Sleep Like A Baby? What Does That Really Mean? (In Vermont)

1
Sleep Like A Baby? What Does That Really Mean?
(In Vermont)
James J. McKenna Ph.D Edmund P.Joyce C.S.C. Chair
in Anthropology..Director, Mother-Baby Behavioral
Sleep Laboratory
University of Notre Dame du Lac
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What is normal, healthy infant sleepDo we
answer from a biological or recent cultural point
of view? Does it matter? If so, How?

• How and in what ways has culture by way of social
  values and goals mediated and influenced not only
  the study and conceptualizing of infant sleep
  i.e. proper positioning, arrangement, nighttime
  feeding patterns, and appropriate parental
  responses
• but the biology of both maternal and infant sleep
  in complex urban western settings?

• Why do 20-40 of western babies have sleep
  problems to solve?

3
1.Disarticulated from mother No touch No
smells No sounds No movement No body
heat No breadth exchange
4
Fact The only object/surface/entity on or around
which the baby is designed to sleep remains the
mothers body.
5
There is no such thing as a baby, there is a
baby and someone. D.Winnicott
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...in our enthusiasm to view the human infant
(culturally) as a separable, autonomous organism,
we have pushed too far the concept of the
infants physiological independence from the
parentconfusing the infants preparedness to
adapt, with actual adaptation confusing the
infants abilities to sleep alone with moral and
scientific truths and meanings
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Hierarchy of value is imposed

• On moral grounds
• the good baby vs. the bad baby,
• but also, the effective /strong parent vs. the
  ineffective/weak parent
• On scientific grounds
• The developmentally superior, competent baby vs.
  the inferior, less competent (spoiled/indulged)
  baby

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Limitations of Western Pediatric Sleep and SIDS
Research
adult- centric non-evolutionary ethnocentric
(a)theoretical (no theory around which to
interpret clinical events or research results)
Who is the infant? What do infants need? What
criteria should be used to decide, that is...
dominant cultural practices? biological?
species-wide? local? Western reductionist science
methods have not served infants well.. Eliminated
concept of the mother-infant dyad as the unit
of analysis
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Western pediatric medicine suffers from what
Professor George Williams callsthe fallacy of
medical normalcy.. if we do it, or practice it,
or value it (in western society)..it must be
right and/or appropriate
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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)
Cultural
least relevant
Where babies actually sleep
Scientific Public Health
Family
including economic status
Infant and Parental Biology Including Feeding
Method
most relevant
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Its not what we know that gets us into
trouble.its what we knowthat just aint
so! From Everybodys Friend (1874) By Mark Twain
14
.culturally favored child care practices change
independent of, and much faster than, infant
biology. (ideologies or goals that underlie
recommendations are often historical and
ideological in origin but passed off as, if not
confused for, scientific findings)
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if...sleeping alone through the night is
medically good for babies
In the west solitary sleeping arrangements became
entangled with, and one and the same with, good
morals

• then dont good babies do so, and good
  parents enforce it?

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Cascading Inter-connections Regarding Western
Parent-infant Sleep Conflicts

• (Infants rarely have sleep problems, parents
  do..!)
• Western parents suffer from a variety of damaging
  diseases not the least of which is.. the disease
  of false and unrealistic expectations..a cultural
  and not a biological model of infants sleep
  patterns
• the disease of confusing parental desires and
  wishes and best interest with that of their
  infants
• 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 competenciesin domains other than sleep
• the presumption of an adversarial relationship
  existing between infants and parents as regards
  sleep..Consider the book title Winning Bedtime
  Sleep Battles..and Babywise

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Why Our Babies Cant Sleep and Why Western
Parents Are the Most Exhausted And Disappointed
Parents In The World

• suffer from the disease of misinformed
  expectations
• 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

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Why Do Parents Have Infant Sleep Problems To
Solve?

