Principle 5:
Ensure Safe Sleep,
Physically and Emotionally
The Critical Importance
of Nighttime Needs
The reality is, no babies need to sleep through the night. That is completely a cultural construct. It is usually not the babies that have the sleep problems—they can sleep where and when they need—but it is the parents who have the sleep problems. These are usually induced by the notions of the baby being separate from the
parent. It is not that the baby can’t sleep, they just can’t sleep how the parents want it, when they want it, and in a solitary environment. Biologically speaking, this is unnatural for them, and their emotions rightly tell them so.
—Dr. Jim McKenna, “The Greatest Gifts We Can Give Our Children,”
in Attachment Parenting: The Journal of API
“Is your baby sleeping through the night?” is often the first question a new parent hears. For many parents, this question undermines their confidence and creates unnecessary anxiety. The truth is that most young babies do not sleep through the night. This is simply a myth that continues to be perpetuated in our modern society—a myth that Dr. Jim McKenna calls “a cultural construct,” since many cultures around the world don’t have that expectation. Babies have needs at night just as they do during the day—to be fed, to be comforted, and to be protected. They may feel fear and loneliness, sadness, or too cold or too hot—and therefore they need the reassurance of a loving parent to help them feel secure during the night. Attachment Parenting International (API) encourages parents to respond to their children’s needs at night just as they do during the day. This requires exploring a variety of different safe sleeping arrangements and choosing the approach that best allows parents to be responsive at night. Some of these approaches are explored in this chapter.
Understanding Infant Sleep Patterns
Many physiological and developmental reasons account for the ways babies sleep. Human infants are designed to feed frequently because mother’s milk is lower in fat and digested very easily. Their immature brains are so underdeveloped that they need frequent feeding and skin-to-skin nurturing to stimulate healthy growth. Dr. William and Martha Sears explain infant sleep patterns in their book Nighttime Parenting: “In the first few months, most babies sleep fourteen to eighteen hours per day without any respect for the differences between day and night. A baby’s sleep pattern resembles his feeding pattern: small frequent feedings and short frequent naps.”1 Adults and infants also sleep differently: adults have fewer periods of rapid eye movement (REM) sleep (also known as active sleep) and more periods of deep sleep or “quiet sleep,” whereas infants have frequent periods of REM sleep and fewer periods of quiet sleep.
1 Sears and Sears, Nighttime Parenting, 16.
During REM sleep, our brains are actively dreaming, which seems to stimulate the development of higher brain functions. Sleep researchers believe that the more complex the brain, the more REM sleep is required to help in its development. From a biological perspective, infant sleep patterns appear to increase the baby’s ability to survive, allowing her to feed more often and maintain close contact with the mother. The younger the human being, the more REM sleep she requires, which increases the probability of wakefulness, especially during the transitions from active sleep to quiet sleep, which tend to occur on average every ninety minutes.
As we get older, periods of REM sleep lessen greatly. Infants’ sleep patterns gradually adjust to adultlike sleep patterns beginning around the age of two or three years.
When it comes to sleeping like a baby, we know the following:
- Most babies don’t sleep through the night but may wake up every one and a half to two hours to be fed.
- Babies weren’t designed by nature to sleep seven to eight hours straight. In fact, some experts feel it could be dangerous for an infant to sleep that long.
- When you bring your newborn home from the hospital, it’s a good idea to begin a routine of sleeping when the baby sleeps to catch up on the hours you missed during the night.
- You will feel more rested if you keep your baby close by or in bed with you, as long as you follow safe cosleeping guidelines.
Cosleeping and bedsharing (also referred to as “sharing sleep” or the “family bed”) are terms often incorrectly used interchangeably to describe a sleep arrangement in which family members sleep in the same bed. References to these words often lead to confusion about publicized information on safe versus unsafe infant sleep practices. Cosleeping, however, is an umbrella term that is used to refer to infants and their adult caregivers sleeping in “close proximity,” though not necessarily in the same bed. Bedsharing, one form of cosleeping, is sharing the same bed with an infant. Cosleeping is encouraged by API and the American Academy of Pediatrics (AAP) and governed by safe practice guidelines. Unsafe infant sleep practices, including sleeping with an infant on a couch, recliner, or other nonbed surface, are not accepted forms of cosleeping or bedsharing.
From a purely practical standpoint, parents report that they get more sleep with fewer interruptions when they cosleep. They don’t need to get up to attend to baby’s needs, which keeps parents from having to wake up fully during feedings. Cosleeping improves a mother’s milk supply, increases the number of feedings, and increases the duration of the breastfeeding relationship. This can also suppress ovulation, helping to prevent another pregnancy.2 While the American Academy of Pediatrics does not support bedsharing, it does recommend that infants sleep in the same room as the parents separately and in close proximity.
