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Interaction Between Feeding Method and Co‐Sleeping on Maternal‐Newborn Sleep
Abstract
Background:
Previous studies have demonstrated that breastfed newborns spend more time awake than bottle-fed newborns, breastfeeding mothers have more fragmented sleep than bottle-feeding mothers, and mother-newborn sleeping arrangements may affect the sleep/wake pattern of mother-newborn pairs.
Objective:
To address the unsolved question of whether there is an interaction between type of feeding and sleeping arrangements that affects postpartum sleep during the 4th postpartum week.
Design:
Correlational, two-way design using feeding method and location of newborn at night as independent variables, and sleep patterns as the dependent variables.
Setting:
Patient's home during 4th week after giving birth.
Patients/participants:
First-time mothers and their newborns (n = 33).
Main outcome measures:
Amount of total sleep, amount of night sleep, number of night awakenings, and number of sleep periods in 24 hours using a modified version of the self-report sleep instrument by Barnard and Eyres.
Results:
Breastfed newborns had less total sleep per day than bottle-fed newborns, and breastfeeding mothers had more sleep periods in 24 hours than bottle-feeding mothers. Breastfeeding mothers slept more than bottle-feeding mothers when co-sleeping, but bottle-feeding mothers' sleep was unaffected by location of newborn. Average total sleep for 4-week-old newborns was about 14 hours daily.
Conclusions:
More sleep was obtained when breastfeeding mothers slept with the newborn. Methods or devices that allow breastfeeding mothers and newborns to sleep next to each other in complete safety need to be developed.
... The articles were excluded if they: (a) examined sleep among mothers with preterm infants or twins, (b) examined sleep among mothers with infants with newborn complications or admitted to the Neonatal Intensive Care Unit (NICU), and (c) were not published in English. Additionally, most of the original studies excluded women with certain complications and conditions including working night shifts, taking medications that alter sleep, and history of diagnosed sleep disorders or affective disorders from the study (Crittenden et al., 2018;Doan et al., 2007;Doan et al., 2014;Gay et al., 2004;Quillin & Glenn, 2004). We limited the cut-off for the postpartum period at the fourth week (1 month) to 12 months and included quantitative studies (observational, cross-sectional, or interventional) if they reported maternal night-time sleep (mean ± SD: h) by feeding types. ...
... After the full-text review of each article, in total 28 articles were excluded due to the following reasons: (i) 23 of the articles did not report maternal sleep for each feeding type, (ii) two studies were conducted in mothers with preterm or twin infants, (iii) two articles reported data from studies in infants with a complication or admitted to the NICU, and (iv) one study was published in another language (Chinese). After excluding the mentioned articles, seven articles remained for the review and meta-analysis (Crittenden et al., 2018;Doan et al., 2007;Doan et al., 2014;Gay et al., 2004;Kendall-Tackett et al., 2013;Quillin, 1997;and Quillin & Glenn, 2004). The review was limited to quantitative or mixed-methods studies, excluding studies that were solely qualitative. ...
... The main purpose across the studies was to explore the relationship between infant feeding types and maternal sleep from the first to the 12th-month postpartum. All the included studies in this review are described in Table 2. Of the seven studies in this review, five were conducted in the United States (Doan et al., 2007;Gay et al., 2004;Quillin, 1997;Quillin & Glenn, 2004;and Kendall-Tackett et al., 2013), one in East Africa (Crittenden et al., 2018), and one in Canada (Doan et al., 2014). Two studies were a part of RCTs (Doan et al., 2007;Gay et al., 2004). ...
The aim of this meta‐analysis was to examine the associations among infant feeding types, sleeping habits, and maternal sleep postpartum. Databases including Cumulative Index of Nursing and Allied‐Health Literature (CINAHL), PubMed, and Google Scholar were searched in addition to reference lists from selected articles and other key references. A critical review of relevant articles from the data sources was conducted with attention to the infant feeding types and maternal night‐time sleep. The methodological quality was assessed systematically. The pooled mean difference was calculated. Narrative summaries were also used. A total of 6,472 participants from seven studies were included in the meta‐analysis. A random‐effects model demonstrated a significantly higher maternal night‐time sleep in breastfeeding mothers than non‐breastfeeding mothers with a pooled standardized mean difference of 0.24 h (95% confidence interval 0.03–0.46, p = 0.026). Co‐sleeping with infants during the night also increased the sleeping hours in breastfeeding mothers. Homogeneity was observed with a Tau2 of 0.0308 and I2 of 44.3%. Funnel plots, Egger's and Begg's tests revealed no evidence of publication bias. This systematic review and meta‐analysis demonstrated that breastfeeding may be associated with a longer night‐time sleep postpartum and the synthesis of the literature suggested that co‐sleeping with the infant was associated with longer sleep duration in breastfeeding women. Further research into factors involving maternal decisions on infant feeding types and their effects on maternal sleep is needed to better understand the mothers' attitude toward infant feeding and their own sleep.
... Table 1 summarizes the characteristics of all 21 studies included in the systematic review. Among these, nine (43%) were cross-sectional [19,[29][30][31][32][33][34][35][36], six (29%) were cohort studies [23,[37][38][39][40][41], five (24%) were longitudinal studies [17,[42][43][44][45], and one study combined randomized control trials [46]. The studies were mainly conducted in the United Kingdom (n = 5), and the United States (n = 8), making up more than half of the included studies. ...
... The sample size of the included studies ranged from 20 to 1676 participants, totaling 6225 infants under 12 months-of-age. Subjective methods including sleep dairies/timetables, Brief Infant Sleep Questionnaire (BISQ), and other sleep questionnaires were used in 15 studies [17,19,[30][31][32][33][34][35][36][37][38][39]41,42,46] to assess sleep. The remaining six studies used objective methods to measure sleep, such as an actigraph or electroencephalogram (EEG). ...
... All twenty-one studies reported on type of milk feeding in relation to infant sleep patterns as shown in Table 2. The type of milk feeding was reported prospectively by parents or caregivers through questionnaires [17,19,23,30,31,35,38], interviews [32,46], feeding logs [36,37,45], and by maternal self-report [33,34,39,40,43,44] except for one study [41], that assessed type of milk feeding retrospectively through a questionnaire. Two studies [29,42] did not specify their assessment methods. ...
Inconsistent conclusions from infant sleep and feeding studies may influence parents feeding-related decisions. This study aimed to systematically review the existing literature on infant sleep and its relation to the timing of introduction to complementary foods and type of milk feeding to better understand their role(s) in infant sleep. Cohort, longitudinal, cross-sectional studies, and controlled trials were identified using online searches of five databases up to April 2020. Twenty-one articles with a total of 6225 infants under 12 months-of-age were eligible. Exclusively breastfed infants (≤6 months-of-age) had a greater number of night wakings, but most studies (67%) reported no difference in night-time and 24 h sleep duration compared to formula-fed infants. However, after 6 months-of-age, most studies (>65%) reported breastfed infants to sleep less in the night-time and over 24 h compared to formula-fed infants. Furthermore, studies reported no association between the timing of introduction to complementary foods and infant sleep duration (<12 months-of-age). Future studies using standardized methodologies and definitions, transdisciplinary expertise, and longitudinal design are required to better understand the complex role of feeding on sleep.
... 6 Besides a range of behavioural interventions, 7 nutrition has been implied to influence the wake-sleep cycle of infants, but conflicting findings have been reported. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Breastfed infants have more nighttime wakings, [8][9][10][11][12][13] less nighttime sleep, 14 and less total sleep, [15][16][17] as compared to formula-fed infants. The most commonly described explanation for shorter total sleep duration is the faster digestion of human milk (HM) as compared to cow's milk-based infant formula (CMF). ...
... 6 Besides a range of behavioural interventions, 7 nutrition has been implied to influence the wake-sleep cycle of infants, but conflicting findings have been reported. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Breastfed infants have more nighttime wakings, [8][9][10][11][12][13] less nighttime sleep, 14 and less total sleep, [15][16][17] as compared to formula-fed infants. The most commonly described explanation for shorter total sleep duration is the faster digestion of human milk (HM) as compared to cow's milk-based infant formula (CMF). ...
Objectives
To determine total, night‐ and daytime sleep duration and waking frequency among infants exclusively fed goat milk‐based infant formula (GMF) or cow's milk‐based infant formula (CMF) enroled in a randomised controlled trial and compare these to a human milk (HM) fed reference group.
Methods
Post hoc analysis from a double‐blind randomised controlled trial in 304 healthy term infants was performed. Formula‐fed infants were randomly assigned to receive exclusively GMF or CMF for a period of 112 days and compared to a reference group fed HM. Sleep was assessed using a 3‐day 24‐h diary before the five visits throughout the trial. The association between feeding type and sleep was studied longitudinally and cross‐sectionally at the five visits. All models were adjusted for infant sex and study site of enrolment. For associations between formula‐fed infants and the non‐randomised HM group, additional adjustments were made.
Results
Total sleep duration slowly and similarly decreased over the course of study duration for all groups, with a decrease of about an hour between the first and last measurement. Longitudinally, daytime sleep duration was significantly longer for GMF (mean 8.6 h, standard error [SE] 0.17) and HM (8.8, 0.18) fed infants as compared to CMF (8.1, 0.17; p < 0.05). Cross‐sectional analyses show that infants fed GMF or HM had higher total sleep duration than infants fed CMF at all visits, with significant differences between the groups at Visits 3 and 4.
Conclusions
In infants fed GMF a significantly longer daytime sleep duration and a non‐significant trend towards a longer total sleep duration were found when compared to infants fed CMF. These findings suggest that nutrition plays a role in sleep duration.
... Also, in relation to these findings we should consider the factor of breastfeeding as there are studies that link breastfeeding with interrupted sleep [55,56]. Therefore, as most of the co-sleeping mothers in this study are breastfeeding, we cannot be sure whether the cause of the infant's sleep problems stems from the co-sleeping practice itself or because of the baby wanting to breastfeed more often. ...
... Also, in future research, the general sleep profile of the mother before childbirth should be investigated. For example, a study of 153 families showed that women who had co-sleeping and reported having greater sleep problems had sleep-related difficulties even before pregnancy [4,56]. ...
Background: This study explores whether the implementation of co-sleeping in infants aged 6–12 months (a) is associated with maternal complaints and mothers’ difficulties regarding their infant’s sleep, (b) is associated with maternal mental health, (c) affects infant sleep characteristics and maternal sleep quality, and (d) is associated with breastfeeding. Methods: This study is a cross-sectional study conducted from July to November 2021. A total of 151 new mothers of infants aged 6–12 months participated. All participants were divided into two different groups, the group of mothers who adopted the co-sleeping method from birth up to the time of the survey and the group of those who did not adopt co-sleeping at that time. The Brief Infant Sleep Questionnaire—Revised Short Form (BISQ-R SF), the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), and a questionnaire on mothers’ demographics were administered. Results: Regarding the mothers’ complaints, mothers who co-sleep with their children have lower sleep quality than those who do not co-sleep. In respect of the mothers’ mental health, there did not seem to be a statistically significant difference in the two groups. Regarding the difficulties during the sleep process, children who sleep with their parents seem to have more difficulties compared to the others (p = 0.008). It was also shown that co-sleeping children seem to have more disturbed sleep compared to those who sleep alone (p = 0.018), and a general trend obtained of a significantly higher number of awakenings for co-sleeping children (p < 0.001). Finally, breastfeeding appeared to be more related to the children of the present sample sleeping with their parents (p < 0.001). Conclusions: This study showed that co-sleeping is associated with more difficulties in infant and maternal sleep, but no direct correlation with maternal mental health was found. In addition, it showed a positive correlation of co-sleeping with breastfeeding.
... One study, for example, emphasizes the many benefits of breastfeeding for both mother and baby during cosleeping, with increased TST for breastfeeding mothers (5.9 h). 21 In contrast, total sleep time during bottlefeeding (5.7 h) was unaffected by the baby's sleep location. 21 While numerous studies have investigated many factors influencing prenatal and postnatal sleep in women, only a very limited number of studies have investigated and integrated sleep in expectant fathers and fathers both during pregnancy and postpartum. ...
... 21 In contrast, total sleep time during bottlefeeding (5.7 h) was unaffected by the baby's sleep location. 21 While numerous studies have investigated many factors influencing prenatal and postnatal sleep in women, only a very limited number of studies have investigated and integrated sleep in expectant fathers and fathers both during pregnancy and postpartum. 4,5,20,23,31 ...
Background
Sleep disturbances are frequent during pregnancy and postpartum. However, detailed research of sleep in couples during pregnancy and postpartum is lacking.
Objective
Changes of sleep for primi- and multiparous pregnant women and their partners from late pregnancy to three months postpartum. The particular focus of this study is on sex differences in sleep, sleep problems, mutual sleep influence of couples, and the influences of parity and feeding methods on couples’ sleep.
Materials and Methods
The sample included 69 pregnant couples in the last trimester of pregnancy (t1) and three months after birth (t2). Sleep was measured with sleep diary for both times of measurement. The Pittsburgh Sleep Quality Index (PSQI) assessed sleep disturbances. Other variables as parity and infant feeding type were determined by questionnaire. Besides results for woman and men, also dyadic data are calculated.
Results
Over the time women had a worse sleep quality than men. They had a prolonged sleep onset latency, higher frequency and longer duration of night wakings than men. Sleep efficiency for women was prepartal 83.32% and postpartal 83.6% below the clinically cut-off value of 85%. For 56.52% of women at t1 and for 55.07% at t2 PSQI scores exceeded the clinically cut-off of 5. However, men suffered from a sleep loss after birth of their child, too. In pregnancy and postpartum men reported lower total sleep time at both times of measurement in comparison to women. For 30.43% of men at T1 and for 24.64% at T2 PSQI score exceeded the clinically cut-off of 5. Sleep efficiency for men was prepartal 90.96% and postpartal 90.69%. Results indicate predictive links between prepartal PSQI of couples to postpartal PSQI. Neither parity nor feeding method could explain variance in postpartal PSQI-score.
