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“ Normal Sleep? Mother And Baby Together For Better” Part II.  Reducing SIDS:  Why We Never Ask Is it Safe For Infants To ...
Babyhood …….by Paul Reiser “ Getting your child to sleep becomes a blinding obsession. I myself would often loose sight of...
 
Until recent, western historic periods, no human parents ever asked: Where will my baby sleep, how will I lay my baby down...
“ 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...
For the human infant the three functionally inter-related (adaptive) components of normal, healthy infant sleep include: <...
The cultural dismantling of this biological system led to the deaths of thousands of western infants from, SIDS, accidenta...
Cultural   Scientific Public Health  Family Interacting factors-- ( most and least relevant ?) From: Sally Baddock (New Ze...
<ul><li>devoid of the “relational” familial factors (where baby sleeps and feeds as regards parental emotions and goals;) ...
Historical Forces Effected Western Infancy and How We Think About Infant Development <ul><li>rise of child care experts re...
 
How Do Babies Sleep? Anyway They Want! Where Do Babies Sleep? Anywhere They Want! But seriously… The question about  how  ...
Western  pediatric sleep medicine is limited and constrained by the fact that  …. uniquely  western folk traditions and so...
“ Scientific” History of Pediatric  Sleep Studies? become one and the same with the original forces that produced them..(s...
Culture Producing Science Producing Culture:   How A Folk Myth Achieved Scientific Validation   “ Scientific” validation o...
Infant Care Is A “Moral Good” benefits, risks,  what’s safe what SAFETY “problems” are worth and not worth solving ..depen...
if... sleeping alone through the night  is  “good” for babies then “good” babies sleep alone, don’t they?
 
Changing perceptions….of what’s good for baby… “THE CONSTANT HANDLING OF AN INFANT IS NOT GOOD FOR HIM. THE LESS HE IS LIF...
CHANGING PERCEPTIONS OF WHAT INFANTS NEED...  THE MOTHERHOOD BOOK (1935) “ BABIES SHOULD BE TRAINED FROM THEIR EARLIEST DA...
“… SLEEPING IN YOUR BED CAN MAKE an infant confused and anxious rather than relaxed and reassured. Even a toddler may find...
BENJAMIN SPOCK: SPEAKING TO MOTHERS IN:  BABY CARE (THE UNDERMINING OF MATERNAL CONFIDENCE AND KNOWLEDGE)   “ YOU KNOW MOR...
ON RESPONDING TO INFANT CRIES... “ A RAPID AND SYMPATHETIC RESPONSE TO OUR BABIES CRIES IS THE FOUNDATION OF STRONG FAMILY...
 
 
 
If solitary infant sleep is needed for “good adult sleep hygiene” as all western sleep training advocates like Ferber main...
Ahhh… The question of promoting infant “independence” (three questions) <ul><li>what  exactly  is “independence for  a 2-3...
But, is “independence” really best in the long run.. that is, is “independence” from parental intervention at  13 or 14 ye...
According to Daniel Stern (1985) <ul><li>“ ..the emotionally disturbed patient is one whose early experiences lacked attun...
“ Autonomy in the sense of psychotherapy, implies taking control of one’s life…emotional autonomy does not mean isolation ...
… .the psychopath… is unaware of the feelings of others. The emotionally autonomous individual does not suppress her feeli...
Short Term Benefits of Co-sleeping (Mothers)  (Infants)   <ul><li>More sleep (in minutes) and increased nightly satisfacti...
Scientific studies of the long- term effects of  elected (non- reactive)  co-sleeping (refereed articles)  <ul><li>Co-slee...
Re-doing American Concepts of “Healthy” “Normal” Infant Sleep <ul><li>Infants rarely have sleep problems, parents do..! </...
Infant Sleep and Infant Sleeping Arrangements It’s Only History, It’s Only Prehistory? It’s Only Biology!
Infant Sleep, Sleeping Arrangements,  And Feeding Issues Whether Related To SIDS or Not..  Why So Controversial In Western...
cultural influences on infant touching <ul><li>“  In the western world it is perhaps a great advantage for an infant to ha...
Some ideas….culturally favored  child care practices change independent of,  and much faster than,  infant biology…. (ideo...
Jill Porter   City wakes up to infant co-sleeping danger  2 MORE DEATHS TRIGGER ACTION  “ N OW  THEY GET IT” .  “City offi...
 
