Your Baby Week by Week - Consultant Paed Advocates Cry It Out?

Unless you've been living in a parenting cave the last few days, you can't have failed to see the image on the left which has been doing the social media rounds.

A baby book which appears to suggest that should a baby cry so hard they vomit, you can change the sheet half the cot at a time.  And resist any urge to comfort, cuddle or speak to baby as parents need to be strong minded.

I noticed when reading the discussions, some people claimed the snippet had been taken out of context. And they're right; the next line might read "don't ever do this!".  So I decided to take a look on Amazon at exactly what the book does and doesn't say.

Book Title: Your Baby Week by Week
Author: Dr Caroline Fertleman & Simone Cave
ISBN-13: 978-0091910556
Relevant Pages: 260+

Below you can find the sleep section in question:

My Amazon preview finished there, but a book owner copied the following conclusion to Facebook:

"and cry even harder. By all means try the popping-in technique, although you’ll probably find that it just seems as though you’re teasing him. Checking your baby will give you some reassurance that he’s still safe and well, despite being very upset, but leaving the room will be hard for both of you. So our advice is to check on your baby without him seeing you – perhaps through a crack in the door. The next day Your baby will wake up refreshed, be as cuddly and loving as ever and behave as though nothing happened. You’re bound to be feeling guilty, but see the programme through because you’ve made a decision to try controlled crying and it really won’t do your baby any harm.

What many first time parents reading this book may not be aware of, is that all the above is really rather controversial.  Whilst statements are written definitively ie "it really wont do your baby any harm", other specialists vehemently disagree with this opinion.

This makes it tricky.  A paediatrician, someone who many hold as the ultimate baby expert, is saying it absolutely won't do any harm to leave a baby crying so hard they vomit.

Firstly I would like to say that whilst the term "controlled crying" is used a lot, this book isn't advocating "controlled crying" (CC), but "cry it out" (CIO).  CC involves returning to the baby with ever extending gaps, CIO is basically just leaving them to cry, end of.

Let's start at paragraph one.

Five months is the recommended age to start.  I'm not sure why, ie who picked this date - it doesn't tie in with any research I've seen recently, and there are no references in the book to support the claims. According to all SIDS guidelines baby should still be in their parent's room at this stage right?

As a lactation consultant it's concerning, because many breastfed infants continue to need a night feed at 5 months - they haven't even started solids at this age.

Infants whose primary source of energy is breastmilk will often wake frequently to nurse, something that is essential for the breastfeeding relationship to continue (Ball, 2009).

The thing is, take the feeding out of the equation - and we know it's still biologically normal for infants of this age to wake regularly.  (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).  More about what is normal infant sleep here.

How can any parent of a 5 month old be sure their baby doesn't need milk, but that it's "just" a want?  To me it really highlights the formula feeding culture many health professionals live in.  That a bottle is simply calories and we can calculate whether they are deemed necessary.  It doesn't consider that the breast is a whole lot more than food.  Breastfeeding is recognised as an anaelgesic by the BMJ - therefore an infant in discomfort will often want to feed.  It releases relaxing, sleepy hormones to both mum and baby (often helping mothers themselves get back to sleep quickly after night wakings), helps baby pass any trapped wind (gas), and is the ultimate "comfort item".  It seems it's OK for babies to rely on bits of cloth or "loveys" as their comfort, but heaven forbid a baby derives comfort from its own mother.

We then have to warn the neighbours.  Seriously.  And apparently if you do this, they will be tolerant.   To be honest we clearly mix in different circles, as many of my friends would be horrified if their neighbours informed them of this, and would likely print off oodles of reading as to to the risks before dropping it round with an offer of babysitting!

You then basically need to book time off work, as you have to expect 4 nights of crying - right before they warn you will feel stressed as your baby howls.  

Dear readers this "stress" felt is called INSTINCT.  Many mothers can use their "stressed" feeling as an accurate gauge as to their baby's need.   There is the low pitched, almost moany non urgent cry, that many of us attend to - but we might pop to the loo en route calling out we are on our way.  It's the polar opposite of the high pitched scream that makes you want to sprint and stop that baby crying now.

"Don't stand unmoving outside the door of a crying baby whose only desire is to touch you. Go to your baby. Go to your baby a million times." - Peggy O'Mara

Next we check baby is well, presumably we're assuming onset of illness can't occur in the middle of the night.  We then have to add extra creams in case baby poops whilst crying.  Er why?  Are we seriously suggesting not changing the nappy if baby soils it?