2 McKenna, Sleeping with Your Baby, 48–49.
Babies feel warm, secure, and protected; therefore, they fret and cry less. Research has found that mothers tend to be more responsive when cosleeping, which may be a protective behavior.3 Mothers worry less about their infants at night when they can reach out and touch them, and both parents develop a closer bond with their baby. In addition to these benefits, cosleeping also enhances the breastfeeding and attachment relationships. A study of military families found that cosleeping was associated with parental reports of higher social and life skills and less psychiatric treatment.4 Another study found that cosleeping is associated with family nurturance, less use of transitional objects, flexibility in family structure, and parental reports of higher adaptive functioning on the part of the children.5
3 Mosko et al., “Parent-infant cosleeping”; Mosko et al., “Infant arousals during mother-infant bed sharing.”
4 Forbes et al., “The cosleeping habits of military children.”
5 Witman-Flann, “Parent-child cosleeping.”
From a physiological basis, when cosleeping, the baby experiences more periods of light sleep, which stabilize the heart rate and breathing pattern, and the risk of sudden infant death syndrome (SIDS) decreases. We have had mothers over the years report to us that they believe they were able to save their children’s lives—some from sleep apnea, some from other unforeseen occurrences—because they were bedsharing. The following story powerfully illustrates the importance of mother-baby togetherness at night:
I had decided to cosleep with my son for many reasons. I enjoyed looking at him cradled in my arms, nursing him at night was easier, and, as a first-time mother, having him right there relieved any fears that something may be wrong. On the night of his six-week appointment, by my side was the best place for him. I was wary of having my son vaccinated because of the controversies, including their possible link to autism. Having an autistic younger brother myself made my fears seem reasonable. But after his physician assured me that any chance of a reaction was remote, my son Angus received his DTaP [a combination vaccine that protects against diphtheria, tetanus, and pertussis (whooping cough)], along with his other shots.
We had an early appointment that morning, and we returned home to what seemed to be a normal day. Angus became grumpy later in the afternoon and had a slight fever, as well as some redness around the injection site, but the nurse on call said that this was normal and to give him ibuprofen. By 8:00 pm, we were both tired, and he fell asleep at my breast as he had done since his birth.
At about 11:00 pm, I felt something slapping against my chest. It was not hard but was repeated rapidly. I had a night-light on, and when I looked next to me, I saw my son thrashing his arms about and an expression of a silent scream on his face. He was not breathing. My reflexes took over, and I sat up and yanked him into the air and to my chest. As I raised him up, I heard him inhale deeply, and he began to scream. I called the doctor and found that he had indeed had a reaction to the shots and to give him Benadryl. Within thirty minutes of that dose, he calmed down and was able to sleep again, though I could not.
I know that if Angus had not been sleeping there by my side, I would have woken up to a crib death. Because of cosleeping, my son is alive. Angus is now five years old.
—Lilith M.
Are There Dangers with Bedsharing?
A little historical background may help put the concern of danger into better perspective. It’s important to know that infant solitary sleep is a relatively new practice that has evolved in the Western world only within the last one hundred years. Recently, various medical and professional organizations have discouraged parents from sleeping with their children for fear that it contributes to an increase in SIDS. However, new research demonstrates that sharing sleep, when practiced by informed parents, can be safe and beneficial. In fact, many cultures around the world, where millions of parents routinely sleep with their children, have reported some of the lowest SIDS rates. In some of these cultures, such as China and Japan, it is virtually nonexistent. Dr. James McKenna, one of the few cosleeping researchers in the world, offers important advice to all parents about solitary sleep:
Now we at least know that if you’re going to put a baby alone in a crib in a room by itself, you would put a baby on its back, and at least that’s a big step up in the chances of the baby surviving. But what we also now know is three to four studies show quite conclusively that putting babies to sleep in a room by themselves at three to six months of age doubles their chances of dying from SIDS. Indeed, when cosleeping is defined by the baby sleeping within the proximity of a responsible adult caregiver, and not necessarily bedsharing, the hypothesis that cosleeping reduces the chance of SIDS has in fact been confirmed.6
6 Parker, “The greatest gifts we can give our children.”
British researcher Dr. Helen Ball found that breastfeeding mothers were more likely to sleep on one side in a protective position—tucking their knees up under their babies—and awaken more quickly than bottle-feeding mothers. Further research by Dr. McKenna and his colleagues found that when studying mother-infant breastfeeding pairs, babies were largely responsible for positioning themselves during the night and spent most of their sleep on their sides or backs, just inches away from their mothers’ faces. Mothers reported that they got a better quality of sleep when their babies slept nearby.7 For those reasons, McKenna recommends that bottle-fed babies sleep on a separate surface yet close to the mother.8
7 McKenna et al., “Infant-parent cosleeping in an evolutionary perspective.”
8 McKenna, Sleeping with Your Baby, 48–49.
Parents often worry that they might roll over and suffocate their baby during the night, but remember that just as we are able to sleep in a bed without falling out of it, sober parents are acutely aware that a baby is in the bed. Research conducted by Dr. Miranda Barone put this worry to the test and videotaped mothers and babies sleeping together. “In more than 1,000 hours of observing forty mother-infant pairs, no mother was ever remotely close to overlying or suffocating her infant. Instead, maternal and infant behaviors were beautifully synchronized—when one moved, the other responded, without fully awakening.”9 In fact, she says that in the context of attachment relationships, her study found that the “attachment behavioral system [such as the need to be physically close to the caregiver and other sensory needs] operates twenty-four hours per day and does not deactivate during sleep, where infants spend 60 percent of their time.”10
9 Barone, “Sleeping like a baby.”
10 Ibid.
Musings from a Mother of Multiples (continued)
I was very lucky that my boys had the same natural sleep patterns. From completely anecdotal evidence, this seems to be much more common with identical twins than with fraternal twins. Still, it was a challenge to do it safely. I made a bit of a “nest” for myself in our king-size bed. I’d lie on my back without a shirt, with a pillow next to my body on each side and a pillow under my knees. I’d lay my arms on top of the pillows, and then each boy would lie on one arm, so that he was on his side, half on my torso and half on my arm. I made sure there was no way he could come into contact with a pillow. From this position, I could easily nurse whichever boy woke without disturbing the other. I’m quite sure it looked absolutely ludicrous, but it was the only way I could get a little sleep. In hindsight, I wish I’d gotten a photograph.