Conclusion
This is one of the very rare studies incorporating dyadic data. Results show the need of diagnosing and treating existing sleep problems in pregnancy to prevent future sleep problems postpartum.
... We are not aware of comparable studies that have assessed associations between maternal and infant sleep at various time points. Indeed, the few studies that have assessed both maternal and infant sleep have not focused on associations between sleep behaviors in the mother-infant dyad (e.g., (Quillin and Glenn 2004)). Behavioral patterns within the mother-infant dyad undergo dynamic changes during the early postpartum weeks (Acebo and Thoman 1995;Anders et al. 1992), and we may have been unable to show associations in maternal and infant-sleep patterns after 2 weeks because of variability in infant development, as well as differences and changes in maternal responsiveness during that time period. ...
... Our data on maternal and infant-sleep times are similar to those reported in the literature at similar time points. For instance, Quillin and Glenn (Quillin and Glenn 2004) reported an average maternally reported infant-sleep time of 13.9 h and maternal nocturnal sleep time of 5.8 h at 4 weeks postpartum in their study comparing sleep between breast-and bottlefeeding mothers. Lee and colleagues (Lee et al. 2000b) reported a mean polysomographically recorded sleep duration of 379 min in mothers at 3-4 weeks postpartum, which is nearly identical to our sleep durations estimated with actigraphy. ...
Our goal was to examine associations of infant sleep and feeding patterns with maternal sleep and mood among women at risk for postpartum depression. Participants were 30 women (age ± SD = 28.3 ± 5.1 years) with a history of MDD (but not in a mood episode at enrollment) who completed daily sleep diaries, wore wrist actigraphs to estimate sleep, and had their mood assessed with the Hamilton Depression Rating Scale (HAM-D-17) during four separate weeks of the perinatal period (33 weeks pregnancy and weeks 2, 6, and 16 postpartum). They logged their infants' sleep and feeding behaviors daily and reported postnatal stress on the Childcare Stress Inventory (CSI) at week 16. Mothers' actigraphically estimated sleep showed associations with infant sleep and feeding patterns only at postpartum week 2. Shorter duration of the longest infant-sleep bout was associated with shorter maternal sleep duration (p = .02) and lower sleep efficiency (p = .04), and maternal sleep efficiency was negatively associated with the number of infant-sleep bouts (p = .008) and duration of infant feeding (p = .008). Neither infant sleep nor feeding was associated with maternal sleep at 6 or 16 weeks, but more disturbed infant sleep and more frequent feeding at 6 weeks were associated with higher HAM-D scores at 6 and 16 weeks and higher CSI scores. Sleep in the mother-infant dyad is most tightly linked in the early postpartum weeks, but mothers continue to experience disturbed sleep and infant sleep and feeding behaviors continue to be associated with mothers' depressive symptoms and stress ratings as long as 16 weeks postpartum. These data imply that interventions designed to improve maternal sleep and postpartum mood should include both mothers and infants because improving infant sleep alone is not likely to improve maternal sleep, and poor infant sleep is linked to postpartum depression and stress.
... Auch die nächtliche Wachzeit der Mütter ist bedeutsam und trägt zum Schlafmangel bei, dies gilt laut einigen Studienergebnissen wohl vor allem für Erstgebärende [30,61]. Stillende Mütter haben eine höhere Gesamtschlafzeit, wenn das Baby nah bei ihnen schläft (Co-Sleeping), im Vergleich zu Müttern, die mit Flaschen füttern [43]. Auswertungen der KiGGS-Studie zeigten, dass junge Erwachsene (insbesondere Frauen), die mit Kindern in einem Haushalt leben, mehr als doppelt so häufig Ein-und Durchschlafschwierigkeiten angaben (35,2 %) als Personen aus kinderlosen Haushalten (17,9 %) [27]. ...
Zusammenfassung
Hintergrund
Viele Eltern berichten, nach der Geburt ihres Kindes übermüdet zu sein und Schwierigkeiten zu haben, den Alltag zu bewältigen. Dies betrifft vor allem erstgebärende Mütter. Schlafmangel und Schlafschwierigkeiten gelten als Risikofaktor für viele Beeinträchtigungen wie Depression, Aggressivität, Abnahme der Beziehungsqualität und Kindeswohlgefährdung. Ziel dieser Arbeit war es daher, eine Reihe an Verhaltensempfehlungen für Eltern zu geben, um einer möglichen Gefährdung der eigenen Person oder des Kindes entgegenzuwirken.
Methode
In einem interdisziplinären Team wurden basierend auf der gegenwärtigen Literatur sowie der klinischen Expertise die Empfehlungen formuliert, reflektiert und diskutiert.
Ergebnisse
Es wurden insgesamt 33 Verhaltensempfehlungen für müde Eltern formuliert, die sich auf die Person selbst, die Partnerschaft und Familie, den Abend und die Nacht sowie die Arbeit beziehen. Die Empfehlungen sind vor allem für Eltern jüngerer Kinder geeignet.
Diskussion
Mithilfe der hier formulierten Empfehlungen sollen alltagsnahe Hilfen geschaffen werden, um Eltern niederschwellig Unterstützung zukommen zu lassen. Solche Tipps können als Selbsthilfemaßnahmen, als Basis für eine Schlafberatung sowie für eine weiterführende ausführliche Behandlung dienen.
... 4 Earlier research also found that sleep duration was improved when breastfeeding mothers co-slept with their infant, but sleeping duration was independent of co-sleeping for nonbreastfeeding mothers. 14 In a literature review on breastfeeding and co-sleeping and bed-sharing, 8 of 11 studies generally demonstrated a positive relationship between the 2 practices. 15 Another systematic review of 21 relevant studies of bed-sharing on health outcomes 3 concluded that bed-sharing was positively related to breastfeeding (at 1 month), as well as an increased risk of SIDS, but the quality of the evidence was considered low, and future research deemed necessary. ...
Introduction: Given the lack of clarity in the literature related to the impact of breastfeeding intentions on sleeping practices, the current research aimed to investigate the relationship between co-sleeping or bed-sharing and breastfeeding intentions among a sample of pregnant adults, during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Pregnant adults from a large nationally representative sample, responded to a one-time, online Qualtrics survey between October and November 2020. Pregnant adults (n = 544) were asked closed and open-ended questions about their family characteristics, sociodemographic factors, sleeping and breastfeeding habits, and intentions. This protocol was approved by the Wesleyan University Institutional Review Board. Results: Bed-sharing (odds ratio [OR] = 2.47) and co-sleeping (OR = 3.52) intentions doubled and tripled, respectively, intentions to breastfeed at 3 months. Additionally, income at some higher levels (i.e., $150,000+/year) significantly increased breastfeeding intentions at 3 months compared with the lowest income category (OR = 5.74, p = 0.011). There was also a significant relationship between intentions to bed-share (OR = 2.96, p = 0.012) and co-sleep (OR = 3.62, p < 0.001) with breastfeeding at 6 months. Prior breastfeeding experience was significantly associated with breastfeeding intention at 6 months (OR = 1.88, p = 0.035). Based on the qualitative findings, breastfeeding ease was by far the most common motivation for co-sleeping or bed-sharing, followed by security/safety, closeness, and past experience. Conclusion: Plans to bed-share and co-sleep, significantly increased the odds of breastfeeding intentions up to 6 months postpartum. Supporting breastfeeding should include conversations about parent-infant sleeping modality, style, and preference. Future research is necessary to understand the directional impacts of these decisions and the predictive role of prenatal intentions on postpartum behaviors in this context.
... pointed out that breastfed infants have a shorter total daily sleep time than formula-fed infants (Quillin & Glenn, 2004). The data from Huang et al. revealed that breastfeeding and sharing a bed may be related to insufficient sleep time in infants (Huang et al., 2016). ...
Abstract The purpose of this study was to compare the effects of different infant formulas on the growth and development, sleep, allergy symptoms, and intestinal flora of infants. A total of 428 infants participated in the study. Breastfeeding (BF) was used as the control, and the remaining subjects were randomly assigned to the full goat milk protein formula group (FGM), partial goat milk protein formula group (PGM), and cow milk formula group (M). During the 6‐month feeding experiment, data on the growth, sleep, allergy symptoms, and intestinal flora of infants were collected using questionnaires, anthropometric measurements, and biochemical examinations. In general, the basic information of the participants was consistent among the groups. There were no differences in infant weight, length, or head circumference among the groups (p > .05). The sleep time of infants in the formula‐fed groups was longer than that of the breastfeeding group at baseline (p .05). The incidence of allergic symptoms continued to decrease, and the total scores of allergic symptoms did not differ among the groups (p > .05). The relative abundance of intestinal Bifidobacteriaceae in the PGM group was lower than that in the other groups (p .05). There were strong correlations in the composition of the main intestinal flora at the family level between the formula and breastfeeding groups. This study showed that within 6 months of feeding, there were no significant differences in the growth and development, allergic symptoms, or intestinal flora of the infants among the groups.
... Así logran una mayor duración del sueño que las madres que no comparten la cama. Compartir la cama es una estrategia utilizada por las madres que amamantan para reducir la interrupción del sueño y el desgaste físico que esto produce (17,18). ...
El colecho es la práctica en la que el bebé duerme en la misma superficie que los padres. Esta es una práctica común en todo el mundo. A veces es una elección a conciencia y en otras ocasiones puede suceder cuando los padres están cansados. Los padres actualmente reciben mensajes contradictorios con respeto compartir la cama: “Debería dormir con su bebé” y que “es peligroso dormir juntos”. Aunque las madres que amamantan y comparten la cama se despiertan con frecuencia para alimentar al bebé, estas están despiertos por períodos más cortos y se vuelven a dormir más rápidamente. Compartir la cama es una estrategia utilizada por las madres que amamantan para reducir la interrupción del sueño y el desgaste físico que esto produce.
... 6,7 Also, the composition of breast milk requires more frequent feeding for the growth of the baby and more frequent stimulation for the continuation of milk production. 8 The effect of breastfeeding on the mother's sleep has to be considered in relation to the infant's sleep, and the opportunity the mother has (or does not have) to mitigate the effects of normal infant sleep behaviors on her own sleep through taking maternal daytime naps or earlier bedtime, reducing other work burdens, 7 co-sleeping, 9,10 or sleeping in the same room. 8 According to studies investigating the effect of feeding methods on maternal sleep, there is little evidence to support the idea that breastfeeding has a negative effect on maternal sleep. ...
Introduction: This study, which used a cross-sectional design, was carried out to examine the factors associated with the way mothers fed their infants such as breastfeeding or bottle feeding, and to compare perceived sleep quality and fatigue levels. Method: The study sample consisted of a total of 100 women in the 4th to 16th week postpartum, including 50 women breastfeeding and 50 women bottle feeding their infants. The data of the study were collected in Family Health Centers (FHC) through the face-to-face interview technique using "a Personal Information Form," "the Pittsburgh Sleep Quality Index-PSQI," and "the Checklist Individual Strength-CIS." Results: The mothers' total sleep quality (PSQI) score was found to not differ significantly according to the type of infant feeding. Similarly, total scores for fatigue assessment obtained from the CIS did not differ according to the infant feeding type variable. A significant positive correlation was found between total sleep quality and total fatigue level, and subjective fatigue level. Discussion: The sleep quality and fatigue levels of mothers are independent of the method of feeding their infants. Midwives should plan initiatives with parents to improve maternal sleep quality and reduce fatigue levels and inform parents that breastfeeding is not a factor that reduces sleep quality or increases fatigue. Clinical Trials.gov ID: 1129/5463.
... However, some measures of sleep quality improve: while deep sleep is drastically reduced in late pregnancy, it is recovered postpartum (Karacan et al., 1968). Most sleep disturbances in this period are related to feeding and caring for the newborn, and could also be impacted by feeding method (Shinkoda et al., 1999;Quillin and Glenn, 2004). It is therefore challenging to distinguish between the effects of hormone changes from the effects of early childrearing on sleep, and both factors are likely involved. ...
Sleep is crucial for optimal well-being, and sex differences in sleep quality have significant implications for women’s health. We review the current literature on sex differences in sleep, such as differences in objective and subjective sleep measures and their relationship with aging. We then discuss the convincing evidence for the role of ovarian hormones in regulating female sleep, and survey how these hormones act on a multitude of brain regions and neurochemicals to impact sleep. Lastly, we identify several important areas in need of future research to narrow the knowledge gap and improve the health of women and other understudied populations.
... Cosleepers had a slightly larger negative association between breastfeeding frequency and PPD symptoms, as well as a nonsignificant association between infant night waking and breastfeeding, both indicating that a potential effect of infant night waking on PPD symptoms would be mediated by fatigue related to lost sleep and not breastfeeding. This is in line with the results of Quillin et al. [67], who found that nighttime breastfeeding among co-sleepers was associated with more frequent maternal wakings but greater total sleep duration. However, we did not find support for our prediction that mothers using infant formula would show a weaker effect between infant night waking and PPD symptoms, adding to the inconclusive findings regarding breastfeeding-related fatigue and PPD symptoms. ...
Background and objectives
As the mother-offspring relationship is central to human reproduction, postpartum depression symptoms are difficult to explain in evolutionary terms. We proposed that postpartum depression might arise as a result of evolutionary mother-offspring conflict over maternal investment, and investigated the association between postpartum depression symptoms, infant night waking, maternal sleep disturbance and breastfeeding frequency.