The next paragraph about vomit, makes me feel like doing the same.  I have no words.

Whilst he's screaming we have to remind ourselves he isn't hungry or in pain.  Hmmm what about all the other emotions we humans have?  We are seriously limiting babies to two or three?

Oh no wait, it's ok because the next paragraph tells us he's probably not feeling abandoned or scared, because he isn't a teenager and only has basic needs.  Yep that's right, the basic need of a responsive caregiver.

If it all gets too much, watch a film, pop in some earplugs.  Forget your 5 month old is so desperate for you they're vomiting - because apparently whilst babies aren't mature enough to feel complex emotions, they're capable of a mastermind level of manipulation.

Wendy Middlemiss, Associate Professor of Educational Psychology at the University of North Texas decided to study exactly what does happen to babies who are left to cry.

"Saliva was sampled for mothers and infants at initiation of infants' nighttime sleep and following infants' falling to sleep on two program days and later assayed for cortisol. As expected on the first day of the program, mothers' and infants' cortisol levels were positively associated at initiation of nighttime sleep following a day of shared activities. Also, when infants expressed distress in response to the sleep transition, mother and infant cortisol responses were again positively associated. On the third day of the program, however, results showed that infants' physiological and behavioral responses were dissociated. They no longer expressed behavioral distress during the sleep transition but their cortisol levels were elevated. Without the infants' distress cue, mothers' cortisol levels decreased. The dissociation between infants' behavioral and physiological responses resulted in asynchrony in mothers' and infants' cortisol levels" here

What does this mean?  Basically it tells us that during the first two nights of sleep training, both mum and baby released increased levels of a hormone, indicating they were stressed at the "sleep training" taking place.  However by the third night, the baby stopped signalling this distress - the "result" that this book aims to achieve.

What is critical to note though, is that baby's saliva showed they were indeed still stressed - they just stopped signalling this distress to their caregiver.  Therefore mother's stress hormone dropped and for the first time during the study mother's and baby's cortisol was mismatched.

This also confirms that when mothers feel so incredibly stressed on nights one or two that they just want to go and retrieve their baby (which the authors acknowledge will happen) - he is feeling the exact same desperately overwhelming levels of stress too...

So what does cortisol, this stress hormone do to the brain when it's produced in excess? It has been linked to chemical and hormonal imbalances, a suppressed immune system, ADHD, and a negative impact on emotional development. Read full with references here

Darcia Narvaez is a Professor of Psychology at the University of Notre Dame and Executive Editor of the Journal of Moral Education agrees:

"With neuroscience, we can confirm what our ancestors took for granted---that letting babies get distressed is a practice that can damage children and their relational capacities in many ways for the long term."

She goes on to say:

When the baby is greatly distressed,it creates conditions for damage to synapses, the network construction which is ongoing in the infant brain. The hormone cortisol is released. In excess, it's a neuron killer but its consequences many not be apparent immediately (Thomas et al. 2007). A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing rapid brain growth. The brain grows on average three times as large by the end of the first year (and head size growth in the first year is a sign of intelligence, e.g., Gale et al., 2006).

Darcia also believes there are other significant potential consequences, which are discussed fully in her article here.

Perhaps the most ironic thing, is that Penn State researchers recently suggested receptiveness is more important than routine.

Emotional availability of mothering at bedtime was significantly and inversely related to infant sleep disruption, and, although these links were stronger for younger infants, they were significant for older infants as well. 

These findings demonstrate that parents' emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality. Results support the theoretical premise that parents' emotional availability to children in sleep contexts promotes feelings of safety and security and, as a result, better-regulated child sleep.

The Australian Association for Infant Mental Health Inc (AAIMHI) in its 2002 position paper (revised in 2004) on controlled crying:

'AAIMHI is concerned that the widely practised technique of controlled crying is not consistent with what infants need for their optimal emotional and psychological health, and may have unintended negative consequences.' You can read the background to these concerns in a PDF document that can be downloaded from the AAIMHI's website .

I would like to conclude by thinking again about the advice to not interact, respond or communicate in anyway with baby when they are distressed.  I think this video clip highlights perfectly that whilst as non psychologists, emotional and psychological damage may not be easy to recognise - that doesn't mean it isn't happening.



