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Reasons mothers bedshare: A review of its effects on infant behavior and development

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Abstract

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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... 105 The model acknowledges that broader environmental contexts and socio-structural factors such as socioeconomic status, education level, minority status, poverty, and crowded housing are associated with infant sleep and parenting practices. 6,38 Very little is known about whether these factors impact infant sleep in nonwestern cultures. For example, a recent study found no association between noise levels and infant sleep duration among infants in Sri Lanka. ...
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... Bedsharing and breastsleeping behaviors, although controversial in contemporary Western societies, are representative of human infant evolution and are well supported in some disciplines including evolutionary pediatrics, anthropology, and cultural psychology. Barry and McKenna's (2022) Understanding provider perspectives regarding breastsleeping may inform continuing education opportunities for clinicians caring for childbearing populations. The Theory of Planned Behavior suggests that clinician attitudes toward breastsleeping are integral to understanding provider inclination to support breastsleeping in client families (Swanson & Power, 2005). ...
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... Nem Az ismertetett eredmények megfelelnek az áttekintett külföldi szakirodalomnak, hiszen alátámasztják, hogy a kisgyermekek és szüleik tényleges élményei és szükségletei (vö. Ball, Tomori and McKenna, 2019;Barry and McKenna, 2022), szemben a hazai ajánlással (EMMI, 2019), nem ritkán magukba foglalják a csecsemő és az anya egy ágyban alvását. Az eredmények igazolják továbbá, hogy az együtt alvás összefüggést mutat a szoptatással és az éjszakai ébredésekkel (vö. ...
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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.
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During the early period of hypothesis building and empirical testing of attachment theory, a major emphasis was placed on mother-infant physical contact. In spite of this, mother-infant contact has received scant attention amongst attachment and child development researchers in the past decades. Here, a brief theoretical framework for mother-infant contact is presented, drawing on animal studies as well as human studies of preterm infants and neonates. Salient mechanisms may include an extended sensitive period during early infancy, requiring specific somatosensory stimuli for bio-behavioral homeorhesis; oxytocinergic and epigenetic pathways; kinesthetic stimuli and face-to-face proximity allowing for increased social interaction. Studies of extended human mother-full-term infant physical contact have demonstrated positive effects in multiple domains. For infants, these include sleep organization, temperature and heart rate regulation, behavioral response, crying/colic, socio-emotional development, attachment quality, speech development opportunities and mother-child interactions. For mothers, studies demonstrate improved depressive symptomatology, physiological stress regulation, contingent responsivity, breastfeeding and mother-child interactions. Parent-infant attachment quality has gained prominence as a trauma-resilience factor as well as a predictor of adult physical health. The potential role of mother-infant contact as an attachment promoting intervention as well as future research subjects are discussed. Current evidence supports the original attachment research that early maternal touch provision may influence infant socio-emotional development and attachment quality, with positive implications for mother-child relationship functioning.
Article
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.
Article
In families with infants between the ages of 6 and 18 months, sleep disruption can be significant, often putting parents at risk of a range of negative psychological and psychosocial consequences. Commonly prescribed sleep interventions typically involve ‘extinction’ methods, which require parents to completely or periodically ignore their infant's overnight cries. These methods can be effective in many, but not all cases. For over 40 years 30–40% of parents have consistently reported difficulty ignoring their child. For this group, ignoring their child is behaviourally and/or ideologically difficult with attrition often leading to a perceived sense of failure. For these parents the treatment may be worse than the problem. On the other hand, there is emerging evidence to support the use of more responsive methods for those who find extinction approaches behaviourally or ideologically challenging. In this paper we propose an integrated, less polarised approach to infant behavioural sleep interventions that better caters to those who have difficulty with extinction methods – our so‐called ‘Plan B’. This approach potentially resolves the often opposing ideological and theoretical perspectives of extinction versus responsiveness into a practical, complementary and pragmatic treatment framework. Recommendations on how best to implement Plan B are also presented. In our view, Plan B could provide practitioners with a logically integrated well‐targeted suite of clinical interventions that could potentially improve compliance, reduce attrition and ultimately benefit the sleep and well‐being of all infants and their parents, especially those who struggle with traditional extinction methodologies.