Methodology
We conducted a cross-sectional analysis using survey responses at six months postpartum from 1598 Finnish mothers. We hypothesized that infant night waking at six months postpartum would be associated with postpartum depression symptoms, and that this association would be mediated by maternal sleep disturbance and a higher breastfeeding frequency.
Results
Infant night waking was moderately associated with postpartum depression symptoms, and this association was mediated by maternal sleep disturbance (R2 = .09). Contrary to our prediction, we found that increased breastfeeding was associated with less postpartum depression symptoms.
Conclusions and implications
We conclude that postpartum depression symptoms might partly be the result of increased maternal fatigue stemming from high offspring demands on maternal investment, but that this is not due to the metabolic strain from increased breastfeeding. Studying postpartum depression from the mother-offspring conflict perspective can potentially improve our understanding of the involved behavioral processes of both mother and offspring, and allow interventions designed to benefit the well-being of both parties.
... Studies show that breastfeeding mothers are more likely to practice co-sleeping Teti et al., 2015) and are more likely to have more awakenings and poorer sleep quality than mothers who are bottle feeding (Gay et al., 2004;Quillin & Glenn, 2004;Volkovich et al., 2015). While the presence of breastfeeding was not significantly correlated with infant sleep location in our sample, the majority of mothers were breastfeeding and almost half of the sample reported a bed sharing arrangement at least 1-2 times/week. ...
Sleep disruption and deprivation are highly prevalent among parents of an infant. However, most postpartum sleep studies focus solely on mothers, and few studies have investigated whether sleep differs between first‐time and experienced parents. The present study aimed to determine whether self‐reported sleep duration and quality differ between first‐time and experienced mothers and fathers during the postpartum period. A total of 111 parents (54 couples and three single mothers) of 6‐month‐old infants completed a 2‐week sleep diary to evaluate measures of sleep duration, sleep continuity, and sleep quality. An analysis of covariance model was used to compare the sleep variables of first‐time to experienced parents. Breastfeeding frequency, infant sleep location, depression, education, and work status were used as co‐variables. First‐time mothers reported a longer consecutive nocturnal sleep duration (mean [SEM] 297.34 [17.15] versus 246.01 [14.79] min, p < .05), fewer nocturnal awakenings (mean [SEM] 1.57 [0.20] versus 2.12 [0.17], p < .05), and rated their sleep quality higher (mean [SEM] score 7.07 [0.36] versus 5.97 [0.30], p < .05) than experienced mothers, while total nocturnal sleep duration did not differ. There were no differences in subjective sleep measures between first‐time and experienced fathers. The present study indicates that experienced mothers reported more fragmented sleep and perceived having worse sleep quality than first‐time mothers, but that paternal sleep did not differ as a function of parental experience. These findings have clinical implications for healthcare professionals working with families of various configurations and sizes.
... Co-sleepers had a slightly larger negative association between breastfeeding frequency and PPD symptoms, as well as a non-significant association between infant night waking and breastfeeding, both indicating that a potential effect of infant night waking on PPD symptoms would be mediated by fatigue related to lost sleep and not breastfeeding. This is in line with the results of Quillin et al. [67], who found that nighttime breastfeeding among co-sleepers was associated with more frequent maternal wakings but greater total sleep duration. However, we did not find support for our prediction that mothers using infant formula would show a weaker effect between infant night waking and PPD symptoms, adding to the inconclusive findings regarding breastfeeding-related Downloaded from https://academic.oup.com/emph/advance-article/doi/10.1093/emph/eoaa049/6059220 by guest on 01 February 2021 fatigue and PPD symptoms. ...
Background and objectives: As the mother-offspring relationship is central to human reproduction, the high incidence of postpartum depression symptoms is difficult to explain in evolutionary terms. We proposed that postpartum depression might be the adverse result of evolutionary mother-offspring conflict over maternal investment, and investigated the association between postpartum depression symptoms, infant night waking, maternal sleep disturbance and breastfeeding frequency. Methodology: We conducted a cross-sectional analysis using survey responses at six months postpartum from 1598 Finnish mothers. We hypothesized that infant night waking at six months postpartum would be associated with postpartum depression symptoms, and that this association would be mediated by maternal sleep disturbance and a higher breastfeeding frequency.Results: Infant night waking was associated with postpartum depression symptoms, and this association was mediated by maternal sleep disturbance. Contrary to expectations, we found that the increased breastfeeding was associated with less postpartum depression symptoms. Conclusions and implications: We conclude that postpartum depression symptoms might be the result of increased maternal fatigue stemming from high offspring demands on maternal investment, but that this is not due to the metabolic strain from increased breastfeeding. Studying postpartum depression from the mother-offspring conflict perspective improves our understanding of the involved behavioral processes of both mother and offspring, and thus allows interventions designed to improve the well-being of both parties.
... In particular, studies based on questionnaires report lower sleep quality in co-sleeping infants (Hysing et al., 2014;Paul et al., 2017), but several studies based on actigraphy did not find support for significant differences (Teti et al., 2016;Volkovich et al., 2017). Breastfeeding is another factor associated with both higher rates of co-sleeping and infant sleep problems (Galbally, Lewis, McEgan, Scalzo, & Islam, 2013;Quillin & Glenn, 2004). Because breast milk is digested faster than formula, the intervals between feedings are shorter, and, later on, breastfed infants may depend on breastfeeding to settle back to sleep (Touchette et al., 2005). ...
Objective:
This study examined for the first time mother-infant sleep and emotional distress in solo mother families compared with two-parent families and explored whether the links between mother-infant sleep and maternal emotional distress differ as a function of family structure.
Methods:
Thirty-nine solo-mother families and 39 two-parent families, with an infant within the age range of 6-18 months participated in the study. Actigraphy and sleep diaries were used to assess maternal and infant sleep at home. Mothers completed questionnaires to assess maternal depressive and anxiety symptoms, social support, sleeping arrangements, breastfeeding, and demographics.
Results:
Solo mothers were older and more likely to breastfeed and share a bed with their infants than married mothers. There were no significant differences between the groups in mother-infant sleep and maternal emotional distress, while controlling for maternal age, breastfeeding, and sleeping arrangements. Family structure had a moderating effect on the associations between maternal emotional distress and mother-infant sleep. Only in solo-mother families, higher maternal emotional distress was associated with lower maternal and infant sleep quality.
Conclusions:
Our findings suggest that, although there are no significant differences in maternal and infant sleep between solo-mother families and two-parent families, the strength of the associations between maternal emotional distress and both infant and maternal sleep quality are stronger in solo-mother families, compared with two-parent families. Hopefully, understanding which aspects of parenting may contribute to the development of sleep problems in solo-mother families could be helpful in tailoring interventions to this growing population.
... With regard to maternal sleep, numerous studies have confirmed that although bed-sharing breastfeeding mothers wake frequently to feed, they also wake for shorter periods, fall back to sleep more rapidly ( Mosko et al., 1997b), and achieve longer sleep duration (Quillin, & Glenn, 2004), when compared to those not bed-sharing. Mothers choose to bed-share to make night-time care easier and reduce sleep disruption, particularly when breastfeeding ( Ateah et al., 2008;Rudzik et al., 2016). ...
Breastfeeding and the place of sleep for the mother and the infant have been controversial internationally due to reported concerns regarding infant deaths despite the known benefits of exclusive and prolonged breastfeeding, which are increased by breastfeeding at night. The aims of this integrated analysis were to (a) review breastfeeding and maternal and infant sleep research literature via historical, epidemiological, anthropological, and methodological lenses; (b) use this information to determine where we are currently in safeguarding both infant lives and breastfeeding; and (c) postulate the direction that research might take from this point forward to improve our knowledge and inform our policy and practice. Despite well-meaning but unsuccessful campaigns in some countries to dissuade parents from sleeping with their babies, many breastfeeding mothers and caregivers do sleep with their infants whether intentionally or unintentionally. Taking cultural contexts and socio-ecological circumstances into consideration, data supports policies to counsel parents and caregivers on safe sleep practices, including bed-sharing in non-hazardous circumstances, particularly in the absence of parental smoking, recent parental alcohol consumption, or sleeping next to an adult on a sofa. Further research with appropriate methodology is needed to drill down on actual rates of infant deaths, paying close attention to the definitions of deaths, the circumstances of the deaths, and confounding factors, in order to ensure we have the best information with which to derive public health policy. Introduction and use of the concept of “breastsleeping” is a plausible way to remove the negative connotations of “co-sleeping” and redirect ongoing data-driven discussions and education of best practices of breastfeeding and sleep.
... This is congruent with previous literature showing that the quick digestion of breast milk could lead to a more fragmented sleep in breastfed infants (Burness, 1979). However, it is not clear the association between feeding method and other sleep-wake behaviours, namely sleep duration, sleep periods or longest sleep period (Cubero et al., 2005;DeLeon & Karraker, 2007;Demirci et al., 2012;Engler et al., 2012;Huang et al., 2016;Hughes et al., 2015;Kaley et al., 2012;Lampl & Johnson, 2011;Lee, 2000;Mindell et al., 2012;Morgan et al., 2004;Nevarez et al., 2010;Quillin & Glenn, 2004;Ramamurthy et al., 2012;Schwichtenberg & Poehlmann, 2009;Thomas, 2000). ...
This paper aims to provide a systematic review of the literature on the associated factors with infant sleep-wake behaviour during the first 12 months of life, namely (1) the factors positively and negatively associated with sleep-wake behaviour and (2) the factors positively and negatively affected by sleep-wake behaviour. This systematic review was based on a standard protocol constructed according with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement and included 146 papers. Two typologies of factors were found in the literature: factors positively and negatively associated with infant sleep-wake behaviour and effects of sleep-wake behaviour. Different factors were identified as being positively and negatively associated with the different sleep-wake behaviours and positively and negatively affected by the different sleep-wake behaviours during the first 12 months of life. Some inconsistent results could be explained by methodological differences between the studies.
... Badania pokazują, że w czasie pierwszych miesięcy życia dziecka matki karmiące naturalnie śpią dłużej niż matki karmiące mieszankami (średnio 40-45 minut). Również rodzice, których dziecko jest karmione wyłącznie piersią, zgłaszają mniej problemów związanych ze snem (Doan, Gardiner, Gay, Lee, 2007;Doan, Gay, Kennedy, Newman, Lee, 2014;Quillin, Glenn, 2004) Badania oceniające jakość snu wykazały, że u kobiet karmiących wyłącznie piersią występował najwyższy odsetek stadiów snu wolnofalowego podczas nocy (ang. slow-wave sleep, SWS) w porównaniu z kobietami karmiącymi w sposób mieszany i sztuczny. ...
Noworodek ma tylko trzy wymagania. Potrzebuje ciepła w ramionach matki, pokarmu z piersi i bezpieczeństwa płynącego z wiedzy o jej obecności. Karmienie piersią spełnia wszystkie trzy. Grantly Dick-Read Przemoc wyrządza ogromne szkody, szczególnie gdy dotyczy okresu wczesnodziecięcego. Noworodek czy niemowlę zależne od matki, posługujące się płaczem jako główną formą komunikacji, staje się często obiektem jej agresji. Naturalnym elementem tworzenia więzi w diadzie matka-dziecko jest karmienie piersią. Przynosząc ukojenie matce, łagodząc jej reakcje na stres, karmienie naturalne zaspakaja podstawowe potrzeby dziecka i tworzy mu bezpieczną przestrzeń do rozwoju zarówno fizyczne-go, jak i psychicznego. Karmienie piersią stanowi element wzmacniający kompetencje matki i jest czynnikiem chroniącym dziecko przed krzywdzeniem rodzicielskim. Słowa kluczowe: karmienie piersią, oksytocyna, przemoc wobec dziecka, przywiązanie Wprowadzenie Krzywdzenie dzieci ma wielorakie uwarunkowania. Niektórych czynników ryzyka krzywdzenia można upatrywać po stronie rodziców, a niektórych-po stronie dziecka. Inne można rozpatrywać w szerszej perspektywie społecznej i kulturowej. Obok czynników ryzyka i mechanizmów je warunkujących współistnieją też czynniki ochronne, działające protekcyjnie. Chociaż z powodu złożoności etiologii nie można podać jednego, konkretnego powodu krzywdzenia dziecka, to wyniki
... Reflejo agudeza sensorial: permite discriminación del olor materno, el sabor de su leche, el tono de voz, la calidad del contacto corporal y la imagen de su rostro. 20, 22 ...
... Despite our small sample size, our finding is consistent with results from a study of 33 first time mothers and their four-week old infants in the United States that found that breastfeeding mothers recorded more sleep when compared to bottle feeding mothers if their newborns co-slept for any part of the night. 37 Consistent with these data, and the only study in which both the mother and infant were simultaneously monitored over three consecutive nights using polysomnography, routinely bedsharing-breastfeeding (breastsleeping) mothers were found, on average, to sleep for 33 minutes more per night compared with routinely solitary sleeping breastfeeding mothers who slept separately (in different rooms) from their infants. 10 While not exhibiting any reduction in total sleep time, breastfeeding co-sleeping mothers in our sample did, however, exhibit more nighttime awakenings and exhibited more sleep fragmentation, which is consistent with other studies of mothers in the US. ...