At night was the only time I was ever calm. I know it sounds strange, but there in the bed I was able to meet the boys’ needs and do a little relaxation myself. I would do progressive relaxations and meditations. I would smell the boys’ hair and look at their faces. It was the calm between the storms of my days. My husband mounted a TV on the wall for me, and I kept the remote beside me where I could reach it without disturbing a baby. I watched shows and movies on closed captioning so there was no noise.
We put night-lights all over the room so there was always a dim glow. And we set up a baby monitor in reverse, so that I could talk softly and ask my husband for things when he was in the other room.
My nights were a blur of sleeping and waking. I tried to stay as semi-asleep as possible as I nursed. Every once in a while the boys would get off sync, and I’d be awake every hour nursing one or the other. When this happened I’d try to wake the sleeping boy and nurse him at the same time to get them back together again. It usually worked, but sometimes it didn’t, and those days were really rough. I think I survived because I went into it with the expectation that I just wasn’t going to sleep for six months or so. Then when I did manage to sleep for an hour or two, it felt like a bonus. After a few months of very little sleep, I started having very short, bizarre dreams. I’m sure it was a symptom of extreme fatigue. But in a way those dreams became an anchor, something to laugh about in the morning. (To be continued)
—Pam S., mother of four
[Authors’ Note: What would it look like if this mom had received help at night with her babies? Grandmother, auntie, friend, or postpartum doula could care for one baby if he got “off sync” so mother could nurse and doze with one at a time. Some dads are able to take off work and provide the extra arms, too, of course. If a mother is getting seriously sleep-deprived, it’s important to seek help. If support can be arranged only during the day, finding ways for Mom to take a nap will ease the lack of sleep at night.]
Every day dozens of babies are injured in falls from cribs, according to what may be the first study focusing on nonfatal crib-related injuries in children younger than two. In nine out of ten cases, the child was alone when the fall occurred; most of the injuries were to the head and neck. The study, published in the journal Pediatrics, analyzed nationally representative data for 181,654 injuries related to cribs, playpens, and bassinets from 1990 through 2008. Of those injured, 2,140 children, or 1.2 percent, died—most from becoming caught or wedged in the crib.11
11 Yeh et al., “Injuries associated with cribs, playpens, and bassinets.”
America’s Anti-Cosleeping Campaign
In September 1999 and again in May 2002, the U.S. Consumer Product Safety Commission (CPSC) issued warnings about the practice of cosleeping as dangerous and life-threatening. This can be confusing for parents when in fact the American Academy of Pediatrics is in favor of cosleeping, or sleeping in close proximity. What the CPSC is really warning against is bedsharing. As a result, a nationwide campaign began in conjunction with the Juvenile Products Manufacturing Association (JPMA) that discouraged and frightened parents from bringing their infants to bed. Because of this confusion, parents reported sleeping on couches or recliners with their babies, which is many times more dangerous than bedsharing. Ironically, if a baby’s death occurs in this unsafe environment, it is reported as a “cosleeping” death. A groundswell of opposition came from researchers, psychologists, parents, and others who protested the lack of solid science behind the campaign. They found that the data was collected anecdotally and inefficiently from newspaper clippings, coroners’ reports, and death certificates, with very little information from the parents. Even today, no standard interview questions or protocols are used to collect information after a baby dies at home. Additionally important is the need for what researchers call a “control group” of infants in order to make legitimate comparisons for all the factors involved in the children’s sleeping environments.
In the 1990s, researchers in the United Kingdom conducted the largest case-control study ever done on infant deaths, called the Sudden Unexpected Deaths in Infancy (SUDI) study, carried out by the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI). They included information from 450 sudden or unexpected infant deaths and 1,800 matched “control” infants. According to one of the researchers, Dr. Peter Fleming, a professor of infant health and developmental physiology at the University of Bristol and pediatrician at the Royal Hospital for Children in Bristol, “The CESDI study showed that for infants who shared a room with a parent, the risk of SIDS was approximately half that for infants who slept alone. In other words, putting a baby to sleep in a separate room (rather than the room in which the parents slept) doubled the risk of SIDS.”12
12 Fleming, “Where should babies sleep at night?”
In the United States in 2002, scientist Dr. Tina Kimmel reviewed the CPSC data and analyzed data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS), which surveyed mothers with infants from two to six months of age, and included the question “How often does your new baby sleep in the same bed with you?” At the time of the report, only five states kept the data. However, from that information, Dr. Kimmel was able to determine that not only was it safe to sleep with your baby but “it was actually less than half (42 percent) as risky, or more than twice as safe, for an infant to be in an adult bed as in a crib.”13 With all the safety mechanisms in place to make cribs safer, still more infants die alone in cribs than in the family bed, yet there has never been an outcry to ban cribs.