Objective: To describe the proportion of women with improving or worsening symptoms of fatigue at 1, 3, 6, and 12 months after birth; to model the trajectory of fatigue across the first year after birth and identify baseline predictors (e.g., immigrant status) and time-varying predictors; and to describe the degree to which fatigue interferes with activities of daily living across the first year after birth among a cohort of Chinese immigrant and Chinese Canadian-born women. Design: Prospective cohort study. Setting: Toronto, Ontario, Canada. Participants: Chinese women who were recent immigrants (n = 244), nonrecent immigrants (n = 247), or Canadian born (n = 100). Methods: Women completed surveys at 1, 3, 6, and 12 months after birth. We measured fatigue with the use of the Multidimensional Assessment of Fatigue scale. Fatigue predictor variables were classified as baseline (e.g., immigrant status) or time varying (e.g., depression). We used latent growth curve modeling to examine fatigue trajectories and identify predictors over time. Results: Fatigue followed a nonlinear pattern: it improved from 1 to 6 months after birth and then worsened from 6 to 12 months after birth. Depression, anxiety, infant sleep characteristics, and breastfeeding problems, but not immigrant status, significantly increased risk for fatigue. Several daily activities were significantly influenced by fatigue, particularly early in the postpartum period as well as later, which showed a U-shaped relationship between fatigue and activities of daily living. Conclusion: Fatigue is common and persistent across the postpartum period. Modifiable risk factors related to mental health, infant sleep, and breastfeeding difficulties suggest that preventive strategies for maternal fatigue warrant further investigation.
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.
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.
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.
Chapter
We try to keep in mind cultural influences on the advice we give. We remind ourselves that much of what comes to the pediatrician’s attention, as problematic sleep behavior- children who have difficulty falling asleep alone at bedtime, who wake at night and ask for parental attention, or who continue to nurse at night-is problematic only in relation to our society’s expectations, rather than to some more general standard of what con- stitutes difficult behavior in the young child. Our pediatric advice on transitional objects, breast feeding, cosleeping may be unknowingly biased toward traditional Euro Amer- icanviews of childrearing, especially those about bedtime and nighttime behavior. Thus, in giving advice about sleep, pediatric health professionals might dowell to be aware of their own cultural values, to examine closely their patients cultural and family contexts, and to assess parental reactions to children’s sleep behaviors. (1) Who sleeps by whom is not merely a personal or private activity. Instead it is social practice, like burying the dead or expressing gratitude for gifts or eating meals with your family, or honoring the practice of a monogamous marriage, which (for those engaged in the practice) is invested with moral and social meaning for a person’s reputation and good standing in the community. (2) Inclinical pediatrics, cosleeping is thepolitical third rail. If you touch it, youdie. (3) In this chapter, we have contributed a new conclusion to the first version pub- lished in the earlier edition, slightly modified and updated recent developments as regards research into mother-infant cosleeping in the form of bedsharing, and have contributed a new last section that critiques recommendations against any and all bedsharing. But mostly, we provide here (without modification) a cultural background to our thinking about what constitutes “normal, healthy, and desirable” infant sleep and show the interconnectedness between scientific research, cultural values, concerns for morality, and sleeping arrangements that are characteristic of Western society. Specific biological and psychological evidence is put forth supporting the views of Sadeh and Anders (4,5) and Anders (6) on the importance of understanding what is “appropriate” infant sleep on the basis of the overall social and physical context within which it occurs.
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.
Article
Previous studies have found that exclusively breastfeeding (EBF) mothers get more sleep and report higher levels of well-being than mothers who are not EBF. We do not know whether infant sleep location influences these findings. The present analyses are from the Survey of Mothers’ Sleep and Fatigue, an online survey of 6,410 mothers from 59 countries. Feeding method and sleep location do interact and are related to babies’ and mothers’ sleep and measures of mothers’ well-being. EBF/bedsharing mothers reported more sleep, better physical health, and less depression, anger, and anxiety than non-EBF or nonbedsharing mothers. Conversely, bedsharing/non-EBF mothers had some of the worst outcomes. Bedsharing was related to positive outcomes for EBF mothers. Our findings are consistent with recommendations that non-EBF mothers avoid bedsharing.