Objective: Despite widespread interest in maternal–infant co-sleeping, few quantified data on sleep patterns outside of the cultural west exist. Here, we provide the first report on co-sleeping behavior and maternal sleep quality among habitually co-sleeping hunter-gatherers. Design: Data were collected among the Hadza of Tanzania who live in domiciles constructed of grass huts with no access to synthetic lighting or climate controlled sleeping environments. Using interview data, we recorded baseline ethnographic data on co-sleeping. Using actigraph data, we tested whether sleep quality, sleep–wake activity, and/or sleep duration differs among breastfeeding women, non-breastfeeding women, and men. Measurements: CamNtech Motionwatch 8 actigraphs were used to collect 1 minute, epoch-by-epoch data on a sample of 33 adults. Functional linear modeling (FLM) was used to characterize sleep–wake patterns and a linear mixed-effects model was used to assess factors that drive sleep duration and quality. Results: The FLM suggests that breastfeeding mothers were early risers and had reduced day-time activity. Additionally, total number of co-sleepers, not breastfeeding, was associated with less sleep duration and quality, suggesting that greater number of co-sleepers may be a primary driver of poorer sleep. Conclusion: The current study makes important contributions to the cross-cultural literature on sleep and augments our understanding of maternal–infant co-sleeping. The majority of Hadza participants co-sleep with at least one other individual and the majority of married couples sleep with their spouse and their children on the same sleeping surface. Our preliminary sleep quality data suggest that breastfeeding does not negatively impact maternal sleep quality.
... Breastfeeding mothers have a tendency to co-sleep [37,39,40] and breastfed infants often sleep in closer proximity to their mothers than formula-fed infants [1,2,38]. Closer sleep proximity may contribute to greater awareness by mothers of infant sleep and wake patterns, therefore breastfeeding mothers may be more accurate in their reports of infant sleep patterns. ...
Objectives:
Many studies of infant sleep rely solely on parentally-reported data, assuming that parents accurately report their infant's sleep parameters. The objective of this paper is to examine whether night-time sleep parameters of exclusively breastfed or exclusively formula-fed infants differ, and whether correspondence between parental reports and objective measures varies by feeding type.
Methods:
Mother-infant dyads intending to breastfeed or formula-feed exclusively for 18 weeks were recruited. Mothers were multiparas and primiparas, aged between 18 and 45 years. Infants were full-term, normal birthweight singletons. Maternal report and actigraphic data on infant sleep were collected fortnightly, from four to 18 weeks postpartum. Data were analysed cross-sectionally using t-tests and GLM analysis to control for interaction between feed-type and sleep location.
Results:
Actigraphy-assessed infant sleep parameters did not vary by feed-type but parentally reported sleep parameters did. Maternal report and actigraphy data diverged at 10 weeks postpartum and discrepancies were associated with infant feeding type. Compared to actigraphy, maternal reports by formula-feeding mothers (controlling for infant sleep location) over-estimated infant's Total Sleep Time (TST) at 10 weeks and Longest Sleep Period (LSP) at 10, 12 and 18 weeks.
Conclusions:
These results raise questions about the outcomes of previous infant sleep studies where accuracy of parentally-reported infant sleep data is assumed. That parental reports of infant sleep vary by feeding type is particularly important for reconsidering previous studies of infant sleep development and intervention studies designed to influence sleep outcomes, especially where feed-type was heterogeneous, but was not considered as an independent variable.
... A child's routinely sharing the same room/bed with their parents' decreases with age. Children sharing the same bed with their mothers also share their beds with their spouses/ partners or other children (23). Countermine and Teti (24) reported that the adaptation of parents who share the same room with their babies is also inadequate. ...
Objective
The aim of this study is to determine the mother’s perceptions of sleeping problems and sleeping behaviors of their children.
Materials and Methods
This descriptive study was conducted with 294 mothers with children from birth to 2 years of age. Questionnaires on socio-demographic information, behaviors to put a child into the sleep and to determine maternal sleeping habits were applied to mothers.
Results
It was determined that 33% of the children enrolled in the study had sleep problems; 70.1% of the mothers considered this problem to be moderate, and 16.5% of the mothers considered the problem to be serious. Methods that the mothers used most frequently to put their children to sleep were rocking on legs (49.7%), feeding/breastfeeding (44.6%) and singing a lullaby/song (28.2%).
Conclusion
The results of this study show that many children have sleeping problems and the mothers use various methods to put their children to sleep. These results can be useful for increasing the awareness of pediatric health professionals when evaluating a child’s sleeping behavior and sleeping habits and coping with children’s sleeping problems.
... In contrast, women who routinely breastfeed and bed-share report feeling less fatigued, despite being more easily and frequently roused during the night (Quillin and Glenn 2004). Bed-sharing mothers have demonstrated a greater level of responsiveness to their infant's cues (Ball 2002, Baddock et al 2006Joyner et al 2010 and have been observed stimulating their infants during prolonged apnoeic ...
The practice of infant bed-sharing remains controversial in countries such as the UK and the US, despite its prevalence, and healthcare professionals are often faced with the task of advising parents on bed-sharing without the support of consistent or up-to-date guidelines. This article explores UK and US recommendations on infant bed-sharing, considering the existing evidence. The possible relationship between infant bed-sharing and sudden infant death syndrome (SIDS) is explored, alongside other factors that may be linked to SIDS. Areas where further research is required are identified and appropriate resources are provided, with a view to empowering healthcare professionals to support parents in making an informed and proactive decision about infant bed-sharing.
... However, most breast-feeding mothers returned their infant to their own bed after feeding, possibly because of risks and safety issues (Sobralske and Gruber, 2009). Nevertheless, co-sleeping may increase total sleep time of breast-feeding women, as showed by Quillin and Glenn (Quillin and Glenn, 2003), in contrast to bottle-feeding women who recorded similar hours of sleep regardless of the sleeping arrangement. ...
... In a review of the literature, Buswell and Spatz (2007) identified both positive and negative correlations between breast-feeding and co-sleeping. Benefits were identified for both the child (e.g., more feeding (McKenna, Mosko, & Richard, 1997) and mother (e.g., increased sleeping; Quillin & Glenn, 2004). Co-sleeping ameliorates the disruption of frequent nighttime breast-feeding, and mothers who share their beds with their children persist with breast-feeding for longer periods of time (Ball, 2007). ...
The central aim of this study was to expand a limited body of knowledge on the complex relationship between breast-feeding, co-sleeping, and somatic complaints in early childhood. An opportunity sample of 98 parents from the general population with children aged 18 to 60 months consented to participate in the study. Each parent completed a series of questionnaires measuring somatic complaints, sleep problems, co-sleeping, breast-feeding, and demographic factors. Findings indicated that co-sleeping was associated with increased somatic complaints and that breast-feeding associated with decreased somatic complaints. Co-sleeping also was found to be associated with an increase in sleep problems. Boys demonstrated significantly higher levels of sleep problems than did girls. These findings highlight the relationship between co-sleeping during early childhood, which could have implications for prevention, treatment, and intervention regarding somatic complaints and sleep problems in early childhood.
... Breastfeeding is also conducive to better quality of sleep during maternity. Research comparing the quality of sleep of mothers who bottle-feed and those who breastfeed shows that the latter: sleep about 20 -40 minutes longer, have definitely better quality of sleep, less often suffer of depression caused by deprivation of sleep [25]. However, Bylton et al. [26] state that the deep sleep stage of nursing women is three times longer in comparison to women who bottle-feed, and also the light sleep stage is shorter, resulting in lesser fatigue during a day. ...
... Research confirms what breastfeeding mothers often report: that bed-sharing facilitates frequent night-time breastfeeding. Various studies have found that although bed-sharing breastfeeding mothers wake frequently to feed, they also wake for shorter periods, fall back to sleep more rapidly, 21 and achieve greater sleep duration, 22 when compared to not bed-sharing. Recently a Swedish study reported an association between bed-sharing and three or more night-time wakings, but interpreted this as an association with sleep problems rather than as the need of breastfed infants to feed frequently, including at night. ...
More babies bed-share in the first few weeks of life than at any other age. On any given night between 20 and 25% of babies under 3 months of age spend some time sharing a bed with a parent and during their first 3 months up to 70% of babies in Euro-American households will have bed-shared once or more.2,3,4 When parents are interviewed about sleeping with their baby they give various reasons for doing so.5,6,7 Their answers express deeply rooted cultural or religious beliefs and parenting philosophies, invoke the physiological links between lactation and night-time breastfeeding, and reflect the biological compulsion that drives bonding and the urge for close contact. On a practical level they also explain that sleeping with the baby makes night-time care easier, helps them to monitor the baby, provide comfort, and yet obtain sleep. Other parents report having nowhere else to put their baby at night, or that they have fallen asleep with their baby unintentionally. For breastfeeding mothers all of these reasons may apply, and so it is unsurprising that the largest group of bed-sharers around the globe are breastfeeding mothers.
... Not many quantitative studies have examined this relation. Sleep and fatigue in the first month postpartum in a sample of 72 families from San Francisco were not related to bedsharing [171], but more sleep was obtained by a sample of mothers who breastfed and bed-shared, compared with bottle-feeding mothers [172]. ...
The practice of parent and child sharing a sleeping surface, or ‘bed-sharing’, is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed k=659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on k=98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - Anthropology, Psychology/Psychiatry, and Pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children’s social, emotional, and physical development.
... Obserwuje się wówczas mechanizm błędnego koła (10) . Najnowsze badania porównujące jakość snu matek karmiących sztucznie z jakością snu matek karmiących piersią dowodzą, że matki karmiące piersią: 1) częściej budzą się w nocy, 2) śpią o około 20-40 min dłużej, 3) mają zdecydowanie lepszą jakość snu, 4) rzadziej z powodu deprywacji snu cierpią na depresję (11) . Blyton i wsp. ...
Breastfeeding neonates and infants has been shown to improve baby health and intellectual development. World Health Organization (WHO) strongly recommends exclusive breastfeeding for the first six months of life starting within an hour of birth. At six months, other foods should complement breastfeeding, which appears to be the best additional nutrition, for up to two years or more. Recently many researches underline breastfeeding's protective effect against many maternal pathologies, and that skipping the lactation phase would be problematic for mothers' health. Advantages of breastfeeding for mothers include early (during postpartum period) and late beneficial effects. Right after birth breastfeeding helps mothers to recover by accelerating uterine involution, preventing from massive bleeding and iron deficient anaemia. Early breastfeeding also protects mothers from postpartum depression, enhances maternal-infant bonding and empathic behaviour, and improves quality of disrupted at that time sleep. Late advantages include lowering the risk of: some types of cancer (breast cancer, endometrial cancer, ovarian cancer), cardiovascular disorders (coronary artery disease, hypertension), metabolic disorders (diabetes, glucose intolerance, obesity, hyperlipidaemia, hyperinsulinemia), rheumatoid arthritis, and osteoporosis. Long lasting lactation and breastfeeding are also related with economic benefits and free natural contraception. This paper summarizes the published studies related to breastfeeding and mother health outcomes.
... 16 One form of cosleeping, mother-infant bed sharing, is associated with reduced length of maternal nighttime awakenings 17 and increased sleep for breastfeeding mothers. 18 Despite these maternal benefits, bed-sharing is also associated with infant deaths because of overlying and entrapment. 19 Because of insufficient evidence that this practice can be ensured safe, the American Academy of Pediatrics recommends against baby bed-sharing. ...
Prior studies have found that close mother-child sleep proximity helps increase rates of breastfeeding, and breastfeeding itself is linked to better maternal and infant health. In this study, we examine whether breastfeeding and infant bed-sharing are related to daily rhythms of the stress-responsive hormone cortisol. We found that bed-sharing was related to flatter diurnal cortisol slopes, and there was a marginal effect for breastfeeding to predict steeper cortisol slopes. Furthermore, mothers who breastfeed but do not bed-share had the steepest diurnal cortisol slopes, whereas mothers who bed-shared and did not breastfeed had the flattest slopes (P < .05). These results were significant after controlling for subjective sleep quality, perceived stress, depression, socioeconomic status, race, and maternal age. Findings from this study indicate that infant parenting choices recommended for infants (breastfeeding and separate sleep surfaces for babies) may also be associated with more optimal stress hormone profiles for mothers.
... [28][29][30] When breastfeeding mothers bedshare, they get more sleep than if the infant sleeps separately. 31,32 There is also evidence that when breastfeeding mothers try to avoid bedsharing, they either end up giving formula or start bedsharing anyway. 2 ...
Little is known about circadian variations of macronutrients content of expressed preterm human milk (HM). This study evaluated diurnal variations of macronutrients and energy content of preterm HM over the first 7 weeks of lactation and tested the hypothesis that values obtained during a morning sample are predictive of those obtained from an evening sample.
Expressed HM was obtained from 32 mothers of preterm infants (26-33 weeks in gestational age), who routinely expressed all their milk every 3 hours from the beginning of the second to the seventh week after delivery. One aliquot was obtained from the first morning expression and the second from the evening expression. Energy and macronutrients contents were measured using an HM analyzer.
Mean fat and energy contents of all samples obtained during the whole period were significantly higher in evening samples (p<0.0001). There were no significant differences between morning and evening carbohydrates and protein contents. Concentrations of protein, carbohydrates, and fat from morning samples were predictive of evening concentrations to different extents (R(2)=0.720, R(2)=0.663, and R(2)=0.20, respectively; p<0.02). The predictability of evening values by morning values was not influenced by the week of lactation at sampling or by individual patients. In repeated-measures analysis of variance performed on 11 patients who completed the whole 7-week period, over time, there was a significant decrease in fat, energy, and protein contents, whereas carbohydrates content remained unchanged. Day-night differences remained significant only for fat content.
Circadian variations in fat and energy concentrations of HM are consistent over the first 7 weeks of lactation. There are no consistent circadian variations in HM protein and carbohydrates. Over a given day, there are little variations in protein and carbohydrates content, but fat concentrations are more variable, and evening values are less well predicted by morning sample analysis than values for protein or carbohydrates.
