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There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping

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Abstract

Recently Mobbs et al. 2015 describe the need for, and benefits of, immediate and sustained contact, including cosleeping, to establish an appropriate foundation for optimal human infant breastfeeding, neonatal attachment and brain growth. To further support this model we propose a new concept, 'breastsleeping', aimed to help both resolve the bedsharing debate and to distinguish the significant differences (and associated advantages) of the breastfeeding-bedsharing dyad when compared with the non-breastfeeding-bedsharing situations, when the combination of breastfeeding-bedsharing is practiced in the absence of all known hazardous factors. Breastfeeding is so physiologically and behaviorally entwined and functionally interdependent with forms of cosleeping that we propose the use of the term breastsleeping to acknowledge: 1) the critical role that immediate and sustained maternal contact plays in helping to establish optimal breastfeeding; 2) the fact that normal, human (species-wide) infant sleep can only be derived from studies of breastsleeping dyads because of the ways maternal-infant contact affects the delivery of breastmilk, the milk's ingestion, the infant's concomitant and subsequent metabolism and other physiological processes, maternal and infant sleep architecture, including arousal patterns, as well as breastfeeding frequency and prolongation and; 3) that breastsleeping by mother-infant pairs comprises such vastly different behavioral and physiological characteristics compared with non-breastfeeding mothers and infants, this dyadic context must be distinguished and given its own epidemiological category and benefits to risks assessment. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

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... The early postnatal period is important for mother-infant bonding (Kinsey and Hupcey 2013;Wittkowski et al. 2007) and the establishment of breastfeeding to reduce infant mortality (Dewey et al. 2003;Edmond et al. 2006;Mullany et al. 2008). At the same time that breastfeeding is established, mothers learn how to hold, swaddle, and safely co-sleep with their infant (McKenna and Gettler 2016;McKenna et al. 2007). SIDS and accidental suffocation are both significantly reduced in the context of "breastsleeping" with the use of simple, safe co-sleeping practices such as keeping loose bedding away from babies (Gettler and McKenna 2010;McKenna and Gettler 2016). ...
... At the same time that breastfeeding is established, mothers learn how to hold, swaddle, and safely co-sleep with their infant (McKenna and Gettler 2016;McKenna et al. 2007). SIDS and accidental suffocation are both significantly reduced in the context of "breastsleeping" with the use of simple, safe co-sleeping practices such as keeping loose bedding away from babies (Gettler and McKenna 2010;McKenna and Gettler 2016). Insufficient knowledge and emotional support can also lead to serious harm for babies. ...
... Colostrum is typically withheld, with boiled water or goatmilk substituted during the first two neonatal days. Cosleeping, or rather breastsleeping (McKenna and Gettler 2016), is the norm. Himba sleep on a cow hide substrate on a packed earthen floor with blankets used during the winter months. ...
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Maternal grandmothers play a key role in allomaternal care, directly caring for and provisioning their grandchildren as well as helping their daughters with household chores and productive labor. Previous studies have investigated these contributions across a broad time period, from infancy through toddlerhood. Here, we extend and refine the grandmothering literature to investigate the perinatal period as a critical window for grandmaternal contributions. We propose that mother-daughter co-residence during this period affords targeted grandmaternal effort during a period of heightened vulnerability and appreciable impact. We conducted two focus groups and 37 semi-structured interviews with Himba women. Interviews focused on experiences from their first and, if applicable, their most recent birth and included information on social support, domains of teaching and learning, and infant feeding practices. Our qualitative findings reveal three domains in which grandmothers contribute: learning to mother, breastfeeding support, and postnatal health and well-being. We show that informational, emotional, and instrumental support provided to new mothers and their neonates during the perinatal period can aid in the establishment of the mother-infant bond, buffer maternal energy balance, and improve nutritional outcomes for infants. These findings demonstrate that the role of grandmother can be crucial, even when alloparenting is common and breastfeeding is frequent and highly visible. Situated within the broader anthropological and clinical literature, these findings substantiate the claim that humans have evolved in an adaptive sociocultural perinatal complex in which grandmothers provide significant contributions to the health and well-being of their reproductive-age daughters and grandchildren.
... Over the past decade, the scope of anthropological research employing evolutionary, ethological, and biological perspectives on infant sleep has grown substantially, encompassing the interaction of mother-infant sleep proximity with lactation physiology (Ball et al. 2006 and breastfeeding behavior McKenna and Gettler 2016), infant sleep development Ball 2016, 2018), infant nighttime care following caesarean section (Tully and Ball 2012), the effects of co-sleeping on paternal hormonal physiology (Gettler et al. 2012), parental coping strategies Volpe and Ball 2015), and the role of parent-infant conflict theory in understanding infant sleep and nighttime care (Haig 2014;Hinde 2014;Tully and Ball 2013;Volpe, Ball, and McKenna 2013). Together, this work strengthens the evidence base for the core biological anthropological argument that proximate parent-infant sleep combined with lactation represents a complex set of adaptations that constitute the human evolutionary norm. ...
... Although McKenna's research continued with various collaborations (Gettler and McKenna 2011;McKenna and Volpe 2007), the implications of his work on the role of co-sleeping in SIDS prevention faced significant resistance from biomedical practitioners, including clinicians, pathologists, and epidemiologists, who felt strongly that parents should be advised against bed-sharing with their babies (e.g., Carpenter 2006;Fleming, Pease, and Blair 2015;Hauck, Darnall, and Moon 2014;Mitchell 2007Mitchell , 2010Thogmartin, Siebert, and Pellan 2001). Consequently, a major strand of McKenna's work in the United States turned toward critical papers that aimed to expose, challenge, and gradually alter the dominant ideologies around infant sleep (e.g., Gettler and McKenna 2010;McKenna and Gettler 2016;McKenna and McDade 2005). ...
... Those mothers who chose to sleep with their babies, and who subsequently exhibited the longest breastfeeding durations, also had the strongest prenatal intentions to breastfeed ). These findings support McKenna and Gettler's (2016) proposal that breastfeeding and co-sleeping form an adaptive and mutually reinforcing behavioral complex that they have termed "breastsleeping." This concept is further explored in Tomori's work below. ...
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This article provides a novel synthesis of anthropological research on infant sleep, focusing on work in biological and sociocultural anthropology in the past decade. First, we briefly review early biological anthropological research into infant sleep from 1987 to 2007, which provided the evidence base for the argument that proximate parent–infant sleep combined with lactation represents a complex set of adaptations that constitute the human evolutionary norm. This work challenged the Western pediatric infant sleep research paradigm, which positioned formula‐ or bottle‐fed solitary sleeping infants as the basis for research and universal models about human infant sleep. Next, we address how recent research has built on these foundations and extended anthropological insights into new aspects of infant sleep. Biological anthropologists, who continue to lead this research, have advanced into the hormonal and behavioral ecology of parent–infant sleep and trade‐offs in nighttime care and parent–infant conflict. Moreover, they have made significant progress in translating anthropological research into policy and practice in clinical and health delivery settings. Until recently, sociocultural anthropology has primarily addressed infant sleep as part of broader endeavors, without an explicit focus on infant sleep. We highlight key ethnographic works that shed light on the cultural normalcy and interembodied experience of shared maternal–infant sleep with breastfeeding that help de‐center Western discourses of infant sleep. We conclude by discussing future research agendas to forward an integrated anthropology of human infant sleep that considers its full biological and sociocultural context. Integrated anthropological approaches to infant sleep not only present a path forward for novel cross‐subfield anthropological research but could help guide more effective and equitable approaches to maternal‐infant health. [nighttime care, parenting, infancy, sleep] Este artículo provee una síntesis novedosa de la investigación antropológica sobre el sueño de infantes, enfocándose en el trabajo en antropología biológica y sociocultural en la década pasada. Primero, brevemente revisamos la investigación antropológica biológica temprana en el sueño de infantes desde 1987 a 2007, la cual proveyó la evidencia base para el argumento que el sueño padres–infante cercano combinado con la lactación representa un complejo conjunto de adaptaciones que constituye la norma evolucionaria humana. Este trabajo reta el paradigma occidental de la investigación pediátrica en el sueño de infantes, el cual posiciona los bebés durmiendo solitarios alimentados con fórmula o biberón como la base de la investigación y modelos universales acerca del sueño de infantes humanos. Luego, abordamos cómo la investigación reciente ha construido sobre estas bases y extendido los conocimientos antropológicos en nuevos aspectos del sueño de infantes. Antropólogos biológicos, quienes continúan liderando esta investigación, han avanzado en la ecología hormonal y conductual del sueño padres–infante y los intercambios en el cuidado nocturno y el conflicto padres‐infante. Además, ellos han hecho un significante progreso en traducir la investigación antropológica en política y práctica en el marco de prestación de servicios de salud y clínicos. Hasta recientemente, la antropología sociocultural ha abordado primariamente el sueño de infantes como parte de empeños más amplios, sin un enfoque explícito en sueño de infantes. Destacamos trabajos etnográficos claves que arrojan luz en la normalidad cultural y la experiencia intercorporeizada del sueño materno–infante compartido con lactancia materna que ayuda a descentrar los discursos occidentales de sueño de infantes. Concluimos discutiendo los futuros programas de investigación para promover una antropología integrada del sueño de infantes humanos que considera su contexto biológico y sociocultural completo. Aproximaciones antropológicas integradas al sueño de infantes no sólo presentan un camino hacia adelante para novedosa investigación antropológica a través de subcampos sino también puede ayudar a guiar aproximaciones más efectivas y equitativas a la salud materno‐infantil. [cuidado nocturno, crianza de los hijos, infancia, sueño]
... Drawing on such cross-species insights as well as crosscultural perspectives, evolutionary medicine and anthropological research has been foundational to the study of the mutual dependence of human breastfeeding and mother-infant sleep proximity, including on shared sleep surfaces, which is characterized by the recently proposed concept of 'breastsleeping' [6,11,13,14]. Given its phylogenetic underpinnings along with the extreme dependency of human infants, the breastsleeping environment is argued to be the sleep ecology to which human babies are adapted evolutionarily [6,11,13,14]. ...
... Drawing on such cross-species insights as well as crosscultural perspectives, evolutionary medicine and anthropological research has been foundational to the study of the mutual dependence of human breastfeeding and mother-infant sleep proximity, including on shared sleep surfaces, which is characterized by the recently proposed concept of 'breastsleeping' [6,11,13,14]. Given its phylogenetic underpinnings along with the extreme dependency of human infants, the breastsleeping environment is argued to be the sleep ecology to which human babies are adapted evolutionarily [6,11,13,14]. Across human societies, it is also common for fathers and other family members to be present in the cosleeping environment, which is consistent with the importance of cooperative caregiving to the evolution of human life history and converges with sleep ecologies in other primate species that have evolved biparental and alloparental care [6,11,[14][15][16][17]. The present study focuses on infant sleep location and measures of psychosocial and affective dynamics in fathers-an area that has received little attention in the literature [9,15,18]. ...
