do or do not want to sleep and parents tend to change their arrangements accordingly. An unsettled baby means disturbed nights for the whole family.

Breastfeeding was an uphill struggle for me with my first child and wasn't fully established for some weeks. I gradually stopped following up nursing sessions with formula and persevered until my baby was able to latch and stay attached to the breast all the way through a feeding. Once we were breastfeeding exclusively, I still couldn't (or didn't want to) put Felix to sleep anywhere other than by my side. My partner felt much the same as I did, fortunately.

While I was happy with the arrangement of sleeping with my baby, it was clear to me that it was seen as a problem by others. I lost count of the number of people who asked me, "Is he sleeping through the night yet?" Well, no he wasn't, but we were getting plenty of sleep and his nighttime feeds were not disturbing us. Reactions were mixed, but I perceived that there was a common thread of disapproval. Some other mothers shared with me that they too slept with their babies. I usually got the impression that this was something they felt they should not be doing, or even that it was a failure on their part not to get their babies to sleep alone. I wondered at times whether my need to keep my baby with me at night arose simply from my initial fears surrounding our early separation. My fears were, however, overridden by the convenience of the arrangement. I needed my rest and simply couldn't contemplate getting out of bed in the night to feed him!

What Is "Normal"?

In cultures that define solitary infant sleeping arrangements as "normal," the ability of babies to sleep through the night and to soothe them-selves back to sleep without parental intervention is viewed as a desirable developmental milestone. Sleeping alone is popularly regarded as the healthiest and safest form of infant sleep by both psychologists and parents, who assume that this practice promotes physiological and social autonomy. Along with many mothers who have trusted their instincts in child rearing, I don't believe that babies were designed by nature to sleep alone for long periods. Cutting edge research is challenging the validity of these common assumptions. The research now points to the potential benefits to infants derived from sleeping in close proximity to their parents.

James J. McKenna, a professor with the University of Notre Dame Mother-Baby Behavioral Sleep Lab (Indiana, USA), has examined the safety of different sleep environments as well as the physiological and/or psychological consequences of the different choices of sleeping arrangements parents make. He says (1993):

Infants sleeping for long periods in social isolation from parents constitutes an extremely recent cultural experiment, the biological and psychological consequences of which have never been evaluated.

Frequent Feeds for Tiny Tummies

Born with only 25 percent of adult brain volume, the human baby is neurologically the most immature infant primate of all, the slowest developing, and the most reliant on its mother for the longest period of time for physiological regulation and support. The composition of human milk (characterized by its low protein and fat content and high lactose) necessitates short intervals between breastfeeds. Babies have tiny stomachs and human milk is very easily and quickly digested. Human mother-infant cosleeping is not only expected but is, according to James Mckenna, biologically necessary. Anthropologic studies confirm that human babies were intended to feed frequently and have done so throughout most of history (Stuart-Macadam et al. 1995).

Babies Sleep Differently

There are two main states of sleep: rapid eye movement sleep (REM), known as active sleep (when dreams occur), and non-REM (or quiet) sleep. During REM sleep, the eyes may be partially open and moving and breathing is irregular. We pass from wakefulness through four stages of gradually deepening non-REM sleep before moving gradually back through the stages of non-REM sleep. The movement to and from REM sleep and back happens in cycles throughout the night.

The younger the human being, the greater the percentage of REM sleep. The period of life when humans sleep the most and the brain is developing the most rapidly is also when they require the most REM sleep. It appears that the predominance of active sleep in infants has developmental benefits. Infants have shorter sleep cycles than adults, with nearly twice as much REM sleep. Babies don't crash into non-REM sleep in the way adults do; they have an initial REM period and a transitional period before entering quiet sleep during which they awaken easily, and so may appear difficult to settle or awaken more easily in the night. In NIGHTTIME PARENTING, Dr. William Sears states that a baby should be parented to sleep:

He needs to be gentled through the initial REM state until he descends into deep sleep. Likewise, if a baby rouses during a subsequent period of REM sleep, he can be gentled through it until he is again in a deep sleep.

The high percentage of REM sleep falls as babies mature.

Unrealistic Expectations

Breastfeeding your baby is a wonderful way of gentling him to sleep. Babies can't tell the time and have little concept of day and night, so it is unrealistic for parents to expect them to sleep for long stretches. If your baby wakes frequently and this is getting you down, remind yourself that he is doing only what is required for his brain to develop and so he can communicate his survival needs for frequent feeds. The formula fed baby may perhaps sleep longer stretches, but the large amount of food he has taken in will put an unnecessary strain on his immature gut. As a baby grows, he will naturally adapt to the rhythm of life in his new environment and requires no prompting or training to do so.