... However, research on the impact of feeding type on infant sleep has been inconclusive. Some studies suggest that breastfed babies sleep less, wake more or wake for longer than formula fed infants [27]. In the last decade, an increasing number of studies have found that breastfeeding mothers and infants experience as much or more sleep than formula-feeding pairs, that breastfeeding mothers return to sleep more rapidly after overnight awakenings, and that hormonal mechanisms associated with breastfeeding may result in higher quality sleep [7,9,22]. ...
In a context with strong rhetorical support for breastfeeding in the health system, yet extremely low rates of breastfeeding after hospital discharge, UK women's decisions about infant feeding reflect the reality of competing priorities in their lives, including obtaining adequate sleep. Popular wisdom in the UK tightly links breastfeeding and inadequate night-time sleep. Mothers are advised by peers and family to introduce formula or solid foods to infants to promote longer sleep.
The first objective of this study was to investigate women's understandings of the nature of infant sleep and their perceptions of links between infant feeding method and sleep. The second was to explore how these perceptions influence infant feeding and sleep practices. Underpinning our work is the understanding that infant care choices result from trade-offs by which mothers strive to balance infant- and self-care.
We conducted seven focus groups with mothers of infants in two regions of the UK. Verbatim transcripts were thematically coded and emergent themes were identified.
We found clearly diverging narratives between breastfeeding and formula-feeding mothers. Breastfeeding mothers viewed the fragmentary nature of infant sleep as natural, while mothers who were formula feeding felt this was a problem to be fixed.
The strategies used to promote infant and maternal sleep in each group were aligned with their underlying perception of how infant sleep works. Maternal perceptions of the nature of infant sleep and its relation to infant feeding method impact infant care practices in the first year of life.
... Formula fed infants continued to wake but were not fed. The study did not measure total sleep time but previous work has shown that mothers of breastfed infants get more sleep than formula fed infants overall 34 , particularly if they co--sleep 45 . This may be because feeding the infant soothes them back to sleep in a relatively quick period of time compared to settling an infant without a feed. ...
Infant sleep is a common concern for new parents. Although many expect a newborn infant to wake frequently, encouraging a baby to sleep through the night by a few months of age is seen as both a developmental aim and a parenting success. Many new mothers believe that their infants' diet is related to their sleep; formula milk or increased levels of solid food are often given in an attempt to promote sleep. However, the impact of these in later infancy is not understood. In the current study 715 mothers with an infant 6-12 months of age reported their infants' typical night wakings and night feeds alongside any breastfeeding and frequency of solid meals. Of infants in this age range, 78.6% still regularly woke at least once a night, with 61.4% receiving one or more milk feeds. Both night wakings and night feeds decreased with age. No difference in night wakings or night feeds was found between mothers who were currently breastfeeding or formula feeding. However, infants who received more milk or solid feeds during the day were less likely to feed at night but not less likely to wake. The findings have important implications for health professionals who support new mothers with infant sleep and diet in the first year. Increasing infant calories during the day may therefore reduce the likelihood of night feeding but will not reduce the need for parents to attend to the infant in the night. Breastfeeding has no impact on infant sleep in the second 6 months postpartum.
Background:
Western parents swaddle infants to promote sleep and reduce night-waking, however recent evidence of the effects of swaddling on the sleep of healthy infants has not been systematically reviewed.
Objective:
To investigate the effect of swaddling on the sleep of infants up to 1 year of age using a narrative synthesis approach.
Data sources:
We systematically searched five academic databases, including the Cochrane trial registry (Pubmed, PsycINFO, Embase, the Cochrane library, and Blackwell Synergy). We manually searched reference lists and citations of included studies and reference lists of existing reviews.
Study selection:
Studies of any type, published since 2007, reporting primary data whose subjects were humans up to 12 months of age with outcome measures relating to the impact of swaddling on sleep and arousal.
Data extraction:
By hand using a customized template. A narrative synthesis is used to present the results.
Results:
In total 171 studies were retrieved with 115 studies discarded at title. A further 43 were discarded at abstract, and six were discarded at full text. Two papers were combined as they reported on the same study giving a total of 6 studies that met the inclusion criteria for the review. An evidence hierarchy was used to assess Risk of Bias in the included studies; the results are presented via a narrative synthesis. Swaddling was associated with increased duration of quiet sleep in infants and a significantly reduced number of sleep state changes among infants naïve to the intervention.
Limitations:
The integrity of the intervention (swaddling) including its baseline characteristics, was defined broadly across the included studies limiting the interpretation and transferability of the results of this review.
Conclusions:
Swaddling appears to increase quiet sleep duration in infants and reduces the number of sleep state changes among infants naïve to the intervention. Parents should be made aware that implementing conditions unfavorable to arousability may increase SUDI risk among infant who have not previously been swaddled. This review has relevance for informing future practice recommendations and parent advice as well as in designing future studies.
Background
Breastfeeding duration has been linked with the health of both women and their children, but research that considers women's weight change postpartum and practical factors that may impact their quality of life (i.e., sleep quantity, number of children) is limited.
Method
A survey was administered to 568 women (M age = 31.32 years; SD = 4.21) who had given birth within the past year. The survey included assessments of pre- and post-pregnancy weight and height, breastfeeding practices, current sleep quantity, presence of breastfeeding-specific support, and other demographics including their total number of children.
Results
Greater pre-pregnancy to postpartum weight increase was related to shorter duration of breastfeeding. Mothers who exclusively breastfed for the first six months had less postpartum weight increase (i.e., the discrepancy between their pre-pregnancy and post-pregnancy weight was smaller) than those who did not. Fewer children and greater hours of sleep were significantly associated with longer duration of breastfeeding. Sleep partially accounted for the relationship between body mass index change and breastfeeding duration. Breastfeeding-specific support did not impact the effect of low sleep on shorter breastfeeding duration.
Conclusions
Duration of breastfeeding may suffer due to fatigue. Sleep plays a key role in understanding the ways in which weight change impact breastfeeding behavior. Greater holistic support for mothers in the postpartum period is needed to foster an environment that encourages breastfeeding.
Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the “review behind the review,” highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers’ decisions about infant sleep location influence infant behavior and development.
Infants evolved in the context of close contact (including co-sleeping). Evolutionary context is rarely considered in psychological infant sleep research, and Western sleep researchers make assumptions about what optimal “normal” infant sleep is and how to achieve early, deep, infant sleep consolidation and avoid infant sleep problems. However, an evolutionary and anthropological view of infant sleep as species-typical recognizes that human evolution likely prepared the infant brain for optimal development within its evolutionary context – co-sleeping. Thus, “normal” infant sleep, sleep consolidation, and sleep problems should all be understood within the framework of co-sleeping infants, not the historically new-phenomenon of solitary-sleeping infants. Much work needs to be done in order to understand “normal” infant sleep as species-typical and how adaptive infants are to environments that stray from their evolutionary norm.
Giriş: Emzirme yenidoğan için en yararlı beslenme şeklidir. Fakat farklı nedenlerden dolayı anneler bebeklerine anne sütü dışında ürünler verebilmektedir. Postpartum dönemde yenidoğanın beslenme şekline ilişkin yaşanabilecek sorunlar annelerin bu süreci olumsuz deneyimlemesine neden olabilir. Amaç: Yenidoğanın beslenme şeklinin annenin uyku ve yorgunluğuna etkisini incelemektir. Yöntem: Çalışma tanımlayıcı ve retrospektif tipte olup, postpartum beşinci haftada bulunan 245 anne ile gerçekleştirilmiştir. Annelerin postpartum birinci haftada ve ikinci haftadan dördüncü haftanın sonuna kadar uyku ve yorgunlukları geriye dönük değerlendirilmiştir. Veri toplamak amacıyla Tanıtıcı Bilgi Formu, Annenin Uyku Durumunu Değerlendirme Formu ve Visual Yorgunluk Değerlendirme skalası kullanılmıştır. Veriler Mann Whitney-U ve ki-kare testi ile değerlendirilmiştir. Bulgular: Birinci hafta tam emziren annelerin toplam uyku süresi kısmi emzirenlere göre daha az olmasına rağmen uykularını daha yeterli buldukları (p =.000) ve hissettikleri yorgunluğun daha az olduğu (p =.000) saptanmıştır. Dördüncü haftanın sonunda ise tam tersi kısmi emziren annelerin toplam uykularını daha yeterli buldukları (p =.000) ve hissettikleri yorgunluğun daha az olduğu (p =.000) saptanmıştır. Sonuç: Bu çalışmanın sonucunda tam emziren anneler postpartum ilk haftada yorgunlukları ve uyku bölünmeleriyle daha iyi baş ederken özellikle birinci haftanın sonrasında zorlandıkları saptanmıştır. Postpartum dönemde emzirme uykuyu geliştirip iyileştirebileceği için yeni anneler tam emzirmeye teşvik edilmelidir Anahtar Sözcükler: Uyku, Yorgunluk, Postpartum Dönem, Emzirme.
Abstract The Effects of Newborn Feeding Methods on the Sleep and Fatigue of the Mother Background: Breastfeeding is the healtiest feeding method for newborn. But because of different factors the mothers can led to give their babies some supplements. Problems that may arise regarding the feeding the newborn in the postpartum period could potentially cause adverse experience this process. Objectives: To examine the effects of newborn feeding methods on the sleep and fatigue of the mother. Methods: It is a descriptive and retrospective study, carried out with 245 mothers that are in postpartum fifth week. The data related to the sleep and fatigue of the mothers in postpartum week one and in the end of week four were collected retrospectively. The Introduction Data Form, The Sleep Status of the Mother and the Visual Fatigue Evaluation Form were used. Data were analyzed using the Mann-Whitney U and chi-square test. Results: The first week of exclusive breastfeeding total sleep time by partial breastfeeding, although less than those, they find more adequate sleep (p = .000), and that they felt less fatigue (p = .000) were determined. At the end of the fourth week, the exact opposite, partial breastfeeding mothers than the total they found enough sleep (p = .000) and that they felt less fatigue (p = .000) were determined. Conclusion: The results of this study, exclusive breastfeeding mothers in the first week postpartum, while better cope with fatigue and sleep fragmentation particularly after the first week they were found that forced.
The human need for sleep is universal and unquestioned; however, humans vary in their sleep needs according to age, individual differences, as well as cultural and social norms and practices. Therefore, what is “normal” in infant sleep and the development of sleep architecture in humans is highly dependent on biological and sociocultural variables as well as socially constructed assumptions about what infant sleep “should” look like. This paper uses a multidisciplinary approach to review papers from fields including pediatrics, anthropology, psychology, medicine, and sociology to understand “normal” infant sleep. Because human culture and behavioral practice changes much more quickly than evolved human biology, and because human evolutionary history occurred in the context of breastfeeding and cosleeping, new work in the field of infant sleep architecture development would benefit from a multidisciplinary approach. To come to a consensus about what is “normal” infant sleep, researchers must agree on underlying basic assumptions of infant sleep from which to ask question and interpret findings.
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
Background
Extensive changes in the sleeping patterns of a child take place within the baby’s first year of life. Those changes are due to biological processes which are, however, influenced by environmental and parental factors.
Objectives
This review aims to establish a connection between child sleep on one hand and parental cognitions, interactive behaviour, psychopathologies and environmental influences on the other hand.
Materials and methods
The review includes the analysis of 37 research articles that shed a light on various influential factors on the sleep of a child. Those influential factors are assigned to the model of sleep-wake-regulations.
Results
Parental behaviour, in relation with going-to-bed rituals and calming techniques, has a significant influence on child sleep. Higher parental engagement is related to more fragmented sleep of the child. Studies show that parental cognition and psychopathologies, in addition to further influential factors caused by occupation and sleeping problems that are related to screaming and feeding disorders, govern parental sleep-related behaviours and have therefore direct effects on child sleep.
Conclusions
Child sleep is highly influenced by parental sleep-related behaviours and should always be viewed in the context of the family. There are reciprocal interactions between the individual members of the family and the aforementioned influential factors on child sleep can serve as essential starting points for suitable interventions. Further research in this field needs to be conducted.
In this chapter we address whether and how breastfeeding contributes toward differences in the newborn infant’s neurobehavioral development. We then consider how differences of this nature might underlie or help account for some of known benefits of breastfeeding to infant health, and to possible advantages to intellectual development. The chapter reports that crying in the breastfed infant may be more frequent but of shorter duration and lesser intensity. Its relation to pain threshold is unclear. Findings on the breastfed infant’s sleep appear to suggest that sleep latency is shorter in duration, sleep intervals are of shorter duration, and arousability is greater. The breastfed infant’s sleep architecture may relate to child health. Some potential benefits relate to the incidence of SIDS, enuresis, and obesity. Breastfed newborns show more optimal social behavior, alertness, motor development, and neurological organization. Correspondingly, they have been found having longer heart rate, elevated heart period variability, and higher vagal tone, suggesting more optimal physiological organization. These strengths may contribute to superior cognitive skills, especially the ability to concentrate. They may also help advance cognitive and social development through their enhancing effects on parenting behavior.
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
The KIDSCODE® Baby Process is a three-day, in-home intervention aimed at assisting parents to support their infant in developing self-regulation and achieving sleep easily. The program also aims to help parents to reduce their own stress, anxiety and depressive symptoms. This pilot study evaluated the outcomes of the KIDSCODE® Baby Process for families with an infant sleep problem. Ten families with an infant aged between six weeks and 15 months participated. Findings indicate that, after completing the KIDSCODE® Baby Process, infant night-time sleep increased significantly in quantity. Infant sleep was also found to improve in quality. One week after the intervention, the number of night wakings, the number of aids needed to settle to sleep, and the time taken to settle infants to sleep had all reduced significantly. Parents were able to maintain these changes over time. Following intervention, mothers also had significantly more sleep, and stress, anxiety and depression reduced significantly for both mothers and fathers over the month following intervention.