• Because no two people in any relationship have
  exactly the same best interests..always
  trade-offs are involvedsleep is relational..not
  medical
• current one-size- must- fit- all model devoid of
  relational-emotional aspects including unique
  infant intrinsic factors
• such as infant sleep personality-temperament and
  how these articulate with unique needs of parents
  to respond to perceived infant needs, as well as
  the parents own needs for contact with their
  infants
• Current models either ignore altogether the
  critical relationship between nighttime
  breastfeeding and sleep, or minimize its
  significance to infant-maternal health.. seeing
  breastfeeding as a threat and not added value
• wish nighttime feeding would just go away as it
  threatens the priority given to consolidated
  sleep (the predominant cultural
• value)
• Transition away from thinking of co-sleeping as
  pathology (psychology) to dangerous (medical)

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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 dont!
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For the human infant the three functionally
inter-related (adaptive) components of normal,
healthy infant sleep include

• Sleep location
• (next to mother for social or co-sleeping
  behavior involving on-going sensory exchanges,
  monitoring and mutual regulation)
• Nighttime feeding
• exclusive breast feeding
• Sleep position
• Back (supine)

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The cultural-medical 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
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THE UNDERMINING OF MATERNAL CONFIDENCE AND
KNOWLEDGE Benjamin Spock wrote to mothers in
Baby Care

• You know more than you think you do.
• dont be afraid 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 doctor gives you!
• cited by tina thenevin,1993, mothering and
  fathering

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To understand current debate/discourse over sleep
must understand Bridget Jordans delineation of
the place of authoritative medical knowledge in
our western culture.

• Decision -making hierarchy is distributed--physici
  an at top, lactation consultant, nurses, parents
  at bottom
• the power of authoritative knowledge is not that
  it is correct but that it counts
• Standard Care enforced by legal and
  institutional actions
• Examples prosecution of Salt Lake City couple
  whose infant died after co-sleeping (child abuse
  homicide) or lactation consultants fired if they
  give safety information on bedsharing.

• Invalidates other knowledge systems
• Parental knowledge counts for nothing
• Parents must override instincts- as medical
  personnel always know best

Modified from Birth In Four Cultures by Bridget
Jordan
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Authoritative medical knowledge

• to legitimize one way of knowing as
  authoritative devalues, often totally
  dismisses, all other ways of knowing. Those who
  reject authoritative knowledge systems tend to be
  seen as backward, ignorant, or naïve
  troublemakers

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Socio-cultural and Historical Factors and Forces
Leading to Erroneous Scientific Understandings
(Undermining Parental Confidences and
Empowerment)

• rise of child care experts using moral judgments
  as a basis of recommending what infants
  need..what is worth investing in as a
  practice..
• belief in superiority of technology, rather than
  on maternal bodies to stimulate, hold and
  nurture
• emphasis on average expectable population
  outcomes rather than on individual variability
  or potential.. per any given behavioral
  parenting strategy
• emphasis on ethnocentric social values and
  ideologies (not biology) to guide research and
  conclusions..fallacy of medical normalcy
  (GWilliams)
• improper medicalization of relational
  (caregiving) issues ..assumed to be best
  understood by pediatricians (who generally have
  no training in human social development or human
  evolution
• Pathologizing of normal behavior (crying when
  left alone) ..making infants into patients
  (blaming the victim for the crime) in need of
  correction when they fail to follow cultural
  scripts..Never let a baby fall asleep at the
  breast AAP Guidelines For Infant Sleep
• social constructions of infancy, not /biological-
  evolutionary based (influences of Freud, Klein,
  Watson..psychology in general)
• Science of infant feeding (bottle-formula
  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
  vis a vis distance, authority and separation from
  childrenalso, ideologies about the bedroom as a
  sexual place..

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The Complex History of Infant Sleeping
Arrangements In Western Industrial Societies Is
Reduced To Simple Understandings Congruent With
Present Cultural Beliefs

• inevitable suffocation/overlying/SIDS
• inevitable psychic damage to infant
• inevitable rupture to conjugal (husband/wife)
  relationship
• inevitable prolonged dependency of infant/ child
• inevitable lack of autonomy in infant/child
• NOTE not one controlled scientific study
  documents the benefits of solitary infant sleep,
  or the alleged deleterious social/psychological/ph
  ysiological consequences of safe cosleeping with
  breast feeding

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How A Folk Myth (normal, healthy babies sleep
alone) Achieved Scientific Validation
1 Initial test conditioninfant sleeps alone,
is bottle fed, and has little or no parental
contact
5 To produce healthy infant sleep, replicate
the test condition
Scientific validation of solitary infant sleep
as normal and healthy
2 Derive measurements of infant sleep under
these conditions
4 Publish clinical model on what constitutes
desirable, healthy infant sleep.
3 Repeat measurements across ages, creating an
infant sleep model
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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 shapeliness of his
little body. the newborn infant should spend the
greater portion of his life on the bed

• FROM THE BABY
• MARIANNA WHEELER 1901
• HARPER BROS NEW YPRK LONDON

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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

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Richard Ferber, M.D.

