Breastfeeding and co-sleeping: A biologic Imperative

Dr. McKenna speaking at UCSD 2016 Breastfeeding Week mini-seminar.
“Sleep like a baby” is a common expression, but what does it really mean?

According to Dr. James McKenna, an anthropology professor at University of Notre Dame and a world-recognized behavioral sleep expert, it means baby sleeps near the mother with frequent breastmilk delivery.

Then why parents in today’s industrialized world often believe that that solitary infant sleep is the norm?

At a recent World Breastfeeding Week MIni-Seminar sponsored by UCSD Medicine School and SDCBC, Dr. MeKenna discussed the historical and cultural circumstances that led to the assumption.

Until recent historic periods in the western world, no human ancestral or modern infant was ever separated from its caregiver. In the 1700s, Catholic Church in Europe banned bedspring to help prevent infanticide among poor, starving mothers who confessed to “overlaying their babies” due to lack of birth control and the means to support a family.

Then In 1901, Marianna Wheeler, a superintendent of the Babies’ Hospital in New York, published a book “The Baby” and wrote, “The constant handling of an infant is not good for him. The less he is lifted, held and passed from one pair of hands to another, the better… The newborn infant should spend the greater portion of his life on the bed.”

American psychologist John Watson believed that no child could get too little affection, his psychological school of behaviorism had a huge influence on models of child development in the 1920s. He once said, “never hug or kiss your children…Never let them sit on your lap. If you must, kiss them once on the forehead when they say goodnight. Shake hands with them in the morning.”

“The Motherhood Book” published in 1935 claimed “babies should be trained from their earliest days to sleep regularly and should never be woken in the night for feeding,” “baby should be given his own bedroom from the very beginning. He should never be brought into the living room at night.” 

And year later, Dr. Spock, the American pediatrician authority of the 1940s, promoted the same view. 
In the 1980s, America sleep research began when only 9% of American were being breastfed and formula feeding was the craze. AAP guidelines stated “never let a baby fall asleep at the breast.”

More recently, Dr. Richard Ferber, the inventor of famous Ferber Method, published “Solve Your Child’s Sleep Problems” and wrote “sleeping in your bed can make an infant confused and anxious rather than relaxed and reassured. Even a toddler may find this repeated experience overly stimulating…if you find that you actually prefer to sleep with your baby, you should consider your own feelings very carefully.” 

Dr. McKenna called this a “damaging statement.” In a matter of fact, Dr. Ferber changed his mind later and rewrote his famous “Solve Your Child’s Sleep Problems” in 2006. This time, he wrote, “Whatever yo want to do, whatever you feel comfortable doing, is the right thing to do, as long as it works…most problem can be solved regardless of the philosophical approach chosen.”

But even after that, the American authorities still warned mothers about co-sleeping. Just in 2008, Deanne Tilton Durfee, director of the LA County Inter-Agency Council on Child Abuse and Neglect, issued a warning, “We know that value of holding your child, cuddling your child, loving your child But if you take the baby to bed with you and fall asleep, you are committing a potentially lethal act.”

The truth is, co-sleeping doesn’t increase the chance of SUDI, sudden unexpected death in infancy. In most of the SUDI cases, babies were already in an unsafe sleeping environment,  they could die by sleeping all alone, it doesn’t matter if she’s sleeping with the parents. In many cases, the parent roll over the baby when high on drug. On the other hand, co-sleeping promote exclusive breastfeeding, which reduces SUDI rates by 80%.

Fortunately, the erroneous assumption is changing. “The whole fuzz is caused by 10 people,” said Dr. McKenna, “and I’, sure they can be easily replaced by another 10 people. Two decades from now, co-sleeping will be the norm.”

Many new researches show that co-sleeping benefits mother and infant in many ways. Dr. McKenna’s recent research stated that co-sleeping and breastfeeding is a mutual re-enforcing system; he called it “breastsleeping.” An 2007 research found that co-sleepers are more secure being left alone.
So what makes co-sleep safe? Dr. McKenna provided the following factors:
  • Supine sleep position.
  • Exclusive breastfeeding.
  • No maternal smoking.
  • No children co-sleeping with ​infant.
  • Adhere to routine practice. 
  • Avoid co-sleeping on couches, armchairs, reclines, or waterbeds. 
  • Avoid bed-sharing if the baby is bottle feeding or the parent is a smoker, place crib or bassinet next to bed instead.    
This is an original post for San Diego County Breastfeeding Coalition by To-wen Tseng.

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