13 Kimmel, “How the stats really stack up.”
Dr. Fleming questions the logic behind this sweeping campaign:
No one would suggest that because sleeping in a crib can be hazardous under certain conditions, no baby should sleep in a crib. By analogy, therefore, it is equally illogical to suggest that because under certain circumstances bedsharing can be hazardous, parents should not bedshare with their baby. Given the near universality of the practice of bedsharing at some stage, it is far more logical to identify the conditions under which bedsharing is hazardous and to give parents information on how to avoid them.14
14 Fleming, “Where should babies sleep at night?”
The blanket condemnation of bedsharing without any attempts to educate the public about how to do it safely is a big concern of many parents and professionals. The bottom line is that many parents are going to do it at some point, anyway, so they need to be well versed in safe cosleeping guidelines. Dr. McKenna expressed his disappointment and concern with the short-sighted focus of the anti-cosleeping campaign:
By refusing to point out that cosleeping, and cosleeping in the form of bedsharing, can be practiced either safely or unsafely, and that sleeping next to a baby is not inherently dangerous, especially for a breastfeeding, sober mother, the CPSC misses opportunities to educate millions of parents about how to cosleep safely. Its actions suggest instead that parents are neither educable nor intelligent enough to make their own decisions about how, or whether, to cosleep.”15
15 McKenna, “An exclusive Mothering special report.”
Dr. Fleming agrees: “Rather than issuing broad statements, not based upon good evidence, to suggest that parents should not bedshare with their babies, I suggest that giving them accurate information, based upon careful studies of healthy babies as well as babies who have died, will allow parents to make safe and appropriate choices.”16
16 Fleming, “Where should babies sleep at night?”
In 2009, the Alaska Division of Public Health examined thirteen years of infant deaths that occurred while bedsharing to assess the contribution of known risk factors. Their conclusion was that 99 percent of all bedsharing deaths occurred in association with other risk factors, such as smoking (75%), substance abuse, or placing the infant prone for sleeping. This suggests that bedsharing alone does not increase the risk of infant death.17
17 Bleabey and Gessner, “Infant bed-sharing practices and associated risk factors.”
Regardless of the research, some parents just don’t feel comfortable sleeping, or are unable to sleep, with their baby in the bed. If you’re one of those parents, then it’s important to know that it’s okay. You can still practice attachment parenting without sleeping with your baby—it’s about being responsive to your baby and being in close proximity during the night. We uphold a parent’s right to choose, to make informed decisions that feel right for everyone. The American Academy of Pediatrics provides safety guidelines for the use of cribs and other separate sleeping surfaces on its website (www.healthychildren.org/English/news/Pages/AAP-Expands-Guidelines-for-Infant-Sleep-Safety-and-SIDS-Risk-Reduction.
aspx).
In 2010 the following findings were published from a survey of nearly 5,000 families with infants up to 12 months of age in the United States.
- Despite ongoing anti-bedsharing campaigns, U.S. parents continue to bedshare in high numbers.
- Bedsharing families cite both ideological and pragmatic reasons for sleeping with their babies.
- They appear well aware of prohibitions on bedsharing, but, consistent with the results of previous studies, the majority continue to bedshare.
- In a possible attempt to avoid bedsharing, 55 percent of mothers feed their babies at night on chairs, recliners, or sofas. Forty-four percent (25 percent of the sample) admit that they fall asleep with their babies in these locations. Of all sleep locations, chairs, sofas, and recliners are by far the most dangerous and dramatically increase the risk of suffocation.
Safe-sleep campaigns should include information on safe bedsharing. In the absence of this information, parents are likely to continue bedsharing but may do so in unsafe ways. Alternatively, safe-sleep campaigns could provide other strategies, such as encouraging babies to sleep on adjacent, yet separate, surfaces.18
18 Kendall-Tackett et al., “Mother-infant sleep locations and nighttime feeding behavior.”
What About Cosleeping with
Nonbiological Parents?
Many adoption agencies are beginning to support cosleeping with adopted babies for a couple of very good reasons. First, many internationally adopted babies come from countries where it is the custom to sleep with the baby. Second, adopted babies seem to adjust much better and are more likely to form a secure attachment with their adoptive parents sooner when the parents sleep with them.
In the case of stepparents, the biological parent will need to discuss this openly to gauge the stepparent’s feelings about bedsharing. If the stepparent has a close, loving relationship with the baby, has mentally and physically taken on the role of a parent, and agrees to follow the safe-sleeping guidelines, then the biological parent may decide that it would be safe to cosleep. Any parent, biological or step, who is a deep sleeper should not sleep with an infant in the bed, because he or she is less likely to be as aware of the baby.
Some may have an unspoken fear that sleeping with a young child may stimulate sexual feelings—especially in a nonbiological parent. It’s important to remember that sexual abusers are not born but created by their own horrible experiences in childhood and that a normal, healthy adult will not be tempted to abuse a child, whether or not they share bed. It is, however, imperative that biological parents take time to get to know a person very well before inviting him or her into the family and the family bed. A stepparent may feel uncomfortable with the situation based on his or her personal beliefs or childhood experiences—these feelings, if that is the case, should be respected and alternative arrangements discussed.