Article
Objectives: Many studies of infant sleep rely solely on parentally-reported data, assuming that parents accurately report their infant's sleep parameters. The objective of this paper is to examine whether night-time sleep parameters of exclusively breastfed or exclusively formula-fed infants differ, and whether correspondence between parental reports and objective measures varies by feeding type. Methods: Mother-infant dyads intending to breastfeed or formula-feed exclusively for 18 weeks were recruited. Mothers were multiparas and primiparas, aged between 18 and 45 years. Infants were full-term, normal birthweight singletons. Maternal report and actigraphic data on infant sleep were collected fortnightly, from four to 18 weeks postpartum. Data were analysed cross-sectionally using t-tests and GLM analysis to control for interaction between feed-type and sleep location. Results: Actigraphy-assessed infant sleep parameters did not vary by feed-type but parentally reported sleep parameters did. Maternal report and actigraphy data diverged at 10 weeks postpartum and discrepancies were associated with infant feeding type. Compared to actigraphy, maternal reports by formula-feeding mothers (controlling for infant sleep location) over-estimated infant's Total Sleep Time (TST) at 10 weeks and Longest Sleep Period (LSP) at 10, 12 and 18 weeks. Conclusions: These results raise questions about the outcomes of previous infant sleep studies where accuracy of parentally-reported infant sleep data is assumed. That parental reports of infant sleep vary by feeding type is particularly important for reconsidering previous studies of infant sleep development and intervention studies designed to influence sleep outcomes, especially where feed-type was heterogeneous, but was not considered as an independent variable.
Article
Introduction Breastfeeding rates in the United States continue to fall short of Healthy People 2020 goals. Bedsharing has been promoted as a way of increasing breastfeeding durations. Methods We used prospectively collected Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) and PRAMS‐2 data from 2276 women to explore whether bedsharing frequency predicts age at weaning. Bedsharing was assessed at 14 weeks after birth (PRAMS), and duration of breastfeeding was assessed at 2 years after birth (PRAMS‐2). Cox proportional hazards models controlled for primiparity, cesarean birth, marital status, employment status, maternal race and ethnicity, and pregravid body mass index. Results Women in this sample reported high rates of bedsharing: only 15.7% of PRAMS respondents said they never shared a bed with their infant. We also observed a dose‐response association between bedsharing frequency and breastfeeding duration when the analysis controlled for covariables: women who reported more frequent bedsharing at 14 weeks postpartum were more likely to wean later. Hazard ratios ranged from 1.18 (95% CI, 1.02‐1.35) for “often” versus “always” bedsharing to 1.92 (95% CI, 1.66‐2.24) for “never” versus “always.” In other words, at any given infant age, women who always bedshared were more likely to keep breastfeeding. Women who always bedshared at 14 weeks postpartum breastfed their infant for a median of 13 months (95% CI, 12‐14), compared with 10 months (95% CI, 9‐11) for women who never bedshared at 14 weeks. Discussion Although we cannot rule out confounding by breastfeeding intention, our results suggest that bedsharing in early infancy might lead to later weaning. Regardless of infant feeding method, given the frequency of bedsharing reported by women in this and other samples, clinicians encountering pregnant and postpartum women should teach safe bedsharing practices.
Article
Ignoring children's bedtime crying (ICBC) is an issue that polarizes parents as well as pediatricians. While most studies have focused on the effectiveness of sleep interventions, no study has yet questioned which parents use ICBC. Parents often find children's sleep difficulties to be very challenging, but factors such as the influence of Western approaches to infant care, stress, and sensitivity have not been analyzed in terms of ICBC. A sample of 586 parents completed a questionnaire to investigate the relationships between parental factors and the method of ICBC. Data were analyzed using structural equation modeling. Latent variables were used to measure parental stress (Parental Stress Scale; J.O. Berry & W.H. Jones, 1995), sensitivity (Situation-Reaction-Questionnaire; Y. Hänggi, K. Schweinberger, N. Gugger, & M. Perrez, 2010), Western-oriented parental beliefs (Rigidity), and children's temperament (Parenting Stress Index; H. Tröster & R.R. Abidin). ICBC was used by 32.6% (n = 191) of parents in this study. Parents' Western-oriented beliefs predicted ICBC. Attitudes such as feeding a child on a time schedule and not carrying it out to prevent dependence were associated with letting the child cry to fall asleep. Low-sensitivity parents as well as parents of children with a difficult temperament used ICBC more frequently. Path analysis shows that parental stress did not predict ICBC. The results suggest that ICBC has become part of Western childrearing tradition.
