In the Dark about Infant Sleep?

By Barbara Behrmann, Ph.D. 

© 2006

Breastfeeding?  Confused about where your baby should sleep?  If so, you’re not alone.  Where babies should sleep, whether they should sleep alone or with a parent, and to what extent they should be expected to sleep through the night are huge and loaded questions in American culture.  They also have significant implications for breastfeeding.

 American culture places a strong emphasis on fostering early independence and self-reliance, as well as a great value on parental privacy.  Not surprisingly, then, many babies sleep in a crib, down the hall from mom – and dad.  In fact, it is rare for an expectant couple to not question the need to get a crib.  It’s right up there with car seats, and diapers.

But is a crib truly necessary?  In some cases, absolutely!  But not always.   So before you’re left out in the dark about infant sleep, here are a few things to think about.

Nighttime from the Baby’s Perspective

Only in the U.S. and in similar cultures do babies sleep away from their mothers in separate rooms.  In most of the world, and for most of history, human babies have slept with their mothers.  Co-sleeping meets a baby’s emotional, psychological, and developmental needs, and is the “normal” sleeping arrangement against which other models should be assessed.  Plain and simple, we are mammals and mammal babies are designed to sleep with their mothers.  Besides, if you’ve ever had the experience of waking up next to the person you love most in the world, you can imagine how your baby must feel waking up feeling secure with your warm body and warm milk right there. 

Babies are biologically designed to need physical contact during the night.  Studies of infant sleep were first developed during a time when formula-feeding was even more than the cultural norm it is today.  Because babies fed formula sleep more deeply and can go for longer periods of time without eating, it contributed to the expectation that babies should be able to sleep through the night by themselves, an expectation that lingers today.  But breastfed babies digest their food quickly and easily.  They can’t wait until morning to eat.   Many of the struggles nursing moms face are based on unrealistic expectations, rather than any immaturity or problem on the part of our babies. 

If deeper sleep makes formula sound appealing, consider that formula feeding and solitary sleeping are actually risk factors for SIDS - Sudden Infant Death Syndrome.  These babies have more difficulty rousing themselves from deep sleep, which may contribute to SIDS.  Co-sleeping, nursing babies, on the other hand, tend to follow the sleep patterns of their mothers, helping them develop more mature sleeping and breathing patterns.  

So What to Do?

The real question is how can you meet your baby’s needs as easily – and safely - as possible so that everyone in the family can get a good night’s sleep?

Studies reveal what most nursing mothers quickly discover:  co-sleeping often makes breastfeeding easier.  Having to rouse yourself out of bed every couple of hours quickly becomes exhausting!  And when something is easier, you are more likely to do it and keep doing it.  With your baby beside you, you can simply roll over, offer a breast, and get on with your sleep.  In fact, you may not even always wake up for the feeding!       

Moreover, studies also show that because babies who sleep with their mothers nurse more often than those who don’t, it’s a way of preventing breast engorgement and breast infections.  And mothers who sleep with babies also tend to nurse over a longer period of time than mothers whose babies sleep away from them.

Is Bed Sharing Safe?

From a safety perspective, bed sharing is not safe for everyone, and how it is done is equally important.  But safety precautions are equally necessary for babies to sleep safely in cribs.  And the data simply don’t support the claim that babies are necessarily safer when sleeping alone.  When we hear reports of babies dying while sleeping with an adult, further analysis almost always shows that it is not co-sleeping itself which is the cause, but the circumstances surrounding it; e.g., the parent was intoxicated, the mother smoked during pregnancy (a known risk factor for SIDS), or the sleep surface was too soft, leading to suffocation.  Moreover, reports seldom distinguish between situations where the infant is alone at the time of death or with someone.  If the baby dies during sleep, but not in a crib, bed sharing is blamed.

James McKenna, Director of  the Center for Behavioral Studies of Mother-Infant Sleep at The University of Notre Dame and one of the leading authorities on the topic, talks about the U.S. cultural bias against bed sharing.  When a baby dies in a bed sharing situation, he asserts, the result is in an indictment against bed sharing.  But when a baby dies while in a crib, it merely represents a problem to be solved.  We treat the situations with different degrees of alarm and consequence. 

The bottom line is this:  breastfeeding, safe sleep, and compassionate parenting are all important.  You may not want to sleep with your baby.  Maybe you want to start off with your baby in a crib, but move him next to you after she wakes up.  Maybe you will sleep better without your baby in bed with you.  And maybe your family situation is one where that’s a wise choice.  But know the risk factors for bed sharing as well as for solitary sleeping, and then decide what’s best for your family.  Children are killed in car accidents, for example.  But car seats and other precautions help us protect them.   Here are a few guidelines who help you make informed nighttime decisions.

Guidelines for safe sleep

● If you smoke do not sleep with your baby.  This is a known risk factor for SIDS.  And if you abuse drugs or alcohol you will be less able to respond to any potential distress your baby may have.  Keep your baby nearby, but not in bed with you.

●Regardless of where your baby sleeps,  place your baby on its back, not its belly or side.  This reduces the risk for SIDS and suffocation.  

●If you use a crib, make sure it meets current safety standards and has a firm, tight-fitting mattress. The bedding should be light and avoid pillows.  The latter helps avoid potential suffocation and holds true for all sleep locations. 

●If your baby is sleeping in a separate room from you, a baby monitor can help you hear her when she wakes up or is in distress.  You may also want to use a monitor that works the other way around and lets your baby be aware of your voice and movements.  Knowing you are nearby helps her feel less alone. 

●Regardless of whether your baby sleeps with you or not, avoid having him or her sleep on a waterbed, a reclining chair, a sofa, or adjacent to spaces that could lead to suffocation, strangulation, or entrapment.  All are potentially dangerous locations for a young baby.  

●For a list of frequently asked questions about bed sharing, visit Dr. James McKenna’s website at:  http://www.nd.edu/%7Ejmckenn1/lab/faq.html 

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Barbara L. Behrmann, Ph.D. is a writer, researcher, and author of The Breastfeeding Café: Mothers Share the Joys, Secrets & Challenges of Nursing, University of Michigan Press, 2005. She is a frequent speaker around the country and is available for talks, readings, and conducting birthing and breastfeeding writing circles. The mother of two formerly breastfed children, Barbara lives in upstate New York.