... Getting infants to sleep through the night early in the post-partum also became entrenched as a culturally emphasized priority, particularly related to notions of establishing child independence, and, aligning with these values, the parental bed was often viewed as a site for adult (uninterrupted) sleep and conjugal privacy [6,11,[19][20][21][22]. Ultimately, the concomitant prevalence of solitary sleep practices and decrease in breastfeeding in the mid-to-late 20th century in the USA and elsewhere created a potential mismatch between infants' evolved sleep physiology and the culturally shaped nighttime sleep ecologies to which many were exposed [6,11,13,14]. These mismatched circumstances increased mortality risks for many infants, based on current epidemiological evidence that links solitary sleep and lower breastfeeding duration, respectively, to higher risk of Sudden Infant Death Syndrome [23,24]. ...
Article
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Background and objectives: Evolutionary-grounded sleep research has been critical to establishing the mutual dependence of breastfeeding and nighttime sleep proximity for mothers and infants. Evolutionary perspectives on cosleeping also often emphasize the emotional motivations for and potential benefits of sleep proximity, including for parent-infant bonding. However, this potential link between infant sleep location and bonding remains understudied for both mothers and fathers. Moreover, in Euro-American contexts bedsharing has been linked to family stress and difficult child temperament, primarily via maternal reports. We know relatively little about whether paternal psychosocial dynamics differ based on family sleep arrangements, despite fathers and other kin often being present in the cosleeping environment across cultures. Here, we aim to help address some of these gaps in knowledge pertaining to fathers and family sleep arrangements. Methodology: Drawing on a sample of Midwestern U.S. fathers (N=195), we collected sociodemographic and survey data to analyze links between infant nighttime sleep location, paternal psychosocial well-being, father-infant bonding, and infant temperament. From fathers' reports, families were characterized as routinely solitary sleeping, bedsharing, or roomsharing (without bedsharing). Results: We found that routinely roomsharing or bedsharing fathers, respectively, reported stronger bonding than solitary sleepers. Bedsharing fathers also reported that their infants had more negative temperaments and also tended to report greater parenting-related stress due to difficulties with their children. Conclusions: These cross-sectional results help to highlight how a practice with deep phylogenetic and evolutionary history, such as cosleeping, can be variably expressed within communities with the potential for family-dependent benefits or strains.
... Although breastfeeding is protective against SUIDs, many breastfeeding mothers also bed-share, a common risk factor for SUIDs. Research studies have found a positive association between bed-sharing and breastfeeding worldwide, and many groups believe that bed-sharing is a necessary tool for facilitating successful breastfeeding (Thoman 2006;Horsley et al. 2007;Mileva-Seitz et al. 2016;McKenna and Gettler 2016;Ball 2003;Ward 2015). While the AAP promotes breastfeeding, they emphatically warn that bed-sharing can increase the risk of infant strangulation, suffocation, entrapment, overlay, and other unintentional injuries (Moon and Task Force On Sudden Infant Death 2016;Mileva-Seitz et al. 2016). ...
... Generally, there seems to be two popular, yet conflicting safe sleep messages: one that recommends breastfeeding while bed-sharing (McKenna and Gettler 2016) and the other that recommends breastfeeding while room-sharing (Moon and Task Force On Sudden Infant Death 2016). In regards to bed-sharing and breastfeeding, most studies have found a positive association between bed-sharing and breastfeeding worldwide (Thoman 2006;Horsley et al. 2007;Mileva-Seitz et al. 2016;McKenna and Gettler 2016;Ball 2003;Ward 2015), although there is little evidence that shows the temporality between these two behaviors. Some of the benefits of breastfeeding and bed-sharing include physical and emotional mother-infant bonding, better sleep for infants and mothers, and double or triple the number of breastfeeds per night (Mileva-Seitz et al. 2016;McKenna and Gettler 2016;Ward 2015). ...
... In regards to bed-sharing and breastfeeding, most studies have found a positive association between bed-sharing and breastfeeding worldwide (Thoman 2006;Horsley et al. 2007;Mileva-Seitz et al. 2016;McKenna and Gettler 2016;Ball 2003;Ward 2015), although there is little evidence that shows the temporality between these two behaviors. Some of the benefits of breastfeeding and bed-sharing include physical and emotional mother-infant bonding, better sleep for infants and mothers, and double or triple the number of breastfeeds per night (Mileva-Seitz et al. 2016;McKenna and Gettler 2016;Ward 2015). Some groups therefore believe that bedsharing is necessary for facilitating successful breastfeeding. ...
Article
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Background: Sudden unexpected infant death (SUID) accounted for approximately 3700 infant deaths in the US in 2015. SUID risk factors include prone sleeping, bed-sharing, soft bedding use, and maternal smoking. Infant safe sleep data in at-risk communities are difficult to obtain and home visiting programs can add to what we know. This study's purpose is to determine how often caregivers enrolled in home visiting programs provide safe sleep environments for their infants in relation to breastfeeding status and tobacco use. Methods: Female caregivers in at-risk communities were prospectively enrolled in Midwestern home visiting programs. Those that had infants < 365 days old and completed a safe sleep survey between October 1, 2016 and May 18, 2017 were included. Caregivers' responses (always, sometimes, or never) to three safe sleep questions were compared by breastfeeding status, caregiver tobacco use, and household tobacco use using Pearson's chi-squared or Fisher's exact test. Results: The characteristics of the 289 eligible female caregivers included 120 (42%) ≤ 21 years old, 137 (47%) black, 77 (27%) breastfeeding, and 60 (22%) with household tobacco use. Two hundred forty-six (85%) caregivers always placed infants in the supine position, 148 (51%) never bed-shared, and 186 (64%) never used soft bedding. Ongoing breastfeeding caregivers never bed-shared more often than those who never breastfed or weaned (66% vs. 53% vs. 39%, p = 0.003). Households with tobacco use placed infants in the supine position less (75% vs. 88%, p = 0.03), bed-shared more (62% vs. 44%, p = 0.04), and used soft bedding more (50% vs. 32%, p = 0.004) relative to those without tobacco use. Conclusions: In this group of at-risk young mothers, those who breastfed bed-shared less than mothers who were not breastfeeding; this finding has implications toward reducing the SUID risk in similar populations. This study also demonstrated that infants living with a tobacco user are less likely to be sleeping safely. This suggests that a multifaceted approach to safe sleep counseling may be needed.
... In practice, this encouragement often takes the form of allowing the baby to cry, usually for specified periods of time, and the withholding of comfort from the child in the belief that the child will learn to soothe themselves (Hiscock & Fisher 2015). A significant minority of parenting ' experts' advocate for practices such as co-sleeping (Ramos &Youngclarke 2006), bedsharing and'breast-sleeping' (McKenna &Gettler 2016). 3 These practices see mothers make themselves available to comfort their children at night, often by sharing a sleeping space or surface with their child (Ramos & Youngclarke 2006). ...
... Advocates of co-sleeping are also usually advocates of breastfeeding and other practices, like babywearing, that are associated with promoting strong attachments between mother and infant (see for example Sears & Sears 2001). There is research that suggests that these practices lead to better wellbeing for mothers and babies (see for example Bartick et al. 2017;McKenna & Gettler 2016). The natural parenting movement, including advocates of co-sleeping, often seek to spread this information to mothers to encourage them to make 'natural' parenting choices (Büskens 2001). ...
... There is a significant scientific opinion that suggests that bedsharing can be safely practiced and can be preferable to solitary sleep (Bartick et al. 2017). Nonetheless, recommendations for completely separate sleep for infants remain mainstream, despite the indications that a large number of parents have significant difficulties following such directives (Bartick et al. 2017;Kendall-Tackett et al. 2005;McKenna & Gettler 2016). ...
Article
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This article proposes to investigate maternal practices concerning infant sleep from a feminist perspective, with particular attention to the growing critical interest in vulnerability. The topic of baby sleep and the practices that should be employed to manage it is one of the most controversial topics of paediatric research and parenting advice. It is also an issue that causes division between mothers. Opinion is polarised into two camps, one recommending independent sleep achieved through practices of sleep-training that involve leaving babies to cry; the other that encourages practices of ‘co-sleeping’ and attentive and responsive night-time care often achieved through mother and baby sharing a bed. In this article, I argue that both advocates of sleep-training and co-sleeping are seeking to offer neoliberally-informed individual solutions to social and political problems. I argue that baby sleep and the maternal practices employed to manage it have to be understood as strategies for managing human vulnerability in a culture and political environment that seeks to ignore it. I suggest that the debate between sleep-training and co-sleeping can be better understood through a consideration of care relations and the care deficit in post-industrial society. I argue that attention also needs to be given to discourses of medicalised childcare, and how the subject positions of mothers and babies are deeply troubled in a society where subjectivity is equated with independence.
... 1,8 Parentinfant bedsharing with breastfeeding constitutes the human evolutionary norm as demonstrated in anthropological research. [63][64][65][66][67] In industrialized countries until the early 20th century, most infants were bedsharing and breastfeeding. 68 After that time, solitary sleep developed as an ideal among the middle classes, reinforced by the growing trends of artificial feeding and medicalization of childbirth, separating infants from mothers. ...
... 10,[71][72][73] The concept of ''breastsleeping'' was proposed to describe a biologically based model of sustained contact between the mother and infant, starting immediately after birth, in which sleeping and breastfeeding are inextricably combined, assuming no hazardous risk factors. 15,64 Described in cultures around the world, the breastsleeping mother and infant feed frequently during the night while lying in bed together, and by morning, the mother may not recall how many times she fed or for how long. 74 The breastsleeping concept acknowledges the critical role that immediate and sustained maternal contact plays in helping establish optimal breastfeeding 63,75,76 ; and recognizes that the behavior and physiology of breastsleeping dyads may be different from that of ABM PROTOCOL 7 bedsharing nonbreastfeeding dyads, signifying that the safety assessments for bedsharing with breastfeeding versus feeding human milk substitutes likely require different approaches. ...
Article
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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.
... In 2016 Mobbs and colleagues described the need for, and benefits of, immediate and sustained contact, including cosleeping, to establish an appropriate foundation for optimal human infant breastfeeding, neonatal attachment, and brain growth. In further support of this model, and building upon existing knowledge of breastfeeding and sleep data, McKenna and Gettler (2016) proposed the concept of breastsleeping, with which they aimed to help resolve the bedsharing debate and to distinguish between the known and potential differences between breastfeeding, bed-sharing dyads and non-breastfeeding, bed-sharing situations, particularly when breastfeeding and bed-sharing is practiced in the absence of all known hazardous factors. They argued that, because breastfeeding "is so physiologically and behaviorally entwined and functionally interdependent with forms of co-sleeping" (McKenna & Gettler, 2016, p. 17) the term breastsleeping would encourage acknowledgment of the following components: ...
... (i) the critical role that immediate and sustained maternal contact plays in helping to establish optimal breastfeeding (Ball, 2008;2017b;Ball & Russell, 2012); (ii) normal, human (species wide) infant sleep parameters should only be derived from studies of breastsleeping dyads because of the ways maternal-infant contact affects the delivery of the mother's milk, the milk's ingestion, the infant's concomitant and subsequent metabolism, and other physiological processes, maternal and infant sleep architecture, including arousal patterns (McKenna et al., 1990;Mosko et al., 1997aMosko et al., , 1997b as well as breastfeeding frequency and prolongation ; and (iii) that breastsleeping by mother-infant pairs appears to involve substantially different behavioral and physiological characteristics compared with neverbreastfeeding mothers and infants. This dyadic context must be more closely researched and more carefully understood, and potentially distinguished as a separate epidemiological category for the purpose of benefit and risk assessment (Baddock et al., 2019;Ball, 2006;McKenna & Gettler, 2016;Mobbs, Mobbs, & Mobbs, 2016). ...