Article
The present study examined differences in social criticism and maternal distress and in household, maternal, and infant characteristics between families who co-slept with their infants beyond 6 months and those who moved their infants to a separate room by 6 months. Data for infant sleeping arrangements, preferences for their sleeping arrangement choices, criticism, depressive and anxiety symptoms, and worries about infant sleep were collected from 103 European American mothers during the infant's first year. Mothers who co-slept with their infants beyond 6 months (persistent co-sleepers) were more likely than mothers who moved their infants to solitary sleep by 6 months to receive criticism and report depression and worry about infants' sleep behaviour, even after controlling for preference for the sleep arrangement they used. Interestingly, criticism was associated with maternal depression and worries only for persistent co-sleeping mothers. Further, these mothers had lower income, reported greater space constraints; were younger, single, or unemployed; were less likely to have a Bachelor's degree; and were more likely to have infants with greater negative affectivity or problematic night waking, compared to mothers of solitary sleeping infants. Adherence to cultural norms regarding infant sleeping arrangements may be a strong predictor of social criticism and maternal well-being.
Article
Objective: Childhood sleep problems are associated with insufficient parental sleep and adverse maternal mental health symptoms, which may be exacerbated when mothers/toddlers co-sleep (i.e., bed/room sharing). This study examines maternal sleep duration as a mechanism linking perceived toddler sleep problems with maternal mental health and examines whether these associations vary by co-sleeping, in addition to exploring alternative models. Methods: Low-income mothers of toddlers (n = 280) (age 12-32 months) recruited from Women, Infants, and Children and pediatric clinics provided demographic information and completed questionnaires on their toddler's sleep and their own sleep duration and mental health symptoms (depressive symptoms, anxiety, and stress). Indirect and conditional indirect models were conducted to examine the relation between perceived toddler sleep problems and maternal mental health. Results: Perceived toddler sleep problems were associated with an average decrease of 51 minutes in maternal sleep when co-sleeping (mean = 6.1 h). Maternal sleep duration mediated the relation between perceived toddler sleep problems and maternal symptoms of depression, anxiety, and stress for co-sleeping mothers. Maternal sleep duration did not mediate relations between maternal mental health symptoms and perceived toddler sleep problems. Conclusion: This study provides a conceptual model by which parent and child sleep is related to parental mental health. Practitioners might consider alternatives to co-sleeping when discussing sleep arrangements with parents. Future studies should replicate results longitudinally and examine whether reducing co-sleeping improves maternal sleep duration and reduces perceptions of toddler sleep problems.
Article
This study assessed infant sleep-wake behavior at two weeks, three and six months as function of feeding method at three months (exclusively breastfed, partially breastfed, and exclusively formula fed infants). Mothers of 163 first-born, full-term, normal birth weight, healthy infants completed socio-demographic, depression, anxiety, and infant sleep-wake behavior measures. No effects were found for sleep arrangements, depression or anxiety, on feeding methods and sleep-wake behavior at three months. At two weeks exclusively breastfed infants at three months spent more hours sleeping and less hours awake during the 24-h period than partially breastfed infants. At three months, exclusively breastfed infants had a shorter of the longest sleep period at night than exclusively formula fed infants. At six months, exclusively breastfed infants at three months spent more hours awake at night than partially breastfed infants, awake more at night than exclusively formula fed infants, and had a shorter sleep period at night than partially breastfed and exclusively formula fed infants. This study showed differences in sleep-wake behaviors at two weeks, three and six months, when exclusively breastfed infants are compared with partially breastfed and exclusively formula fed infants at three months, while no effects were found for sleep arrangements, depression or anxiety.
Article
Objectives: The American Academy of Pediatrics recommends infant-parent room-sharing until age 1. We assessed the association between room-sharing and sleep outcomes. Methods: The Intervention Nurses Start Infants Growing on Healthy Trajectories study is an obesity prevention trial comparing a responsive parenting intervention with a safety control among primiparous mother-infant dyads. Mothers completed the Brief Infant Sleep Questionnaire at 4, 9, 12, and 30 months. Reported sleep duration and overnight behaviors, adjusted for intervention group, were compared among early independent sleepers (own room <4 months), later independent sleepers (own room between 4 and 9 months), and room-sharers at 9 months. Results: At 4 months, reported overnight sleep duration was similar between groups, but compared with room-sharers, early independent sleepers had better sleep consolidation (longest stretch: 46 more minutes, P = .02). At 9 months, early independent sleepers slept 40 more minutes nightly than room-sharers and 26 more minutes than later independent sleepers (P = .008). The longest stretch for early independent sleepers was 100 and 45 minutes more than room-sharers and later independent sleepers, respectively (P = .01). At 30 months, infants sleeping independently by 9 months slept >45 more minutes nightly than those room-sharing at 9 months (P = .004). Room-sharers had 4 times the odds of transitioning to bed-sharing overnight at both 4 and 9 months (P < .01 for both). Conclusions: Room-sharing at ages 4 and 9 months is associated with less nighttime sleep in both the short and long-term, reduced sleep consolidation, and unsafe sleep practices previously associated with sleep-related death.