Part II:   Is It Safe For Babies To Sleep Alone? Why the answer is an unequivical NO! But, then the question is..how to co...
American Academy of Pediatrics Revised SIDS Guidelines 2005 Key changes.. infants should sleep proximate to mother i.e. sh...
“ Dave’s” Top  Eleven  List: What Every Health Professional Should Know <ul><li>Cosleeping is normative human behavior, it...
The co-sleeping debate: two faces, two “truths” in one.. do you see them.. ( a young and and old woman, in one face?)
 
 
At the population level “outcomes” are not explained by “practice”   (Black Box) who? what? why?  What kind of relationshi...
 
 
risks of infants sleeping alone <ul><li>“ Lack of supervision at the time of fatal asphyxiation   was a feature of all of ...
Enter… human   biology… <ul><li>The human “obstetrical dilemma”; </li></ul><ul><li>Human Fetal Head Size Exceeds Outlet Di...
“ For species such as primates, the mother  IS  the environment.” Sarah Blaffer Hrdy,  Mother Nature  (1999) Babies Celebr...
Percentage of Adult Brain Size: Chimpanzee Infant  Human Infant At Birth 3 months 6 9 1 year 2 4 8-9  45 50 60 65 70 75 85...
Biology of Mother’s Milk Predicts Mothering Behavior <ul><li>Feed and Leave   Species </li></ul><ul><ul><li>(Ungulates) </...
Consider the physical intimacy of the maternal-infant relationship … socially and medically obscured by western culture Ba...
http://www.bfnews.blogspot.com/  (2004) is this what we mean when we say….. “ a good taste in art” ?
 
Breathing mechanical Teddy Bear! (reduces infant  apneas by 60%) (Evelyn Thoman 1985)
 
Maternal behavior among primates extends throughout an extremely long infant and juvenile period, with prolonged periods o...
1.Dis-articulated from mother… No touch; No smells; No  sounds No  movement; No body  heat’ No breadth  exchange
 
 
 
All-night sleep-wake histograms for five (A-E) cosleeping pairs.  Mosko, McKenna et al (1993).  Journal of Behavioral Medi...
Body- Facial Orientations Amongst  24 Solitary Sleeping  and Bedsharing Mothers and Infants Research funded by National In...
<ul><li>Figure  Synchronous breathing pauses of cosleeping mother-infant pairs. </li></ul><ul><li>McKenna, JJ and Mosko, S...
Mean Frequencies of Breast Feeding Episodes and Mean Total Nightly Breast Feeding Durations Amongst Routinely Bedsharing a...
 
 
Hidden regulatory mechanisms..  calming a baby by  “shhhhh..ing” A universal practice!   <ul><li>prenatal sensory experien...
is the human mother’s sleeping body an inherent lethal weapon against which she and her infant need to be protected…?
 
 
 
Carpenter et.al…2004…Lancet breast feeding remained undistinguished  in the sample, as  was type of bedsharing “ ...  Abou...
 
<ul><li>When an infant dies sleeping prone in a crib, the contributing cause of death is not assumed to be the crib, but s...
 
take…for example, the article by Person et al 2002..take a look at how the numbers are presented, interpreted..and the con...
“ These findings support recent studies that suggest that co-sleeping or placing an infant in an adult bed is a potentiall...
 
 
Alaska SIDS/  Pediatrics  Gessner et al. 2000:108:923-927 <ul><li>“ Recently, researchers using the Consumer Product Safet...
“ Association Between Sudden Infant death Syndrome, Prone Sleep Position, Bedsharing, and Sleeping Outside of An Infant Cr...
 
 
 
At long last! The Consumer  Product Safety  Commission is finally happy! Co-sleeping finally works!
 
Under The Cover Of Darkness:   Behavioral And Physiological Studies Of Bedsharing and Solitary Sleeping Mother-Infant Pair...
 
 
 
What Is Co-sleeping? “ When my two lovely daughters are sleeping at the same time”  Robert Hahn, Ph.D. ( Center for Diseas...
 
WHY Co-sleep? to retrieve babies quickly Because of earthquakes Because of household fires Because some parents are blind ...
 
The origin of supine infant sleep is traced to its role in facilitating nighttime breastfeeding in the context of mother-i...
 
