Baby Co-Sleeping Fact Sheet

To encourage Mums and Dads who are co-sleeping1 with their babies and to help meet night-time needs of infants by providing information on their sleep physiology.

It's ok

... to breastfeed your baby to sleep
... to breastfeed several times in the night
... if your baby doesn't sleep through the night
... if your baby wants to be with you all night
... to bed/room share with your baby

Why it's ok

1Human babies need to be close to their mothers 24 hours a day (not just from 7am to 7pm), and their biology reflects this. This biology is not subject to cultural influence, indeed human evolution has remained relatively unchanged for the past 10,000 years:2

CAREGIVER ABSENCE: Human infants cry when their parents leave them, unlike the offspring of nested mammals, which expect to be left alone and therefore never cry spontaneously during the absence of their mother.3 Protesting against solitary sleep is an instinctive self-preserving mechanism.4 Meanwhile mothers are biologically programmed to give a nurturant response to her baby's cries and not to restrain herself. Upon hearing her baby cry, the blood flow to a mother's breasts increases, accompanied by a biological urge to "pick up and nurse.5

MILK: Non primate mammals eg lions and deer, have milk with high fat and protein to sustain young which may be left alone for 4-12 hours. Human breast milk is low in fat (3%) and protein and high in lactose requiring regular feeding and closeness to the mother.6 A human infant is biologically designed to sleep next to its mother's body and to breastfeed intermittently throughout the night, at least for the first year of its life."

BRAIN DEVELOPMENT: The human infant has only 25% of its brain developed at birth, the least of all primates, and relies on support and external regulation (eg of heart rate and breathing) especially for the first year.7

DEFECATION: Mothers of baby mammals who are left alone for periods in the nest, lick their babies to stimulate defecation and urination. Human infants defecate spontaneously, as they do not expect to be left alone.8

2Infant sleep physiology evolved under conditions of continual parental contact - so to remove external stimulus during sleep could have negative effect on infant sleep development, and co-sleeping facilitates development.9

3Babies fall asleep at the breast because they are biologically programmed to do so.10 "I am feeding, therefore I am with my mother, therefore I am safe, therefore I can sleep".

4Babies sleeping through the night in their own room is a western model created since the industrial revolution, which saw irrevocable changes in human labour, consumption, and family and social structure. Sadly many of these changes devalued the role of mothers, the needs of their babies and the support of the father and extended family. Instead placing a premium on a forced independence. As James McKenna says "Ideas on infant sleep are based on who we want our babies to become, not on who they are".11 200 year old cultural changes are trying to override the biology of infants, which has taken 200,000 years to evolve.

5When mothers are about to give their babies up for adoption, health care professionals assist them with a programme of "unbonding" from the baby. This includes physical separation of mother and baby. Society encourages separation by saying "you're spoiling your baby" or "your baby's just being manipulative" when we breastfeed our babies to sleep, pick them up at the first cry, or sleep with them.12

6The expectation that babies sleep through the night is based on research done in the 1950s in the US, when less than 9% of babies were breastfed. The starting point for the research was solitary sleeping, formula fed babies.13 Similarly the 3-4 hour feed schedule is based on formula-fed and not breast-fed babies.14 New research by Prof James McKenna, looks at the sleep patterns of breastfed babies from an anthropological perspective (across all time and all cultures), shows that healthy functioning includes multiple wakings, light REM sleep, regular night feeding and proximity of the mother.

7The Australian Association for Infant Mental Health say that controlled crying "is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences".15 They advise that babies should not be left to cry until they can understand that their carer will return - at around 3 years of age.

8Separation causes harmful changes in the body systems of infants. For example a one hour separation of mother and baby monkey young caused a compromised immune system, drop in temperature, cardiac arrhythmias and release of stress hormones in the infant. As a fellow primate, but with an even more dependent infant, the implications for human babies are worse.16

9Babies which sleep without an adult caregiver in the same room are twice as likely to die from SIDS17 , which is suspected to relate to a breathing control error occurring during sleep18:

•  Overheating is a risk factor in SIDS.19 Solitary sleeping infants cry more which leads to overheating, and they are not capable of regulating their thermal environment - unlike a bed-sharing mother who will wake to eg adjust bedding to cool a baby.

•  Solitary sleepers may accelerate the maturation of deep sleep, before arousal mechanisms are mature. 20

•  Their systems such as breathing and heart rate are not regulated by a nearby parent.

•  Respiratory drive will be increased in infants who co-sleep due to the increased CO2 content of the room.

•  The presence of a parent provides movement (breathing and bodily) which reduce apneic pauses (physical suspension of breathing) in infants.21

•  In countries such as Japan and Hong Kong, bedsharing is common and SIDS is uncommon. The surface slept upon is usually very firm, & few mothers in these cultures smoke.22

10The first 6-9 months of life have rapid changes in sleep-awake patterns so you should not try to identify or correct 'sleep problems' before that time.23

11There are numerous studies showing the psychological benefits of bed sharing for babies into childhood and adulthood and its impact on positive adult mental health.24

12Infants which sleep with their mothers breastfeed more frequently and for a longer feed duration. And mothers who co-sleep are more likely to breastfeed for longer.25

13The suffocation risk of bed-sharing is exaggerated and fails to differentiate between unsafe and safe co-sleeping practices (see text box). When being warned off bed-sharing with examples of infant deaths, always ask for details, as they are likely to reveal unsafe co-sleeping practices. Did the mother smoke during her pregnancy, were siblings present in the bed, for example.

14"If they sleep in your bed, they'll never leave". Anecdotal evidence from co-sleeping parents does not bear this out. Many co-sleeping parents report that their children become willing to leave, with little or no persuasion, around age two or three, as they mature physically, emotionally and cognitively. Co-sleeping families tend not to see things in terms of habits that need to be broken, but as patterns that can be established, but that continually evolve and change. For co-sleeping families, laying the foundation for security and closeness takes precedence over early independence.26

A final thought

While co-sleeping may be ideal when seen in the context above, you have to find a balance between meeting your needs and those of your baby. Don't feel bad if you can't do it all, just feel good that you are trying to do some of it, some of the time.

References