It can be a little more complex to cosleep with more than one infant. Dr. McKenna recommends bedsharing with one baby at a time while the mother is breastfeeding. If the mother is single or otherwise doesn’t have a partner to help care for one of the babies in the family bed while she cares for the other, then she can make sure, such as in the case of twins, that both are in front of her and she is sleeping in a protective position with her knees bent upward. Two or more babies in the family bed make it a little more difficult for everyone to be comfortable or safe. If you share the bed with twins, be aware that as they grow they will begin to move around in the bed and can fall onto the floor if the bed isn’t securely protected or if the mattress isn’t on the floor (please read the Safe Cosleeping Guidelines that follow).
Parents of multiples can consider placing young infants in the same bassinet, crib, or cosleeping device (called cobedding) while in the same room with the parents. This practice may be frowned upon by your pediatrician or others, but in his book Sleeping with Your Baby, Dr. McKenna writes, “Nowadays when you hear a recommendation against cobedding, it often illustrates cultural biases against cosleeping in general where medical authorities assume, without any data, that if some instances of bedsharing between an adult and a baby are dangerous, then certainly two infants of equal body size must likewise pose a mutual threat.”
For more information about safe cosleeping with multiples, we recommend you read Dr. McKenna’s book, as well as Mothering Multiples by Karen Gromada.
API recommends the following research-based guidelines that, when followed, allow parents and infants to share sleep in the safest way possible. These guidelines should be followed regardless of where the baby sleeps:
1. Place your baby to sleep on her back. This helps protect her from sudden infant death syndrome (SIDS).
2. Choose a firm mattress, free from fluffy bedding, bumpers, and stuffed animals. Never place your baby—or fall asleep with your baby—on a couch, recliner, beanbag chair, foldout couch, inflatable bed, or water bed to sleep.
3. Keep baby cool. Adjust clothing and room temperature to keep baby from overheating. UNICEF recommends a temperature of 60 to 64 degrees Fahrenheit for nighttime sleep.
4. Use a fan in the room where baby sleeps to help circulate air and maintain a cooler environment.
If your baby sleeps with you:
1. Breastfeed your baby. Breastfeeding mothers spend more time in lighter stages of sleep, making them more aware of the baby. They also tend to sleep in a protective position (with knees bent upward), which prevents baby from moving down under the covers.
2. Place the baby next to the mother rather than between the mother and father.
3. Use approved side rails or bed extenders when placing your baby in the family bed. Fill in any crevice between the bed and the walls or furniture with a rolled-up baby blanket or towel. Do not bedshare on a water bed or soft memory foam mattress topper. Placing the adult mattress on the floor (like a futon) creates the safest possible sleep environment.
4. A baby should not be left to sleep alone on an adult bed, even during naps. If parents do not have access to a crib or cosleeping device for naps, place a smaller, firm mattress or futon on the floor.
5. Be mindful about sharing sleep and settle the baby safely next to Mom in a planned environment rather than falling asleep from exhaustion on the couch, a recliner, a beanbag chair, or another unsafe place to share sleep.
6. Only primary caregivers should sleep with an infant. Do not allow babysitters or older siblings to sleep with the baby.
If your baby sleeps in a crib, the
crib must meet CPSC safety guidelines:
1. Slat spacing should be less than 2-3/8 inches.
2. Slats must not be loose or broken.
3. The headboard and footboard must not have cutout designs.
4. Corner posts should be no more than 1/16 inch higher than other rails.
5. Use firm, tightly fitting mattress with tightly fitting bottom sheet.
6. Remove loose bedding, bumper pads, and soft toys.
Parenting and infant care should focus on both health and safety. Bedsharing with an infant is healthy and safe in most cases, but there are situations that require parents to use a bassinet or crib instead.
You should not share a bed with an infant if any of the following apply:
1. You use alcohol or drugs. Using any substances that interfere with your judgment or level of consciousness at night will interfere with your ability to be aware of your baby. These substances include over-the-counter medication such as sleep aids or cold medication.
2. You smoke. A higher risk of SIDS has been associated with parental cigarette smoking and bedsharing.
3. You have a poor sleeping surface. Sharing sleep with your baby should not be done on a couch, a recliner, a water bed, or any location where the infant could become wedged between the surface and the parent.
4. Your baby is premature, is of low birth weight, or has a high fever.
5. There are other children or animals in the bed. The family bed should not include older children, who may not be as aware of the baby in bed.
Establishing Nighttime Routines
Regardless of which sleeping arrangement a family chooses, nighttime routines help everyone unwind from a busy day and help establish healthier sleep habits. Remember that especially for working parents, this is a “high attachment” part of the day! In the early weeks, the main routine is likely to be holding, rocking, and feeding. As mentioned earlier, your baby will sleep a lot at first and will have his own routine for a while, which is sure to be very different from yours. As he becomes a little more mature, his sleep routines will become a little more predictable, but they are guaranteed not to stay that way. Some infants are easily overstimulated by the environment, whether that environment includes television noise, playful siblings, car travel, or the general busyness of the day.