Further reading:

Baby Taming, if it works does that make it right?

Evolutionary Parenting: Educating the Experts – Lesson One: Crying

Dear Sleep Trainer Expert

This has been on the "notes" section of the Facebook wall for a while, but as I often get asked where it is, I'm resharing here :)  written by Emma Ashworth Breastfeeding Counsellor.

Dear Sleep Trainer Expert,

My Grandfather died a month ago and my Grandmother was still not sleeping very well until last week and she was crying a lot in the night. It's really been disturbing my sleep. She had a stroke about 2 years ago and can't walk or talk so I'm her primary carer. It's hard work but I love her, and I know it will pass but I really needed more sleep! I was desperate!

I wanted to tell you how pleased I was to find your book "The Contented Little Baby Whisperer's guide to Saving my Sleep". Over the last few nights I've been sensible and strong. It's been tough, but we did it!

I've put Gran onto a routine where I feed her at 7pm, and that's THAT. She's learning now that if she's thirsty in the night, she'll have to wait. I bathe her with the lights low and tuck her in bed with 16 blankets, said goodnight and left her to it. Let me tell you she didn't half complain on that first night! She cried and cried but I wasn't going to let her manipulate me. Just because she's slept next to Grandpa for the last 45 years! She has to learn to be independent from other people, I realise that now.

I found that going in every few minutes and not giving her eye contact eventually meant she got the message. She was sick at one point which was a shock. I didn't know old people could manipulate like that! Anyway, I cleaned her up and just ignored it so she won't be trying that again.

She seems very happy today. Well, she's quiet anyway. Not hassling me at all! Bonus.

I can't wait to tell all my friends about your amazing system. My friend Sally has a disabled daughter who is 10 and can't talk or walk. I'm sure she'd find this system works brilliantly for her, too.

Love your biggest fan,



xxx

Mothers SHOULD leave babies to cry, because the study says so?

"Don't get up if your baby cries at night: Mothers SHOULD leave their babies to 'self-soothe' says leading expert "

Was the Daily Mail headline.  Science Daily went for:

"Let Crying Babes Lie: Study Supports Notion of Leaving Infants to Cry Themselves Back to Sleep"

Crikey, right!  What about dads or mum's partner, can they respond?  ;-)

Let's see the evidence...

From a study of 1200 infants

"66% of the children showed a flat trajectory of sleep awakenings from 6 through 36 months, with mothers reporting their infant awakening from sleep about 1 night per week. 

The second group, labelled Transitional Sleepers, included 34% of the infants. These children had 7 reported nights of awakenings per week at 6 months, dropping to 2 nights per week at 15 months and to 1 night per week by 24 months."

To summarise, 2/3rds of babies woke once per week, 1/3 woke seven times per week. Given a whole 1/3rd continued to wake, it was hardly a tiny minority.  What is also interesting to note is that the authors used data collected in 1991, that's 20 years ago!

This is significant as there was a dip in breastfeeding initiation rates in the late 1980s, followed by a return in the mid-1990s (1); ie breastfeeding rates were low at the time of data collection.  Are we basing our "normal infant sleep" on infants fed human milk or that of another species?  No idea as the study doesn't tell us that...

It does note:

"Compared with Sleepers, Transitional Sleepers were more likely to be boys, score higher on the 6-month difficult temperament assessment, be breastfed at 6 and 15 months old, and have more depressed mothers at 6 months old."

1.  "Score higher on the 6-month difficult temperament assessment":  A parental assessment (not independently validated), the flaws of which are discussed here, in a piece that discusses why "irritability" might actually be a positive behavioural trait:

"Humans often perceive infant crying as stress, but for infant animals irritability is a normal component of signalling to parents. The expression of offspring demand is part of a dynamic signalling system between parents and offspring, and has received much attention from zoologists studying a variety of bird and mammal species."

Philip Zeskind, an associate professor of psychology states:

"Although breast-fed babies are perceived to be more irritable than bottle-fed newborns, our results suggest that the behaviors of breast-fed infants are physiologically more desirable. Feeding infants formula may make them sleep more and may disrupt the smooth running of their arousal systems."

2.  "Be breastfed at 6 and 15 months old":  Given that we know beyond any doubt human infants are supposed to receive human milk at this age, if babies wake more frequently when breastfed this is probably the norm.