 
 
Why Is Breast Feeding So Important to the Bedsharing Issue? <ul><li>Mother-infant co-sleeping with breast feeding is an in...
Helen Ball: Great Britain University of Durham Studies <ul><li>253 families, North Tees, United Kingdom; </li></ul><ul><li...
H.L. Ball (2003) Breastfeeding, Bed-Sharing, and Infant Sleep. BIRTH 30:3
Diversity of Co-sleeping ( requires taxonomic distinctions) Co-bedding twins (within sensory range) partial, mixed bedshar...
Parent -infant co-sleeping is biologically and psychologically expectable, if not inevitable.
Face-to-Face: Maternal Contribution to Infant CO 2  Environment   <ul><li>1) 12 RB mother-infants on bedsharing night (BN)...
USA National Percentages of Full or Part-Time Bedsharing Mothers <ul><li>Willinger et al. 2003…as high as 50% (part of nig...
Percent Parents Who Bedshare (USA)  Source: National Center   For Health Statistics 1999 <ul><li>Almost Always...  Sometim...
Evidence -Based Science:  Infants sleeping alone in a room by themselves are at least twice as likely to die from SIDS tha...
Race Matters In All Areas Of Infant Mortality <ul><li>“ Breastfed infants are 80% less likely to die before age 1 year tha...
Forste et al. 2001 “ Analysis of infant mortality indicated that breast feeding accounts for race difference in infant mor...
Why Do Babies Co-sleep?   because they are supposed to…!
 
“ Never let a baby fall asleep at the breast” ? the very context within which the infant’s “falling asleep” evolved Amer A...
Multi-facetted Discourse on Bedsharing: Who (else) And What (else) Must Be Considered? <ul><li>Physiological (biological) ...
Evidence -Based Science:  Infants sleeping alone in a room by themselves are at least twice as likely to die from SIDS tha...
University of Notre Dame Mother-Baby Behavioral Sleep Laboratory (morning wake up) first time mothers, teen moms… Research...
Mother-Baby Behavioral Sleep Laboratory University of Notre Dame
Mother-Baby Behavioral Sleep Laboratory lounge lounge baby’s room parent’s room
Variations of Safe/Unsafe Sleep Practices Infra-red Video Studies: Crib-Solitary and Bedsharing ( HD 39456-01 ) Examples: ...
Distribution of  Number of Feeds Received by  Infants Per Group Per Night   RB-SN RB-BN RS-SN RS-BN
 
“ Breast Feeding and the Risk of Post-neonatal Death In the United States” <ul><li>Studied 1204 infants who died between 2...
The origin of supine infant sleep is traced to its role in facilitating nighttime breastfeeding in the context of mother-i...
Co-Sleeping with breast feeding promotes the safer supine infant sleep position Richard et. al 1996,  Sleep
Mother and Infant Bedsharing Orientation on BN (in min) From: Richard et al., Sleep   19 (9) 1996  ( F ace  E ach  O ther)
Number of Maternal Arousals With Temporal Overlap *note sensitivity of routine bedsharing mother waking to infant  arousal...
Mean Duration of Stage 3-4 Sleep: Why Important ?   <ul><li>Schechtman et al. report that, at 3-4 months of age, siblings ...
Fighting Against Scientific Distortions of the Bedsharing Issue Contributions by: Peter Fleming James McKenna Helen Ball B...
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  • An astonishing 75% of human brain growth (more than any other mammal) occurs post-natally. As a consequence of its immaturity the human infant is forced to rely on external regulation and support, especially in the first year of life (see Galef, 1981; Rosenbloom and Schwartz 1984; and McKenna, 1986 for further discussions). The extent to which, on a minute-to-minute basis, the infant&apos;s most fundamental physiology such as heart rate, body temperature, breathing, EEG patterns, can, and likely are, influenced by the caregiver may be the most difficult and challenging concept for sleep and SIDS researchers to accept. Yet, the human infant is the least neurologically mature mammal at birth. It experiences the longest delays in both social and biological maturation (Lancaster and Lancaster 1982)--a fact not likely to be appreciated without a comparative analysis of mammalian evolution and development, and known physiological effects of short-term separation from a caregiver, as briefly described below.
  • Transcript of "Florida 2005"