A baby can't be forced to sleep. A lot of parents are left physically and emotionally exhausted by trying to sleep train their babies. Left to his own devices, a baby will drift easily in and out of sleep as his body requires it, but it is not uncommon for sleep (like food) to become a battleground. Popularly, babies are looked at as manipulators, and "pandering" to their cries will "spoil" them. Personally, I don't think it's possible to show a baby too much affection.

If only we knew how not to battle. We need to rediscover what families throughout history have known instinctively -- how to offer children complete security, so that they can grow and develop in confidence….If we are always pushing our children away, they will return, clinging, for many years to come (Jackson 2003).

Nursing her baby at bedtime can help a mother to let go of all the day's cares (hormones help here) and, if she doesn't drift off to sleep, will leave a woman in a relaxed mood to spend some time alone with her partner once baby is asleep. Lactation actually suppresses the body's hormonal response to stress, which leaves a mother more able to cope with whatever life throws at her during the time she is breastfeeding.

Fathers benefit from sleeping with their babies, too, because it aids the bonding process. Welcoming baby into the parental bed makes a child feel that his needs are important at night as well as in the day and adds to his developing sense of self-esteem. Sleeping in bodily contact with a baby enables him to explore human touch in an uninhibited and non-sexual way and allows him to grow up feeling at ease with his own body.

Although a worry for some parents, sleeping babies are oblivious to their parents' lovemaking. There is no need for babies to put a stop to sexual relations; after all, just look at advocate of cosleeping, Dr. William Sears -- he has eight children! It is vital to talk about any ambivalent feelings with your partner.

Every Family Is Different

Some authorities have recently been advising parents that, whatever the circumstances, placing baby to sleep in a crib by the bed is safer than bedsharing. Such "one-size-fits-all" advice does not take into account important differences between families, in particular whether a baby is exclusively breastfed. What may be safer for one family may not be safer (or even possible) for another. Each family needs information to help them choose the best and safest sleep option for them.

These warnings, along with pressure from family and friends, may cause some parents to stop sharing sleep with their babies. If you're considering taking baby out of the family bed for whatever reason, remember that babies have a biological need to be in close physical contact with their mothers for much of the time (Hrdy 1999), so some babies may become distressed if this need is denied at night.

Mothers often find it difficult to stop themselves falling asleep while breastfeeding. The hormonal effects of suckling a baby can cause a mother to doze off even if she isn't lying down in bed at the time! It is better that parents take steps to increase the safety of bedsharing than chance falling asleep in more risky places (such as on the couch).

It is possible that in an attempt to follow recommendations against bedsharing, a mother may experience such difficulties at night that she decides to give up breastfeeding, with serious health implications for herself and her baby.

Infant sleep researchers, including Dr. Helen Ball of The University of Durham Parent-Infant Sleep Lab (UK) and Dr. James McKenna of the Mother-Baby Behavioral Sleep Laboratory of Notre Dame University, have questioned these warnings not to bed share (Wailoo et al. 2004; McKenna and McDade 2005; McKenna 2003). Their research shows that when parents share sleep safely with their infants, babies thrive.

Protective Effects

While no sleeping environment can be entirely risk free, studies by Dr. Ball have found that mothers who sleep with their breastfed babies in bed adopt a protective position that makes over-laying difficult, and smothering by pillows or bedding unlikely (Ball 2006). She also observes that babies "demonstrably do not overheat in this situation" and that they breastfeed more successfully and for longer, which has significant health benefits for mother and child (Wailoo et al. 2004).

Dr. McKenna suggests that as fast acting bacteria, colds, and flu viruses can increase a baby's susceptibility to Sudden Infant Death Syndrome (SIDS), and as breastfeeding helps protect babies against such illnesses, caution should be exercised before discouraging practices such as bedsharing, which are known to increase the intensity and duration of breastfeeding.

Dr McKenna's research has shown that babies who sleep close to a "committed, adult care-giver" have half the chance of dying from SIDS, compared to those infants who sleep in a room alone, or even in a room with other children. This closeness may take the form of a crib by the bed, or bedsharing with mother. Dr McKenna points out that while we cannot say that bedsharing of itself protects infants against SIDS, where an exclusively breastfeeding mother takes careful precaution against known risks, it is quite possible for her to make bedsharing a safe and beneficial experience (McKenna and McDade 2005).

Sharing sleep with your baby when he is unwell helps you to care for him more easily. You can tell straight away whether his temperature is soaring or whether he is shivering. Babies commonly want to stay attached to the breast for long periods when they are feeling poorly, and it is more restful for mom, dad, and baby to sleep in the same bed.

The instinct to keep baby close at night is powerful. Michel Odent points out that cosleeping is often the last practice to be abandoned by non-Western people. Some cultures that have started to adopt the Western practice of placing infants alone in cribs to sleep and enforcing sleep training programs are now experiencing SIDS for the first time.