3.  "and have more depressed mothers at 6 months old":  Perhaps because they're constantly being bombarded with the notion their baby should be sleeping and that it's their fault if not?  Perhaps because nobody told them 1/3rd of babies continue to wake as per normal behaviour?

Professor Marsha Weinraub, from Temple University, Philadelphia, who led the study, said in an interview:

‘When mothers tune in to these night time awakenings... then he or she may not be learning how to self-soothe, something that is critical for regular sleep.’

Anyone else wonder how long it would be before we hit those infamous words "self soothing"?

The key mantra of baby tamers everywhere, seems key to this study too.  But that in itself is rather a stumbling block, as blogger "Uncommon sense" highlights in her piece "Self-soothing. Possibly the biggest lie ever foisted on parents".

But let's run with it for the moment and assume that Weinraubs can actually provide evidence in her study that a) mothers shouldn't tune in to night time awakenings; b) if they do this disturbs the baby's learning how to self-soothe which is critical.  Where does Weinraubs say we should be leaving them to cry as per the media reports?

Furthermore, perhaps we had better a) nudge all those teenagers who were raised responsively, but now enjoy sleeping until noon! b) let mothers across the world know this ASAP.  Because as Jared Diamond, author of the book The World Until Yesterday: What can we learn from traditional societies? explains:

“A cross-cultural sample of 90 traditional human societies identified not a single one with mother and infant sleeping in separate rooms.  The current Western practice [of separate rooms for mother and child] is a recent invention responsible for the struggles at putting kids to bed that torment modern Western parents.”

And that's the interesting thing, "sleep problems" appear to be a Western phenomenon.   In fact what constitutes a sleep problem seems based upon parental expectations, rather than any sort of official criteria:

"Healthy babies cycle through sleep stages, waking several times during the night. Generally, babies soothe themselves and return to sleep without alerting their parents (Anders et al, 1992; Goodlin-Jones, Burnham, Gaylor, & Anders, 2001)
When babies are not able to return to sleep on their own, they may signal their awakening to their parents. This signaling may take the form of either crying or calling out, and it alerts the parents to the child’s awakening. 

This signaling can be disruptive to parents (Karraker & Young, 2007) and considered a sleep “problem.” Some researchers see these sleep awakenings reported by parents to be sleep continuity problems (e.g., Sadeh & Anders, 1993). Although not all parents experience infant signaling upon awakening as problematic (Karraker & Young, 2007), describing and understanding sleep awakenings poses an important challenge for developmental psychologists".

So generally babies soothe themselves and return to sleep without alerting their parents?  Which babies are these?  How were they fed?  Where did they sleep?  Had they been "trained" to sleep?  It's certainly not what many cultures expect:

In a piece entitled "Why African Babies Don't Cry: An African Perspective" by Claire Niala, one of the key tips is:

• Co-sleep. Many times you can feed your baby before they are fully awake, which will allow them to go back to sleep easier and get you more rest.

Quite!  But should we be thinking about shipping some of our best therapists to Africa, as surely nobody will learn to sleep with parenting this responsive?

I decided to get the whole paper, but quickly regretted it.

It's all based around the notion that infants calling/signalling (ie crying) to their parents at night is disruptive, and therefore a sleep problem.  Which, if a good chunk of the world expects babies to wake, would explain why we're the only ones with problems!

The study starts by considering "Intrinsic Variables Related to Sleep Awakenings" - of course based on said assumptions.

"In particular, babies who breastfeed may find it difficult to soothe themselves and return to sleep in the middle of the night because they have become accustomed to falling asleep while nursing (e.g. Karraker, 2008). Early in infancy, breastfed babies may awaken more frequently throughout the night than formulafed infants (e.g. Elias, Nicholson, Bora & Johnston, 1986) because breast milk is digested more quickly; later in infancy, breastfed infants may awaken more frequently, not because they are hungry but because they have difficulty returning to sleep without the customary nursing (Karraker, 2008; Middlemiss, 2004)."

So babies who are fed as per the biological norm may find it difficult to soothe themselves because they fall asleep when feeding.  This is in part because breastmilk delivers a nice dose of sleepy, relaxing hormones; and also because they're snuggled up warm with mum, her scent, touch and taste.  Anyone who has breastfed a baby who isn't sleepy may  have noted the eye-rolling  "milk coma" breastfeeding can induce.  So we have to stop breastfeeding?