Article
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.
... There is considerable debate over whether this advice is sound, or if guidance on safe bedsharing should be provided, especially considering the well-established relationship between bedsharing and breastfeeding, which is associated with significantly lower risk of sudden infant deaths (cf. Ball 2017;McKenna et al 2007;McKenna & Gettler 2016;Bovjberg et al 2018). In this study, all but one (seventeen of eighteen couples) intended that their baby would sleep in a separate bed from them, and all intended to transition their baby to another room within a few months. ...
... Unlike in the case we have discussed, shared mother-infant sleep and nighttime breastfeeding, is the cultural norm in most of the world (Barry & Paxson 1971;McKenna Ball andGettler, 2007, Tomori 2018). Anthropologists McKenna and Gettler (2016) have recently coined the term "breastsleeping" to reflect the profound evolutionary, physiological, and cross-cultural connections between breastfeeding and infant sleep. The disjunction between cultural expectations and the realities of night-time breastfeeding and sleep is particularly acute in settings like the United States where breastfeeding has been making a steady come-back after many decades where formula feeding and solitary sleep (with quick elimination of nighttime feedings) were the established norm (Tomori 2015, Tomori in press). ...
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This article explores how understandings of parental and infant personhood are negotiated in and through the space of the home. We argue that through spatial practices of creating and using (and not using) nurseries, understandings of parental and infant personhood are both made and unmade. Analysis is based on a rich body of ethnographic research undertaken between 2006 and 2009 with eighteen middle-class breastfeeding families and their communities in the United States, which we analyze through lenses of new materialist and Deleuzian theory. We begin by considering some of the ways in which homes are modified by parents-to-be prior to birth, positing these changes as an effort to call forth both particular kinds of embodied interrelations between parents and babies, as well as infant subjects who possess the specific capacity to sleep independently from a young age. We then argue that lived nighttime practice postbirth often confounds planned bodily, affective, and somatic geographies, driven by agentic infants themselves who express their own strong preferences about staying near their parents’ bodies to both sleep and breastfeed. Our research reveals parents negotiating how and where they sleep in collaboration with their new infants, often settling on spatial arrangements that do not reflect either expert advice or their own prebirth plans. This work advances scholarship in and beyond geography by furthering understanding of the intimate spaces of early parenting (including nighttime domestic geographies) about which little is currently known, thus extending scholarship across fields of children’s geographies, geographies of parenting, geographies of the home, geographies of the night, and geographies of sleep. Key Words: breastfeeding, geographies of the home, infant sleep, materiality, nighttime, parenting.
... The majority of the world practices simultaneous co-sleeping and breastfeeding, more recently referred to as "breastsleeping". 7 yet the current canon of research is dominated by studies conducted among western, educated, industrialized, rich, and democratic populations, the so called "WEIRD" societies. 8 Indeed, while the concept of breastsleeping may be new to some WEIRD breastfeeding communities (including physicians, support groups, doulas, and midwives), most human beings worldwide would simply consider this practice a mutually reinforcing sleeping and feeding arrangement with no better alternative. ...
... Interviews were conducted for all 33 participants where the following information was collected: (1) basic demographic questions (sex, age, breastfeeding status); (2) self-reported average number of hours slept per night; (3) whether or not reported number of hours slept was considered sufficient by the participant; (4) whether or not the participants slept in the same hut (co-roomed) with anyone; (5) whether or not the participants slept on the same sleeping surface (co-slept) with anyone; (6) the total number of individuals (including participant) who co-slept on the same surface, (7) and who the co-sleepers consisted of. The three participants who were breastfeeding participated in an additional interview where the following information was collected: (1) approximate age of breastfeeding infant, (2) self-reported estimated number of infant feedings during the night, (3) whether or not they found cosleeping with an infant disruptive to sleep, (4) whether or not they considered co-sleeping with an infant to be dangerous, (5) whether or not they considered co-sleeping with an infant to place the infant in mortal danger, and finally, (6) why they chose to co-sleep. ...
Article
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.
... The SIDS reduction is thought to result, at least in part, from parents being more available during the night to quickly detect threatening situations and to respond to signs of infant distress (Tappin et al., 2005). In addition to a decreased risk of SIDS, other benefits of room sharing have been reported during infancy as well, such as longer breastfeeding duration (McKenna & Gettler, 2016). Whether room sharing early in life also relates to outcomes beyond infancy is the focus of this study. ...
... Both bed sharing and cosleeping have been found to facilitate breastfeeding, which is known for its health benefits for the infant (e.g., Ball, 2007;Cunningham, Vally, & Bugeja, 2018;McKenna & McDade, 2005;Sobralske & Gruber, 2009). The uninterrupted mother-infant proximity as a result of cosleeping is thought to be important for establishing breastfeeding, a phenomenon recently referred to as breastsleeping (McKenna & Gettler, 2016). One study found infant attachment to be a correlate of sleeping arrangements: When compared to any bed sharing, never bed sharing (i.e., solitary sleeping from birth onwards) was related to greater odds of insecure attachment and, in particular, to greater odds of resistant attachment . ...
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Current recommendations encourage parent–infant room sharing for the first 6 months of life. This longitudinal study (N = 193) is the first to examine long‐term relations of early room sharing with three domains of child behavior: sleep, behavior problems, and prosocial behavior. Information on room sharing was collected daily for infants’ first 6 months. At ages 6, 7, and 8 years, outcomes were assessed with maternal and teacher questionnaires and behavioral observations. Early room sharing was not related to sleep problems or behavior problems. Additionally, more weeks of room sharing were positively related to higher maternal ratings of child sleep quality and more prosocial behavior. In conclusion, early room sharing appears to be related to positive, but not negative, behavior outcomes in middle childhood.
... These are significant sources of risk that can sometimes be overshadowed by conversations about bedsharing or cosleeping (Middlemiss, Yaure, & Huey, 2014). With this, NPs can encourage breastfeeding to support infant health, as well as share information that breastfeeding also protects infants from risk of SIDS (see McKenna and Gettler [2016)] for a discussion of breastsleeping). ...
... However, because cosleeping reported did not include duration of cosleeping, mothers may have brought infants to bed during the night as a way to help infants settle or soothe. With a strong body of literature associating better sleep outcomes with breastfeeding or breastfeeding and bedsharing (McKenna & Gettler, 2016), it is important to explore other possible contributors to sleep quality. For example, negative emotionality is one measure of infants' regulatory capacity. ...
Article
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Background and purpose: Based on the Women, Work, and Wee Ones longitudinal study, mothers' likelihood of breastfeeding is examined across demographic and health variables. Methods: Frequencies of breastfeeding and cosleeping by 285 mothers from the Women, Work, and Wee Ones cohort are reported as related to mothers' work schedule, marital status, or mother or infant health. Conclusions: Breastfeeding rates were about 30% across most maternal characteristics. The frequency of mothers' breastfeeding was higher when mothers were both breastfeeding and cosleeping (breastfeeding-cosleeping), in comparison with breastfeeding only, as evident for mothers with nonstandard work schedules. Cosleeping was common across all mothers. Breastfeeding rates were low, perhaps reflecting challenges of early care. Premature infants were more likely to be cosleeping than breastfeeding. Approximately 30% of mothers breastfed across the different factors examined. Implications for practice: The information may help nurse practitioners in addressing early care needs and supporting breastfeeding across groups. Younger mothers were least likely to breastfeed and reported higher frequency of cosleeping. Overall breastfeeding frequency was higher when mothers were cosleeping. Nurse practitioners may find it important to provide clear information about safe infant sleep and safe approaches to protecting infants.
... Uzamış emzirme süresine bağlı olarak annenin sağlığının da olumlu etkileneceği öngörülebilir. Meme uykusunun anne ve bebek için olası yararları Tablo 1'de özetlenmiştir (10). Sadece anne sütü alan birlikte uyuyan ve uyumayan anne-bebek çiftleri izlendiğinde, birlikte uyuyan çiftlerin daha sık uyanmalarına karşın, bu bebeklerin uykudaki toplam uyanıklıkları azalmıştır. ...
... Meme uykusu uyuyan anne-bebek çiftlerinin davranışsal ve fizyolojik karakterleri de emzirmeyen anne-bebek çiftlerinden farklılıklar göstermektedir. Yapılacak araştırmalarda, birlikte uyuyan anne-bebek çiftlerinin epidemiyolojik kategori ve yarar-zarar değerlendirilmesinin de ayrı olması önerisinde bulunulmuştur (10). Çalışan ebeveynler bebekleri ile daha fazla yakın zaman geçirmek, daha uzun uyumak, süt miktarını korumak, gün içinde emziremediği zamanı telafi etmek için de birlikte uyuduklarını belirtmektedirler (13). ...
... Breastfeeding cannot be separated from other infant activities such as sleeping or being held or carried. Drawing on data showing the mutually reinforcing relationship of breastfeeding and shared mother-infant sleep, McKenna and Gettler (2015) coined the term "breastsleeping" to connote that breastfeeding and (safe) co-sleeping are part of the same process. By recognizing breastsleeping as an evolutionary adaptation that has contributed to the survival of our species and the ethnocentrism entailed in much of current U.S. and western infant sleep guidance, we must completely reframe how we examine current public health interventions and research questions on this topic. ...
... The "Back to Sleep" campaign (to place babies in the supine position for sleep) has been associated with a reduction in sleep-related infant deaths, a decline that began even prior to the 1992 campaign (Pelligra, Doman, & Leisman, 2005). Yet it is important to note that sleeping prone is not in the behavioural repertoire of normal human breastsleeping infants (McKenna & Gettler, 2015;Richard, Mosko, McKenna, & Drummond, 1996), and this important recommendation arose out of the recent cultural context of solitary sleep and artificial feeding, in which infants were frequently placed prone alone in their cribs. In the only video study done comparing bedsharing formula feeding and breastfeeding infants, the formula feeding infants were more likely to have their heads placed level with their mother's face, whereas the breastfeeding infant's head was placed at breast-level, and the breastfeeding mothers spent more time turned towards their infants, who also faced their mothers, whereas the formula-fed infants spent more time sleeping on their backs (Ball, 2006). ...
... Indeed, according to experimental research, infant sleep and infant sleep position differs significantly depending on the social context in which it happens. Starting in the 1990s infant sleep researchers have described noticeable characteristics for babies sleeping in proximity to their breastfeeding mothers-this 'breastsleeping' pattern is considered the evolved, species typical arrangement in humans by evolutionary biologists as well as anthropologists [20][21][22][23]. After all, babies placed alone for sleep would have been prone to be abducted by predators, to be bitten or stung by reptiles and insects, or would have suffered compromised thermoregulation in most climate zones. ...