Article
Objectives: Cross-cultural sleep research is critical to deciphering whether modern sleep expression is the product of recent selective pressures, or an example of evolutionary mismatch to ancestral sleep ecology. We worked with the Hadza, an equatorial, hunter-gatherer community in Tanzania, to better understand ancestral sleep patterns and to test hypotheses related to sleep segmentation. Methods: We used actigraphy to analyze sleep-wake patterns in thirty-three volunteers for a total of 393 days. Linear mixed effects modeling was performed to assess ecological predictors of sleep duration and quality. Additionally, functional linear modeling (FLM) was used to characterize 24-hr time averaged circadian patterns. Results: Compared with post-industrialized western populations, the Hadza were characterized by shorter (6.25 hr), poorer quality sleep (sleep efficiency = 68.9%), yet had stronger circadian rhythms. Sleep duration time was negatively influenced by greater activity, age, light (lux) exposure, and moon phase, and positively influenced by increased day length and mean nighttime temperature. The average daily nap ratio (i.e., the proportion of days where a nap was present) was 0.54 (SE = 0.05), with an average nap duration of 47.5 min (SE = 2.71; n = 139). Discussion: This study showed that circadian rhythms in small-scale foraging populations are more entrained to their ecological environments than Western populations. Additionally, Hadza sleep is characterized as flexible, with a consistent early morning sleep period yet reliance upon opportunistic daytime napping. We propose that plasticity in sleep-wake patterns has been a target of natural selection in human evolution.
Article
The present longitudinal study addressed the ongoing debate regarding the benefits and risks of infant-parent cosleeping by examining associations between sleep arrangement patterns across the first year of life and infant and parent sleep, marital and family functioning, and quality of mothers' behavior with infants at bedtime. Patterns of infant sleep arrangements across the infants' first year were derived from information obtained from 139 families at 1, 3, 6, 9, and 12 months of infant age in a central Pennsylvania sample. Linkages between these patterns and parent-infant sleep, marital and coparenting stress, and maternal behavior at bedtime (from video-recordings) were assessed. Compared with families whose infants were solitary sleepers by 6 months, persistent cosleeping was associated with sleep disruption in mothers but not in infants, although mothers in persistent cosleeping arrangements reported that their infants had more frequent night awakenings. Persistent cosleeping was also associated with mother reports of marital and coparenting distress, and lower maternal emotional availability with infants at bedtime (from home observations). Persistent cosleeping appeared to be a marker of, though not necessarily a cause of, heightened family stress, although the present design did not enable strong tests of causal processes, and results may be particular to cultures that are not supportive of cosleeping. Findings are discussed in terms of cultural contexts of infant sleep and the need for further investigations into the role of the health of the family system in influencing how parents structure infant sleep. (PsycINFO Database Record
Article
Aims and objectives: To explore Canadian mothers' experiences with infant sleep safety. Background: Parents decide when, how and where to place their infants to sleep. It is anticipated that they will follow international Sudden Infant Death Syndrome prevention sleep safety guidelines. Limited evidence is available for how parents take up guidelines; no studies have explored Canadian mothers' experiences regarding infant sleep safety. Design: An inductive qualitative descriptive study using some elements of grounded theory, including concurrent data collection and analysis and memoing. Methods: Semi-structured interviews and constant comparative analysis were employed to explore infant sleep safety experiences of 14 Canadian mothers residing in Metro Vancouver. Data collection commenced in December 2012 and ended in July 2013. Findings: The core theme, Infant Sleep Safety Cycle, represents a cyclical process encompassing sleep safety from the prenatal period to the first six months of infants' lives. The cyclical process includes five segments: mothers' expectations of sleep safety, their struggles with reality as opposed to maternal visions, modifications of expectations, provision of rationale for choices and shifts in mothers' views of infants' developmental capabilities. Mothers' experiences were influenced by four factors: perceptions of everyone's needs, familial influences, attitudes and judgments from outsiders and resource availability and accessibility. Conclusion: To manage infants' sleep, mothers reframed sleep safety guidelines and downplayed the risk of Sudden Infant Death Syndrome for all forms of sleep at all times. Healthcare providers can support mothers' efforts to manage their infants' sleep challenges. During prenatal and postpartum periods, providers' interventions can influence mothers' efforts to adhere to sleep safety principles. Relevance to clinical practice: The study findings support healthcare providers' efforts to assist mothers to modify expectations and develop strategies to support sleep safety principles while acknowledging their challenges.