• Director,
• Center for
• Pediatric
• Sleep Disorders, Childrens
• Hospital, Boston
• slide courtesy of Meret Keller and Wendy Goldberg

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Dr. Richard Ferber changes his mind..?? But the
larger and more important question isWhat is it
about our culture that makes us care, or makes it
important what someone who has no familiarity
with our baby or our family thinks about this
very personal issue?

• If you find that you actually prefer to to sleep
  with your baby you should consider your own
  feelings very carefully.
• Whatever you want to do , whatever you feel
  comfortable doing, is the right thing to do, as
  longs as it works.. most problems can be solved
  regardless of the philosophical approach chosen
  (Ferber 2006 41)

1976
2006
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(1976, 1999)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(2006)
Changing concepts related to where babies can or
should sleep..the beat goes on

• Children do not grow up insecure just because
  they sleep alone or with other siblings, away
  from their parents and they are not prevented
  from learning to separate, or from developing
  their own sense of individuality simply because
  they sleep with their parents (Ferber 200641).

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Sleeping With Baby An Internet -based Sampling
of Parental Experiences, Choices, Perceptions,
and Interpretations In A Western Industrialized
ContextJ.J. McKenna and L.E. Volpe in press
Inf. Child Dev.

• Based on self-selected sample of 200 mostly
  middle class mothers from Canada, United States,
  Australia, and Great Britain.
• 400 pages of narrative ethno histories in
  response to nine questions

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Sleeping With Baby An Internet -based Sampling
of Parental Experiences, Choices, Perceptions,
and Interpretations In A Western Industrialized
Context

• How did you, do you, co-sleep?
• How long did you/have you co-slept?
• Why are you co sleeping, or, why did you
  co-sleep?
• If you already have children who moved on from
  co-sleeping, what do you think of your
  experience?
• If you are still co-sleeping, what do you think
  of it now (i.e. as opposed to your attitude when
  you began?
• How well do your children sleep now?
• Are you breast feeding or did you breast feed? If
  so, for how long?
• Do you and/or your partner smoke?
• By co-sleeping, do you think you ever saved your
  childs life?
• questions originally posted on

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Recurrent parental themes

• awareness of comments concerning warnings
  against bedsharing and knowledge of bedsharing
  risks
• relationship between breast feeding and
  bedsharing
• emotional bases of and correlates to co-sleeping
  for mothers (parents) and infants alike
• transition to separate beds
• co-sleeping and effects on childs
  socio-emotional development
• potential life saving experiences

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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)

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Ahhh The question of promoting infant
independence(three questions)

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

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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?

43
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

44
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.
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dependency AS autonomy
A similar state of emotional heteronomy affects
the psycho- path who 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
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Crying
47
Chimps have.
..bad days, too!
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Recent cultural ideologies place BOTH infants and
parents at odds with their biology (emotions)

• Western Caregiving
• Child is not in contact with mother most of the
  time (crib, stroller)
• Baby is kept supine
• Scheduled separated feedings
• Social pressures not to respond to infant crying
  for fear of spoiling
• Separation, minimal feedings, is thought to be
  good for baby

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Function of Crying

• primary form of pre-verbal communication
• evolved maximize chances of infant survival and
  parental reproductive success.
• signals infant distress, fear, hunger, pain
  and/or discomfort..
• crying ensures proximity to parent, protection
  from predators.. (Bowlby)
• Though crying is not the normal way by which
  infants receive breast milkcrying is a late sign
  of infant hunger signals

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Evolutionary Adaptedness

• A number of studies in human infants have
  confirmed the potential importance of both
  contact and nutrients as regulators of infant
  behavioral stateincreasing carrying from 3 to
  more than 4 hours a day reduces durationof
  crying/fussing behavior by 43 at 6 weeks of age
  (41).