Objective:
Controversies exist regarding the impact of co-sleeping on infant sleep quality. In this context, the current study examined: (a) the differences in objective and subjective sleep patterns between co-sleeping (mostly room-sharing) and solitary sleeping mother-infant dyads; (b) the predictive links between maternal sleep during pregnancy and postnatal sleeping arrangement; (c) the bi-directional prospective associations between sleeping arrangement and infant/maternal sleep quality at three and six months postpartum.
Methods:
The sample included 153 families recruited during pregnancy. Data were obtained in home settings during the third trimester of pregnancy and at three and six months postpartum. Mothers were asked to monitor their own sleep and their infants' sleep for five nights using actigraphy and sleep diaries. Questionnaires were used to assess sleeping arrangements, feeding methods, socio-demographic characteristics, and maternal depressive and anxiety symptoms.
Results:
Mothers of co-sleeping infants reported more infant night-wakings than mothers of solitary sleeping infants. However, none of the objective sleep measures was significantly different between co-sleeping and solitary sleeping infants, after controlling for feeding techniques. Co-sleeping mothers had significantly more objective and subjective sleep disturbances than mothers in the solitary sleeping group. Moreover, poorer maternal sleep during pregnancy and at three months postpartum predicted higher levels of co-sleeping at six months.
Conclusion:
Mothers of co-sleeping infants report more infant night-wakings, and experience poorer sleep than mothers of solitary sleeping infants. The quality of maternal sleep should be taken into clinical consideration when parents consult about co-sleeping.
Summary The mothers of 180 preschool children were interviewed in their homes in a survey of feeding preferences and sleeping behaviour. We report here on the differences in current sleeping patterns and the age at which night feeds were dropped. There are clear differences in these two behaviours according to whether the baby was breast or bottle fed, and this result is not explicable in terms of social class. Night feeds disappear more slowly in the breast fed infant, and the problem of night waking both in the first year of life and when at nursery school appears to be associated with earlier breast feeding. The importance of such a finding is discussed in relation to the advice offered to mothers by health professionals.
Despite their common use parental diaries of infants' cry and fuss behaviour have not been compared with objective methods of recording. To understand what is meant by the descriptions of crying and fussing in the diaries, the diaries of 10 mothers of 6 week old infants were compared with tape recordings of vocalisations made by the babies over a 24 hour period. There were moderately strong correlations between the frequency of episodes (clusters of 'negative vocalisations') on the audiotape and episodes of 'crying and fussing' in the diaries, and between the duration of episodes on the audiotape and episodes of 'crying' in the diaries. To assess the acceptability of the diaries for recording information for clinical and epidemiological research, they were then used in a population study of a wide socioeconomic group. Usable data were obtained from 91% of the sample. The results suggest that despite pronounced differences between recording methods, these diaries may provide valid and useful reports of crying and fussing in the short term.
A prospective study of 132 infants aged from 1 month to 1 year found that infants who were breast fed or breast plus bottle fed were significantly more likely to wake at night throughout the first year. Social class of the family, parity of the mother, and the weight gain of the infant had no consistent effects. This increased waking was not due to mothers of wakeful infants prolonging breast feeding to soothe their infants.
Published norms for infant sleep/wake patterns during the first 2 years of life include an increase in length of maximum sleep bout from four to five to eight to ten hours by 4 months but little decrease in total sleep in 24 hours from 13 to 15 hours. Thirty-two breast-fed infants were followed for 2 years and data collected on 24-hour patterns of nursing and sleep. Infants who were breast-fed into the second year did not develop sleep/wake patterns in conformance with the norms. Instead of having long unbroken night sleep, they continued to sleep in short bouts with frequent wakings. Their total sleep in 24 hours was less than that of weaned infants. This pattern was most pronounced in infants who both nursed and shared a bed with the mother, common practices in many nonwestern cultures. The sleep/wake development accepted as the physiologic norm may be attributable to the early weaning and separated sleeping practiced in western culture. As prolonged breast-feeding becomes more popular in our society, the norms of sleep/wake patterns in infancy will have to be revised.
Although solitary sleeping in infancy is a very recent custom, limited to Western industrialized societies, and most contemporary people practice parent-infant co-sleeping, virtually all laboratory research on sleep in human infants assumes that solitary infant sleep is the normal and desirable environment. We have used evolutionary and developmental data to challenge this view. We suggest that co-sleeping provides a sensory-rich environment which is the more appropriate environment in which to study infant sleep. In addition, two preliminary, in-laboratory, polygraphic investigations of mother-infant co-sleeping are reported in normal infants, within the peak age range for sudden infant death syndrome (SIDS). Five mother-infant pairs co-slept one night in the first study; in the second, three additional pairs slept separately for two nights and co-slept the third consecutive night. The results suggest that co-sleeping is associated with enhanced infant arousals and striking temporal overlap (synchronicity) in infant and maternal arousals, and that, possibly as a result, co-sleeping mothers and infants spend more time in the same sleep stage or awake condition. The implications of the hypothesis and preliminary results for research on the normal development of infant sleep and on SIDS are discussed.
To compare the sleep patterns, mood states, and cognitive functioning of primiparous mothers during the first 3 weeks postpartum with those of a control group of nonpostpartum women and to assess the relationships among these variables.
For the first 3 weeks postpartum, 30 primiparous women and 28 nonpostpartum mothers completed daily assessments of mood and recorded multiple aspects of sleep including time of retiring, occurrence and duration of sleep interruption, time of awakening, and morning alertness. Objective measures of memory, attention/concentration, and psychomotor performance were obtained on three occasions.
Postpartum women reported more evening awakenings, more time awake after retiring, and more naps than controls, but overall sleep time was similar. New mothers experienced a higher level of dysphoric mood during the first week than nonpostpartum controls; however, controlling for the effect for "time awake" at night eliminated the significant effect for dysphoric mood. Few differences were observed on the multiple assessments of cognitive function; however, performances of new mothers on memory and psychomotor tasks were likely to be influenced by sleep loss.
Women must make important adjustments in their sleep patterns during the postpartum period. In the study group, these adjustments were largely successful, particularly after the first week postpartum, in avoiding the negative consequences of sleep disturbances such as dysphoric mood and impaired cognitive function. Nevertheless, the significant associations between sleep indices and mood and objective measures of cognitive function point to the importance of encouraging appropriate amounts of sleep for recently delivered women.
We studied changes in the sleep patterns of ten young women from late pregnancy (36 weeks) to the sixth postpartum week, focusing on the relationship between the women's sleep patterns and their infants' movements. The mothers' polysomnograms and their infants' ankle actigrams were simultaneously recorded using a Medilog 9000 at home in three sessions, during the first, third, and sixth postpartum weeks. The mother-infant pairs slept in close proximity. Two subjects had difficulty with their infants and were dealt with as a separate group. Analysis for the eight subjects who adapted well to the postpartum period showed that wake time after sleep onset increased significantly during the postpartum period compared with late pregnancy given responsibility for feeding. Stage 3+4 and Stage REM did not change across the four sessions (pregnancy, first, third, and sixth postpartum weeks), but Stage 2 decreased significantly from pregnancy to postpartum. There was a high synchronization between infants' movements and mothers' wakefulness. Eight mothers did not complain of sleep disturbance, while the two mothers who had difficulty with their infants did. We suggest that mothers who tolerate well sleep interruption arising from feeding and maintain their Stages 3+4 and REM should not be considered as suffering from sleep disturbance. Mothers who have difficulty with their infants and complain of sleep disturbance should be considered as suffering from sleep disturbance.
To determine the relationship between cosleeping and sleep problems in cultures with very different sleep practices.
Interview study.
Families in urban Japan and the United States identified through pediatric and other professional contacts.
Parents of healthy 6- to 48-month-old children (56 Japanese parents and 61 white US parents). All children had been breast-fed and lived in 2-parent, middleclass households.
None.
Sleep practices and sleep problems.
More Japanese than US children coslept 3 or more times per week (59% vs. 15%, P<.001). All cosleeping Japanese children regularly slept all night with their parents (vs. 11% of US cosleepers, P<.001). Japanese and US children did not differ in part-night cosleeping (7% vs. 13%, P = .37). Most Japanese children had adult company and body contact as they fell asleep, and fathers slept separately in 23% of families. A greater proportion of US children had regular bedtime struggles and night waking. Within the US sample, cosleeping was associated with more bedtime struggles (P<.001), night waking (P<.01), and overall stressful sleep problems (P<.01). In the Japanese sample, cosleeping was associated only with night waking (P<.05); however, the proportion of cosleeping Japanese children with frequent night waking was at the level reported for US children who slept alone (30% vs 23%, P = .47).
Cultural differences seem to influence the relationship between sleep practices and sleep problems. The experience of the Japanese families indicates that cosleeping per se is not associated with increased sleep problems in early childhood.
Factors that place an infant at increased risk of sudden infant death include the prone sleep position, overheating and parental smoking, while practices such as bottle-feeding, co-sleeping and the use of pacifiers remain controversial. Major publicity campaigns have been undertaken, which have included the distribution of printed material and extensive media coverage.
To examine if Irish parents follow the currently recommended childcare guidelines to reduce the risk of sudden infant death and to examine factors that may have impact on their acceptance.
A random selection of 197 infants from the Birth Register of the Eastern Health Board. Parents were interviewed and a semi-structured survey questionnaire was completed.
Forty one per cent of infants are still placed on their side to sleep, an inherently unstable position. First time parents are more likely to place their infants on their backs. Over 60% of infants are exposed to one or more adults smoking in the home despite parental knowledge of its association with sudden infant death syndrome (SIDS). Sixty eight per cent of infants are overwrapped at night and parental understanding of what constitutes overwrapping is poor. Thirteen per cent of infants regularly co-sleep with their parents and 20% of these parents smoke. Pacifier use is common.
Future programmes should target first time parents, should provide clear information regarding appropriate infant thermal environment, and should ensure regular updating of medical personnel so that they can instruct families on best current practice. Smoking remains a significant health issue with an impact on sudden infant death.
The American Academy of Pediatrics has recommended since 1992 that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since that time, the frequency of prone sleeping has decreased from >70% to ~20% of US infants, and the SIDS rate has decreased by >40%. However, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (eg, maternal smoking), the importance of other hazards, such as soft bedding and covered airways, has been demonstrated only recently. The present statement is intended to review the evidence about prone sleeping and other risk factors and to make recommendations about strategies that may be effective for further reducing the risk of SIDS. This statement is intended to consolidate and supplant previous statements made by this Task Force.
To describe perceived levels of fatigue and energy before, during, and after pregnancy in a group of healthy women experiencing uncomplicated pregnancies; and to examine relationships between their perception of fatigue and energy, parity, and physiologic indicators of sleep disturbances, thyroid function, and iron deficiency.
Prospective, longitudinal.
Participants’homes.
Participants: Convenience sample of 24 primiparous and 18 multiparous women.
Change in fatigue and energy over time. Measures were obtained at follicular and luteal phases of the menstrual cycle before pregnancy, at each trimester, and at 1 and 3 months after delivery.
Younger age and lower prepregnancy levels of iron, ferritin, and hemoglobin explained 1st trimester fatigue. Less total sleep was related to fatigue in the 3rd trimester. Postpartum fatigue was related to reduced amounts of sleep and low levels of ferritin and hemoglobin.
With the exception of premenstrual (luteal) fatigue, progesterone levels were unrelated to fatigue. Neither paid employment nor family variables influenced perception of fatigue. Nurses working with childbearing populations should counsel women about significant 1st trimester fatigue so they can prepare their work and home environments in an attempt to achieve adequate rest.
Background: The postpartum is a time when women commonly report increased fatigue that may contribute to depression. Studies have not examined fatigue alone as a predictor of postpartum depression.
Objective: To examine whether and when fatigue in the early postpartum is predictive of postpartum depression.
Design: Correlational, longitudinal study.
Setting: Two hospitals and participants' homes in central Pennsylvania.
Participants: Convenience sample of 38 healthy women recruited from hospital maternity units within 24 hours after an uncomplicated birth.
Main Outcome Measures: Fatigue was measured using the Modified Fatigue Symptom Checklist (MFSC) on Days 0, 7, 14, and 28 after childbirth. Depression was assessed using the Center for Epidemiological Studies-Depressive Symptomatology Scale (CES-D) on Day 28.
Results: After adjustments for multiple comparisons, a significant correlation was obtained between fatigue as measured by the MFSC and postpartum depression on Day 7 (r = .46; p < .05), Day 14 (r = .57), and Day 28 (r = .70). Fatigue on Day 0 was correlated with fatigue on Day 7 (r = .45), Day 14 (r = .58), and Day 28 (r = .34).
Conclusions: Fatigue as early as 7 days postpartum is predictive of depression at Day 28 postpartum.
Self-reported sleep disturbances and levels of vitality and fatigue were studied in a secondary analysis of 25 pregnant and 29 postpartum employed women. Results indicate that pregnant women have problems initiating and maintaining sleep, and postpartum women have problems maintaining sleep, but not falling asleep. The primary reason for midsleep awakenings was urinary frequency among the pregnant women, and child care responsibilities among the postpartum women. Chronic sleep disturbance was indicated by a greater percentage of postpartum women who fell asleep easily, very few who felt highly energetic at work, and most who perceived a high level of fatigue during the past week. Even with these sleep disruptions, no differences occurred in the mean scores for perception of fatigue and vitality between the two groups. Clinicians can use these findings to educate women about some changes they may anticipate and how they might manage them during pregnancy and postpartum.