Article
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Lay Summary: In industrialized societies some babies develop flattening of the back part of their head. It is thought that this comes from sleeping supine, which has been shown to be the safest option for babies. However, this explanation cannot be correct from an evolutionary standpoint: why should safe sleep come at the cost of a misshaped head? Babies in industrialized societies are generally healthy. The medical problems they may be afflicted with are usually well understood. Deformational plagiocephaly presents a notable exception. In many industrialized countries, one in six babies shows posterior flattening of the skull—a feature noteworthy from an evolutionary perspective as the well rounded cranium is part of the ‘Kindchenschema’ evolved to secure care for the infant. It is commonly held that the deformation of the posterior cranium occurs as a consequence of the supine sleep position, now advocated as the safest sleep position for babies by medical experts. This explanation, however, does not fare well in the light of evolutionary theory: why should safe sleep come at the cost of a social handicap? Here, we present an alternative hypothesis that is grounded on evolutionary mismatch theory and exemplifies how evolutionary reasoning can help clarify medical conditions relevant to today’s public health.
... Proximate sleep and breastfeeding are part of the same evolutionary system (Ball, 2017b). Anthropologists McKenna and Gettler (2015) coined the term "breastsleeping" to reflect the evolutionary and physiological integration of these activities. Co-sleeping with breastfeeding is the physiological norm for humans and other primates. ...
Article
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Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low‐income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high‐prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low‐income inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co‐occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.
... Despite the increased risk of SUDI associated with bed-sharing in some situations, it is clear that many mothers adopt bed-sharing for breastfeeding, despite no public education campaigns promoting bed-sharing for this purpose [4]. The interdependent relationship between bed-sharing and breastfeeding has led McKenna and Gettler to suggest the term "breastsleeping" to emphasise this relationship [96]. ...
... A systematic review of 34 studies found a common reason for bed-sharing was to facilitate breastfeeding [7]. Breastfeeding advocates suggest that bed-sharing promotes breastfeeding [8][9][10][11][12][13], and the side-lying breastfeeding position is commonly taught [14,15]. Moreover, many mothers report falling asleep while breastfeeding [3,16]. ...
Article
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Breastfeeding benefits both infant and mother, including reducing the risk of Sudden Infant Death Syndrome (SIDS). To further reduce risk of SIDS, the American Academy of Pediatrics recommends infants sleep on their backs on a separate sleep surface. Our objective was to describe trends and factors associated with breastfeeding and infant sleep practices in Georgia. Pregnancy Risk Assessment Monitoring System 2004–2013 data were obtained from the Georgia Department of Public Health. Chi square tests for trends were utilized to determine whether there were significant linear trends in breastfeeding and infant sleep overtime and by survey phase. After exclusions, 4643 cases remained for analysis. From 2004 to 2013, there was a slight (insignificant) decrease in breastfeeding initiation, with the highest proportion in 2010 (79.9%) and the lowest in 2013 (66.9%). Rates of exclusive breastfeeding increased significantly from 2004 (31.3%) to 2013 (81.7%). During that time, the proportion of infants being placed back to sleep slightly decreased (though not significantly), from 59.7 to 48.9%. The proportion of mothers who reported never bed-sharing increased significantly from 26.7 to 45.1% over this period. The decreasing breastfeeding initiation rates in Georgia diverge from national upward trends, however, exclusive breastfeeding rates by survey phase were slightly higher than national trends. Our results suggest the need for targeted education and support for breastfeeding and safe sleep practices. State-level trends data on breastfeeding and infant sleep practices provide valuable information for state-level public health professionals and policy makers, health care providers, and breastfeeding and safe sleep advocates.
... Many new mothers report feeling shocked at the intensity of infant needs and motherhood (Hollway, 2010), often feeling under informed as to what infant care really involved (Brown, 2016). Many interpret normal infant feeding and sleeping patterns as a sign that something is wrong, feeling concerned that their baby should be in a routine (Arnott & Brown, 2013;Deave, Johnson, & Ingram, 2008;McKenna & Gettler, 2016). ...
Article
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Baby care books that promote strict infant care routines are popular but little research has considered their impact upon maternal infant care behaviours. We explored whether mothers who have read these books guide their infant care behaviours based on their concepts, and how this is associated with infant feeding, night time care, and response to infant's needs. Three hundred and fifty‐four UK mothers with a baby aged 0–12 months completed an online questionnaire exploring use of baby care books, motivations for use, whether guidance was followed, and infant care behaviours. Mothers who read the books were drawn to them for information about how to settle their infant, infant sleep and infant feeding behaviour. Those who read the books were less likely to breastfeed, feed responsively, have their infant sleep in the same room, cuddle their infant to sleep, or respond promptly to infant cries. Although the causality between reading these books and care cannot be determined through this study design, and is likely bidirectional with some reading the books to confirm existing preferences, around 25–40% of mothers noted the information determined their care decisions. Regardless of specific causal pathways, there is an association between these books and behaviours that go against infant feeding and responsive care recommendations. Understanding what drives mothers to follow these books, and increasing support for new mothers in these areas is important. The findings will be important for those supporting mothers in the perinatal period in starting conversations around responsive infant care.
... A shift in attitudes is therefore required to ensure the safety of infants who bed share. Use of the recently coined word "breastsleeping" may be an effective way of changing the polemic discourse around bed sharing (McKenna & Gettler, 2016). This term makes a useful epidemiological distinction between bed sharing in the context of breastfeeding and in the absence of other known dangerous factors, and other types of bed sharing (such as for non-breastfeeding infants, sleeping on a couch, a parent who smokes, or a parent under the influence of alcohol, or other drugs). ...
Article
Background Debate about mother and infant bed sharing has been polarized between supporters of bed sharing and public health policies that attempt to mitigate the risk of Sudden Infant Death Syndrome. Differences in group demographics may be an important aspect in co-sleeping acceptability. Research aims The first aim of this study was to investigate infant sleeping location in a dataset of mothers with strong breastfeeding outcomes. The second aim was to investigate the association between infant sleeping location and breastfeeding (exclusive breastfeeding to 6 months and total breastfeeding duration). Finally, we aimed to investigate predictors of breastfeeding duration. Methods Participants comprised 174 women who had applied to train as counselors with the Australian Breastfeeding Association. Data were compiled from a survey of the participants’ lactation histories, including questions related to the exclusivity and duration of breastfeeding, concerns about and problems encountered during breastfeeding, type of birth, medications during birth, demographics, and infant sleeping location. The study design was a cross-sectional, one-group survey design. Results A high proportion of participants in this study bed shared and room shared: At 0–1 month ( n = 58), 33% of participants bed-shared, which increased to 58% by 6–12 months ( n = 80). Infants who co-slept were more likely to be exclusively breastfed at 6 months (χ ² (2, n = 116) = 4.83, p = .03) and had longer breastfeeding duration ( t (62.61) = 3.81, p < .001). Conclusions Breastfeeding targets have been difficult to achieve globally, and innovative ideas are required to improve breastfeeding outcomes through public health messaging. There was a strong association in the current study between breastfeeding outcomes and degree of closeness of the infant to the mother at night. This finding should be brought into the discourse on breastfeeding and infant sleep arrangements, accompanied by evidence-based advice about safe sleeping and the promotion of breastfeeding.
... Populations that engage in high levels of mother-infant physical contact through babywearing and cosleeping (i.e., maintaining physical contact throughout the night by bed-sharing) are characterized as proximal care cultures (Keller, 2002). This sustained physical contact throughout the day and night is proposed to have implications for infant nutrition (e.g., Little, Legare, & Carver, 2018;McKenna & Gettler, 2016;Pisacane, Continisio, Filosa, Tagliamonte, & Continisio, 2012) and direct skin-to-skin contact has well documented effects on maternal health and infant development (e.g., Bigelow, Power, MacLellan-Peters, Alex, & McDonald, 2012;Moore, Anderson, Bergman, & Dowswell, 2012). Less is known about how carrying -without direct skin-to-skin contact -may shape maternal responsiveness and mother-infant interaction. ...
Article
Ethnographic research suggests mother-infant physical contact predicts high levels of maternal responsiveness to infant cues, yet it is unclear whether this responsiveness is driven by the act of physical contact or by underlying beliefs about responsiveness. We examine beliefs and behavior associated with infant carrying (i.e., babywearing) among U.S. mothers and experimentally test the effect of mother-infant physical contact on maternal responsiveness. In Study 1 (N = 23 dyads), babywearing mothers were more likely to interact contingently in response to infant cues than non-babywearing mothers during an in-lab play session. In Study 2 (N = 492 mothers), babywearing predicted maternal beliefs emphasizing responsiveness to infant cues. In Study 3 (N = 20 dyads), we experimentally manipulated mother-infant physical contact in the lab using a within-subjects design and found that babywearing increased maternal tactile interaction, decreased maternal and infant object contact, and increased maternal responsiveness to infant vocalizations. Our results motivate further research examining how culturally-mediated infant carrying practices shape the infant's early social environment and subsequent development.
... Because of all these described benefits, the term "breastsleeping" was coined. It tries to englobe the notion that maternal contact has a critical role in optimization of breastfeeding, and the fact that data and information should be gathered from studies of breastsleeping dyads, because of possible different outcomes from studies where no breast sleeping is performed [26]. ...
Article
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Introduction Sudden Unexpected Infant Death (SUID) is a term that englobes the sudden and unexpected death of an infant less than 12 months, which can be explained by organic or traumatic causes, or that can't be explained such as cases of Sudden Infant Death Syndrome (SIDS). Although many risk factors have been associated with this syndrome, one of the most widely associated and studied are incorrect sleeping techniques and practices. In 2016, the American Academy of Pediatrics (AAP) updated their safe-sleeping guidelines and sleeping environment recommendations and strategies to prevent SIDS. Methods We conducted a cross-sectional study to analyze the sleeping environments in infants that attended both the inpatient and outpatient services at a public pediatric hospital in Mexico City. A 6-item questionnaire was applied to the parent or guardian to assess the sleeping habits of infants in their homes. Results A total of 184 infants were included in the study, with a mean age of 5.87 months. Overall, the number of parents that follow safe sleeping practices was very low, with no parents following all the AAP recommendations, and over 10% not following any. Although there is uncertainty about the pathogenesis of this syndrome, the focus has shifted to prevention, especially regarding the modifiable risk factors. Conclusions It was demonstrated that our population did not know about the proper and safe sleeping techniques. In the nearby future, our goal is for health authorities in our country to implement a strategy to make the AAP recommendations part of government health campaigns.
... 87 In contrast, proximal sleep is regularly linked to greater breastfeeding rates and continuity of breastfeeding. 88 Mothers bedsharing in the context of breastfeeding often report better sleep quality, 84 quicker response to their infant, and efficient resumption of sleep after waking at night. 89 In addition, close proximity can help alleviate parental stress and improve wellbeing and maternal-infant connection. ...
Article
Infant sleep problems are one of the commonly reported reasons parents seek professional help, yet what constitutes a “sleep problem” depends on the models used to explain the development of infant sleep. The current models are based on research conducted in the western context where infant solitary sleeping is the norm. Parent-child co-sleeping is the norm in many cultures around the world. We argue that the primary focus of current research on parent-child interactions as the mediating context for the development of infant sleep problems has inherently made these models and ensuing interventions less sensitive and applicable to infant sleep problems in the context of co-sleeping families. When families present for help with infant sleep difficulties, extinction based behavioral interventions or interventions focused on reducing parental presence at bedtime are commonly recommended. These recommendations may not always align with cultural values and parenting practices of all families, therefore precluding these families from getting necessary help. In attempting to provide families with choices that depart from behavioral based interventions, this paper draws on research and adapts current models to propose an alternative to conceptualize perceptions of infant sleep problems that may be sensitive to and applied across various cultural and personal contexts. We attempt to provide a rationale for interventions that are inclusive and sensitive to families where reduced parental nighttime responsiveness may not be a preferred choice.