Article
Objective: To investigate practices, knowledge, attitudes, and beliefs regarding infant sleep among adolescent mothers, a demographic at high risk for sudden unexpected infant death, and to identify novel public health interventions targeting the particular reasons of this population. Study design: Seven targeted focus groups including 43 adolescent mothers were conducted at high school daycare centers throughout Colorado. Focus groups were recorded, transcribed, validated, and then analyzed in NVivo 10. Validation included coding consistency statistics and expert review. Results: Most mothers knew many of the American Academy of Pediatrics recommendations for infant sleep. However, almost all teens reported bedsharing regularly and used loose blankets or soft bedding despite being informed of risks. Reasons for nonadherence to recommendations included beliefs that babies are safest and sleep more/better in bed with them, that bedsharing is a bonding opportunity, and that bedsharing is easier than using a separate sleep space. The most common justifications for blankets were infant comfort and concern that babies were cold. Participants' decision making was often influenced by their own mothers, with whom they often resided. Participants felt that their instincts trumped professional advice, even when in direct contradiction to safe sleep recommendations. Conclusions: Among focus group participants, adherence with safe sleep practices was poor despite awareness of the American Academy of Pediatrics recommendations. Many mothers expressed beliefs and instincts that infants were safe in various unsafe sleep environments. Future study should investigate the efficacy of alternative educational strategies, including education of grandmothers, who have significant influence over adolescent mothers.
Article
The authors develop a conceptual, testable model suggesting lack of developmental synchrony between cortical and subcortical neural tracts necessary for breathing control underlying human vocalization (speech breathing), potentially leaving infants vulnerable to inconsolable crying. They propose that this lack of developmental synchrony also helps explain the human susceptibility to sudden infant death syndrome. Beginning around 1 month, during sleep and awake periods, infants gradually learn to shift between volitional and autonomic breathing control based on developing functional interconnections between cortical and subcortical neural networks. The existence of sudden infant death syndrome and inconsolable crying may reflect adaptive failures exacerbated by prolonged parent–infant separation, whether night or day, due to one or the other subsystem of neural networks and/or their functioning nuclei not being equally mature or able to sufficiently send, detect, or respond to signals provided by the other. Implications of these proposed models for family practice and family science research are examined.
Article
Parenting behaviours play a major role in the evolution of infant sleep. Sleep problems in infancy have been associated with excessive parental involvement at night-time, and with shorter delays in response to infant night wakings and signalling. Infant crying and sleep problems are linked, yet little is known about the impact of parental responses to crying on infant sleep patterns. This study examined the hypothesis that lower parental tolerance for crying is associated with infant sleep problems. We studied 144 married couples divided into three groups: parents of infants suffering from night-waking problems (i.e. the clinical group), parents of infants without sleep problems and childless couples. Crying tolerance was assessed using questionnaires, audio recordings of crying infants and using a novel paradigm, in which participants were shown a video of a crying infant and asked when they would intervene. Parents in the clinical group demonstrated shorter intervention delays in the crying infant clip (group effect: P < 0.0001), and tended to attribute more distress to the crying infants compared to parents in both control groups (P < 0.05). Additionally, women demonstrated lower tolerance for infant crying on most measures compared to men. Our results suggest that parents of sleep-disturbed infants appear to have lower tolerance for infant crying, which may be a predisposition underlying their excessive involvement in soothing their infants to sleep which may lead to the development of sleep problems. These preliminary findings should be explored further to assess their clinical validity and utility.