Risk factors found to be related to infant deaths in an adult bed are a smoking parent, prone sleeping position, parents affected by alcohol or drugs, use of heavy comforters or blankets that can cause overheating, and inappropriate sleep locations, such as a couch or waterbed.19
19 McKenna et al., “Infant-parent cosleeping in an evolutionary perspective.”
Sometimes babies will get fussy and cry and seem to fight sleep because they are overstimulated. What they may need is calming down by slowing down the home environment. A pleasant bedtime routine may include playing soft music, giving the child a warm bath or a massage, rocking, reading, or singing to the child, and reducing stimulation in the period before sleep. You’ll soon learn what quiet activities your baby enjoys, and it will serve to deepen your connection. Ignore any well-intentioned advice that by doing this you will “spoil” the baby. These kinds of routines, while seemingly tedious at times, can create lasting, loving memories.
For many generations, mothers and fathers around the world have enjoyed rocking and singing to their babies. Today’s parents are relearning long-forgotten lullabies from their own mothers, or learning new ones as they listen to lullabies on CDs. Researchers have found that mothers who sing to their babies every day have babies who are more advanced in their language and early communication skills, and they found an unexpected benefit to the mother. A recent study found “a number of parents who said [that] when they’d had post-natal depression, or feelings like that after the birth of their child, [singing] not only relaxed the child but relaxed them as well.”20
20 McDonald, “Lullabies help children’s language development.”
No matter what the stresses of the day have been, one of the most relaxing things you can do is rock and sing to your baby. There are obvious benefits to the baby, who has been hearing her mother’s voice in the womb for many months, and it has an immediate calming effect. The rocking motion is also important for the baby’s vestibular system in the brain, which is responsible for balance, spatial perception, movement, and motor coordination. Several lullaby CDs are listed in Appendix C.
Developing Healthy Sleep Habits for the Older Child
Parents can experiment to find the routine that works best for their child, and remember that any bedtime routine is likely to take from thirty minutes to an hour or more. Some parents find it helpful to begin quieting down the environment up to two hours before bedtime. Recommendations for older children include eliminating food or drinks with caffeine or a lot of sugar (for some children, food dyes can create hyperactivity) from their diet, turning off the TV, dimming the lights, or reducing noisy activities before bedtime. If you are breastfeeding a toddler, continue to watch your diet, avoiding caffeine in drinks or chocolate and spicy or gassy foods—even foods with citric acid can be culprits. Also avoid sweeteners such as aspartame if you suspect they could be bothering your baby.
As bedtime approaches, many children calm down easily with a predictable nighttime routine; others experience a high-energy spurt just before bedtime and may need high-energy play before they can relax. Some children are relaxed by a bath, while others are excited by it. Do what works to help each individual child prepare for sleep, and remember the importance of a regular bedtime that is early enough to allow sufficient sleep—eight to ten hours—if the child must wake early for school or other activities.
It may be a “different” arrangement, but I can’t imagine it being any other way. I am awake and leaving the house before anyone else begins to stir. Some mornings it takes every ounce of self-restraint to keep from climbing back into bed and snuggling up to my loved ones in our big family bed. There is something surreal about sharing space, time, and warmth and listening to one another breathe in synchronicity for a moment, splinter into our own rhythms, and then find one another again.
We were already sharing a family bed when we heard about “cosleeping.” Neither my wife nor I came from cosleeping families, but when our first son was born, it simply felt right to continue to have him right next to us. He had shared our bed while in utero; why should it change after he was born? Of course we had well-meaning friends and relatives express concern when they heard about our sleeping arrangement. We read other people’s thoughts about it, both those for and against it. Even after we learned more about cosleeping, continuing to have our son in our bed simply worked for us.
Our oldest son knows that there is an option to sleep in his own bed in our room or in a separate room, but the choice and the change will be one that is based on his needs. When I wake up in the morning to see my little family cuddled together, nestled in against the coldest mornings, it’s just what I need to go on.
—Dax L.
Keep in mind that sleep routines change as the child grows and matures. Try not to get stressed out; keep a sense of humor and remain flexible.
[With] four kids . . . Bedtime is a crisis . . . they act like they’ve never been to sleep before. “Beeeddd? What’s that? Naw, I don’t want to do that!” Then it becomes some hostage negotiation but in reverse. “Look, if you will stay in there I will give you whatever you want! I will meet your demands. . . . [W]hat do you want, a
helicopter to Cuba? Anything! Stay in there!”
—Jim Gaffigan, stand-up comedian, Mr. Universe
Bedtimes may shift earlier or later as nap schedules and sleep needs change, and the total amount of sleep that a child needs decreases as he gets older. When a child transitions out of a nap or starts school, the sleep cycle can become erratic for a while. Illness and growth spurts can also contribute to changing sleep patterns. Through all of these changes, parents can help the child learn to trust his body and recognize the signs of tiredness without forcing him to go to sleep when he is not tired or keeping him awake when he needs sleep, just for the sake of a routine. Parents can be proactive in teaching their child ways to calm down to prepare his mind and body for sleep.
