Study primarily involving developmental psychologists Large, longitudinal study representing four different parts of the U.S. using ethnically-matched samples of adolescent, low-education adult and high-education adult first-time mothers. (High-ed qualification based on 2 years of college education) Goal is to identify mothers at risk of neglecting their children in order to design intervention strategies that target the identified parenting deficits.
Sleep lab study only being done at the South Bend/Notre Dame site. Sleep lab visits coincide with the home visits that are conducted at 4 and 8 months, particularly because we do some naturalistic observation in the home. This enables some comparison between direct observation measures of daytime and nighttime parenting.
The study is compiling a wealth of data using multiple measures and multiple informants across the first three years of the child’s life. The parenting measures are collected both in the laboratory and in the home, and one unique component of this study is that we also give the participants cell phones to allow periods of intensive data collection with minimal disruption to the mothers’ lives. The data discussed in this presentation will pull together information from a variety of these sources.
Caring for parents
Caring For Babies, Caring For Parents: What Human Infants Really Need And Why James J.McKenna Ph.D. Edmund Joyce Professor of Anthropology Director of Mother-Baby Behavioral Sleep Laboratory University of Notre Dame Saturday Scholar Series
Western Perceptions of, and Approaches To, Caring For Baby? Whose baby is it, anyway? How and when did parents give up their rights to make decisions about how they would care for their infants? Or Did we? Do we ..abdicate decision making to outside medical authorities? Why do we seem to care so much that others approve of what we do with our infants? How did Western parents lose their own confidences in how to be a “good” parent?
“ 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
Infant Care Is A “Moral Good” The kind and nature of parental care is critically judged by community members based on societal values..roles of men, women and children… What’s “good” parenting? What is safe? What problem is worth solving?
if... sleeping alone through the night is “good” for babies then “good” babies sleep alone, don’t they?
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>
Until recent, western historic periods, no human parents ever asked: Where will my baby sleep, how will I lay my baby down to sleep, and how will I feed my baby? most human parents still don’t!
For the human infant the three functionally inter-related (adaptive) components of normal, healthy infant sleep include: <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>
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
American Academy Of Pediatrics New SIDS Prevention Recommendations proximate but separate sleep for baby; no side position sleeping; cuddling but no bedsharing pacifers for sleeping infants, after breast feeding is established; more holding and carrying
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>
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”?
“… 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
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
<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!
Who is the infant? What do infants need and why? Who decides and ..does it matter? ..the behavior of infants is not independent of the theories of human infancy that parents adopt Based on Leon Eisenberg “The Nature of Human Nature” pg 165 (1972)
compared with other primates.. neurological age of the human neonate at birth is rolled back… <ul><li>hence…. </li></ul><ul><li>relatively speaking, all human infants might be considered “preemies”, non-ambulatory, unable to cling, incontinent, unable to speak, keep warm, reason, discriminate, </li></ul><ul><li>attach social meaning to on-going events…. </li></ul>
Enter… human biology… Guess Who’s Coming To Dinner? <ul><li>The human obstetrical dilemma; </li></ul><ul><li>YIKES! </li></ul><ul><li>Human Fetal Head Size Exceeds Outlet Dimensions With Emergence of Bipedalism </li></ul>
small biological aside… What is the origin of mammalian breastfeeding Ahhhh … let’s see..?
Primitive “Mothering” Reptiles <ul><li>The antecedents to mammalian parenting was likely an egg laying--dedicated, protective mother who shared a nest, den or burrow--who protected and retrieved, rather than fed. </li></ul>
Female duck-billed platypus <ul><li>Incubates eggs safely inside a grass-lined burrow; </li></ul><ul><li>Sealed up with their mother, hatchlings feed on milk dripping from hairs surrounding a teatless milk-producing gland </li></ul>
http://www. bfnews . blogspot .com/ (2004) But, is this what we mean when we say….. “ he has a good taste in art” ? Now, this is biology!
Biology of Mother’s Milk Predicts Contact and Cosleeping 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>
Maternal behavior among primates extends throughout an extremely long infant and juvenile period, with prolonged periods of physical contact. Orang-Utan
Consider the physical intimacy of the maternal-infant relationship … socially and medically obscured by western culture Balinese Mother and infant
A major basis of maternal-infant attachment is “contact-comfort” (rather than satiation)… Harry Harlow “ Attachment”: Unfolding, discriminating bond between parent and infant; genetically-based….. Immediate survival and protection from predators is main outcome;
Just how ideological is baby care socialization? Consider these “Aboriginal (toy clay dolls ) and mud breasts” Now Available at Toys R Us ? ……(as if!)