    1. 1. “ Normal Sleep? Mother And Baby Together For Better” Part II. Reducing SIDS: Why We Never Ask Is it Safe For Infants To Sleep Alone James J. McKenna Ph.D. Edmund P. Joyce CSC Chair in Anthropology Director, Mother-Baby Behavioral Sleep Laboratory University of Notre Dame Cultural History Masquerading As Science….
    2. 2. 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”?
    3. 4. 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!
    4. 5. “ 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 Josh Billings
    5. 6. For the human infant the three functionally inter-related (adaptive) components of normal, healthy infant sleep include: <ul><li>Sleep location </li></ul><ul><ul><li>(next to mother for social or co-sleeping behavior involving on-going sensory exchanges, monitoring and mutual regulation) </li></ul></ul><ul><li>Nighttime feeding </li></ul><ul><ul><li>exclusive breast feeding </li></ul></ul><ul><li>Sleep position </li></ul><ul><ul><li>Back (supine) </li></ul></ul>
    6. 7. The cultural 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
    7. 8. 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) Determinants of infant sleep location Infant and Parental Biology Including Feeding Method most relevant least relevant including economic status
    8. 9. <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!
    9. 10. 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 (bottle-formula feeding) and sleep pediatrics became one and the same with… </li></ul><ul><li>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, touch =sex? </li></ul>
    10. 12. How Do Babies Sleep? Anyway They Want! Where Do Babies Sleep? Anywhere They Want! But seriously… The question about how babies sleep is intimately connected to where babies sleep…
    11. 13. Western pediatric sleep medicine is limited and constrained by the fact that …. uniquely western folk traditions and social ideology masquerade as science
    12. 14. “ Scientific” History of Pediatric Sleep Studies? become one and the same with the original forces that produced them..(science and history are mutually reinforcing).. Yet, the ideology on which they are based (separation and individualism) conflict with human infant and parental biology!
    13. 15. Culture Producing Science Producing Culture: How A Folk Myth 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
    14. 16. Infant Care Is A “Moral Good” benefits, risks, what’s safe what SAFETY “problems” are worth and not worth solving ..depends on…. P E R S P E C T I V E
    15. 17. if... sleeping alone through the night is “good” for babies then “good” babies sleep alone, don’t they?
    16. 19. 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
    17. 20. 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”
    18. 21. “… 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” really? R. FERBER (1886,1999) SOLVE YOUR CHILD’S SLEEP PROBLEMS
    19. 22. 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
    20. 23. 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)
    21. 27. 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?
    22. 28. 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>
    23. 29. 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?
    24. 30. 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>
    25. 31. “ 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 any cost 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
    26. 32. … .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
    27. 33. 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>
    28. 34. 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>
    29. 35. 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>
    30. 36. Infant Sleep and Infant Sleeping Arrangements It’s Only History, It’s Only Prehistory? It’s Only Biology!
    31. 37. Infant Sleep, Sleeping Arrangements, And Feeding Issues Whether Related To SIDS or Not.. Why So Controversial In Western Society?
    32. 38. cultural influences on infant touching <ul><li>“ In the western world it is perhaps a great advantage for an infant to have a sensitive skin or diaper rash or some other dermatological disorder, for then, at least, it can be assured of receiving something resembling an adequate amount of cutaneous stimulation” (Montagu :1986:247) </li></ul>
    33. 39. Some ideas….culturally favored child care practices change independent of, and much faster than, infant biology…. (ideologies or goals that underlie recommendations are often historical in origin, but confused nonetheless for science..)
