Thursday, May 31, 2012

Why babies should never sleep alone

Below is a piece I wrote in response (slightly edited) to a discussion on cosleeping and bedsharing with fellow parenting educators which included placement of the baby. It's important to put this into dilemma into a larger context. This is long but necessary to explain the deeper layers of this debate. Read Dr. James McKenna's article Why Babies Should not Sleep Alone. Biologically speaking the human infant is designed to stay in close proximity with its mother or primary caregiver, with whose voice and smells it is accustomed to. The brain of the human infant is the most neurologically immature of all mammals with only 25% of the brain developed at birth. In many ways the human infant needs a fourth trimester of care similar to in utero. Yet our culture is driven by a need to force our infants to become independent, sometimes as soon as it is born! I've heard countless horror stories of mothers being told to let their baby cry-it-out within two weeks of birth by their pediatricians (who in general have no child development background by the way). One mother called me and said she had let her baby cry for seven....that's 7 hours trying to teach it to sleep on its own. She said she finally gave in to the baby...who was under a year old. There is also a belief that infants can manipulate, even at weeks and months old. This myth is common among parents and pediatricians. It's the underlying theme of sleep-training books that advise parents not to pick up their infant if it cries to much that it vomits in the bed. Just clean it up and put the baby back down because otherwise it would be reinforcing negative behavior (the old behaviorism model.) Neuroscientists will tell you that infants area incapable of manipulating. That would require higher cortical functions that have not yet developed. They are totally right-brained beings that initially use the right side of their brains, which means they only know what they feel: hungry, lonely, cold, hot, frightened, happy, joyful etc. Anthropologists have found that human infants are what are considered "carry" mammals, whose mothers produce milk that is low in protein and high in carbohydrates, which means it digests quickly , within a couple of hours, thereby requiring more frequent feeds, compared to cows, deer etc. whose milk is high in protein, low in carbohydrates. Accordingly, the offspring of different mammal subspecies are born with innate instincts and expectations of feeding and care upon birth. In our book, Attached at the Heart, we talk about the 4 Ps that human infants are born to expect: Proximity, Protection, Predictability and Play. In our care of human infants, we adults try to force them into being something they aren't designed to be, which creates tremendous stress for them. For many parents, they too have instincts but are often suppressed by societal pressures. The cry of the infant is meant to be disturbing to adults so that we will respond. It is the only way they can communicate. If left alone and not responded to, research has shown they they eventually shut down. I'm talking about infants under a year, not toddlers necessarily. If we look strictly at the research that has been conducted on infant cosleeping and separate sleeping, it was found that by having the infant in the same room as the parent reduced SIDS deaths by 50%, breastfeeding reduced SIDS by 50% as well. In thousands of hours of video tape taken by researchers of mothers bedsharing with their infants, never once did the researchers ever witness the mother come close to rolling over on her baby. I might add here too that in most instances infants are on their side, while breastfeeding and lay on their back more comfortably with the mother close by, encircling the baby with her arm. When an infant lays on her back any movement or sound can stimulate the startle reflex which is why, to a mother, seems like an unnatural way to put a baby to sleep. I just want to add that the research on infant deaths is still unclear and the research that is currently used is based on coronor's reports, emergency room reports, death notices etc. As of now there is no standard protocol when investigating infant deaths, although there are efforts to do so in certain cities and states. Unfortunately infants die for many reasons that we may never know. For decades it was called crib death and now that term is no longer used yet still infants die in cribs as do some in the adult bed. It is often assumed that when an infant dies in the adult bed that that the baby was accidentally suffocated rather than being an actual SIDS/SUID (Sudden Unexpected Infant Death. A complete death investigation needs to be conducted rather than relying on the opinions of coroners or unlicensed medical examiners. I and other colleagues have long been concerned about the practice of crying-it-out sleep training that is often recommended for newborns and infants under a year. In my opinion this is one of the most harmful practices we subject infants too and I am concerned that the practice is being recommended during such a fragile time of an infants life when SIDS is most prevalent. Like spanking, it may work but at what cost? Where is the evidence to show that it doesn't do long term damage to the baby's developing brain. There is growing evidence to show that extreme stress like being left to cry can cause a cascade of stress hormones that over time, can change the architecture of the brain. We must look at all variables and do a death scene investigation with a protocol in place in order to closely examine the causes for infant deaths, realizing that we may never know. I think what we are learning that a young infant should probably never sleep alone because if the baby is at least in the same room as the parent, the parent will be alerted and be able to intervene. Dr. Kathy Kendall-Tackett found in her survey of over 6,000 parents that because of their fear of sleeping with their child in the adult bed, and in an effort to comfort their babies in the middle of the night they were more likely to fall asleep on couches or recliners. A massive education campaign for safe infant sleep needs to be mounted rather than using advertising scare tactics and "just say no" approaches. Of course I would never suggest that all parents should bedshare with their infants because not every parent should. Families who exhibit risk factors should also be educated on creating a safe environment using a crib but all parents need to be educated about safe sleep. The AAP recommends "cosleeping" in other words, sleeping in close proximity, in the same room as the parents for the first six months of life but does not recommend bedsharing, as to be expected. Parents need to given good information and taught nurturing strategies to help them get through the difficult times when their baby is learning how to adapt to sleeping in their new world.

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