... Indeed, extensive parent-infant skin-to-skin contact may be considered the biological norm, as it has also been found to promote child self-regulation and parental sensitivity (Braungart-Rieker et al., 2001;Feldman et al., 2003;Feldman, 2004). The term 'breastsleeping' has been offered to draw attention to the deeply interconnected nature of dyadic sleep, feeding, and contact (McKenna & Gettler, 2016). Ultimately, behaviors within bedsharing, such as the amount and degree of mother-infant contact, differ (Volpe, Ball, & McKenna, 2013); thus, the extent of contact between mother and infant during the night may promote the associations hypothesized in the current study. ...
Article
Parents in the United States increasingly report bed-sharing with their infants (i.e., sleeping on a shared sleep surface), but the relationship between bed-sharing and child socioemotional outcomes are not well understood. The current study examines the links between mother-infant bed-sharing at 3 months and infant affect and behavior during a dyadic challenge task at 6 months. Further, we examine nighttime mother-infant contact at 3 months as a possible mechanism that may mediate linkages between bed-sharing and infant outcomes. Using observational data from a sample of 63 mother-infant dyads, we found that infants who bed-shared for any proportion of the observation period at 3 months displayed significantly more self-regulatory behaviors during the still-face episode of the Still-Face Paradigm (SFP) at 6 months, compared to non-bed-sharing infants. Also, infants of mothers who bed-shared for the entire observation period displayed significantly less negativity during the reunion episode than non-bed-sharing infants. There was no evidence that the relations between mother-infant bed-sharing practices and infant affect and behavior during the SFP were mediated through nighttime mother-infant contact. Results suggest that infant regulation at 6 months postpartum may vary based on early nighttime experiences, with bed-sharing potentially promoting more positive and well-regulated behavior during dyadic interaction.
... 5 Doğum anından hemen sonra bebeğin anne memesi ile teması emzirmenin sürdürülmesinde kritik rol oynar. 2 Etkin emzirme, annenin bebeği memesinde doğru konumlandırması ve bebeğin anne memesini iyi kavraması sonucu gerçekleşir. Bebeğin anne sütüyle beslenerek yeterli büyümesinin sağlanması ve annede meme problemlerinin yaşanmaması başarılı emzirmenin önemli bir göstergesidir. ...
Chapter
T üm canlılar içinde memeliler, içgüdüsel olarak yavrularına yakındırlar. Diğer memelilerle karşılaştırıldığında, insan yavrusu gelişimi en geç olan türdür ve bi-yolojik açıdan anneye, bakım kişiye bağımlı kalma süresi en uzun olandır. 1 Post-natal 6-9 ay boyunca yaşamak için anneye bağımlı olma hali, Antropolog Ashley Montagu tarafından "eksterogestatör" tanımı ile ifade edilmiştir. Anne ile bebeğin sürekli beraber olması ve fiziksel temas, anne ile bebek arasında fizyolojik ve sosyal bir bağın kurulmasını, bebeğin hayatta kalmasını sağlar. 2,3 Gebeliğin ikinci trimestrinde; östrojen, progesteron, plasental prolaktinin etkisi ile meme dokusundaki duktal ve alveolar yapının olgunlaşmasıyla laktogenez başlar. Doğum ile birlikte plasentanın ayrılması sonucu östrojen, progesteron seviyesi düşer, prolaktin yüksek düzeyde kalır. Meme dokusunun prolaktine duyarlı hale gelmesi ile süt yapımı başlar. İnsanlarda, süt üretimi ve süt salınımının başlaması prolaktin uyarısı ile memenin hazırlanması, dokunsal duyarlılığın ve süt kanalların oksitosine tepkisinin artması ile mümkündür. 4 Hayatın ilk dakikalarının en güzel gözlemi, doğumdan hemen sonra bebek annenin karnına sessizce bırakıldığında, bebeğin sürünerek annenin göğsüne doğru ilerlemesi ve meme ucunu bularak emmeye başlamasıdır. Buna meme emekle-mesi (breast crawl) denir. Anne vücudunun bebeğinin ısısını koruyabilme kapasitesi ve 31 İyi Kavrama ve Etkin Emzirme Good Latch and Effective Breastfeeding ÖZET Hayatın ilk 6 ayında sadece anne sütü ile beslenme oranlarının artırılması ve emzirmenin 2 yaş ve ötesini kapsayacak şekilde sürdürülmesinin desteklenmesi, kabul edilmiş bir halk sağlığı önceliğidir. Yenidoğanın anne memesini başarılı bir şekilde kavrayamaması ve etkin bir şekilde emememesi yeter-siz anne sütü alımına, ve meme sorunlarının gelişimine yol açarak emzirmenin erken sonlandırılmasına neden olabilmektedir. Bu derleme, iyi kavramanın etkin emzirmedeki önemini vurgulamayı ve emziren kadınlara bakım veren sağlık çalışanlarına başarılı emzirmenin sağlanmasında yol göstermeyi amaçla-maktadır. Anah tar Ke li me ler: Emzirme; anne sütü ABS TRACT Increasing exclusively breastfeeding rates in the first 6 months of life and supporting breastfeeding at the age of 2 years and beyond is an accepted public health priority. Inability of the newborn to successfully latch on the breast and hence inability to be breastfed by mother effectively may lead to insufficient breast milk intake and the development of breast problems, leading to early termination of breastfeeding. This review aims to emphasize the importance of latch in effective breastfeeding and to guide healthcare professionals who care for breastfeeding women in providing effective breastfeed-ing.
... The biosocial framework has been used to examine human health, development, and behavior across the life course by researchers from a variety of disciplines (Harris & McDade, 2018). Relevant to this review, this framework has been applied by anthropologists and other social scientists to other aspects of breastfeeding research for decades, such as weaning, breastsleeping (the integrated combination of breastfeeding and shared sleep), and milk sharing (McDade & Worthman, 1998;McKenna & Gettler, 2016;Tomori et al., 2017;Van Esterik & O'Connor, 2017). ...
Article
Background: Breastfeeding is recommended to improve maternal and infant health globally. Depression has been posited to negatively impact breastfeeding, although potential causal and bidirectional pathways between these two phenomena have not been sufficiently characterized. We therefore conducted a systematic review to critically evaluate available evidence on the relationship between perinatal depressive symptoms and breastfeeding behaviors; to identify knowledge gaps and propose a biosocial research agenda to advance our understanding of this topic. Methods: A systematic search strategy was applied across seven databases. Data were extracted and aggregated using the matrix method to provide a narrative synthesis of findings. Results: Thirty-eight studies from 20 countries spanning 1988 through 2018 fit the inclusion criteria. In general, methods across studies were heterogeneous. Fourteen different tools were used to measure perinatal depressive symptoms. Nearly half the studies did not provide breastfeeding definitions. No studies from low-income countries met inclusion criteria. More than half (63%) of studies demonstrated a negative association between depressive symptoms across the perinatal period and less exclusive breastfeeding and/or shorter breastfeeding durations. Limitations: Heterogeneity in study design, definitions, assessment tools, and measurement time points limited the comparability of study findings. Causality cannot be assessed. Conclusions: Available evidence suggests perinatal depressive symptoms negatively associated with breastfeeding exclusivity and duration, which can lead to suboptimal infant nutrition and detrimental impacts on maternal mental and physical health. To better understand this relationship, we propose including consistent operationalization and assessment of depression and breastfeeding globally and concurrent repeated measures of key biological and social factors.
... In the current study, breastfeeding rates were significantly higher in the intervention group at follow-up compared with that in the usual care group. Breastfeeding outcomes have rarely been studied in the field of infant sleep, though it has been observed that discouraging nocturnal feeds may have a detrimental impact on sustained breastfeeding [27], and that breastfed infants' sleep patterns differ from bottle-fed infants' patterns [28]. If the mother is willing to breastfeed during the night in response to their child's needs, the Possum sleep intervention program encourages breastfeeding during infancy to help the baby go back to sleep as quickly as possible [13,15]. ...
Article
Full-text available
For infants and their families, sleep consolidation is important in maturing neural and circadian rhythms, and in family dynamics. The Possums Infant Sleep Program is a cued care approach to infant sleep, responding to infant cues in a flexible manner, dialing down the infant’s sympathetic nervous system. The current study evaluated the effect of the Possums program on infant sleep and breastfeeding in infants (6–12 months) from a well-child outpatient clinic in Turkey, with the program intervention group (n = 91) compared with usual care (n = 92). In total, 157 mother-infant dyads completed the study. Infant sleep and breastfeeding rates were assessed at baseline and after 3 months. Nocturnal wakefulness, daytime sleep duration, naps, and night wakening decreased in both groups. Nocturnal sleep duration and the longest stretch of time the child was asleep during the night increased significantly in both groups without any change in total sleep duration. Night wakening was significantly lower and nocturnal sleep duration was significantly higher in the intervention group. However, mixed effects model analyses indicated no significant differences between the groups on any of the sleep outcomes after adjusting for confounders. Despite this, breastfeeding rates were significantly higher in the intervention group compared with those in the usual care group at follow-up.Conclusion: The Possum infant sleep program provided equivalent positive results on sleep parameters compared to usual care while advocating a more cued response. The critical difference was evident in sustained breastfeeding. What is Known: • Responsive sleep programs produce sleep consolidation, by responding to the infant’s cues without ignoring, and then gradually reducing parental interaction. • Breastfeeding to sleep may be considered an undesirable sleep association in some infant sleep interventions. What is New: • The Possums Infant Sleep Program provided equivalent positive results to usual care while advocating a more cued response. • The critical difference was in sustaining breastfeeding, and the program was associated with better breastfeeding rates.
... On-demand breastfeeding is related with enhanced milk supply [2,9], which in turn facilitates breastfeeding maintenance. Conversely, the association between mother-infant bed-sharing and longer breastfeeding duration can be explained by the increased physical contact between mother and infant and the easy access to breastfeeding at night [30]. However, there is no consensus recommendation regarding bed-sharing due to the possibility of an increased risk of sudden infant death syndrome when the infant shares the bed with their parents, especially in the first 3 months of life [24]. ...