Let's flip the language:
"Early in infancy non breastfed babies may awaken less frequently throughout the night than breastfed infants, because formula is more difficult to digest.

And this is a good thing for babies?

We then do a U-turn as authors acknowledge:

"As capacity for self-regulation in the second and third years of life increases, most children resolve their early difficulties with sleep awakening (Bronson, 2000; Tikotzky & Sadeh, 2009)."

Aaaahh right, so perhaps instead of "resolving early difficulties", they just develop normally and transition towards independence as so many other cultures expect?  Cancel the therapists!

The study goes on to say:

"Difficult temperament appears related to sleep awakenings and sleep problems in general. According to Sadeh & Anders (1993), infants who are irritable and hypersensitive and have lower sensory thresholds may sleep for shorter periods and nap irregularly. Morrell and Steele (2003) suggested that difficult infants may elicit more active parent comforting, which may perpetuate night awakenings."

So babies who have a "difficult temperament" also tend to have disturbed sleep.  Note this doesn't suggest that disturbed sleep causes the "difficult temperament", only that the two are observed together.  In practice if something is making baby irritable during the day, it can also disturb sleep; it's hardly a ground breaking revelation (as millions of parents who have soothed a teething baby know).

Next up breastfeeding:

"Several studies have associated problems with sleep awakenings with factors related to breastfeeding— being nursed to sleep, having parental presence until sleep onset, or being fed on awakening (Lam et al., 2003; Touchette et al., 2005). Elias, Nicholson, Bora, and Johnston (1986), following babies for 2 years, reported that sleep awakenings were common in breastfed infants throughout the first 2 years of life; few studies have disputed this finding."

Uh oh, several studies have found our biological norm is to feed and wake frequently, like our closest mammalian relatives and other carrying mammals :O  So, ultimately what these studies confirm is that it is normal.

What's even more interesting is the paper (the one the media claim supports leaving babies to cry!) states:

"By 18 months old, not only are Transitional Sleepers able to sleep through the night without awakening their parents, but they are indistinguishable from the children who, from the beginning, had frequently slept through the night without signaling."

But hang on, I thought this learning to self soothe and stopping "signalling" early was critical?  Yet by 18 months all children slept the same?

It continues:

"The suggestion by Morrell and Steele (2003) that difficult infants may elicit more active parent comforting that may perpetuate night awakenings does not gain support from our findings"

And

"Most studies generally show that that maternal sensitivity is related to optimal and more desirable or advanced developmental infant outcomes (Davis & Logsdon, 2011). 

Here, we found that greater sensitivity was related to more awakenings at each assessment period. Infants whose mothers display sensitivity during play and structured interactions are more likely to continue to awaken more frequently than infants whose mothers are less responsive."

So there is nothing to support the theory babies wake because they are comforted, but studies show the less responsive the mother in general, the less the baby wakes.  Furthermore, responsive parenting has been repeatedly shown to "more desirable or advanced developmental infant outcomes".

It goes on to theorise:

"One explanation may be that generally sensitive mothers during the day are also more inclined to intervene when the infant shows signs of struggling with sleep. This may support Karraker’s (2008) suggestion that when mothers attempt to assist their children in returning to sleep, their responsiveness reinforce behaviors in the child that run counter to self-soothing and self-regulation.

One counter to this interpretation is that we find this relation between infant signaling upon awakening and maternal sensitivity as early as 6 months old, a time when infants might not be as sensitive to instrumental learning as after 9 months (Bell & Ainsworth, 1972). 

Alternatively, it may be that mothers who are more sensitive are more likely to hear their children signaling upon awakening, and they are therefore more likely to report these awakenings. Their behavior may not be instrumental in interfering with children’s self-soothing at all. "

So basically they don't know?

But wait.

Where is the evidence to support the comments researcher Professor Marsha Weinraub made about self soothing?  This study doesn't give us anything beyond an observation of sleep patterns of babies 20 years ago, mixed up with some hypothesising and possible theory making?