    34. 40. Jill Porter City wakes up to infant co-sleeping danger 2 MORE DEATHS TRIGGER ACTION “ N OW THEY GET IT” . “City officials called a hasty press conference yesterday to warn the public that sleeping with an infant puts the baby at risk of sudden death. Because, since Saturday, two more babies have died in Philadelphia while sleeping with other people. ….” Philadelphia Daily News 10-06-2004
    35. 42. Part II: Is It Safe For Babies To Sleep Alone? Why the answer is an unequivical NO! But, then the question is..how to cosleep safely….
    36. 43. American Academy of Pediatrics Revised SIDS Guidelines 2005 Key changes.. infants should sleep proximate to mother i.e. should cosleep/roomshare bedsharing should be avoided (is hazardous) infants should be taken out of bed to sleep; avoid side position; use pacifiers during sleep and once breast feeding is established
    37. 44. “ Dave’s” Top Eleven List: What Every Health Professional Should Know <ul><li>Cosleeping is normative human behavior, it is not irresponsible behavior.. </li></ul><ul><li>Sweeping recommendations must resonate emotionally-socially with the constiuencies for whom they are intended; </li></ul><ul><li>Where infants sleep is often unplanned, health brochures are critical; </li></ul><ul><li>Infants encounter more than one sleep location; </li></ul><ul><li>Cosleeping is biologically interdependent with breast feeding; </li></ul><ul><li>6. Difference between act of cosleeping/bedsharing and the conditions within which it occurs; </li></ul><ul><li>7. Cosleeping is not the same health issue as prone sleep; </li></ul><ul><ul><li>no consensus </li></ul></ul><ul><ul><li>It’s natural, biologically appropriate </li></ul></ul><ul><ul><li>it is heterogenous </li></ul></ul><ul><li>8.Parents must remain the final arbiters of their infant needsnot medical authorities.. </li></ul><ul><li>9. Where babies sleep is not ultimately a medical issue at all, but is a relational and economic issue; </li></ul><ul><li>10. No one-size must-fit all strategy will work: there is more than one way to save babies lives; </li></ul><ul><li>11.Cosleeping is not illegal, child abuse or neglect, or immoral behavior; </li></ul>
    38. 45. The co-sleeping debate: two faces, two “truths” in one.. do you see them.. ( a young and and old woman, in one face?)
    39. 48. At the population level “outcomes” are not explained by “practice” (Black Box) who? what? why? What kind of relationship is brought to bed ? How is bedsharing linked to quality of attachment, maternal mental health, motivation, knowledge of adverse risk factors? LEADS TO BENEFITS LEADS TO DEATH (Bedsharing Practices) How linked to family characteristics ?
    40. 51. risks of infants sleeping alone <ul><li>“ Lack of supervision at the time of fatal asphyxiation was a feature of all of the cases where a history was available” </li></ul><ul><li>(R.Byard 1994:499) </li></ul><ul><li>Arch Dis Childhood (1994); 71:497-500 </li></ul>
    41. 52. Enter… human biology… <ul><li>The human “obstetrical dilemma”; </li></ul><ul><li>Human Fetal Head Size Exceeds Outlet Dimensions With Emergence of Bipedalism </li></ul>
    42. 53. “ For species such as primates, the mother IS the environment.” Sarah Blaffer Hrdy, Mother Nature (1999) Babies Celebrated , Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc. Nothing an infant can or cannot do makes sense, except in light of mother’s body
    43. 54. Percentage of Adult Brain Size: Chimpanzee Infant Human Infant At Birth 3 months 6 9 1 year 2 4 8-9 45 50 60 65 70 75 85 100 25 35 45 50 60 70 80 95 *(100% at 14-17 years)
    44. 55. Biology of Mother’s Milk Predicts Mothering Behavior <ul><li>Feed and Leave Species </li></ul><ul><ul><li>(Ungulates) </li></ul></ul><ul><ul><ul><li>High fat </li></ul></ul></ul><ul><ul><ul><li>High protein </li></ul></ul></ul><ul><ul><ul><li>Low carbohydrate </li></ul></ul></ul><ul><li>High calorie = long </li></ul><ul><li>feeding interval; </li></ul><ul><li>(to avoid predators nested infants do defecate or cry in mother’s absence) </li></ul><ul><li>Contact, Co-sleeping, And Carry Species </li></ul><ul><ul><li>(Primates—Humans) </li></ul></ul><ul><ul><ul><li>Low fat </li></ul></ul></ul><ul><ul><ul><li>Low protein </li></ul></ul></ul><ul><ul><ul><li>High carbohydrate </li></ul></ul></ul><ul><li>Low calorie = short feeding interval; </li></ul><ul><li>(carried infants cry in mothers absence and defecate spontaneously) </li></ul>
    45. 56. Consider the physical intimacy of the maternal-infant relationship … socially and medically obscured by western culture Balinese Mother and infant