Article
Full-text available
Background Little is known about the factors associated with the World Health Organization (WHO) recommendation of breastfeeding for at least 2 years. The objective of this study was to identify risk factors for and protective factors against breastfeeding interruption before 2 years of age. Methods In this live birth cohort, mother and infant dyads were followed for 2 years. Data collection was performed at the maternity ward and subsequently at the children’s homes, monthly during the first 6 months of life and then at 9, 12, 18, and 24 months. The outcome of interest was breastfeeding interruption before 2 years of age. Median duration of breastfeeding was estimated using Kaplan-Meier’s survival analysis, and the associations were tested using Cox’s hierarchical multivariate model. Significance was set at 5%. Results Data from a total of 1344 dyads were assessed. Median breastfeeding duration was 385 days. The following risk factors for breastfeeding interruption were identified: white skin color (adjusted hazard ratio [HRa]: 1.31; 95% confidence interval [95%CI]: 1.10–1.56), primiparity (HRa: 1.21; 95%CI: 1.05–1.40), working outside the home (HRa: 1.52; 95%CI: 1.30–1.77), child sex male (HRa: 1.18; 95%CI: 1.03–1.35) and use of a pacifier (HRa: 3.46; 95%CI: 2.98–4.01). Conversely, the following protective factors were identified: lower family income (HRa: 0.81; 95%CI: 0.71–0.94), mother-infant bed-sharing (HRa:0.61, 95%CI: 0.52–0.73), on-demand breastfeeding in the first month (HRa: 0.64; 95%CI: 0.47–0.89) and exclusive breastfeeding at 4 months (HRa: 0.58, 95%CI: 0.48–0.70). Conclusions The findings allowed to identify both risk factors for and protective factors against breastfeeding interruption before 2 years of age. Knowledge of these factors may help prevent this event and aid in the development of programs that help women maintain breastfeeding for at least 2 years, as recommended by the WHO.
Article
Objective To evaluate patterns of mother-infant sleeping behaviors among United States (US) based mothers who received care from midwives and breastfed their infants the majority of time at six weeks postpartum. Study Design Infant sleep locations were reported for 24,915 mother-infant dyads followed through six weeks postpartum, following midwife-led singleton births. Using data derived from medical records, we used multinomial logistic regression to identify predictors of sleep location. Results The median maternal age was 31 years (Interquartile range: 27-34). The majority were White (84.5%), reported having a partner or spouse (95%), had a community birth (87%), and reported bedsharing with their infant for part (13.2%) or most of the night (43.8%). In the adjusted analysis, positive predictors of always bedsharing included increasing maternal age (OR:1.17, 95% CI: 1.13-1.21; per 5 years), cesarean birth (OR:1.49, CI: 1.18-1.86), Medicaid eligibility (OR:1.76, CI:1.62-1.91), and maternal race/ethnicity (Black OR:1.40, CI:1.09-1.79: Latinx OR:1.53; CI:1.35-1.74; Multiracial OR:1.69; CI:1.39-2.07). Negative predictors of bedsharing included having a partner/spouse (OR:0.66; CI: 0.56-0.77) and birth location in hospitals (OR:0.56, CI:0.49-0.64) or birthing centers (OR:0.48, CI: 0.44-0.51). Partial breastfeeding dyads were less likely to bedshare than those who were exclusively breastfeeding (always bedsharing OR:0.48, CI: 0.41-0.56; sometimes bedsharing OR: 0.69, CI: 0.56-0.83). Conclusion These data suggest that co-sleeping is common among US families who choose community births, most of whom exclusively breastfeed through at least six weeks.
Article
Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a “complex adaptive system” (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.
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Peter Singer has long contended it is “speciesist” to regard all human life as of equal moral worth, maintaining that the moral value of life itself hinges on certain intellectual and psychological capacities. I argue that “speciesism” can be wrested from the ableism with which Singer aligns this term of critique and reclaimed as an important term of ethical analysis serving the interests of both animal ethics and disability bioethics alike, but the term must be extracted from capacity-based moral reasoning to do so. I turn to Eva Kittay, Sunaura Taylor, and Emmanuel Levinas to advance this argument.
Article
Objective: Studies have shown that mothers sleeping with their babies have longer breastfeeding duration. Bedsharing (BS) is thought to be a risk factor for Sudden Infant Death Syndrome. The aim was to investigate the frequency of BS and roomsharing (RS) and the effect of those on breastfeeding during the first 2 years of life. Also to evaluate risk-bearing situations regarding sleep environment. Methods and Study Design: This is a cross-sectional study, with retrospective cohort features for the evaluation of some data. The setting was a Well-Child Clinic at Bakırköy Research and Training Hospital. The children were followed from the first month until survey. Feeding history was collected retrospectively from child health records. Parents were surveyed concerning sleeping location and sleeping arrangements with a questionnaire. The study encompassed 351 children and their families. Results: The rate of exclusive breastfeeding was found to be 50.2% for the first 6 months of life and BS increased in exclusively breastfed infants. When breastfeeding continued after 6 months, the trend of increased BS through months was observed. RS, BS, and breastsleeping rates were 80.6%, 22.8%, 56.1%, respectively, in the whole cohort. Working mothers and mothers >35 years of age were significantly more likely to bedshare. Cigarette smoking in BS parents was identified as a child health risk. Unsafe sleep environment was found in 72.4% of the group. Conclusions: BS increases breastfeeding for the first 6 months. Families need guidance on safe sleeping practices and should be advised regarding avoidable risks and unsafe situations in BS. Parents should be counseled to make informed decisions.
Article
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.
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(analítico)Se caracteriza el fenómeno del colecho en términos sociodemográficos, socioeconómicos y en relación con las vulnerabilidades específicas de los hogares, tales como la violencia intrafamiliar y los consumos nocivos. A través de la Encuesta de la Deuda Social Argentina y un análisis multivariado cuantitativo, se abordan los siguientes interrogantes: ¿el colecho es una práctica asociada únicamente a los bebés?, ¿resulta más frecuente en contextos de pobreza o se trata de una práctica que atraviesa a diferentes infancias? Se concluye que el colecho no es un fenómeno exclusivo de los y las bebés; que en la adolescencia es más regresivo para las mujeres y que el factor socioeconómico remite a un «colecho forzoso» que se especifica en interacción con el hacinamiento, la monoparentalidad, los consumos nocivos y la violencia intrafamiliar. Palabras clave: Infancia, desarrollo del niño, relación padres-hijos, crianza del niño, bienestar de la infancia, desigualdad social, familia monoparental, demografía, salud.
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An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of how fetal monitoring may lead to overuse of birth-related interventions, commentaries on reviews focused on bedsharing, and women’s lifetime estrogen exposure and risk of cardiovascular mortality.
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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.
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Maternal-neonate separation for human newborns has been the standard of care since the last century; low birth weight and preterm infants are still routinely separated from their mothers. With advanced technology, survival is good, but long-term developmental outcomes are very poor for these especially vulnerable newborns. The poor outcomes are similar to those described for adversity in childhood, ascribed to toxic stress. Toxic stress is defined as the absence of the buffering protection of adult support. Parental absence has been strictly enforced in neonatal care units for many reasons and could lead to toxic stress. The understanding of toxic stress comes from discoveries about our genome and epigenetics, the microbiome, developmental neuroscience and the brain connectome, and life history theory. The common factor is the early environment that gives (a) signals to epigenes, (b) sensory inputs to neural circuits, and (c) experiences for reproductive fitness. For human newborns that environment is direct skin-to-skin contact from birth. Highly conserved neuroendocrine behaviors determined by environment are described in this review. The scientific rationale underlying skin-to-skin contact is presented: autonomic development and regulation of the physiology leads to emotional connection and achieving resilience. Maternal-neonate separation prevents these critical neural processes from taking place, but also channel development into an alternative developmental strategy. This enables better coping in a stressful environment in the short term, but with permanently elevated stress systems that negatively impact mental and physical health in the long term. This may explain the increasing incidence of developmental problems in childhood, and also Developmental Origins of Health and Disease. Arguments are presented that maternal-neonate separation is indeed a source of toxic stress, and some suggestions are offered toward a "zero separation" paradigm.
Article
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.
Article
Background Research suggests that home visiting interventions can promote breastfeeding initiation, though their effects on breastfeeding continuation are unclear. No known studies have assessed the impact of home visiting on bedsharing. Aims To test the effects of home visiting on breastfeeding and bedsharing in a low-income, urban sample in the United States. Methods During a field trial conducted in Milwaukee, Wisconsin, from April 2014 to March 2017, referrals to a public health department were randomized to a Healthy Families America (HFA) program or a prenatal care and coordination (PNCC) program. Of the 204 women who accepted services, 139 consented to the study and were allocated to the two treatment groups, which were compared with each other and a third quasi-experimental group of 100 women who did not accept services. Data were collected at four time points up to 12 months postpartum. Results Breastfeeding initiation was higher among 72 HFA participants (88.4%; odds ratio [OR] = 2.7) and 67 PNCC participants (88.5%; OR = 2.2) than 100 comparison participants (76.5%). Similar results emerged for breastfeeding duration, though group differences were not statistically significant. Unexpectedly, bedsharing prevalence was higher among HFA participants (56.5%) than PNCC participants (31.1%; OR = 2.9) and comparison group participants (38.8%; OR = 2.0). Discussion Home visiting was linked to increased breastfeeding, while effects on bedsharing varied by program. Progress toward precision home visiting will be advanced by identifying program components that promote breastfeeding and safe sleep. Conclusion Further research is needed to examine whether home visiting reduces disparities in breastfeeding and safe sleep practices.
Article
Co-sleeping is a complex familial phenomenon that has yet to be well understood by Western scientists. This paper provides an interdisciplinary review of research from anthropology, nursing, pediatrics, sociology, social work, public health, family studies, and psychology to focus on the role of physical touch in the context of co-sleeping, and how close physical contact in this context affects infants and their caregivers. Including an anthropological, evolutionary view of co-sleeping with other perspectives highlights it as an experience-expectant proximal context for infant growth and development. From this view, the importance of physical contact and touch in the nighttime caretaking microenvironment of co-sleeping becomes a central question, rather than an artifactual byproduct of "unhealthy" sleep arrangements. Rather than trying to eliminate co-sleeping, public health messages for parents would likely benefit from a more culturally-sensitive approach that focuses on advising how to co-sleep safely for families choosing it. For families trying to retain physical closeness between parent(s) and infants in the context of modern (especially Western) infant care practices that have reduced this physical contact, co-sleeping can be an important developmental context for encouraging and engaging in sensitive and responsive caregiving and providing a context for maternal-infant physiological synchrony and regulation.
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The American Academy of Pediatrics recommends against bed-sharing between infants and caregivers due to an association with suffocation. Caregivers continue to share a bed with their infant despite these recommendations for a multitude of reasons. A close examination of the bed-sharing literature reveals that the debate is fundamentally about theoretical differences. The major theories used to frame this problem include the triple risk model of bed-sharing and evolutionary theories. Nurses are masters of multidisciplinary collaboration and are well positioned to unify the triple risk and evolutionary views of infant bed-sharing to guide future innovations in health care practice and research.
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The cry-it-out (CIO) method is a sleep training method that encourage parents to let their infants cry at night by themselves for increments of time in order to get them to eventually sleep through the night, on their own. The purpose of this analysis is to explore how the CIO method was constructed as authoritative knowledge to become a normative practice among modern parents. Drawing on various forms of media relevant to laying the groundwork for the promotion of the CIO method over the last 200 years, we examine how parents’ methods for getting babies to sleep have changed. We then argue that the CIO method ascended as authoritative knowledge mostly via the use of fear-based messages, enabling parents to feel validated when they decide to ignore their infants’ nighttime cries so that they can achieve better household sleep.