Touch Is Important

Touching, cuddling, skin-to-skin contact, and falling asleep together are comforting to both mother and baby.

Tactile stimulation is greatly increased when a mother sleeps next to her baby. In early postnatal life, Allan N. Schore, a leading researcher in the field of neuropsychology, writes: "Maintenance of critical levels of tactile input of specific quality and emotional content is important for normal brain maturation" (Schore 2001).

Modern baby care is often lacking in physical contact. Babies are placed in seats, prams, and cribs. Yet, for the newborn, human touch may be "the only stabilizing force in a world that is at once foreign and frightening" (Jackson 2003). Studies have shown that when babies are deprived of physical contact, they are more likely to grow into aggressive adults. Dr. William Sears suspects that babies thrive better when sleeping with their parents:

How much of the growth that results [from taking the baby to bed to nurse] is due to extra nourishment and how much is due to extra touching is difficult to determine.

Pacifiers?

The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome in 2005 recommended that infants older than one month be put to sleep while sucking a pacifier. According to one of the members of the Task Force, pacifier usage at the beginning of every sleep period triggers some unknown physiological mechanism that seems to promote a lower arousal threshold in the infant. It may also promote a more open airway through the forward position of the tongue. It is possible that a baby falling asleep with a "dummy" mimics babies falling asleep at the breast (Blair and Fleming 2006; Fleming et al. 1999).

The Task Force recognizes the value of non-nutritive sucking, but states that such sucking on a pacifier does not significantly impact the breastfeeding relationship or the mother's milk supply, which is not in fact the case. Human milk production works on a supply and demand basis. The recommended pacifier usage could cause a reduction in milk supply due to reduced stimulation of the breasts and may affect breastfeeding duration. The Task Force acknowledges that pacifier usage increases the baby's risk of developing ear, gastrointestinal, and oral Candida (thrush) infections, all of which pose threats to the baby's health (AAP Task Force on SIDS 2005).

Current recommendations for pacifier/dummy use at sleep time are that one should:

  • Not be used to replace breastfeeding.
  • Not be replaced after a baby falls asleep.
  • Not be given to a baby who doesn't want it.

It would seem from these recommendations, that a baby who breastfeeds to sleep is unlikely to want or need a dummy (Hauck et al. 2005).

Moving Out and On

When my last baby moves into her own bed, I'll miss her little warm body and those cozy nighttime cuddles. I did fret that we'd have difficulty getting my first son to move into his own bed, but I needn't have worried. The transition was an easy one and made without tears. He assumed his independence to sleep alone once he was ready for it, and I remember how thrilled he was choosing dinosaur print bedding for his own bed. My second son took a longer period of transition, which involved my sleeping with his baby sister on a mattress in his room so he could climb in if he needed company in the night. This only lasted for a brief period. I think my partner, Simon, thought I was being a little indulgent at the time, but he has since agreed that the arrangement worked well.

Peace and privacy are, believe it or not, important to children, too. But one vital quality of privacy is that we take it when we choose, otherwise it's called loneliness (Jackson 2003).

None of my children has suffered from nighttime terrors and it's only when they are unwell or excited on Christmas night that they ever disturb us at night now. Cosleeping has been right for my family.

La Leche League doesn't prescribe cosleeping with baby as the correct way to parent at night -- the only correct way is the one that each individual family discovers for itself. Sweet dreams!

References

AAP Task Force on SIDS. The Changing Concepts of Sudden Infant Death Syndrome. Pediatrics 2005; 116(5):1245-55.
Ball, H.L. Parent-infant bed-sharing behaviour: Effects of feeding type, and presence of father. Human Nature 2006; 17(3):301-318.
Blair, P.S. and Fleming, P.J. Dummies and SIDS: Causality has not been established. BMJ 2006; 332:178.
Fleming, P.J. et al. Pacifier use and sudden infant death syndrome: Results from the CESDI/SUDI case control study. Arch Dis Child 1999; 81:112-6.
Hauck, F.R. et al. Do pacifiers reduce the risk of sudden infant death syndrome? A meta-analysis­­. Pediatrics 2005 Nov; 116(5):e716-23.
Hrdy, S.B. Mother Nature: A History of Mothers, Infants and Natural Selection. New York: Ballantine Books, 1999.
Jackson, D. Three In A Bed: The Benefits of Sleeping with Your Baby. London, England: Bloomsbury, 2003; 35, 257.
McKenna, J. Mother-infant co-sleeping with breastfeeding: Adaptive behaviors worth fighting for. Breastfeeding Abstracts 2003 Nov; 3-4.
McKenna, J., McDade, T. Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev 2005 Jun; 6(2):134-52.
McKenna, J. Rethinking "healthy" infant sleep. Breastfeeding Abstracts 1993 Feb; 12(3).
Schore, A. The effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal 2001; 22:7-66.
Sears, W. Nighttime Parenting. Schaumburg, IL: LLLI, 1999.
Stuart-Macadam, P., Dettwyler, K. Breastfeeding: Biocultural Perspectives. Hawthorne, New York: Aldine de Gruyter, 1995; 129.
Wailoo, M., Ball, H.L., et al. Infants bed-sharing with mothers: Helpful, harmful or don't we know? Archives of Diseases in Childhood 2004; 89:1082-1083.
Womanly Art of Breastfeeding, Seventh revised edition. Schaumburg, IL: LLLI, 2004.