    46. 57. http://www.bfnews.blogspot.com/ (2004) is this what we mean when we say….. “ a good taste in art” ?
    47. 59. Breathing mechanical Teddy Bear! (reduces infant apneas by 60%) (Evelyn Thoman 1985)
    48. 61. Maternal behavior among primates extends throughout an extremely long infant and juvenile period, with prolonged periods of physical contact. Orang-Utan
    49. 62. 1.Dis-articulated from mother… No touch; No smells; No sounds No movement; No body heat’ No breadth exchange
    50. 66. All-night sleep-wake histograms for five (A-E) cosleeping pairs. Mosko, McKenna et al (1993). Journal of Behavioral Medicine 16 (6). Mom Baby Wake Sleep Mom Mom Baby Mom Baby Mom Baby Baby Wake Sleep
    51. 67. Body- Facial Orientations Amongst 24 Solitary Sleeping and Bedsharing Mothers and Infants Research funded by National Institutes of Child Health and Human Development RO1 27482
    52. 68. <ul><li>Figure Synchronous breathing pauses of cosleeping mother-infant pairs. </li></ul><ul><li>McKenna, JJ and Mosko, S. (1990). Human Nature 1 (3). </li></ul>Baby > Mom >
    53. 69. Mean Frequencies of Breast Feeding Episodes and Mean Total Nightly Breast Feeding Durations Amongst Routinely Bedsharing and Routinely Solitary Sleeping Mother-Infant Dyads
    54. 72. Hidden regulatory mechanisms.. calming a baby by “shhhhh..ing” A universal practice! <ul><li>prenatal sensory experiences--fetus hears rhythmic “ shhoosh--sha ” as blood pulses by infant’s ear every .10 of a second following maternal heart contraction.. </li></ul><ul><ul><li>“ chamosh (Urdu) “ sh uu” (Vietnamese) </li></ul></ul><ul><ul><li>ch utee (Serbian), “ soos ” Armenian </li></ul></ul><ul><ul><li>Hu sh - s ilen ce (English), “ s tille” (German), </li></ul></ul><ul><ul><li>“ hu sh ket” (Arabic),” sh eket (Hebrew) </li></ul></ul><ul><ul><li>“ Shuh-shuh ” Chinese, “too sst ” Swedish </li></ul></ul>(From H.Karp 2002)
    55. 73. is the human mother’s sleeping body an inherent lethal weapon against which she and her infant need to be protected…?
    56. 77. Carpenter et.al…2004…Lancet breast feeding remained undistinguished in the sample, as was type of bedsharing “ ... About 16% percent of cases were attributable to bedsharing and roughly 36% to the baby sleeping in a separate room.
    57. 79. <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:
    58. 81. take…for example, the article by Person et al 2002..take a look at how the numbers are presented, interpreted..and the conclusion reached .. Infants sleeping alone..29/56 deaths Cribs..19 (65% of total) Adult bed… 5 (17% of total) Couch..3 (10.3% of total) Car seat 1, dresser drawer 1 (each 3.4%) Infants co-sleeping..27/56 deaths 48%
    59. 82. “ These findings support recent studies that suggest that co-sleeping or placing an infant in an adult bed is a potentially dangerous practice” T.Person W.Levezzi and B.Wolf 2002 Arch Pathol Lab Med vol 126 Macrh 2002. <ul><li>Of 27 co sleeping deaths… </li></ul><ul><ul><li>14 slept with adults, </li></ul></ul><ul><ul><li>7 of which were intoxicated..bringing unexplained co-sleeping deaths down to 20 </li></ul></ul><ul><li>of these 20-- </li></ul><ul><ul><li>9 babies died while sleeping on a couch (known to be extremely dangerous) bringing total down to 11 co-sleeping deaths … </li></ul></ul><ul><li>of these 11, </li></ul><ul><ul><li>4 babies were sleeping with their twin sibling in cribs..bringing total to 7 </li></ul></ul><ul><li>Of the original undifferentiated “co-sleeping deaths” 7 infants died while sleeping with an adult in a bed..but no “risk factors” or other confounding variables are reportedincluding feeding method, infant sleep position and/or maternal smoking. </li></ul>
    60. 85. Alaska SIDS/ Pediatrics Gessner et al. 2000:108:923-927 <ul><li>“ Recently, researchers using the Consumer Product Safety Commission data--with limited information on some pertinent risk factors, such as parental drug use have recommended against bedsharing. </li></ul><ul><ul><ul><li>“ Our data do not support this recommendation . Almost all SIDS deaths associated with parental bedsharing occurred in conjunction with a history of parental drug use and occurred in association with prone sleep position or sleeping on sleep surfaces such as a a couch or water bed”. </li></ul></ul></ul><ul><li>“ Because of these findings the state of Alaska does not counsel caregivers to avoid bedsharing with their infants. Instead, a simple message consistent with the existing data has been developed: infants should sleep in the supine position and in their or with an unimpaired caregiver on an adult non-water mattress” Gessner et al 2000: 926). </li></ul>