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In this chapter, we use an evolutionary lens to deepen understanding of maternal and family needs in the early postpartum period so that health care can be more aligned with confronted realities. The discussion is centered around the concept of the 4th trimester, which is the period between birth and the first 3 months postpartum. This framework encourages a holistic understanding of perinatal health by drawing attention to evolved maternal-infant needs. By addressing these ultimate-level contributors to health issues, we can facilitate more effective clinical support, comprehensive research, and a fuller “village” to enable new families to thrive. Core to this approach is the concept of trade-offs between parents and offspring, exemplified by lactation as a prime example of the complexities of dyadic needs and gap between the current culture of health and optimal support.
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Human sleeping arrangements have evolved over time and differ across cultures. The majority of adults share their bed at one time or another with a partner or child, and many also sleep with pets. In fact, around half of dog and cat owners report sharing a bed or bedroom with their pet(s). However, interspecies co-sleeping has been trivialized in the literature relative to interpersonal or human-human co-sleeping, receiving little attention from an interdisciplinary psychological perspective. In this paper, we provide a historical outline of the “civilizing process” that has led to current sociocultural conceptions of sleep as an individual, private function crucial for the functioning of society and the health of individuals. We identify similar historical processes at work in the formation of contemporary constructions of socially normative sleeping arrangements for humans and animals. Importantly, since previous examinations of co-sleeping practices have anthropocentrically framed this topic, the result is an incomplete understanding of co-sleeping practices. By using dogs as an exemplar of human-animal co-sleeping, and comparing human-canine sleeping with adult-child co-sleeping, we determine that both forms of co-sleeping share common factors for establishment and maintenance, and often result in similar benefits and drawbacks. We propose that human-animal and adult-child co-sleeping should be approached as legitimate and socially relevant forms of co-sleeping, and we recommend that co-sleeping be approached broadly as a social practice involving relations with humans and other animals. Because our proposition is speculative and derived from canine-centric data, we recommend ongoing theoretical refinement grounded in empirical research addressing co-sleeping between humans and multiple animal species.
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Instinctive behaviours have evolved favouring the maternal-infant dyad based on fundamental processes of neurological development, including oral tactile imprinting and latchment. Latchment is the first stage of emotional development based on the successful achievement of biological imprinting. The mechanisms underpinning imprinting are identified and the evolutionary benefits discussed. It is proposed that the oral tactile imprint to the breast is a keystone for optimal latchment and breastfeeding, promoting evolutionary success. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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AimDespite its declining incidence, sudden infant death syndrome (SIDS) is still an important cause of death in infancy. This study investigated the environmental circumstances associated with SIDS, by analysing data from all sudden unexpected deaths in infancy (SUDI) in Sweden from 2005-2011.Methods All Swedish infants forensically autopsied up to the age of 365 days from 2005-2011 were included. Medical records and supplementary data were obtained from the Swedish Medical Birth Register.ResultsOf the 261 infants, 136 were defined as SIDS and 125 as explained SUDI. The documentation in the medical records was poor when it came to issues like bed sharing, sleep position, smoking, breastfeeding and pacifier use. The main findings were a significantly higher prevalence of bed sharing in SIDS than in explained deaths (odds ratio 7.77, 95% confidence interval 2.36-25.57) and that prone sleeping was still overrepresented. Bronchopneumonia, other infections and congenital anomalies were the most common causes of explained SUDI.Conclusion Bed sharing and prone sleeping were more common in SIDS than in explained SUDI. Sparse data in medical records was a problem and the authors are now working with the National Board of Health and Welfare on a project to establish new routines.This article is protected by copyright. All rights reserved.
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This paper reviews updated advice and factual material from the Swedish National Board of Health and Welfare on reducing the risk of Sudden Infant Death Syndrome.Issues covered by the guidance for parents and healthcare professionals include sleeping positions, smoking, breastfeeding, bed sharing and using pacifiers.Conclusion. The guidelines conclude that infants under three-months-of-age are safest sleeping in their own cot andthat a pacifier can be used when they are going to sleep. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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Objective The risk of sudden infant death syndrome (SIDS) among infants who co-sleep in the absence of hazardous circumstances is unclear and needs to be quantified. Design Combined individual-analysis of two population-based case-control studies of SIDS infants and controls comparable for age and time of last sleep. Setting Parents of 400 SIDS infants and 1386 controls provided information from five English health regions between 1993–6 (population: 17.7 million) and one of these regions between 2003–6 (population:4.9 million). Results Over a third of SIDS infants (36%) were found co-sleeping with an adult at the time of death compared to 15% of control infants after the reference sleep (multivariate OR = 3.9 [95% CI: 2.7–5.6]). The multivariable risk associated with co-sleeping on a sofa (OR = 18.3 [95% CI: 7.1–47.4]) or next to a parent who drank more than two units of alcohol (OR = 18.3 [95% CI: 7.7–43.5]) was very high and significant for infants of all ages. The risk associated with co-sleeping next to someone who smoked was significant for infants under 3 months old (OR = 8.9 [95% CI: 5.3–15.1]) but not for older infants (OR = 1.4 [95% CI: 0.7–2.8]). The multivariable risk associated with bed-sharing in the absence of these hazards was not significant overall (OR = 1.1 [95% CI: 0.6–2.0]), for infants less than 3 months old (OR = 1.6 [95% CI: 0.96–2.7]), and was in the direction of protection for older infants (OR = 0.1 [95% CI: 0.01–0.5]). Dummy use was associated with a lower risk of SIDS only among co-sleepers and prone sleeping was a higher risk only among infants sleeping alone. Conclusion These findings support a public health strategy that underlines specific hazardous co-sleeping environments parents should avoid. Sofa-sharing is not a safe alternative to bed-sharing and bed-sharing should be avoided if parents consume alcohol, smoke or take drugs or if the infant is pre-term.
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To resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed. Bed sharing was defined as sleeping with a baby in the parents' bed; room sharing as baby sleeping in the parents' room. Frequency of bed sharing during last sleep was compared between babies who died of SIDS and living control infants. Five large SIDS case-control datasets were combined. Missing data were imputed. Random effects logistic regression controlled for confounding factors. Home sleeping arrangements of infants in 19 studies across the UK, Europe and Australasia. 1472 SIDS cases, and 4679 controls. Each study effectively included all cases, by standard criteria. Controls were randomly selected normal infants of similar age, time and place. In the combined dataset, 22.2% of cases and 9.6% of controls were bed sharing, adjusted OR (AOR) for all ages 2.7; 95% CI (1.4 to 5.3). Bed sharing risk decreased with increasing infant age. When neither parent smoked, and the baby was less than 3 months, breastfed and had no other risk factors, the AOR for bed sharing versus room sharing was 5.1 (2.3 to 11.4) and estimated absolute risk for these room sharing infants was very low (0.08 (0.05 to 0.14)/1000 live-births). This increased to 0.23 (0.11 to 0.43)/1000 when bed sharing. Smoking and alcohol use greatly increased bed sharing risk. Bed sharing for sleep when the parents do not smoke or take alcohol or drugs increases the risk of SIDS. Risks associated with bed sharing are greatly increased when combined with parental smoking, maternal alcohol consumption and/or drug use. A substantial reduction of SIDS rates could be achieved if parents avoided bed sharing.
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Does breastfeeding alter early brain development? The prevailing consensus from large epidemiological studies posits that early exclusive breastfeeding is associated with improved measures of IQ and cognitive functioning in later childhood and adolescence. Prior morphometric brain imaging studies support these findings, revealing increased white matter and sub-cortical gray matter volume, and parietal lobe cortical thickness, associated with IQ, in adolescents who were breastfed as infants compared to those who were exclusively formula-fed. Yet it remains unknown when these structural differences first manifest and when developmental differences that predict later performance improvements can be detected. In this study, we used quiet magnetic resonance imaging (MRI) scans to compare measures of white matter microstructure (mcDESPOT measures of myelin water fraction) in 133 healthy children from 10months through 4years of age, who were either exclusively breastfed a minimum of 3months; exclusively formula-fed; or received a mixture of breast milk and formula. We also examined the relationship between breastfeeding duration and white matter microstructure. Breastfed children exhibited increased white matter development in later maturing frontal and association brain regions. Positive relationships between white matter microstructure and breastfeeding duration are also exhibited in several brain regions, that are anatomically consistent with observed improvements in cognitive and behavioral performance measures. While the mechanisms underlying these structural differences remains unclear, our findings provide new insight into the earliest developmental advantages associated with breastfeeding, and support the hypothesis that breast milk constituents promote healthy neural growth and white matter development.
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An evolutionary perspective on human infant sleep physiology suggests that parent-infant cosleeping, practiced under safe conditions, might be beneficial to both mothers and infants. However, cosleeping is not part of mainstream parenting ideology in the United States or the United Kingdom, and little evidence is available to indicate whether, and under what circumstances, parents sleep with their newborn infants. We present data from an anthropological investigation into the practices and attitudes of new and experienced parents of newborn infants regarding parent-infant sleeping arrangements in a community in the northeast of England. Despite not having contemplated cosleeping prior to the birth, new parents in our sample found it to be a convenient nighttime caregiving strategy, and one which was practiced regularly. Infants slept with both their parents, some being habitual all-night cosleepers, but commonly beginning the night in a cnb and sleeping with their parents for several hours following the early morning feed, [infant sleep, newborn, cosleeping, new parents]
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The pros and cons of parent-infant bed-sharing have been hotly debated in both the academic and professional literature concerning infant health and early parenting. Much of the debate has focused on data from the US, and little research has examined parents' motives for sleeping with their infants. This paper examines parental bed-sharing practices with young infants in North Tees, UK. We found that bed-sharing was a common night-time care-giving strategy, and the reasons articulated by parents for bed-sharing with their small infants were varied. There was a particularly strong association between bed-sharing and breastfeeding; however, infant irritability or illness was also a frequently given reason for bed-sharing, and a number of other reasons emerged.We conclude it is important that circumstance and motivation are considered in assessments of bed-sharing safety, and parental reasons for bed-sharing are acknowledged in formulating advice for parents regarding bed-sharing.
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To investigate the association between bedsharing at age 3 months and breastfeeding (BF) at age 12 months. Almost all children born in Pelotas, Brazil in 2004 (99.2%) were enrolled in a cohort study. At birth, age 3 months, and age 12 months, mothers were interviewed to gather information on sociodemographic, reproductive, BF, and bedsharing characteristics. Bedsharing was defined as habitual sharing of a bed between mother and child for the entire night or part of the night. The analysis was limited to children from single births who were breastfed at 3 months. Multivariate analyses were carried out using Poisson regression. Of 4231 live births, 2889 were breastfed at age 3 months. The prevalence of BF at age 12 months was 59.2% in the children who bedshared at 3 months and 44% in those who did not (adjusted prevalence ratio [PR] for weaning= 0.75; 95% confidence interval [CI] = 0.69-0.81; P < .001). Among children who were exclusively breastfed at 3 months, 75.1% of those who also bedshared were still breastfed at age 12 months, versus 52.3% of those who did not bedshare (adjusted PR = 0.63; 95% CI = 0.53- 0.75; P < .001). The adjusted PR was 0.74 (95% CI = 0.60-0.90; P = .003) in children who were predominantly breastfed and 0.83 (95% CI = 0.76-0.90; P < .001) in those who were partially breastfed. Bedsharing at 3 months protected against weaning up to age 12 months.