Hidden Regulatory Mechanisms (Myron Hofer/Martin Reite) <ul><li>a given interaction may be guided and even determined by processes hidden to observation; nutritional status of infant, heat, smell, touch, vestibular ; </li></ul><ul><li>repeatedly delivered sensory regulation may have cumulative effects which influence adult roles and behavior by way of: </li></ul><ul><li>internal state responses by baby to caregiving behavior (blood pressure, satiation, anxiety, breathing, heart rate) may be altered by specific aspects of their relationships (labile traits) like being touched, spoken to, and fed frequently (neuro-developmental, long -term effects).. </li></ul>
<ul><li>3-day separation: </li></ul><ul><li>induces physiological </li></ul><ul><li>changes (immune, </li></ul><ul><li>system, heart rate, </li></ul><ul><li>sleep, cortisol, loss of </li></ul><ul><li>body </li></ul><ul><li>temperature.. </li></ul><ul><li>anaclitic depression: </li></ul><ul><li>hyperactivity </li></ul><ul><li>conservation- </li></ul><ul><li>withdrawal; </li></ul><ul><li>death or recovery </li></ul>
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><ul><li>Willinger et al. in press…as high as 50%; </li></ul><ul><li>McCoy et al.(2000) 22% (always), to 50% (sometimes); </li></ul>
Who Bedshares? “ There are two kinds of people in the world…those who sleep with their children and those who lie about it!” Rob Cordes M.D.
Until recent historic periods, no human parents ever asked: Where will my baby sleep, how will I lay my baby down to sleep, how will I feed my baby? most human parents still don’t (Co-sleeping with breast feeding are inevitable and inseparable for most contemporary people)
The Complex History of Infant Sleeping Arrangements In Western Industrial Societies Is Reduced To Simple Understandings Congruent With Present Cultural Beliefs: <ul><li>inevitable suffocation/overlying/SIDS </li></ul><ul><li>inevitable psychic damage to infant </li></ul><ul><li>inevitable rupture to conjugal (husband/wife) relationship </li></ul><ul><li>inevitable prolonged dependency of infant/ child </li></ul><ul><li>inevitable lack of autonomy in infant/child </li></ul><ul><ul><li>NOTE : not one controlled scientific study documents the benefits of solitary infant sleep, or the alleged deleterious social/psychological/physiological consequences of safe cosleeping with breast feeding </li></ul></ul>
1.Dis-articulated from mother… No touch; No smells; No sounds No movement; No body heat’ No breadth exchange
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.
What Co-sleeping Looks Like Maori, New Zealand recliner co-sleeping (unsafe) napping desert Aborigine Koala
University of Notre Dame Mother-Baby Behavioral Sleep Laboratory first time mothers, at risk teens Research funded by NICHD RO1
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-feed bedshare between pillow, teen mom ,lack of maternal response; 4.Breast feeding mothers, high level of responsivity to infant;
Does “Normal” Human Infant Sleep Biology Really Matter? Is It Still Relevant For An “Advanced” Society ?
Distribution of Number of Feeds Received by Infants Per Group Per Night RB-SN RB-BN RS-SN RS-BN
And why do you suppose, 45-60% of American infants…. Have “sleep problems to solve”?
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 (no habituation!)
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
Why Do Babies Co-sleep? because they are supposed to…!
Study Design 4-site prospective longitudinal study of a population-based, representative sample of 400 adolescents and their children and an ethnically matched sample of 400 adult mothers and their children (160 low- education and 160 high-education) TOTAL SAMPLE 400 TEENS 320 ADULTS 100 teens 80 adults 100 teens 80 adults 100 teens 80 adults 100 teens 80 adults Kansas City Washington, DC Birmingham South Bend
University of Kansas Kansas City, KS University of Notre Dame South Bend, IN University of Alabama at Birmingham Birmingham, AL Georgetown University Washington, D.C. USA (The Four Research Sites)
Nighttime Sleep -Activities Study TOTAL SAMPLE 400 TEENS 320 ADULTS 100 teens 80 adults 100 teens 80 adults 100 teens 80 adults 100 teens 80 adults Kansas City Washington, DC Birmingham South Bend Target Sleep Lab Sample: 50 TEENS 30 ADULTS <ul><li>Adolescent and high-education adult mothers recruited to participate in sleep lab study. </li></ul><ul><li>Data collection points at 4 and 8 months. </li></ul>->
Measured Variables Informant Method Contact Consistency (in Parenting) Encouragement Celebrations Protect Stimulate Regularity (in Routines) Unhappiness Affectionate Rigidity Child Abuse Potential Responsiveness Protective/Risky Positional Relatedness Response Latency Punitive/Rejections Impulse Control Verbal Encouragement Confidence Verbal Accessibility Responsivity Sleep Lab Behaviors Maternal- Child Characteristic Scale Cellular Phone Data Mother Other Mother-Child Play
Human milk composition, carrying behavior, supine infant sleep and co-sleeping: An integrated adaptive system
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
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)
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 )
Public Health Tips <ul><li>Infants encounter several different sleep environments ..regardless of how the parents classify themselves…need safety information on all of them, including safe bedsharing </li></ul><ul><li>“ safe “ bedsharing is not an oxymoron…(despite claims to the contrary…)there is an enormous range of safety factors that differentiate bedsharing environments… </li></ul>