Transitioning Out of the Family Bed
When the time comes for a child to transition to her own bed, parents need to make sure that the transition is gentle and respectful of any feelings of fear or upset experienced by the child. This is especially true when a child is transitioning because of the birth of a sibling, since the child may already have some anxiety related to the birth. Young children who have their own beds often go to sleep more willingly when parents lie down with them in their beds until they are very drowsy or until they go to sleep—usually after reading a few stories. Children outgrow this need when they are developmentally ready and will happily go to sleep on their own, although older children may still enjoy a brief snuggle time with parents before bed.
Communicating with Your Partner
Since no set rules govern nighttime parenting, considering the needs of each family member will help you make the best choice for the family. Some parents do not feel comfortable with the idea of having a baby sleep in their bed, or one parent may want to cosleep and the other might not. It’s not unusual for fathers to be a little more reluctant and resistant to cosleeping, but fathers have reported that they found bedsharing “more enjoyable than disruptive.” Bedsharing helps fathers feel more quickly bonded to their babies.21
21 McKenna, Sleeping with Your Baby, 52.
It’s important to discuss individual feelings and to resolve any concerns in a way that is respectful to each parent while still meeting the baby’s nighttime needs. When considering the different possible sleeping arrangements, some parents are concerned about how cosleeping will affect intimacy with the partner. Neither parenthood nor cosleeping has to put a damper on intimacy; a little creativity and preplanning can ensure that intimacy doesn’t wither on the vine. (See Chapter 9 for more information about keeping intimacy and balance in your relationship.)
Parents need to discuss the idea of bedsharing as soon as possible—if not before the baby is born, then again shortly afterward to prevent any misunderstandings. For the family bed to work best, both parents need to be on board with the decision. If the mother is planning on nursing, she will find that bedsharing, or having the baby within arm’s reach, will help her sleep and stay rested while better facilitating the breastfeeding relationship. If Mom is breastfeeding, it usually works out well for Dad, because he doesn’t have to get up to get the baby.
The main priority is for both parents to be on the same page, so that the family bed doesn’t create a wedge in the relationship. Frank, open communication is key in any relationship, so if problems arise, talk about them. If you don’t know the answers, find information that can help you. An endless amount of information can be found on the Internet and in books. You can feel confident about any information that you find through API’s website as well.
As they grow, many babies will go through a phase in which they sleep for longer periods, only to begin waking at night during different developmental stages. They may wake during nightmares (some actually experience “night terrors”), teething, illness, growth spurts, or times of family stress or transition in their lives. Babies are very sensitive to their parents’ stress or when parents are simply trying to steal a few minutes of time to do something else, all of which can affect their sleep-wake patterns. It’s possible that occasionally some babies may be overstimulated by sleeping with the parents. The only way to know is to try having the baby sleep on a separate surface near the adult bed. The key is tuning in to what the baby is trying to communicate and finding the sleep arrangement that works best for the family and in which everyone gets the best sleep. Recent research indicates that some babies do better if their sleep arrangements are consistently in the same place, whether bedsharing or sleeping separately. Just about any parent can tell you that babies seem to have built-in radar for when Mom and Dad want time to themselves. Don’t take it personally! Baby is just trying to keep a connection with Mommy.
After thirty years of caring for children and counseling parents, the Searses has found that most infants wake up several times during the night. He reassures parents that it is not because of anything they have done. “Every baby is different, and sleep behavior has more to do with inborn temperament than with any ‘bad habits’ caused by Mom and Dad,” say the Searses.22
22 Sears and Sears, The Attachment Parenting Book, 90.
Gentle Ways to Get Your Baby to Sleep
Dr. Jay Gordon is a pediatrician who knows firsthand from working with hundreds of families that sleep deprivation can become a big issue for many parents. He describes himself as one of the strongest proponents of attachment parenting and the family bed, but he understands that when parents become unhappy with the arrangement, largely because of frequent nursing and night-waking, then it is time to make some changes. However, Dr. Gordon is adamant that both parents be in agreement and feel good about the decision to gently change their child’s sleep habits. He first warns parents:
I don’t recommend any forced sleep changes during the first year of life. Probably the only exception to this would be an emergency involving a nursing mom’s health. There are many suggestions in books and magazines for pushing “sleeping through the night” during a baby’s early months or during the first year. I don’t think this is the best thing to do, and I am quite sure that the earlier a baby gets “nonresponse” from parents, the more likely he is to close down at least a little.23
23 J. Gordon, “Changing the sleep pattern in the family bed.”
In his books and on his website, Dr. Gordon provides parents with gentle, sensitive ways of teaching toddlers to sleep without nursing. He feels that parents are the best judges of whether his techniques work, and he encourages them to follow their instincts.