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Massive synaptic pruning following over-growth is a general feature of mammalian brain maturation. This article studies the synaptic pruning that occurs in large networks of simulated spiking neurons in the absence of specific input patterns of activity. The evolution of connections between neurons were governed by an original bioinspired spike-timing-dependent synaptic plasticity (STDP) modification rule which included a slow decay term. The network reached a steady state with a bimodal distribution of the synaptic weights that were either incremented to the maximum value or decremented to the lowest value. After 1x10(6) time steps the final number of synapses that remained active was below 10% of the number of initially active synapses independently of network size. The synaptic modification rule did not introduce spurious biases in the geometrical distribution of the remaining active projections. The results show that, under certain conditions, the model is capable of generating spontaneously emergent cell assemblies.
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There has been a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed down for sleep in a nonprone position. Although the SIDS rate continues to fall, some of the recent decrease of the last several years may be a result of coding shifts to other causes of unexpected infant deaths. Since the AAP published its last statement on SIDS in 2000, several issues have become relevant, including the significant risk of side sleeping position; the AAP no longer recognizes side sleeping as a reasonable alternative to fully supine sleeping. The AAP also stresses the need to avoid redundant soft bedding and soft objects in the infant's sleeping environment, the hazards of adults sleeping with an infant in the same bed, the SIDS risk reduction associated with having infants sleep in the same room as adults and with using pacifiers at the time of sleep, the importance of educating secondary caregivers and neonatology practitioners on the importance of "back to sleep," and strategies to reduce the incidence of positional plagiocephaly associated with supine positioning. This statement reviews the evidence associated with these and other SIDS-related issues and proposes new recommendations for further reducing SIDS risk.
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Owing to humans' unique life history pattern, particularly comparatively short interbirth intervals, early weaning, and prolonged support of multiple dependents, human females have greater reproductive value and higher lifetime fertility, on average, than do their Great Ape counterparts.[1-4] As hominin females began weaning their young early and “stacking” dependents of various ages, they must have had cooperative allomaternal care partners already in place or been successful at concurrently soliciting help to ensure a high rate of survival of their offspring.[1-6] Following Hrdy, I define allomaternal care (and its derivatives, such as “allomothers” and “allomothering”) as “care from anyone other than the mother,” which thus encompasses a wide range of individuals, including fathers.[7] Who the likely allomother candidates mothers were and what form that cooperation took remain intriguing, difficult-to-answer questions, which are limited, in some capacity, by the lines of evidence available to us. Here, I present a framework for the ways in which we can integrate neurobiological-endocrine and social-behavioral data (“socioendocrinology”)[8] to contribute to this dialogue in terms of evaluating fathers' roles.
Article
Objective: To estimate the U.S. maternal health burden from current breastfeeding rates both in terms of premature death as well as economic costs. Methods: Using literature on associations between lactation and maternal health, we modeled the health outcomes and costs expected for a U.S. cohort of 15-year-old females followed to age 70 years. In 2002, this cohort included 1.88 million individuals. Using Monte Carlo simulations, we compared the outcomes expected if 90% of mothers were able to breastfeed for at least 1 year after each birth with outcomes under the current 1-year breastfeeding rate of 23%. We modeled cases of breast cancer, premenopausal ovarian cancer, hypertension, type 2 diabetes mellitus, and myocardial infarction considering direct costs, indirect costs, and cost of premature death (before age 70 years) expressed in 2011 dollars. Results: If observed associations between breastfeeding duration and maternal health are causal, we estimate that current breastfeeding rates result in 4,981 excess cases of breast cancer, 53,847 cases of hypertension, and 13,946 cases of myocardial infarction compared with a cohort of 1.88 million U.S. women who optimally breastfed. Using a 3% discount rate, suboptimal breastfeeding incurs a total of $17.4 billion in cost to society resulting from premature death (95% confidence interval [CI] $4.38-24.68 billion), $733.7 million in direct costs (95% CI $612.9-859.7 million), and $126.1 million indirect morbidity costs (95% CI $99.00-153.22 million). We found a nonsignificant difference in number of deaths before age 70 years under current breastfeeding rates (4,396 additional premature deaths, 95% CI -810-7,918). Conclusions: Suboptimal breastfeeding may increase U.S. maternal morbidity and health care costs. Thus, investigating whether the observed associations between suboptimal breastfeeding and adverse maternal health outcomes are causal should be a research priority.
Article
Reviews sleep–wake state physiology in human infants in combination with historical, cross-cultural, and evolutionary perspectives that provide some direction in understanding current practices and making informed recommendations for constructing optimal sleep environments for human infants, including bed sharing, going to bed, infant sleep aids, feeding and sleeping, and responding to night waking. It is suggested that Western cultural sleep environments may be less than optimally physiologically adaptive for infants. Parents are encouraged to follow their intuition and synchronize their needs to those of their infant. The optimal environmental fit is that which satisfies the infant's temperamental needs as well as the mutual expectations of the parents in the broader context of their cultural values. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
A large social science and public health literature addresses infant sleep safety, with implications for infant mortality in the context of accidental deaths and Sudden Infant Death Syndrome (SIDS). As part of risk reduction campaigns in the USA, parents are encouraged to place infants supine and to alter infant bedding and elements of the sleep environment, and are discouraged from allowing infants to sleep unsupervised, from bed-sharing either at all or under specific circumstances, or from sofa-sharing. These recommendations are based on findings from large-scale epidemiological studies that generate odds ratios or relative risk statistics for various practices; however, detailed behavioural data on nighttime parenting and infant sleep environments are limited. To address this issue, this paper presents and discusses the implications of four case studies based on overnight observations conducted with first-time mothers and their four-month old infants. These case studies were collected at the Mother-Baby Behavioral Sleep Lab at the University of Notre Dame USA between September 2002 and June 2004. Each case study provides a detailed description based on video analysis of sleep-related risks observed while mother-infant dyads spent the night in a sleep lab. The case studies provide examples of mothers engaged in the strategic management of nighttime parenting for whom sleep-related risks to infants arose as a result of these strategies. Although risk reduction guidelines focus on eliminating potentially risky infant sleep practices as if the probability of death from each were equal, the majority of instances in which these occur are unlikely to result in infant mortality. Therefore, we hypothesise that mothers assess potential costs and benefits within margins of risk which are not acknowledged by risk-reduction campaigns. Exploring why mothers might choose to manage sleep and nighttime parenting in ways that appear to increase potential risks to infants may help illuminate how risks occur for individual infants.
Article
ABSTRACT Early members of the genus Homo experienced heightened absolute metabolic costs, partially owing to increases in body size. However, as is characteristic of modern humans, they also likely began reproducing with shortened interbirth intervals. Male investment in offspring may help explain how this life history shift occurred. Evolutionary models of hominin male investment in offspring have traditionally focused on provisioning of females and young, yet the extent to which direct male care of offspring was evolutionarily important, from an energetic perspective, is largely unaddressed. I propose an evolutionary model of direct male care, demonstrating that males could have helped reduce the energetic burden of caregiving placed on mothers by carrying young. In doing so, males would have assisted females in achieving and maintaining an energetic condition sufficient for reproduction, thereby hastening the advent of shortened interbirth intervals that played a formative role in the success of our genus.
Article
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).
Article
Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).
Article
Human maternal and infant biology likely coevolved in a context of close physical contact and some approximation of frequent, "infant-initiated" breastfeeding. Still, mothers and infants commonly sleep apart from one another in many western societies, indicating a possible "mismatch" between cultural norms and infant biology. Here we present data from a 3-night laboratory-based study that examines differences in mother-infant sleep physiology and behavior when mothers and infants sleep together on the same surface (bedsharing) and apart in separate rooms (solitary). We analyze breastfeeding frequency and interval data from the first laboratory night (FN) for 52 complementary breastfeeding mothers and infants (26 total mother-infant pairs), of which 12 pairs were routine bedsharers (RB) and 14 were routine solitary sleepers (RS). RB infants were 12.0 ± 2.7 (SD) weeks old; RS infants were 13.0 ± 2.4 weeks old. On the FN, RB mother-infant pairs (while bedsharing) engaged in a greater number of feeds per night compared to RS (while sleeping alone) (P < 0.001). RB also showed lower intervals (min) between feeds relative to RS (P < 0.05). When we evaluated data from all three laboratory nights (n = 36), post hoc, RB breastfed significantly more often (P < 0.01) and showed a trend towards lower intervals between feeds (P < 0.10). Given the widely known risks associated with little or no breastfeeding, the demonstrated mutually regulatory relationship between bedsharing and breastfeeding should be considered in future studies evaluating determinants of breastfeeding outcomes.
Article
Twenty years ago a new area of inquiry was launched when anthropologists proposed that an evolutionary perspective on infancy could contribute to our understanding of unexplained infant deaths. Here we review two decades of research examining parent-infant sleep practices and the variability of maternal and infant sleep physiology and behavior in social and solitary sleeping environments. The results challenge clinical wisdom regarding "normal" infant sleep, and over the past two decades the perspective of evolutionary pediatrics has challenged the supremacy of pediatric sleep medicine in defining what are appropriate sleep environments and behaviors for healthy human infants. In this review, we employ a biocultural approach that integrates diverse lines of evidence in order to illustrate the limitations of pediatric sleep medicine in adopting a view of infants that prioritizes recent western social values over the human infant's biological heritage. We review what is known regarding infant sleeping arrangements among nonhuman primates and briefly explore the possible paleoecological context within which early human sleep patterns and parent-infant sleeping arrangements might have evolved. The first challenges made by anthropologists to the pediatric and SIDS research communities are traced, and two decades of studies into the behavior and physiology of mothers and infants sleeping together are presented up to the present. Laboratory, hospital and home studies are used to assess the biological functions of shared mother-infant sleep, especially with regard to breastfeeding promotion and SIDS reduction. Finally, we encourage other anthropologists to participate in pediatric sleep research using the unique skills and insights anthropological data provide. By employing comparative, evolutionary and cross-cultural perspectives an anthropological approach stimulates new research insights that influence the traditional medical paradigm and help to make it more inclusive. That this review will potentially stimulate similar research by other anthropologists is one obvious goal. That this article might do so makes it ever more possible that anthropologically inspired work on infant sleep will ultimately lead to infant sleep scientists, pediatricians, and parents becoming more informed about the consequences of caring for human infants in ways that are not congruent with their evolutionary biology.
Cost analysis of maternal disease associated with suboptimal breastfeeding
  • M Bartick
  • A Steube
  • E B Schwarz
  • E Bimla
  • C Luongo
  • A Reinhold
Bartick M, Steube A, Schwarz EB, Bimla E, Luongo C, Reinhold A, et al. Cost analysis of maternal disease associated with suboptimal breastfeeding. Obstet Gynecol 2013; 122: 111-9.
What does the community want? What do parents need to know
  • C Fetherston
  • Bedsharing
Fetherston C. Bedsharing. What does the community want? What do parents need to know. Brisbane, Australia: Nurture Parenting Magazine, Spring Issue, 2013.
Evidence Based Medicine: How to Practice and Teach EBM
  • D Sackett
  • S Strauss
Sackett D, Strauss S. Evidence Based Medicine: How to Practice and Teach EBM. London: Church Hill-Livingston, 2000.
New York: Basic Books
  • J Bowlby
  • Attachment
Bowlby J. Attachment. New York: Basic Books, 1969.