Sleep Like A Baby? What Does That Really Mean? James J. McKenna Ph.D. Edmund P Joyce CSE Chair in Anthropology Director, Mother-Baby Behavioral Sleep Laboratory University of Notre Dame 2003
Babyhood …….by Paul Reiser “ Getting your child to sleep becomes a blinding obsession. I myself would often loose sight of the larger picture.What is the actual goal here? Constant sleep? No awake time? Zero consciousness? I mean, we must accept that at some point babies have to be awake.They did not come to the planet just to sleep. Are we determined to get them asleep just so we can get a taste of what life was like before we had a kid? Because, if we are, then why did we have a kid? Just to lie there to look soft and fuzzy? We could have gotten, say, just a peach. A St Bernard? A narcoleptic houseguest? Or why not just a chenille bathrobe? Chenille bathrobes are fuzzy and just lie there”?
Re-doing American Concepts of “Healthy” “Normal” Infant Sleep <ul><li>Infants rarely have sleep problems, parents do..! </li></ul><ul><li>American parents suffer from a variety of damaging diseases not the least of which is.. the disease of false and unrealistic expectations concerning their infant’s sleep patterns; </li></ul><ul><ul><ul><li>the disease of confusing their own needs with that of their infants “best”needs..; </li></ul></ul></ul><ul><ul><ul><li>the “die”model of sleep--the only good sleep is an uninterrupted one; </li></ul></ul></ul><ul><ul><ul><li>that infant sleep behavior correlates with good moral character, and general future social skills and competencies… </li></ul></ul></ul><ul><ul><ul><li>That infants and parents are adversaries as regards getting sleep </li></ul></ul></ul>
<ul><li>devoid of the “relational” familial factors (where baby sleeps and feeds as regards parental emotions and goals;) </li></ul><ul><li>devoid of intrinsic (infant) factors (temperament, personality , sensitivities); </li></ul><ul><li>categorizes infant’s in ability to follow cultural model as…”disease”, sleep disorder, immaturity, and, thus, infant becomes a “patient”; </li></ul><ul><li>promotes one- size- should- fit- all; </li></ul><ul><li>promotes one sleeping arrangement as a moral issue and gives it a specific set of inappropriate meanings; </li></ul>The western medicalized model of infant sleep fails miserably!
Infant Care Is A”Moral Good” benefits, risks, what’s safe what “problems” are worth and not worth solving ..depends on…. P E R S P E C T I V E
Historical Forces Effected Western Infancy and How We Think About Infant Development <ul><li>rise of child care experts replace maternal confidence </li></ul><ul><li>emphasis on technology, rather than on bodies to nurture; </li></ul><ul><li>emphasis on “average expectable outcomes” per any given behavioral parenting strategy..one-size-should- fit all; </li></ul><ul><li>emphasis on social values and ideologies (not biology) to guide research and conclusions..medical care of infants; </li></ul><ul><li>social constructions of infancy, not /biological evolutionary; </li></ul><ul><li>“ Science” of infant 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 </li></ul>
In pediatric sleep medicine and research into sleeping arrangements…. Does social ideology masquerade as science?
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 SHAPLINESS OF HIS LITTLE BODY. THE NEWBORN INFANT SHOULD SPEND THE GREATER PRORTION 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”
“… 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” R. FERBER (1886,1999) SOLVE YOUR CHILD’S SLEEP PROBLEMS
BENJAMIN SPOCK: SPEAKING TO MOTHERS IN: BABY CARE (THE UNDERMINING OF MATERNAL CONFIDENCE AND KNOWLEDGE) “ YOU KNOW MORE THAN YOU THINK YOU DO…. DON’T BE AFRIAD 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 (MALE) DOCTOR GIVES YOU! CITED BY TINA THENEVIN,1993, MOTHERING AND FATHERING
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)
Cultural Scientific Public Health Family Interacting factors--all important--determine and influence where and how, or if, and to what degree any given baby “co-sleeps” Where babies sleep is determined by Infant and Parental Biology (infant temperament, too)
Consider the ideological salience (embedded cultural assumptions) of this recommendation put forth by the American Academy of Pediatrics … “ Never let a baby fall asleep at the breast” (the very context within which the human infant’s “falling asleep” evolved! (AAP Guide To Infant sleep 1999)
Infant-parent co-sleeping, especially with nighttime breast feeding is … <ul><li>inherently safe, protective and beneficial….meaning it is biologically, socially and psychologically appropriate… </li></ul><ul><li>it is how and with whom it is practiced that determines how or if it is made dangerous and/or risky.. </li></ul><ul><li>Yes, it can be MADE dangerous, but it is not inherently so… </li></ul>
Why Do Babies Co-sleep? because they are supposed to…!