    61. 86. “ Association Between Sudden Infant death Syndrome, Prone Sleep Position, Bedsharing, and Sleeping Outside of An Infant Crib in Alaska” (Gessner et al 2000). <ul><li>Of 60 infants who slept alone 57% had a parent with a documented history of drug use; </li></ul><ul><li>--contrasted with 93% who slept with a parent who had a documented history of drug use; </li></ul><ul><li>In addition, dead infants who slept with a parent in Alaska, had a high percentage of other examined risk factors: 11 slept prone, 9 abnormal physiological attributes, 7 slept on a waterbed, 1slept the floor, 1 in a sleeping bag; </li></ul><ul><li>Of 40 infants who slept with a parent at the time of death, only 1 infant who slept supine with a non-drug using parent was identified; </li></ul><ul><li>While 2 infants (1.7%) died alone in a crib while sleeping supine to non-drug using parents; </li></ul>
    62. 90. At long last! The Consumer Product Safety Commission is finally happy! Co-sleeping finally works!
    63. 92. Under The Cover Of Darkness: Behavioral And Physiological Studies Of Bedsharing and Solitary Sleeping Mother-Infant Pairs (Part III) JMcKenna
    64. 96. What Is Co-sleeping? “ When my two lovely daughters are sleeping at the same time” Robert Hahn, Ph.D. ( Center for Disease Control )
    65. 98. WHY Co-sleep? to retrieve babies quickly Because of earthquakes Because of household fires Because some parents are blind Because some parents are deaf or hearing impaired To protect babies from SIDS..
    66. 100. The origin of supine infant sleep is traced to its role in facilitating nighttime breastfeeding in the context of mother-infant cosleeping breast feeding -> cosleeping -> supine position
    67. 104. Why Is Breast Feeding So Important to the Bedsharing Issue? <ul><li>Mother-infant co-sleeping with breast feeding is an integrated, inherently adaptive system, mutually reinforcing, appropriate, predictable; </li></ul><ul><li>Changes social and biological characteristics of infant and maternal sleep (connectedness-sensitivities) of co-sleeping dyad..different from bottle feeding pairs… </li></ul><ul><li>Functional landscape of bed environment i.e. “outcomes” different from non-breast feeding-bedsharing contexts… </li></ul>
    68. 105. Helen Ball: Great Britain University of Durham Studies <ul><li>253 families, North Tees, United Kingdom; </li></ul><ul><li>65% of breast fed babies slept with parents all or part of night (33% formula fed) ; </li></ul><ul><li>Significantly longer duration of breast feeding amongst low income families who bedshare; </li></ul>
    69. 106. H.L. Ball (2003) Breastfeeding, Bed-Sharing, and Infant Sleep. BIRTH 30:3
    70. 107. Diversity of Co-sleeping ( requires taxonomic distinctions) Co-bedding twins (within sensory range) partial, mixed bedsharing with Dad
    71. 108. Parent -infant co-sleeping is biologically and psychologically expectable, if not inevitable.
    72. 109. Face-to-Face: Maternal Contribution to Infant CO 2 Environment <ul><li>1) 12 RB mother-infants on bedsharing night (BN) spent 64% of their time face-to-face with infant at distances less than 20 cm. 2) concentrations of CO 2 in air were measured in six young women at distances of 3, 9, 18, and 21 cm. Room was .04 % CO2 concentration and 2.36% (3cm) and < 4% (under a blanket). </li></ul><ul><li>Mosko, McKenna et al 1998 </li></ul><ul><ul><li>Amer Jour Phys Anthro </li></ul></ul>Photo :Max Helwig-Aquilar Discover Magazine 1992
    73. 110. USA National Percentages of Full or Part-Time Bedsharing Mothers <ul><li>Willinger et al. 2003…as high as 50% (part of night, sometimes ) </li></ul><ul><ul><li>Since 1990, from 5 to 12.2 % routine bedsharing.. </li></ul></ul><ul><li>McCoy et al.(2000) 22% (always), to 50% (sometimes); </li></ul>
    74. 111. Percent Parents Who Bedshare (USA) Source: National Center For Health Statistics 1999 <ul><li>Almost Always... Sometimes……..Never </li></ul><ul><ul><ul><li>Alaska 38.5 39.1 22.5 </li></ul></ul></ul><ul><ul><ul><li>Alabama 32 38,7 31.4 </li></ul></ul></ul><ul><ul><ul><li>Colorado 14.4 48 37.5 </li></ul></ul></ul><ul><ul><ul><li>Oregon 34.4 41.7 23.4 </li></ul></ul></ul><ul><ul><ul><li>West Va. 20.4 37.1 42.5 </li></ul></ul></ul>
    75. 112. 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 )
    76. 113. Race Matters In All Areas Of Infant Mortality <ul><li>“ Breastfed infants are 80% less likely to die before age 1 year than those who never breast fed, even controlling for low birthweight”; </li></ul><ul><ul><li>For every 100 deaths in the formula-fed group, there were 20 deaths in the breast fed group </li></ul></ul><ul><ul><li>Using breast feeding as the normative behavior (20 deaths in the first year) the formula group with 100 deaths, had five times as many deaths or a 500% increase in mortality.. </li></ul></ul><ul><ul><li>Forste et al 2001:108 291-296Pediatrics </li></ul></ul>