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Controlled crying (or controlled comforting..or
sleep training)

1. a technique to manage infants and young children
   who do not settle alone or who wake at night, or
   who settle only if held or if permitted to sleep
   in proximity or contact with their parents.
2. involves leaving the infant to cry for
   increasingly longer periods of time before
   providing comfort
3. the goal is to condition infants or young
   children to sooth themselves back to sleep and
   to stop them from crying or calling out during
   the night

52
Australian Association of Infant Mental Health
Position Paper

• It is normal and healthy for infants and young
  children not to sleep through the night and to
  need attention from parents. This should not be
  labeled a disorder except where it is clearly
  outside the usual patterns
• Parents should be reassured that attending to
  their infants needs/crying will not cause a
  lasting habit..Waking in older infants and
  young children may be due to separation anxiety,
  and in these cases sleeping with or next to a
  parent is a valid option. This often enables all
  to get a good nights sleep

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Australian Association of Infant Mental Health

• The AAIMHI is concerned
• controlled crying is not consistent with what
  infants need for their optimal emotional and
  psychological health, and may have unintended
  negative consequences
• From Controlled Crying AAIMHI Position Paper
  November 2002

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Traditional Western Pediatric and Clinical
Approaches and assumptions to Infant Sleep

• perpetuate the very environmental conditions that
  give rise to the parent-infant sleep problems
  they are asked to solve

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Controlled crying and or sleep training
techniques and philosophies

• reflect social ideologies
• not scientific findings about who infants are
  and what infants need based on empirically-based,
  scientific- biological studies
• techniques reflect who we think we want infants
  to be (convenient) or become or should become
  (autonomous/independent) as early in life as is
  possible

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First Question

• What cultural assumptions about infants and their
  sleep and developmental needs, lead to caregiving
  practices which induce infants to cry in the
  first place, which in turn make controlled
  crying techniques seemingly necessary?

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Second Question (there is a choice)

• What exactly needs to be changed?
• should babies be changed can they be changed
  (biologically?
• -or-
• should the ideas and assumptions which underlie
  and justify recent western infant care
  recommendations be changed ?
• who gets to decide?

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Its one thing to ask if some infants can be
conditioned or trained to sleep alone,
unattended.. through the night (unsupervised,
unfed and unintended)

• Its altogether a different and more serious
  matter to ask if they should be, or if it is not
  nice, dangerous or injurious in either the long
  or short run

59
Misunderstandings by parents often motivate the
use of controlled crying techniques. Parents
are led to believe infants will be cognitively or
socially handicapped--no scientific studies
support such predictions..

60
Infant cryingis it normal or necessary, or an
expectable behavioral expression found in daily
life ? or

• an alarm signal reserved for critical
  circumstances involving.. pain, hunger, fear
  (separation from the caregiver)--all or some of
  these?

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Evidence that it is neither expectable nor
beneficial, but deleterious..

• requires considerable physiological effort with
• increase heart and lung activity (Rao et al.
  1993 Lester et al 1985),
• increased energy loss through..
• Heart rate increases (Pillai and Jane 1990)
• Augmented plasma cortisol levels
• Decreased blood oxygenation (Anders et al.
  1970Levesque et al. 1994)

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And , yet, from a western cultural medical
(clinical) perspective

• protesting infants are considered to be
  developmentally inferior, immature, or spoiled
  compared with infants who comply or acquiesce
  passively to the cultural model of
  separation-----which actually endangers
  infants..
• And parents of such infants assume either that
  their infants are deficient, or that they lack
  good parenting skills???

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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
caregiverSources Great Britain (Blair et al
1999), New Zealand (Mitchell and Scragg 1995),
and European Collaborative Study (Carpenter
et.al.in press, Lancet)
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With respect to crying? and smiling ?

• Both these perceptuo-motor mechanisms according
  to Bowlbypromotes maternal attachment..
• turning on ??, and turning off ?, of each---
  become socially and psychologically mediated as
  the infants neocortex myelinates (baby decides
  whether or not or if, to cry or smileand to whom
  or for whomand when to do so.

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AAIMHI.. recommends that parents should be told.

• The method has not been assessed in terms of
  stress on the infant or the impact on the
  infants emotional development
• A full professional assessment of the childs
  health, and child and family relationships should
  be undertaken before initiating a controlled
  crying program
• .this should include an assessment of whether
  the infants crying is outside the normal levels

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Clinical Application

• Inform parents that early infant crying is normal
  and makes sense from an evolutionary standpoint
• Possible solution to reduce the prolonged
  crying of colic change normative caregiving,
  rather than treating intrinsic or extrinsically
  induced pathology in the infant
• Maintain contact and proximity to infant.