Again, we have no idea what percentage of these infants were sleep trained, where they slept or how they were fed, which aren't the only limitations of the study as the authors themselves acknowledge:

Findings from this study are limited by their reliance on data obtained from maternal report. We have no independent measures of infants’ sleep (e.g., polysomnography or observation) other than maternal report. In addition, we did not have direct measures of sleep routines or bedtime conditions that might affect nighttime sleep awakenings.

Did I miss the section that covers leaving babies to cry it out?  It must be in the paper somewhere given the media coverage?  Perhaps it's under the conclusion of the paper, the "Practical Implications":

"These findings suggest that parents and primary health care providers should be aware that some infants who are generally healthy and typically developing might nevertheless have mothers who report sleep awakenings that extend into their infant’s second year of life. 

Those infants more predisposed to early sleep problems are also those who are reported by their mothers to have difficult temperaments and to be breastfeeding. 
However, for nearly all healthy infants, sleep awakenings tend to abate by the middle of the second year. 

Because our study mothers described infants with many awakenings per week as creating problems for themselves and other family members, parents might be encouraged to establish more nuanced, carefully targeted routines to help babies with self-soothing and to seek occasional respite (Karraker, 2008)."

In short, healthy normally developing infants can wake into the second year of life, and for most these wakings abate by the middle half of the second year.  But given parents find waking problematic they can try routines to help break the habit of their children needing them and take occasional breaks if they need to. Did we really need a study to tell us that?

Lastly something the piece doesn't consider, is that a growing body of evidence from both science and history suggests that the eight-hour sleep may be unnatural.

Roger Ekirch of Virginia Tech published a seminal paper, drawn from 16 years of research, revealing a wealth of historical evidence that humans used to sleep in two distinct chunks. A first sleep which began about two hours after dusk, followed by waking period of one or two hours and then a second sleep. References of two sleeping spells started to wane in the late 17th Century, and by 1920 had receded entirely from our social consciousness.

However this may actually be our natural way to sleep. In the early 1990's, psychiatrist Thomas Wehr conducted an experiment in which a group of people were plunged into darkness for 14 hours every day for a month.  It took some time for their sleep to regulate but by the fourth week the subjects had settled into a very distinct sleeping pattern. They slept first for four hours, then woke for one or two hours before falling into a second four-hour sleep. Read more here

Consider this in light of the above study.  Breastfed babies who were responsively parented, were more likely to wake once per night, were more likely to fit the human norm.  Do we want long sleep stretches from our babies at any cost?  

Given what we know about SIDS, the longer term impact of not responding, and the fact that in the end those who woke frequently settle into longer sleep stretches anyway  - whose needs is that actually meeting?

References:
1. The Resurgence of Breastfeeding at the End of the Second Millennium 1,2 J. Nutr. February 1, 2001vol. 131 no. 2 421S-425S

Slumber Bear - Depriving Newborns Of Contact?

I stumbled upon a forum the other day where "baby essentials" were being discussed. As you know I think there are very few things that are truly essential when baby is small - and as the discussion following the above entry highlighted, essential varies widely parent to parent, baby to baby.

But I did notice the "Slumber Bear" was mentioned several times so I went to check it out.

The description from Amazon:

"Designed by a doctor and used successfully in maternity wards for over 30 years, the Prince Lionheart Slumber Bear Plus has helped millions of newborns (and their parents) get a good night's sleep. The Slumber Bear Plus features a multi-function sound box playing womb sounds, lullabies, ocean waves and white noise. There is also a recordable feature allowing you to save your own unique message for baby. Comforting sounds lull baby to sleep in minutes and sound and motion sensors reactivate the recording when your baby cries or jostles the bear.

Each Slumber Bear Plus arrives with its own silkie. Parents can bond with baby by keeping silkie close to their skin, transferring their scent to the blanket. The scent then comforts and reassures baby when parents are out of reach and the soft, smooth texture provides beneficial tactile stimulation."

and

"How it was designed ... By placing a specially designed 8mm microphone inside a pregnant mother's uterus, directly next to the unborn infant's ear. Insertion of the microphone moments before the mother went into labor enabled Dr. Eller to record the major intrauterine sounds that the baby had been hearing for the last four to five months prior to birth. The recorded sounds were then clinically tested on thousands of babies in hospital nurseries, and proved to be a natural audio baby pacifier. Based on the knowledge that the birth experience and transition from the peaceful, quiet existence inside the mother's body is a very traumatic time for the newborn, it has been proved that the recorded intrauterine sounds produce a calming effect on the newborn infant after birth."