Childbirth and the responsibilities of parenting after birth require a great deal of energy. Fatigue in postpartum women is a concern for maternal-child nurses because of the impact on the health and parenting ability of the mother. To determine fatigue levels and types, 35 women who vaginally delivered were surveyed at 2 days, 2 weeks, and 6 weeks postpartum. This sample was found to be mildly fatigued, with situational and/or psychological fatigue. Nurses can intervene by assessing postpartum fatigue and using teaching/counseling methods for knowledge preparation and for clients at risk.
This study of mother-baby sleep patterns used an exploratory descriptive approach. The subjects were a sample of convenience of nine first time mothers and their baby. Data were collected by means of unstructured non-directive interviews and the Nursing Child Assessment Sleep Activity Record (NCASAR) during the second to fourth postpartum weeks. The findings showed that most of the mothers obtained as many hours of sleep in the postpartum period as they did prior to pregnancy. However, this sleep was subject to many interruptions. All of the subjects felt less rested and complained of tiredness which they ascribed to meeting the needs of their baby rather than with actual reduction in the number of sleep hours. The mothers described tiredness in two ways, physical and emotional. Support from partner and others was critical to the mothers in assisting them to adapt to and cope with the responsibilities of motherhood. The findings of this study confirmed the unpredictable nature of baby sleep-wake cycles during the early postpartum period.
A two-group design was used to compare the state behavior of newborns who roomed-in with their mothers at night with those who were cared for by the traditional nursery-at-night method. Twenty-one full-term, low-risk newborns comprised the study sample. Data were collected using a sleep monitor bassinet for two consecutive nights after delivery. Comparison of the nursery environment with the mother's postpartum room at night revealed greater light and sound levels in the nursery setting. Regarding caregiving practices, rooming-in infants received more contact with the caregiver and care that was more often related to their state behavior. Infants in the mother's room had significantly, p less than .001, more quiet sleep (33% vs. 25.4%), less indeterminate (4.8% vs. 11.2%), and less crying (0.6% vs. 7.5%) states than infants who remained in the nursery.
A longitudinal study, based on interviews with 308 middle-class, preponderantly white mothers, provided an opportunity to evaluate the continuity, predictive factors, and behavioral correlates of sleep problems in young children. When their children were 8 months old, 10% of the mothers reported that their babies woke three or more times per night, 8% reported that the babies took an hour or more to settle after waking, 5% complained that their own sleep was severely disrupted by the child, and 18% reported at least one of these problems. At 3 years of age, 29% of the children had difficulty getting to bed and/or falling asleep or staying asleep. Of children with a sleep problem at 8 months of age, 41% still had a problem at 3 years of age, whereas only 26% of children without a problem at 8 months of age had a problem at 3 years of age (P less than .001). Among children with sleep problems at 8 months of age, mothers' depressed feelings were the only measured demographic or psychosocial factor associated with persistent sleep problems (P = .02). A separate analysis indicated that these depressed feelings did not appear to be a consequence of the child's sleep problem. Future studies should evaluate how maternal depression interacts with other factors to result in persistent sleep problems. Children with persistent sleep problems were more likely to have behavior problems, especially tantrums (P less than .02) and behavior management problems (P less than .01), than were children without persistent sleep problems (P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)
An increasing number of mothers are attempting to breast-feed their babies; however, without sufficient support and guidance many stop a short time after delivery. The nurse has an important role in helping mothers to breast-feed successfully. The purpose of this qualitative, descriptive investigation was to study the concerns of mothers who breast-feed their infants from birth to 4 months. Most of the literature regarding concerns of the breast-feeding mother has focused on shorter periods. A better understanding of the concerns of mothers over a longer period of time is neded to improve planning and to test specific nursing interventions.
To determine whether sleep problems commonly seen in pediatric practice, such as conflicts at bedtime and night waking, are associated with more pervasive disturbances in the child or family, two groups of healthy children were studied. Interview data from a pilot sample were examined to identify factors that might be important in sleep problems, and then the results were validated with data from the second sample. The two samples included 96 white children between 6 months and 4 years of age. In each group, approximately 30% had a sleep problem by the criteria that night waking involving parents or bedtime struggles occurred three or more nights a week for the month preceding the interview, accompanied by conflict or distress. Five experiences distinguished children with sleep problems from those without: an accident or illness in the family, unaccustomed absence of the mother during the day, maternal depressed mood(s), sleeping in the parental bed, and maternal attitude of ambivalence toward the child. These experiences correctly classified 100% of pilot and 83% of validation sample children as having a sleep problem or not. The similarity of findings in the two samples attests to the potential importance of sleep problems as an early childhood symptom. Bedtime conflicts and night waking seem to be quantifiable, easily ascertainable behavior patterns that could alert pediatric health professionals to the existence of more pervasive disturbances in child and family.
Sleep problems had developed at one year in 24 of a sample of 77 babies studied in Cambridge, England. The problem babies slept for shorter periods and woke regularly. There was no relationship between sleep problems and sex, birth order or social class. There was a suggestion that the development of sleep problems might be related to length of labour and the state of the baby at delivery. The problem group were more wakeful and irritable during the first 10 days of life. At 8, 14, 20 and 30 weeks, the problem group showed a continuing pattern of shorter sleep bouts at night. The rôle of parental handling in the development of sleep problems is discussed; while there was no pattern of care common to all mothers of the problem infants, the majority were very responsive. There was no evidence that feeding when the infant awoke at night was related to the problem of waking.
ZUSAMMENFASSUNG
Nächtliches Erwachen in den ersten 14 Lebensmonaten
Bei einer Gruppe von Säuglingen, die in Cambridge, England, beobachtet wurden, gab es bei 24 Kindern im Alter von 1 Jahr Schlafstörungen. Das Problem bestand in verkürzten Schlafperioden und regelmäßigem Aufwachen. Es gab keine Zusammenhänge zwischen den Schlafstörungen und dem Geschlecht, der Stellung in der Geschwisterreihe oder der sozialen Schicht. Es wurde vermutet, daß eine Beziehung zwischen Schlafstörungen und der Geburtsdauer sowie dem Zustand des Babies bei der Geburt bestand. Ferner war die schlafgestörte Gruppe während der ersten 10 Lebenstage häufiger wach und leichter erregbar. Mit 8, 14, 20 und 30 Wochen zeigte die Problemgruppe eine zunehmende Verkürzung der nächtlichen Schlafperioden. Die Rolle der elterlichen Fürsorge im Zusammenhang mit der Entwicklung von Schlafstörungen wurde diskutiert, jedoch wurde bei Müttern mit Problemkiadern keine gemeinsame Eigenheit festgestellt; die Mehrheit war sehr temperamentvoll. Es ergab sich kein Anhalt für die Annahme, daß das Füttern der Kinder während des nächtlichen Aufwachens in Zusammenhang mit den Schlafstörungen stehen könnte.
RESUMEN
Despertar nocturno en los primeros 14 meses de vida
Problemas del sueño se desarrollaron al año de edad en 24 de una muestra de 77 niños estudiados en Cambridge (Inglaterra). Los niños problema dormian durante períodos más cortos y despertaban regularmente. No habia relación entre los problemas del sueño o el sexo, orden de nacimiento o clase social. Se sugirió que el desarrollo de problemas del sueño podría estar relacionado con la duración del parto y el estado del niño en el mismo, ya que el grupo problema se despertaba más y era más irritable durante los 10 primeros días de la vida. A las 8, 14, 20 y 30 semanas el grupo problema mostraba un esquema continuo de pequeños períodos de sueño durante la noche. Se discute el papel de los padres en el desarrollo de problemas del sueño, no habiendo un esquema común de cuidados en las madres de los niños problema siendo la mayoría muy responsables. No había evidencia de que el alimentar al niño al despertarse durante la noche, tuviera relación con el problema del despertar.
In a randomly selected series of 60 infants in a single private practice, 15 (25 per cent) had the sleep disturbance of night waking between 6 and 12 months of age. There was a significant correlation (p<0.02) between night woking and the temperamental characteristic of low sensory threshold as determined by a questionnaire technique. Though this problem is usually attributed to illness in the child or faulty management by the parents, the evidence presented here for a temperamental predisposition illustrates the need for a broader perspective in its diagnosis and management.
Crying behaviour during the first 10 days of life was recorded in diary form for 77 mother‐baby pairs; 20 were first babies and 57 second babies. A peak in crying between 6 p.m. and midnight was found for the sample as a whole. Second babies had lower total crying scores, as mothers responded more quickly to crying, and more often by feeding. Breast‐fed babies showed a more marked 24–hour pattern of crying, with higher total scores and more crying after feeds than bottle‐fed babies. Breast‐feeding mothers were more likely to respond quickly to crying. Flexibility of the mother's attitude to scheduling feeds was related to success in breast‐feeding. The relationship is discussed between the speed of maternal response to the infant cry, maternal sensitivity, and the signal value of the cry.
RÉSUMÉ
Pleurs durant les 10 premiers jours et réponse maternelle
Le comportement de pleurs durant les dix premiers jours de la vie a été relevé journelle‐ment pour 77 couples, mère‐nourrisson. Dans 20 cas, il s'agissait de premiers nés et dans 57 cas de deuxième enfant. Un maximum de pleurs entre 18 heures et minuit a été noté pour 1'échantillon total. Cependant, les seconds enfants montraient des pleurs plus limités du fait que la mère répondait plus vite aux pleurs et plus souvent par l'alimentation. Les nourrissons élevés au sein ont montré un pattern journalier de pleurs plus marqué avec un score total plus élevé et plus de pleurs après la têtée que les bébés nourris au biberon. Les mères nourrissant au sein répondaient généralement d'une façon plus rapide aux pleurs. L'adaptation de l'attitude de la mère à un programme alimentaire précis était liée à I'efficacité de I'alimentation au sein. On discute de la relation existant entre la vitesse de la réponse maternelle aux pleurs, la sensibilité maternelle et la valeur de signal du pleur.
ZUSAMMENFASSUNG
Schreien während der ersten 10 Lebenstage und die mütterlichen Reaktionen Das Schreiverhalten in den ersten 10 Lebenstagen wurdebei 77 Mutter‐Kind Paaren in einer Tagebuchform genau aufgezeichnet; 20 waren erste Kinder und 57 zweite. Bei allen wurde ein Schreigipfel zwischen 18 und 24 Uhr beobachtet. Die zweiten Kinder schreien insgesamt weniger, da die Mütter schneller auf das Schreien reagierten und dann häufiger futterten. Brustgenährte Kinder hatten ein mehr ausgeprägtes 24–Stunden Schreimuster mit höheren Gesamtscores und häufigerem Schreien nach den Mahlzeiten als Flasche genährte Kinder. Stillende Mütter reagierten in der Regel schneller auf Schreien. Die flexible Haltung der Mutter bei der Festsetzung der Mahlzeiten war bedingt durch den Erfolg beim Stillen. Es wird die Beziehung zwischen der Schnelligkeit der mütterlichen Reaktion zu dem Schrei des Kindes, der Empfindsamkeit der Mutter und dem Signalwert des Schreies diskutiert.
RESUMEN
Llanto durante 10s primeros 10 dias de la vida y respuestas maternas Se registró en forma de diario el comportamiento en el llanto en 10s 10 primeros días de vida en 77 parejas madre‐niño; 20 eran primer hijo y 57 segundos. Se encontró un máximo de llanto entre las 6 de la tarde y medianoche en el conjunto de la muestra. Los niños segundogénistos tenian un puntaje de llanto total menor, ya que las madres respondían más rápidamente al llanto y más a menudo con alimento. Los niños criados al pecho mostraron un ‘pattern’ de llanto de 24 horas más marcado, con un puntaje total más alto y más llanto después de los alimentos que 10s niños criados con biberón. Las madres que criaban tenían más tendencia a responder rápidamente al llanto. La flexibilidad de la actitud de la madre a los horarios de alimentación previstos se relacionó con el éxito de la lactancia materna. Se discute la relacion entre la rapidez de la respuesta materna, la sensibilidad materna y el valor como señal del llanto.
As part of a wider study, infant behaviour was reviewed prospectively, using a 24 h diary completed by the mother. Infants' sleep, awake, fussing, crying and feeding behaviour were recorded at 1,2,4,6 and 8 weeks. Completed records were obtained from 21 infants. As expected most time was spent asleep, with a mean of 16.2 h at 1 week and 15.5 h at 8 weeks. Most sleeping occurred between midnight and 4 a.m. even by week 1 and there was a progressive fall in the average duration of feeding during that time interval over the 8 week period. Fussing and crying were mostly noted between 4 and 8 p.m. with an additional peak between 8 a.m. and noon, the latter disappearing by week 4. There was also a progressive drop in both the average feeding and fussing/crying times by week 8, reflecting increased settled and awake periods. It is against a background of normal early infant behaviour patterns that one can evaluate interventions aimed at altering such behaviour and dealing with the vexed problem of 'colic'.
This study was conducted to examine changes in women's mental health over the first postpartum year and factors that are associated with mental health.
Participants included women who were married, employed, English-speaking, and giving birth to their first child at one of two hospitals in St Paul, Minnesota. Women who were eligible and willing to participate were mailed questionnaires at 1, 3, 6, 9, and 12 months postpartum.
There were significant changes in mothers' general mental health, depression, and anxiety over the first postpartum year (P < or = .01), with least favorable outcomes at 1 month and most favorable outcomes at 12 months postpartum. Poor mental health was related to work factors, such as longer work hours and maternity leave of less than 24 weeks, and to variables often associated with recent childbirth, such as maternal fatigue, loss of sleep, concerns about appearance, and infant illnesses. In addition, postpartum symptoms were predicted by physical illness, previous mental problems, poor general health, poor social support, fewer recreational activities, young age, and low income (R2 = 37% to 57%).