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Infant and Child Development (Special Issue)

• (2007) Vol16, Issue 4 331-469
• Co-sleeping during infancy and early childhood
  Key findings and future directions (457-467)
• Wendy Goldberg and Meret Keller

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Next few slides modified from and/or courtesy
ofMeret Keller and Wendy Goldberg.UC Irvine
Dept of PsychologyModeling co-sleeping as a
medical disorder

• Co-sleeping Night wakings
• Night wakings Sleep problems
• THEREFORE
• Co-sleeping Sleep problems

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However

• Cross-cultural samplesChina, India
• Southeast Asia, Japan and others
• U.S. co-sleeping sub- groups such as African
  -Americans, Hispanics, La Leche
  League-Breastfeeding mothers
• populations..

Night wakings not perceived as problematic by
all mothers!
Courtesy of Meret Keller and Wendy Goldberg
70
How such nighttime arousals by infants are
evaluated depends on

• Begin in infancy?
• OR
• Begin in toddlerhood/
• preschool?

• A preferred parental
• practice?
• OR
• Perceived as a
• necessary evil?

Courtesy of Meret Keller and Wendy Goldberg
71
Sleep Groups (UCI Family Sleep Research Project
Keller Goldberg, 2004)

• Solitary Sleepers
• Slept alone from 6 months through 3 years
• Reactive Co-Sleepers
• Slept alone by 6 months began co-sleeping
  during second or third year
• Early Co-Sleepers
• Bedsharers for at least the first year

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
72
Meret Keller and Wendy Goldberg Objective and
Hypotheses

• The primary objective of this study was to
  provide empirical data on co-sleeping in relation
  to reported sleep problems and preschool
  children's independence and autonomy. A secondary
  aim of this study was to investigate sub-types of
  co-sleeping.
• Early co-sleeping mothers view solitary sleeping
  more negatively and co-sleeping more positively
  than either solitary sleeping or reactive
  co-sleeping mothers.
• Reactive co-sleeping mothers report more
  child-related sleep problems and perceive these
  problems as more intense than do solitary
  sleeping and early co-sleeping mothers.
• Solitary sleeping children exhibit greater
  independence in sleep and other domains at
  preschool age compared to early and reactive
  co-sleeping children.

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Results

• Mothers of co-sleepers were least supportive of
  solitary sleeping.
• Reactive co-sleepers had the most sleep problems
  (e.g., night wakings) and their mothers perceived
  them as problematic.
• Solitary sleepers were the most independent in
  the sleep domain.
• As preschoolers, early co-sleepers were most
  independent with peers and in self-care skills.

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Measures

• Sleep Practices Questionnaire (items adapted from
  Crowell et al., 1987 Greenberger Goldberg,
  1989 Lee, 1992 Lozoff, et al., 1984 Stillman,
  1999).
• Independence (not relying on others, Deci et
  al., 1993 Deci Ryan, 1985) in domains of
  sleep, self-reliance, and social behavior with
  peers.

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Sample and Sleep Groups DefinedMeret Keller and
Wendy Goldberg

• The sample consisted of 83 preschool-aged
  children (54 female) and their mothers, who were
  well-educated, middle to upper middle-class, 71
  Caucasian, 18 Asian American, and 5 Latina.
• SOLITARY SLEEPERS
• SLEPT ALONE BY 6 MONTHS AND CONTINUED THAT
  ARRANGEMENT TO AGE 3
• REACTIVE CO-SLEEPERS
• SLEPT ALONE AT 6 MONTHS
• BEGAN CO-SLEEPING DURING SECOND
• OR THIRD YEAR FOR AT LEAST A 6-
• MONTH PERIOD
• EARLY CO-SLEEPERS
• BEDSHARERS AT 6 MONTHS WHO CONTINUED CO-SLEEPING
  AT LEAST UNTIL 12 MONTHS

76
For exampleReactive Co-Sleeping Unwanted,
unplanned co-sleeping

• Definitions
• Children who start out as solitary sleepers in
  infancy and share the parents bed as toddlers or
  preschoolers
• Children who co-sleep (regardless of age) because
  they have difficulty sleeping alone even though
  the parents prefer separate sleeping arrangements
  (i.e., unplanned, unwanted co-sleeping)

Reactive co-sleeping families emerge as a
distinct group from early/intentional co-sleeping
families.
Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
77
Criteria for Sleep Groups
Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
78
FINDINGSSupport for Reactive Co-Sleeper Group

