Sleep Like A Texas Baby What Does That Really Mean

1
Sleep Like A (Texas) 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

2
(No Transcript)
3
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?
4
Re-doing American Concepts of Healthy Normal
Infant Sleep

• Infants rarely have sleep problems, parents do..!
• American parents suffer from a variety of
  damaging diseases not the least of which is.. the
  disease of false and unrealistic expectations
  concerning their infants sleep patterns
• the disease of confusing their own needs with
  that of their infants bestneeds..
• the diemodel of sleep--the only good sleep is
  an uninterrupted one
• that infant sleep behavior correlates with good
  moral character, and general future social skills
  and competencies
• That infants and parents are adversaries as
  regards getting sleep

5
The western medicalized model of infant sleep
fails miserably!

• devoid of the relational familial factors
  (where baby sleeps and feeds as regards parental
  emotions and goals)
• devoid of intrinsic (infant) factors
  (temperament, personality , sensitivities)
• categorizes infants inability to follow
  cultural model asdisease, sleep disorder,
  immaturity, and, thus, infant becomes a
  patient
• promotes one- size- should- fit- all
• promotes one sleeping arrangement as a moral
  issue and gives it a specific set of
  inappropriate meanings

6
Infant Care Is AMoral Goodbenefits, risks,
whats safe what problems are worth and not
worth solving ..depends on.
P E R S P E C T I V E
7
Historical Forces Effected Western Infancy and
How We Think About Infant Development

• rise of child care experts replace maternal
  confidence
• emphasis on technology, rather than on bodies to
  nurture
• emphasis on average expectable outcomes per any
  given behavioral parenting strategy..one-size-shou
  ld- fit all
• emphasis on social values and ideologies (not
  biology) to guide research and conclusions..medica
  l care of infants
• social constructions of infancy, not /biological
  evolutionary
• 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 areand how
  husbands and wives should relate

8
In pediatric sleep medicine and research into
sleeping arrangements.

• Does social ideology masquerade as
• science?

9
Changing perceptions.of whats good for
babyTHE 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

10
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

11
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 CHILDS SLEEP
  PROBLEMS

12
BENJAMIN SPOCK SPEAKING TO MOTHERS IN BABY
CARE(THE UNDERMINING OF MATERNAL CONFIDENCE AND
KNOWLEDGE)

• YOU KNOW MORE THAN YOU THINK YOU DO.
• DONT BE AFRIAD TO TRUST YOUR COMMON SENSE.
  BRINGING UP BABY WONT 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

13
(No Transcript)
14
(No Transcript)
15
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 KARPHAPPIEST BABY ON THE BLOCK
  (2002)

16
Interacting factors--all important--determine and
influence where and how, or if, and to what
degree any given baby co-sleeps
Cultural
Where babies sleep is determined by
Scientific Public Health
Family
Infant and Parental Biology (infant temperament,
too)
17
(No Transcript)
18
(No Transcript)
19
(No Transcript)
20
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 infants
  falling asleep evolved!
• (AAP Guide To Infant sleep 1999)

21
(No Transcript)
22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
Infant-parent co-sleeping, especially with
nighttime breast feeding is

• inherently safe, protective and
  beneficial.meaning it is biologically, socially
  and psychologically appropriate
• it is how and with whom it is practiced that
  determines how or if it is made dangerous and/or
  risky..
• Yes, it can be MADE dangerous, but it is not
  inherently so

27
Why Do Babies Co-sleep?

• because they are supposed to!

28
Why Do Parents Co-sleep With Their Infants and
Children?

• To protect them
• To monitor them
• For ease of feeding
• Because infants stop crying
• Because parents can get more sleep
• Because there is no where else to put them
  (sometimes)
• Because many parents cannot be with their babies
  during the day, due to work..nighttime
  constitutes their nurturing time
• To attach more closely, to enjoy them

29
(No Transcript)
30
(No Transcript)
31
What Is Co-sleeping?
When my two lovely daughters are sleeping at the
same time Robert Hahn, Ph.D. (Center for
Disease Control )
32
Routinely bedsharing/breast feeding infants
(findings published in refereed articles)

Arousals Stage 1-2 (light) sleep Stage 3-4 (deep)
sleep Breast Feeding Crying Non-breast feeding
interventions Sensitivity to mother Sleep
duration







33
Diversity of Co-sleeping(requires taxonomic
distinctions)
partial, mixed
Co-bedding twins
(within sensory range)
bedsharing with Dad
34
Parent -infant co-sleeping is biologically and
psychologically expectable, if not inevitable.
35
if...sleeping alone through the night is good
for babies

• then good babies sleep alone, dont they?

36
If solitary infant sleep is needed for good
adult sleep hygiene as all western sleep
training advocates like Ferber maintain..
Cant have it both ways.can you?

• 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 ?

37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
(No Transcript)
41
Scientific studies of the long- term effects of
elected (non- reactive) co-sleeping (refereed
articles)

• Co-sleeping children under-represented in
  psychiatric populations, compared with solitary
  sleepers living on a Military Base (Forbes, Weiss
  and Folen 1992)
• Increased comfort with sexual identity (Crawford
  1994)
• More independent (than solitary sleeping
  toddlers) and increased control of emotions and
  stress..(teacher and parent reports, Heron 1994)

• Mosenkis (1998) 1411 adult subjects, exhibited
  varied findings including, across five ethnic
  groups, that co-sleepers expressed a greater
  satisfaction with life
• Higher self-esteem (males), more comfortable with
  affection (women) (Lewis and Janda,1988).
• 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
• Okami and Weissner et al (2002) 20 year study of
  alternative life style families.co-sleeping as
  children had positive and benign effects..

42
Short Term Benefits of Co-sleeping(Mothers)
(Infants)

• More sleep (in minutes) and increased nightly
  satisfaction
• Increased sensitization to infants
  physiological-social status
• Increased comfort with and ability to interpret
  behavioral cues of infant
• Increased sucking behavior of infant maintains
  milk supply and
• Increased prolactin levels lead to longer birth
  interval (WHO)
• Increased ability to monitor and physically
  manage and respond to infant needs
• More time with baby for working parents

• Increased breast feeding (total minutes and
  number of nightly sessions)
• Increased infant sleep duration
• Less crying time
• Increased sensitivity to mothers communication
• More light (Stage 1-2) sleep,less deep sleep
  (Stage 3-4) appropriate for age
• Increased ability to read maternal behavioral
  cues
• References McKenna et al 1997, Mosko et al
  1996a, 1996b, 1997 Richard et al 1996

43
Ahhh The question of promoting infant
independence(three questions)

• what exactly is independence for a 2-3 month
  old infant?
• does it really correlate with solitary infant
  sleep practices?
• is independence of children what parents really
  want?

44
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?

45
According to Daniel Stern (1985)

• ..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

46
When dependence IS autonomy
Autonomy in the sense of psychotherapy, implies
taking control of ones lifeemotional 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
47
dependency AS autonomy and AS good mental health
.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)
The Value of Psychotherapy (1991) J.Holmes and
R.Lindley. Oxford University Press
48
How scientific bias works

• When an infant dies sleeping prone in a crib, the
  contributing cause of death is not assumed to be
  the crib, but sleeping prone
• 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

49
Infant Sleep and Infant Sleeping Arrangements

• Its Only History,
• Its Only Prehistory?