In this select group of women, postpartum mental health was found to be least favorable 1 month after delivery and related to factors associated with employment, recent delivery, and level of social support.
Although sleep diaries are widely used in clinical and research settings, only a few studies have compared the subjective information recorded in these diaries to objective information about sleep recorded. The goal of this study was to determine if a sleep diary could be used to obtain reliable data about home sleep/wake patterns over a 24-hour period. Fifty subjects (25 narcoleptic and 25 matched control subjects) completed a sleep diary while undergoing 24-hour ambulatory polysomnographic monitoring. The percentage agreement between the subjective data recorded in the sleep diaries and polysomnographic data was acceptable (kappa = .87). Sensitivity and specificity were also high (92.3% and 95.6%). The sleep diary is a reliable instrument for collecting data about sleep/wake patterns, but should be used with caution when collecting data from subjects who are likely to take frequent daytime naps.
Nursing interventions to enhance breastfeeding affect the health of mothers and babies. Fatigue may interfere with breastfeeding, so interventions minimizing fatigue are important. This repeated measures study of 20 postpartum women investigated the relative efficacy of one intervention, promoting use of the side-lying position. Using the Modified Fatigue Symptoms Checklist, fatigue was measured after breastfeeding in two positions. In mothers who had vaginal deliveries (n = 14), significantly less fatigue was reported following nursing in the side-lying versus the sitting position. Instruction regarding restfulness of the side-lying position should be considered as part of routine postpartum or home health nursing care.
Contrary to popular perception, studies show that parent-infant bedsharing is not uncommon in American society. A belief that bedsharing with infants negatively impacts the quality of adult sleep also appears widespread. This has not been substantiated, however, because the few studies that have measured the impact of bed-sharing on adult sleep examined only bedsharing with another adult. In the present study, laboratory polysomnography was performed in 20 routinely bedsharing and 15 routinely solitary-sleeping, breastfeeding, Latino mother-infant pairs comparing the mothers’ sleep when bedsharing to solitary-sleeping nights. Infants were 11-15 weeks old at the time.
Irrespective of routine sleeping arrangement, mothers’ total sleep time was not decreased on the bedsharing night compared to the solitary night. Across the two groups, percent Stage 3–4 sleep (of total sleep time) was significantly reduced on the bedsharing night but only by 3.9%, while Stage 1–2 sleep was increased 3.7%. Episodes of both Stages 3-4 and 1-2 were significantly shorter. The amount of rapid eye movement (REM) sleep was unaffected. Overall, arousal frequency was significantly increased by 3.6 hour⁻¹. As the increase in arousal frequency was stage specific, it could account for the pattern of stage changes. Nocturnal wakefulness was not increased, however, because awakenings were of shorter duration. These effects of bedsharing did not habituate with routine bedsharing because they were not diminished in the routinely bedsharing mothers compared to the routinely solitary-sleeping mothers.
We find that the impact of bedsharing on maternal sleep is modest and somewhat different from the reported impact of sleeping with another adult. From the infant's standpoint, the effects on maternal sleep are adaptive to the extent that opportunities to monitor the infant's status are enhanced. The mother's caregiver role is likely germane to differential effects on sleep of bedsharing with an infant versus another adult.
Because breastfeeding is thought to be protective against sudden infant death syndrome (SIDS), environmental or child care factors that promote breastfeeding might reduce infant vulnerability to SIDS. The effect of mother-infant bedsharing on nocturnal breastfeeding behavior was studied in 20 routinely bedsharing and 15 routinely solitary sleeping Latino mother-infant pairs when the infants were 3 to 4 months old.
All pairs were healthy and exclusively breastfeeding at night. The videotape portion of all-night laboratory polysomnographic studies was used for the analyses. For each pair, an adaptation night was followed by one night each of bedsharing and solitary sleeping.
The most important finding is that when tested in their usual sleeping conditions, routinely bedsharing infants breastfed approximately three times longer during the night than infants who routinely slept separately: this reflected a two-fold increase in the number of breastfeeding episodes and 39% longer episodes. Breastfeeding was also facilitated on the bedsharing night relative to the solitary night within the routinely bedsharing group: the number and total duration of breastfeeding episodes were significantly larger on the bedsharing night.
We suggest that, by increasing breastfeeding, bedsharing might be protective against SIDS, at least in some contexts. Furthermore, maternal reproductive physiology could be impacted because nursing frequency affects ovulation. This is the first study to directly measure nocturnal breastfeeding behavior in any cultural group.
Using modified Barnard and Eyres (1979) Sleep/Activity Records, 44 mothers recorded diurnal sleep and awake times for themselves and their infants during the 4th week postpartum. Independent two-way analyses of variance, using a two-factor design (3a x 2b), compared data from each mother and each infant. Independent variables were (a) parity groups (mothers feeding their first, second, or third infant) and (b) feeding method (breast vs. bottle). A statistically significant difference (alpha = .05) was apparent between breast-fed and bottle-fed babies regarding the number of awakenings and the hours of night sleep, with breast-fed babies awakening more and sleeping less at night. But there was no statistically significant difference in the hours of total sleep diurnally. Mothers exhibited corresponding differences in sleep patterns, with a statistically significant increase in night waking for breast-feeding mothers. Infants in this study averaged 14.6 hr of sleep in 24 hr, which is in contrast to the 15.5 to 17.3 hr of sleep commonly reported in nursing texts based on studies from the 1960s.
To identify and assess dangers associated with placing children younger than 2 years to sleep in adult beds. This article focuses on overlying, wedging, and strangulation hazards and the relationship of these hazards to children's sleeping environments.
A retrospective review and analysis of data collected by the US Consumer Product Safety Commission on deaths of children younger than 2 years in standard adult beds, daybeds, and waterbeds. The review included incident data from January 1990 through December 1997.
The 8-year records showed a total of 515 deaths of children younger than 2 years who were placed to sleep on adult beds. Of these deaths, 121 were reported to be due to overlying of the child by a parent, other adult, or sibling sleeping in bed with the child and 394 were due to entrapment in the bed structure. Most of these deaths seem to have resulted from suffocation or strangulation caused by entrapment of the child's head in various structures of the bed.
Placing children younger than 2 years to sleep in adult beds exposes them to potentially fatal hazards that are generally not recognized by the parent or caregiver. These hazards include overlying by a parent, sibling, or other adult sharing the bed; entrapment or wedging of the child between the mattress and another object; head entrapment in bed railings; and suffocation on waterbeds. Parents and caregivers should be alerted to these avoidable hazards.
To compare sleep-wake patterns of breastfed and formula-fed preterm infants.
Data were taken from an exploratory study of infant biorhythm maturation. Parents completed a 24-hour diary of infant Sleep, Awake, and Cry states and feedings, recorded at 30-minute intervals. Infant health data were collected from medical records and parents' reports.
Infants were studied in the home after discharge from a neonatal intensive-care unit.
The convenience sample included 12 breastfed and 25 formula-fed preterm infants (gestational age, 26-33 weeks; corrected postnatal age, 4-6 weeks). Groups were comparable in terms of gestational age, postnatal age, Apgar scores, maternal age, and home environment.
The 24-hour recording period was divided into day (0600-1800) and night (1800-0600). Study variables were Day, Night, and 24-hour Sleep, Awake, and Cry.
Breastfed preterm infants exhibited more Day Cry and 24-hour Cry than did formula-fed infants. Infants demonstrated a diurnal pattern in Cry, Awake, and Sleep. Breastfed preterm infants cried approximately 1 hour per day more than formula-fed infants.
Preterm breastfed infants experienced more cry than did formula-fed infants. The relationship between feeding method and sleep-wake pattern has implications for supporting lactation as well as for research design.
It has been assumed that women recover from pregnancy and childbirth within 6 weeks. Recent research shows that women's fatigue levels are the same, or higher, at 6 weeks postpartum as at the time of delivery. This study determined the differences in primiparous women's fatigue and energy levels at 6 weeks and 14 to 19 months postpartum. Determinations of how some contributing factors and outcomes of postpartum fatigue relate to each other and to fatigue and energy at 14 to 19 months postpartum were also made. Analyses revealed that women are more fatigued and less energetic at 14 to 19 months than they were at 6 weeks postpartum. Quality of sleep did not correlate with fatigue or energy. At 14 to 19 months postpartum return to full functional status is almost complete, with household and infant care responsibilities being most complete. The women were experiencing mild life crises of various sorts, were somewhat depressed, and were gratified in the mothering role.
This study was designed to monitor changes in the prevalence of risk factors for sudden infant death syndrome (SIDS) in the New Zealand population. The behaviour of interest is parent/infant co-sleeping. This paper reports parent/infant co-sleeping arrangements of different ethnic groups in New Zealand.
A stratified random sample of 6268 infants attending Plunket clinics for their three and six-month visits was taken over the years 1995-1996. Maori and Pacific infants were oversampled. Parents who shared a bed with their infant were asked how they arranged the babies sleeping place according to pre-coded diagrams. Routine parent/infant co-sleeping was defined as "bed sharing at least four nights over the last two weeks".
There were 2693 infants who shared the bed with their sleeping parents during at least one of the previous 14 nights. Of these infants, 1060 routinely shared the parents' bed. At three months, 56% of routinely co-sleeping infants slept directly in the bed, 29% slept in a raised position, 3% slept in a carrycot or basket, and 5% in other positions. At six months, 60% of the routinely co-sleeping infants slept directly in the bed with their parents, 23% slept in a raised position, 1% slept in a carrycot or basket, and 7% in other positions. There were significant differences in the co-sleeping locations by ethnicity.
There is still some ongoing dispute as to whether parent/infant co-sleeping is a risk factor for SIDS. This study has identified differences in the way infants co-sleep with their parents and this can be used to clarify infant care practices in relation to SIDS.
Night awakening and refusal to go to sleep are common problems during the first three years of life, comprising 6-30% of children in the general population. The organization and regulation of child sleep is thought to be closely related to his mode of attachment to his mother. Sleep aids (pacifier, teddy bear, etc.) during the night seem to reduce the occurrence of sleep disorders whereas prolonged breastfeeding and co-sleep with the parents interfere with the normal development of sleep. During the preschool years, the main issue affecting sleep is the ability of parents to set firm limits while respecting the sense of autonomy of the child. Sleep disorders are considered to be more common among physically and mentally handicapped children. Children with a difficult temperament sleep less than those with an easy one. A clear association is found between sleep patterns and psychopathology of the mother probably due to emotional unavailability and inappropriate behavior. Evaluation of the disorder should follow medical examination. It should take place in the presence of the child in order to view the real interaction as well as given information about the reported interaction between the child and his mother. Therapeutic interventions in cases of early childhood sleep disorders can be behavioral or psychodynamic and are advised to be focused and brief, unless there is psychopathology in the parents.
This study was an attempt to evaluate the present profile of parent-child cosleeping, to investigate the characteristics of those children who cosleep with their parents, and to determine the factors influencing cosleeping in Korea. Observed subjects consisted of 427 young Korean children aged 12 to 84 months. We used an interview method. The incidence of cosleeping was 377 (88.2%). Cosleeping decreased with increasing age. Cosleeping in Korean society was affected mostly by the age of parents and children, attitudes of the mother to cosleeping, and Korean traditional cultural values. The practice of cosleeping in young Korean children is very common and socially acceptable to Korean parents as a natural part of the child-rearing process. Korean family values and a cultural value system emphasizing familial bonds and interpersonal interdependence seems to act as positive reinforcing factors for the practice of cosleeping.
American Academy of Pediatrics guide to your child's sleep
- G J Cohen
Cohen, G. J. (Ed.). (1999). American Academy of Pediatrics guide to your child's sleep. New York: Villard.
Sleep disorders of early childhood: A Co-sleeping Safety Measures Crying during the first 10 days of life and maternal responses
- I Benhamou
Benhamou, I. (2000). Sleep disorders of early childhood: A Co-sleeping Safety Measures. Bernal, J. (1972). Crying during the first 10 days of life and maternal responses. Developmental Medicine and Child Neurology, 14, 362-372.
Breast feeding and human lactation
- J Riordon
- K Auerbach
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The expanding family: Childbearing Fatigue as a predictor of postpartum depression
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Child health assessment, Part 2: The first year of life [Health Manpower Refer-ences
- K E Barnard
- S J Eyres
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Solitary or shared sleep: What's safe? Mothering
- P Donohue-Carey
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What hap-pens when fatigue lingers for 18 months after delivery? Journal of Obstetrics, Gynecology, and Neonatal Nurs-ing
- P L Parks
- E R Lenz
- R A Milligan
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Good night, sleep tight? Safety in the family bed
- P Donohue-Carey
Donohue-Carey, P. (2000). Good night, sleep tight? Safety in the family bed. Childbirth Instructor, pp. 18-23.
The womanly art of breast feeding
- La Leche
La Leche League International. (1997). The womanly art of breast feeding (6th ed.). Schaumburg, IL: Author.
Crying baby, sleepless nights: Why your baby is crying and what you can do about it
- S Jones
Jones, S. (1992). Crying baby, sleepless nights: Why your baby is crying and what you can do about it. Boston: The Har-vard Common Press.
Nighttime parenting: How to get your baby and child to sleep Safe co-sleeping A prospective study of sleep, mood, and cognitive function in postpartum and nonpostpartum women
- W Sears
- A M Swain
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- K R Gorman
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Clinical protocol number 6—Guideline on co-sleeping and breastfeeding. Retrieved from http://www.bfmed.org/protocol/proto6 Sleep patterns of breast-fed and non breast-fed infants
- Breastfeeding Academy
- Medicine
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Your baby and child: From birth to age five
- P Leach
Leach, P. (1992). Your baby and child: From birth to age five (2nd ed.). New York: Knopf.