• Early and reactive co-sleeping
• children awakened more
• frequently than solitary sleepers
• Reactive co-sleeping mothers
• perceived their childrens night
• wakings as more problematic
• than other mothers
• THEREFORE Early co-sleeping mothers did
  not perceive their childs night wakings as
  problematic

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
79
Child Outcomes

• Early co-sleeping children, as preschoolers,
  reportedly more independent in non-sleep domains

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
80
Independence in Sleep Domain

• Solitary sleepers most independent in sleep
  domain
• Solitary sleepers fell asleep on own at earlier
  age
• Solitary sleepers (M5.0 months)
• Reactive co-sleepers (M11.0 months)
• Early co-sleepers (M26.9 months)
• Solitary sleepers slept through the night at
  earlier age
• Solitary sleepers (M6.2 months)
• Reactive co-sleepers (M13.6 months)
• Early co-sleepers (M25.5 months)

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
81
Independence in Non-Sleep Domains

• As preschoolers, early co-
• sleepers were most
• independent in
• Social relations with peers
• Self-care/daily living skills

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
82
Maternal and Family Outcomes

• Maternal autonomy support
• Early co-sleeping mothers more supportive of
  their childs autonomy and less controlling than
  mothers in other groups
• Marital intimacy
• No differences in marital intimacy across sleep
  groups

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
83
Additional Child Outcomes Research

• No differences in behavioral problems at 2 and 3
  years of age for co-sleepers and solitary
  sleepers (except difficulty getting to sleep and
  night wakings) (Madansky and Edelbrock, 1990)
• No differences, at age 6, in behavioral
  difficulties, emotional maturity, mood and
  affect, or creativity (Okami et al., 2002)
• No differences, at age 18, on childs ability to
  relate to parents, adults in general, other
  family members or peers. No link between
  bedsharing history and childs likelihood of
  using alcohol/tobacco/hard drugs having problems
  with self-acceptance engaging in vandalism,
  fights or serious crimes being sexually active
  or having either positive or negative sexual
  experiences (Okami et al. 2002)
• Powerpoint Courtesy of Meret Keller and Wendy
  Goldberg

84
Three In A Bed Where Do Fathers Fit In?
Photo Idea Courtesy of Meret Keller and Wendy
Goldberg
New Research Summer 2008 underlying hormonal
basis of social bond formation and attachment
during nighttime care amongst fathers and their
infants and children..Lee Gettler and James
McKenna
85
Fathers

• In British sample, most fathers shared bed with
  infant 3-5 months post-birth, at least
  occasionally, even when had not expected to
  bedshare
• Fathers responded positively to bedsharing at 3-5
  months post-birth, even when it was not
  anticipated prior to the birth of their child
• Fathers (particularly first-time fathers) had
  fears of rolling over on their infant and of
  disrupted sleep due to the infants presence in
  the bed, but once they adjusted to bedsharing,
  these fears were alleviated.
• Most fathers appeared to enjoy the experience,
  and did not consider the presence of their infant
  in bed as an intrusion on their marital
  relationship (Ball et al., 2000)
• Powerpoint Courtesy of Meret Keller and Wendy
  Goldberg

86
More on Fathers

• Fathers and mothers endorsed similar reasons for
  their families sleep arrangements, although
  reasons differed by type of sleep arrangement
• Satisfaction with sleep arrangements was more
  likely for fathers and mothers whose attitudes
  coincided with their actual sleep practices
• A similar, highly satisfied, stable pattern was
  apparent for fathers and mothers of solitary
  sleepers and early co-sleepers, but satisfaction
  for mothers and fathers of reactive sleepers
  waned over time.
• Powerpoint Courtesy of Meret Keller and Wendy
  Goldberg

87
Will They Ever Leave?
Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
88
WHEN To Move Child To Own Room?

• Depends on family and cultural values
• Does child kick and move around too much?
• Is child getting too big (not enough room?)
• Are parents feeling support or pressure from
  family/friends/culture?
• Does child feel comfortable/ready to move out?

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg
89
HOW To Move Child To Own Room?

• As many ways as there are families
• When child is ready
• Move into room with older sibling
• Parent sleeps temporarily in childs room until
  child is comfortable sleeping on own
• Buy new bunk beds with CARS or DORA THE EXPLORER
  bedsheets and blankets
• Futon on floor of parents room until child feels
  comfortable sleeping on own
• Part-night in own room part night with parents

Powerpoint Courtesy of Meret Keller and Wendy
Goldberg