    77. 114. Forste et al. 2001 “ Analysis of infant mortality indicated that breast feeding accounts for race difference in infant mortality in the United States at least as well as low birth weight does” Pediatrics 2001;108:291-296
    78. 115. Why Do Babies Co-sleep? because they are supposed to…!
    79. 117. “ Never let a baby fall asleep at the breast” ? the very context within which the infant’s “falling asleep” evolved Amer Acad of Pediatrics Guide To Infant Sleep (1999)
    80. 118. Multi-facetted Discourse on Bedsharing: Who (else) And What (else) Must Be Considered? <ul><li>Physiological (biological) studies of infant sleep while bedsharing amongst breast feeding and non-breast feeding dyads; </li></ul><ul><li>Ethnographic-home data on parental decision making, sleep behavior, and sleeping arrangements; </li></ul><ul><li>Lactation consultants and studies of the biological links between infant sleep proximity and breast feeding promotion; </li></ul><ul><li>Case control studies with standardized definitions and new variables; </li></ul><ul><li>Those most effected by public health recommendations including local citizens, WHO, UNICEF, DHHS </li></ul>
    81. 119. 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 )
    82. 120. University of Notre Dame Mother-Baby Behavioral Sleep Laboratory (morning wake up) first time mothers, teen moms… Research funded by NICHD RO1
    83. 121. Mother-Baby Behavioral Sleep Laboratory University of Notre Dame
    84. 122. Mother-Baby Behavioral Sleep Laboratory lounge lounge baby’s room parent’s room
    85. 123. Variations of Safe/Unsafe Sleep Practices Infra-red Video Studies: Crib-Solitary and Bedsharing ( HD 39456-01 ) Examples: 1.Solitary-crib baby placed prone, face down; 2. Neck-wrap, head covering, pillow, solitary, crib baby; 3.Bottle-fed, bedsharing, between pillow, teen mom ,lack of maternal response; 4.Breast feeding mothers, high level of responsivity to infant;
    86. 124. Distribution of Number of Feeds Received by Infants Per Group Per Night RB-SN RB-BN RS-SN RS-BN
    87. 126. “ Breast Feeding and the Risk of Post-neonatal Death In the United States” <ul><li>Studied 1204 infants who died between 28 days and 1 year from causes other than congenital anomaly/tumor.and (7740 children who lived at 1 year) (controls); </li></ul><ul><li>Calculated odds specific odd ratios for ever/never breast feeding amongst all children …race-birth weight specific analysis--and duration-response effects; </li></ul><ul><li>Longer breast feeding associated with lower risk: odds ratio range from: </li></ul><ul><ul><li>.59 95% CI 0.38-0.94 for injuries to 0.84% (95%CI:.67-1.05) for sudden infant death syndrome (SIDS); (Amin Chen and Walter J.Rogan) </li></ul></ul><ul><ul><li>“ Breast feeding has the potential to save or delay ~720 post=neonatal deaths in the United States each year </li></ul></ul><ul><ul><li>Pediatrics (2004) 113: E435-439…url:http://www/pediatrics.org/cgi/content/full/113/e435 </li></ul></ul>
    88. 127. The origin of supine infant sleep is traced to its role in facilitating nighttime breastfeeding in the context of mother-infant cosleeping breast feeding -> cosleeping -> supine position
    89. 128. Co-Sleeping with breast feeding promotes the safer supine infant sleep position Richard et. al 1996, Sleep
    90. 129. Mother and Infant Bedsharing Orientation on BN (in min) From: Richard et al., Sleep 19 (9) 1996 ( F ace E ach O ther)
    91. 130. Number of Maternal Arousals With Temporal Overlap *note sensitivity of routine bedsharing mother waking to infant arousal (no habituation!)
    92. 131. Mean Duration of Stage 3-4 Sleep: Why Important ? <ul><li>Schechtman et al. report that, at 3-4 months of age, siblings of SIDS victims display increased integrated delta amplitude, in early morning hours compared with controls; </li></ul><ul><li>Siblings of SIDS and ALTE infants: deficient arousal responses to hypoxia or hypercapnia; </li></ul><ul><li>SIDS victims: more difficulty awakening from sleep, fewer movements; </li></ul>*p<.o27)
    93. 132. Fighting Against Scientific Distortions of the Bedsharing Issue Contributions by: Peter Fleming James McKenna Helen Ball Barry Taylor Sally Baddock Ed Mitchell David Tepene-Leach Rodney Ford Katie Ramos Miranda Barone Patty Donahue Carey Martin Ward

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