Why Do Parents Co-sleep With Their Infants and Children? <ul><li>To protect them; </li></ul><ul><li>To monitor them; </li></ul><ul><li>For ease of feeding; </li></ul><ul><li>Because infants stop crying; </li></ul><ul><li>Because parents can get more sleep; </li></ul><ul><li>Because there is no where else to put them (sometimes); </li></ul><ul><li>Because many parents cannot be with their babies during the day, due to work..nighttime constitutes their “nurturing time”; </li></ul><ul><li>To “attach” more closely, to enjoy them; </li></ul>
What Is Co-sleeping? “ When my two lovely daughters are sleeping at the same time” Robert Hahn, Ph.D. ( Center for Disease Control )
Arousals Stage 1-2 (light) sleep Stage 3-4 (deep) sleep Breast Feeding Crying Non-breast feeding interventions Sensitivity to mother Sleep duration Routinely bedsharing/breast feeding infants (findings published in refereed articles)
Diversity of Co-sleeping ( requires taxonomic distinctions) Co-bedding twins (within sensory range) partial, mixed bedsharing with Dad
Parent -infant co-sleeping is biologically and psychologically expectable, if not inevitable.
if... sleeping alone through the night is “good” for babies then “good” babies sleep alone, don’t they?
If solitary infant sleep is needed for “good adult sleep hygiene” as all western sleep training advocates like Ferber maintain.. Why are western adults (the Spock generation) and especially Americans the most “sleep deprived” people in the world with 60-70 percent adults claiming to be sleep deprived (tired), according to the 2001 National Sleep Foundation ? Can’t have it both ways….can you?
Scientific studies of the long- term effects of elected (non- reactive) co-sleeping (refereed articles) <ul><li>Co-sleeping children under-represented in psychiatric populations, compared with solitary sleepers living on a Military Base (Forbes, Weiss and Folen 1992); </li></ul><ul><li>Increased comfort with sexual identity (Crawford 1994); </li></ul><ul><li>More independent (than solitary sleeping toddlers) and increased control of emotions and stress..(teacher and parent reports, Heron 1994); </li></ul><ul><li>Mosenkis (1998) 1411 adult subjects, exhibited varied findings including, across five ethnic groups, that co-sleepers expressed a “greater satisfaction with life”; </li></ul><ul><li>Higher self-esteem (males), more comfortable with affection (women) (Lewis and Janda,1988). </li></ul><ul><li>Goldberg et al. in press, routinely co-sleeping children exhibit more independent task initiation and problem solving, and better able to be alone compared with solitary sleeping children; </li></ul><ul><li>Okami and Weissner et al (2002) 20 year study of alternative life style families.co-sleeping as children had positive and benign effects.. </li></ul>
Short Term Benefits of Co-sleeping (Mothers) (Infants) <ul><li>More sleep (in minutes) and increased nightly satisfaction; </li></ul><ul><li>Increased sensitization to infant’s physiological-social status; </li></ul><ul><li>Increased comfort with and ability to interpret behavioral cues of infant; </li></ul><ul><li>Increased sucking behavior of infant maintains milk supply and; </li></ul><ul><li>Increased prolactin levels lead to longer birth interval (WHO); </li></ul><ul><li>Increased ability to monitor and physically manage and respond to infant needs; </li></ul><ul><li>More time with baby for working parents; </li></ul><ul><li>Increased breast feeding (total minutes and number of nightly sessions); </li></ul><ul><li>Increased infant sleep duration; </li></ul><ul><li>Less crying time; </li></ul><ul><li>Increased sensitivity to mother’s communication; </li></ul><ul><li>More light (Stage 1-2) sleep,less deep sleep (Stage 3-4) appropriate for age; </li></ul><ul><li>Increased ability to read maternal behavioral cues; </li></ul><ul><li>References: McKenna et al 1997, Mosko et al 1996a, 1996b, 1997 Richard et al 1996 </li></ul>
Ahhh… The question of promoting infant “independence” (three questions) <ul><li>what exactly is “independence for a 2-3 month old infant? </li></ul><ul><li>does it really correlate with solitary infant sleep practices? </li></ul><ul><li>is “independence of children” what parents really want ? </li></ul>
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) <ul><li>“ ..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” </li></ul>
“ 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”….Jeremy Holmes When dependence IS autonomy
… .the psychopath… 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 and AS good mental health * The Value of Psychotherapy (1991) J.Holmes and R.Lindley. Oxford University Press
<ul><li>When an infant dies sleeping prone in a crib, the contributing cause of death is not assumed to be the crib, but sleeping prone; </li></ul><ul><li>When an infant dies sleeping prone in an adult bed, even when the infant died alone, the contributing cause of death is said to be “bedsharing” </li></ul>How scientific bias works:
Infant Sleep and Infant Sleeping Arrangements It’s Only History, It’s Only Prehistory?