Helpful Web Sites:

La Leche League International
www.llli.org
Dr. James McKenna's Web site
www.nd.edu/~jmckenn1/lab/
Attachment Parenting
www.attachmentparenting.org/cosleepindex.shtml
Georgia Sudden Infant Death Information, Support, and Referral Project
www.sidsga.org
Durham University Parent-Infant Sleep Lab
www.dur.ac.uk/sleep.lab
The Natural Child Project
www.naturalchild.org/articles/sleeping.html

Informed Choices

La Leche League has shared practical tips on nighttime parenting of breastfed infants (including bedsharing) for nearly 50 years, basing its information on the day-to-day experiences of families from around the world and incorporating research-based knowledge.

It is important that mothers are informed about the benefits as well as the possible risks associated with different sleeping places for their babies, in the context of their own family's circumstances. They can then do what parents have always done -- evaluate the risks and benefits, and make the choices for themselves.

The object is easy breastfeeding, safe sleeping, and a good night's rest for everyone -- wherever baby sleeps.

Sleep Safely and Comfortably

As stated in THE WOMANLY ART OF BREASTFEEDING, "Once you can feed the baby while comfortably stretched out, you've eliminated much of the work of mothering for eight of the 24 hours in a day."

Sleep Safety Tips for Parents of Breastfed Babies

Do:

  • Place your baby to sleep on his back.
  • Avoid exposing your baby to cigarette smoke as this increases the risk of SIDS.
  • Keep your sleeping baby close, not in a room alone.
  • Sleep facing your baby in bed (your thigh should prevent him slipping under the covers).
  • Place your baby with his feet to the foot of any crib or pram.
  • Check your baby's sleeping area for hazards.
  • Choose a mattress that is firm, flat, well-fitting, and clean, and cover with a close fitting sheet.
  • Check for gaps he might get trapped in.
  • Ensure he can't fall out.
  • Choose nightclothes without strings or ties that might strangle.
  • Keep covers and pillows away from your baby's head and face.
  • Keep an adult between any older children and your baby in bed.
  • Make sure your baby does not get too hot or too cold while sleeping.
  • Keep pets out of your baby's sleeping place.

Don't leave your sleeping baby:

  • Near a fire or radiator, or in full sun.
  • Wearing warm outdoor clothing when indoors.

Don't sleep with your baby:

  • On a couch or armchair.
  • If any person in the bed has drunk alcohol, taken drugs (legal or illegal) that could make them extra sleepy, or is too exhausted to be aware of your baby.
  • If any person in the bed is a smoker (even if they never smoke in bed).
  • If any person in the bed has an illness or condition that affects their awareness of your baby.

Tips For Easy Nights with Breastfed Babies

Many mothers have found that being inventive with their sleeping arrangements can help make nights easier with a baby. Some of these ideas might make nights easier for you, too, but only you know your own circumstances. Always keep safety in mind.

Extra space can help. Try:

  • Pushing your baby's crib right up to your bed. Lower the side and raise the base for easy access at night (tie the crib to your bed if you can).
  • Using a crib designed for cosleeping.
  • Using a king-size bed.
  • Making your bed bigger: put a single at the side for Dad to sleep on, but keep your baby away from the gap in the mattresses.
  • Nursing on a mattress on the floor.

Avoid tumbles by:

  • Putting a guard rail at the side of the bed.
  • Taking the legs off the bed or putting mattresses on the floor (air them each day to avoid condensation).

Keep comfortable by:

  • Having separate bedding for each sleeper, but make sure your baby doesn't get covered by everyone else's bedding as well as their own.
  • Dressing your baby in light nightclothes to avoid overheating.
  • Putting an extra thick nappy on your baby to avoid unnecessary changes in the night.
  • Keeping a towel handy in case of damp nappies or leaking milk.

Learn to feed lying down by:

  • Practicing in the daytime.
  • Keeping a low light on.
  • Going to La Leche League meetings and learning from other mothers.

The above safety tips apply to healthy full-term breastfed infants. If your baby seems unwell, seek medical advice promptly.

Remember that safety tips can help reduce the risk of SIDS and accidents, but cannot eliminate the risk altogether.

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