Article
The practice of parent and child sharing a sleeping surface, or ‘bed-sharing’, is one of the most controversial topics in parenting research. The lay literature has popularized and polarized this debate, offering on one hand claims of dangers, and on the other, of benefits - both physical and psychological - associated with bed-sharing. To address the scientific evidence behind such claims, we systematically reviewed k=659 published papers (peer-reviewed, editorial pieces, and commentaries) on the topic of parent-child bed-sharing. Our review offers a narrative walkthrough of the many subdomains of bed-sharing research, including its many correlates (e.g., socioeconomic and cultural factors) and purported risks or outcomes (e.g., sudden infant death syndrome, sleep problems). We found general design limitations and a lack of convincing evidence in the literature, which preclude making strong generalizations. A heat-map based on k=98 eligible studies aids the reader to visualize world-wide prevalence in bed-sharing and highlights the need for further research in societies where bed-sharing is the norm. We urge for multiple subfields - Anthropology, Psychology/Psychiatry, and Pediatrics - to come together with the aim of understanding infant sleep and how nightly proximity to the parents influences children’s social, emotional, and physical development.
Article
We tested whether mother-infant bed-sharing is associated with increased secure infant-mother attachment, a previously unexplored association. Frequency of bed-sharing and mothers' nighttime comforting measures at 2 months were assessed with questionnaires in 550 Caucasian mothers from a population-based cohort. Attachment security was assessed with the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978) at 14 months. When using a dichotomous variable, "never bed-sharing" (solitary sleepers) versus "any bed-sharing," the relative risk of being classified as insecurely attached for solitary-sleeping infants (vs. bed-sharers) was 1.21 (95% confidence interval: 1.05-1.40). In multivariate models, solitary sleeping was associated with greater odds of insecure attachment, adjusted odds ratio (OR): 1.50, 95% CI = 1.02-2.20) and, in particular, with greater odds of resistant attachment, adjusted OR = 1.74, 95% CI = 1.10-2.76); and with a lower attachment security score, β = -0.12, t(495) = -2.61, p = .009. However, we found no evidence of a dose-response association between bed-sharing and secure attachment when using a trichotomous bed-sharing variable based on frequency of bed-sharing. Our findings demonstrate some evidence that solitary sleeping is associated with insecure attachment. However, the lack of a dose-response association suggests that further experimental study is necessary before accepting common notions that sharing a bed leads to children who are better or not better adjusted.
Article
Parent-child cosleeping is typically considered by researchers and parenting advisors to be a unitary construct. However, existing evidence suggests that parents who purposefully sleep with their young children at night (intentional cosleepers) may be very different than those who co-sleep in reaction to existing sleep problems (reactive cosleepers). The object of the current study is to compare these two groups along three dimensions: demographics, sleep behaviors, and maternal attitudes toward sleep. Participants recruitment occurred through two parenting e-mail listservs; one considered mainstream and one devoted to attachment parenting. The survey was completed online and submitted electronically. Participants included 450 mothers in the United States (mostly White and well-educated) with a target child between the ages of 6 and 59 months who cosleeps at least occasionally. Reactive cosleepers and intentional cosleepers reported many differences in their children's sleep behaviors and their own attitudes about family sleep, but few demographic differences. Frequent all-night cosleeping and parental ideological endorsement of cosleeping characterize intentional cosleeping. Reactive cosleeping is characterized by reduced parental satisfaction. Reactive and intentional cosleepers both report shared beliefs with their partners and a select group of friends, but a definite lack of shared beliefs with other elements of their social support systems. The distinction between intentional and reactive cosleeping appears to be a valid and useful one. Researchers should be aware of the differences when studying sleep in families with young children.
Article
The American Academy of Pediatrics has recommended since 1992 that infants be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since that time, the frequency of prone sleeping has decreased from >70% to ~20% of US infants, and the SIDS rate has decreased by >40%. However, SIDS remains the highest cause of infant death beyond the neonatal period, and there are still several potentially modifiable risk factors. Although some of these factors have been known for many years (eg, maternal smoking), the importance of other hazards, such as soft bedding and covered airways, has been demonstrated only recently. The present statement is intended to review the evidence about prone sleeping and other risk factors and to make recommendations about strategies that may be effective for further reducing the risk of SIDS. This statement is intended to consolidate and supplant previous statements made by this Task Force.