Mother–infant cosleeping, breastfeeding and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine

Department of Anthropology and Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, Notre Dame, IN 46556, USA.
American Journal of Physical Anthropology (Impact Factor: 2.38). 01/2007; Suppl 45(S45):133-61. DOI: 10.1002/ajpa.20736
Source: PubMed


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.

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    • "The data collected included time of death, position when found deceased, position placed to sleep before death, and sleeping surface. Data were also collected regarding whether the SIDS occurred during bed-sharing, defined as a specific type of co-sleeping pattern in which an infant sleeps with another individual on the same surface (9), and, if so, whether the individual with whom the infant was sleeping had consumed alcohol prior to sharing a bed with the deceased infant. Fisher's exact test was used to compare categorical variables when comparable data were available. "
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    ABSTRACT: This study aimed to elucidate the demographic and sleeping environmental factors associated with sudden infant death syndrome (SIDS) in Korea. The autopsy reports of all SIDS cases reported to the National Forensic Service and Seoul National University College of Medicine between 1996 and 2008 were reviewed for data collection and analysis to identify the risk factors for SIDS. Analysis of the 355 SIDS cases reported within the study period revealed that of the 168 (47.3%) cases for which sleeping position before death had been reported, 75 (44.7%) cases had occurred after placement in prone or side position. Of the 204 (57.5%) cases for which bed-sharing situation had been reported, 121 (59.3%) deaths had occurred during bed-sharing, of which 54 (44.6%) infants were under 3 months of age, a significantly younger age than that of the non-bed-sharing cases (P = 0.0279). Analysis of the results indicated no tendency toward an increase or decrease in the use of a prone or side position. Rather, there was a statistically significant increasing trend for bed-sharing over the study period (OR, 1.087; 95% CI, 1.004-1.177; P = 0.04). These findings indicate the need for nationwide educational programs promoting a safe sleeping environment to enhance SIDS prevention.
    Full-text · Article · Mar 2013 · Journal of Korean medical science
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    • "From this point of view, frequent sucking is part of human nature, evident in most contemporary hunter-gatherers (Konner 2005). Furthermore, James McKenna and colleagues' extensive research on cosleeping and breastfeeding (for review , see McKenna et al. 2007) has informed the argument that mother–infant cosleeping is an evolved behavior that supports breastfeeding. Further, Lee Gettler and McKenna (2011) have encouraged a biocultural perspective through their recent study that demonstrates how breastfeeding frequency is affected by culturally guided decisions about where infants sleep. "
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    ABSTRACT: Anthropologists have long recognized that breastfeeding involves much more than feeding; it entails intimate social interactions between infants or children and their mothers. However, breastfeeding has predominantly been studied with respect to structural features (frequency, timing) as well as nutritional and health aspects of infant feeding. Thus, in this study we complement previous anthropological studies by examining social interactions that occur during breastfeeding among the Aka and Bofi foragers and Ngandu and Bofi farmers at various ages (three to four months, nine to ten months, toddlers). Further, we use an integrated biocultural perspective to explore how patterns of breastfeeding and social interactions can be shaped by economic constraints, cultural values, and children's development. Overall, our findings illustrate how biological and cultural factors interact and provide useful explanations of variations in breastfeeding structure and social interactions more so than either perspective alone.
    Full-text · Article · Mar 2012 · American Anthropologist
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    • "Western countries infants' sleeping arrangements during the first months of life show large inter-individual variation: while some infants sleep in their own room from the beginning , others sleep in a crib in the parents' room, and yet others sleep in bed with the parents. These last two options are commonly referred to as 'co-sleeping' (Goldberg and Keller, 2007a; McKenna et al., 2007). An area that has been largely unexplored is that of the relation between early sleeping arrangements and infant stress reactivity. "
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    ABSTRACT: In this prospective longitudinal study, we investigated the relation between sleeping arrangements and infant cortisol reactivity to stressors in the first two post-natal months. Co-sleeping, as compared to solitary sleeping, is hypothesized to provide more parental external stress regulation by night, thus reducing general stress sensitivity. We therefore expected lower cortisol reactivity to stress in infants who co-slept more regularly. Participants were 163 mothers and infants from uncomplicated, singleton pregnancies. Mothers completed daily diaries on sleeping arrangements in the first 7 weeks of life. Co-sleeping was defined as sleeping in the parents' bedroom (i.e. own or parents' bed). Cortisol reactivity was measured twice: to a mild physical stressor (bathing session) at 5 weeks of age and to a mild pain stressor (vaccination) at 2 months of age. Infants with a solitary sleeping arrangement in their first month of life showed a heightened cortisol response to the bathing session at 5 weeks compared to infants that co-slept regularly. This effect was not explained by breastfeeding practices, maternal caregiving behavior, or infants' night waking and sleep duration. No effects were found of co-sleeping on the cortisol response to the vaccination at 2 months. The results suggest that solitary sleeping in the first month of life is associated with heightened sensitivity of the HPA-axis to a mild stressor, possibly due to less nocturnal parental availability as external stress regulator. Whether this effect continues in later life, remains to be investigated.
    Full-text · Article · Apr 2011 · Psychoneuroendocrinology
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