Other pediatricians, such as Dr. Paul Fleiss, raise concerns about the crying-it-out method of sleep training. He warns parents:
Don’t ignore your children’s cries. After all, they may be sick, in danger, or in pain. Babies and young children are emotional rather than rational creatures. They can’t comprehend why their cries for help are being ignored. Even with the best of intentions, ignoring children leads them to feel abandoned. The result will be insecure, unhappy children. You cannot “spoil” children by responding to their cries. “Spoiled” children are those who don’t know what to expect from their parents. They are often alternately punished or praised for the same activity at different times.24
24 Fleiss, “Pillow talk.”
The Problem with Sleep Training
Parents who are frustrated by frequent night waking or who are sleep-deprived may be tempted to try sleep-training techniques that recommend letting a baby “cry it out.” It was once believed to be healthy to teach a baby to “self-soothe.” New research suggests that these techniques can have detrimental physiological effects on the baby by increasing the stress hormone cortisol in the brain.25 The increase in cortisol can have long-term effects on emotional regulation, sleep patterns, and behavior. In The Science of Parenting, Margot Sunderland describes the physiological processes that occur when a baby is allowed to cry himself to sleep: “His stress levels will have gone up, not down. Studies show that after being left to cry, babies move into a primitive defense mode. This results in an irregularity in breathing and heart rate, both of which can fluctuate wildly, and high levels of cortisol.”26
“A popular childrearing standard encourages parents to allow little babies to cry themselves to sleep, with the presumption that this is the best course for family homeostasis as well as development of independent attitudes. The emphasis behind this practice is on learning to self-soothe at an early age, rather than gradual acquisition of these skills through mutual regulation with a caregiver. A host of reasons both psychological and neurochemical suggest that such practices may be directly or indirectly linked to the ongoing epidemic of depression.”27
25 Sunderland, The Science of Parenting, 79.
26 Ibid., 80.
27 Narvaez et al., Evolution, Early Experience and Human Development, 459–60.
An infant is not neurologically or developmentally capable of calming or soothing herself to sleep in ways that are healthy. The part of the brain that allows her to begin the process of learning to regulate her own emotions, or self-soothe, isn’t well developed until she is two and a half to three years of age. Babies and young children depend on their parents to help them calm down and learn to regulate their intense feelings—they are the child’s “emotional regulators.”
Sleep training involves placing the baby alone in a crib before he is fully asleep. When the baby cries, parents are taught to comfort the child verbally or with pats on his back only after waiting increasing amounts of time to respond and then leaving the room. The child finally falls asleep from exhaustion. After a few nights of this, some children will learn to fall asleep quickly and without crying.
While sleep training has become extremely popular in Western cultures, it is not without controversy, because no evidence has shown that it is really beneficial in the long run, and, in fact, it may be detrimental to emotional and psychological development. Why is it so popular? In an effort to help parents get more sleep, this kind of advice is dispensed in popular parenting books, by pediatricians and sleep researchers who most often have little knowledge of children’s normal emotional, cognitive, or neurological development. Such advice is often based on the premise that infants are neurologically ready to be “taught” when to go to sleep at night and that they should be able to sleep throughout the night uninterrupted.
Leaving infants to cry it out in order to learn to sleep on their own, Dr. McKenna has observed, deprives babies of oxygen and creates a situation in which the baby must redirect her energies away from growing and fighting disease. He states that “the baby is burning energy and calories needlessly that could have been put into other more beneficial processes.”
McKenna offers powerful advice to parents on sleep training:
I think sometimes parents are under the mistaken impression that if they don’t sleep train their babies, somehow some developmental or social skill or competency later in life will be kept from them or that their babies will never exhibit good sleep patterns later in life.
If they think this, then they really ought to know that there has never been a scientific study anywhere that has shown any benefit for babies whatsoever in sleeping through the night at young ages, or even sleeping through the night at any particular time. What is important is the nature of social relationships and support within which babies develop all kinds of skills pertaining to independence.
One of the most important things I am hoping to do is remind parents that no one can tell them what they should do with their babies. They have to learn to trust their own judgment, look at the research that is now available on these issues of sleep behavior, and see that there are major critiques about this solitary sleep-training model.28
28 Parker, “The greatest gifts we can give our children.”
It’s very likely that your baby’s pediatrician will discourage you from bedsharing, but he or she should be supportive of the baby sleeping in close proximity in accordance with the AAP guidelines, which state, “Room-sharing but not bed-sharing is recommended—there is evidence that [room-sharing] decreases the risk of SIDS by as much as 50%.” In addition, the AAP recommends that bedsharing should be avoided with a baby younger than three months, and never to bedshare if either parent is a smoker or takes prescription medication, alcohol, or illicit drugs. Babies should never bedshare with anyone other than a parent.29 You are not obligated to share information about your child’s sleeping arrangements with your pediatrician, but you are obligated to be informed and to provide a safe sleeping environment wherever your child sleeps. For that reason, API has launched the Safe Sleep Campaign to help educate parents and professionals about how to create a safe environment. A brochure entitled Safe Infant Sleep Guidelines is available for free at http://attachmentparenting.org/infantsleepsafety. This brochure can be downloaded and used by any parent, professional, and agency. Be skeptical of any advice that goes against your instincts, and listen to your baby! As the parent, you have the right to make informed decisions for your child; when it comes to sleeping, keep it safe!
29 American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome, “SIDS and other sleep-related deaths.”
A sleep training program for infants looked at the physiological and behavioral dynamics of infants and their mothers. Saliva samples that measure levels of cortisol (a hormone that registers stress) were taken when the babies were left to “cry it out” for the night. Both mothers and babies had high cortisol levels when the babies were crying. After three days of sleep training the babies no longer cried for their mothers, resulting in the mother’s cortisol levels being reduced, however the babies’ levels remained high. The researchers were concerned that this “disconnect” could disrupt maternal-infant attunement which is essential for optimum child development. 30
30 Middlemiss et al., “Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity.”