  Firstly I wonder how they define a "good night's sleep", is that by the newborn standards or parental norms?   Secondly why on earth do parents need to bond with baby via a piece of cheap cloth?  You can hold the cloth to transfer your scent, then this cloth can be reassuring to the baby?

Seriously how did the human race bond before?

Perhaps (just throwing random ideas out there) they held the baby, he was in turn comforted by the scent, touch and sounds of his mother or father - oxytocin was released all round and thus they bonded?

Now babies can't have free access to their parents, instead they have to learn to soothe themselves to sleep alone - with parent smelling material and a machine making parental sounds?

The trouble is it seems, that newborns need their parents - but that doesn't make money!  As is highlighted above, transition to the outside world can be traumatic for newborns; as a result they are meant to stay close to their mother - her scent, milk, voice all serving to ease that transition.

If a baby needed to hear womb sounds to settle appropriately, wouldn't our bodies make this sound?  Or maybe babies actually only need this if separated from their parents - if they can't have the real thing.  Doesn't it kind of trick babies into thinking they're close?

And is this a risk free plan?

Earlier this year a study by Nils Bergman published in Biological Psychiatry found:

Heart rate variability in 2-day-old sleeping babies for one hour each during skin-to-skin contact with mother and alone in a cot next to mother's bed. Neonatal autonomic activity was 176% higher and quiet sleep 86% lower during maternal separation compared to skin-to-skin contact."

Indeed Dr. John Krystal, Editor of Biological Psychiatry, commented on the study's findings:

"This paper highlights the profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."

 Read more here

From the description above, note how the product was developed and tested in hospital nurseries - places where babies are separated from their mother and placed alone in cots.

Read the reviews on Amazon and it's noted how great that when the baby makes a sound it restarts and soothes them!  No parental effort required, genius.  If the cot is next to you, give it a tap and away it goes.  I don't see any reviews from those sleeping with their baby, only from those having trouble putting their baby down alone or settling/sleeping alone.

"His Mummy wore the snuggle blanket down her top for a night to make it smell of her and now the combination works a treat.  The little man keeps hold of his snuggle blanket while asleep and if ever he wakes with a start the noise machine kicks in and soothes him back to sleep"

and

"Firstly I should state that this has been absolutely instrumental in getting my baby to sleep in her own bed and I would recommend it to anyone who's baby has trouble self soothing."

and

"Bought this as a last resort for our baby who would only ever settle in our bed, as soon as we tried to put him down he would scream. Now he falls asleep to the womb noises and also settles very quickly."

and

"We bought this for our son when he was 4 days old as he wouldn't settle in his crib at night."

and

"Slumber bear - only thing that got her to sleep in her basket"

Notice the pattern?

Plus some rather worrying ones:

"We had an eight week old baby who wasn't sleeping and thought, what the hell, we will try anything! Within a few nights we could see her settle."

and

"I credit this with helping my baby learn how to sleep. He is 4 months old now and has slept through the night (12 hours a night without waking up) since he was 2 and a half months old because each time he woke up at the end of his short sleep cycles not for a feed it helped him get straight back to sleep."

8 week old human infants aren't supposed to sleep for 12 hours without waking up - they're meant to wake and rouse (for a whole myriad of reasons).  Using something like this to induce abnormal sleep/wake cycles isn't "natural" or beneficial to the baby - even if it's convenient to parents who want their 12 hours!

Perhaps someone will come up with something so the parents don't even have to faff around feeding baby themselves, the other big newborn need.  Depriving baby of even more contact...

Oh wait, they did already!

So there may be risks baby will choke, but you know parents are busy nowadays!  Who has time to stop and feed a baby anyway - let alone get up and soothe one when you can kick the cot and have it done for you.  Babies are hardy, they will adapt with lots of gadgets to replace their parents right?

Nappy changing robot anyone?

PS - white noise can be settling to an overtired unsettled infant; vacuum cleaners, untuned radios, hairdryers, white noise machines and white noise phone apps are all available. Sure they wont restart when your baby murmurs, wont play womb noises but if these are more than occasional use items it makes more sense to address the cause of the fussyness and consider whether expectations are realistic.

FFS - UK Anti Bed Sharing Campaigns

I was stunned earlier in the week to be shown this campaign poster on the left from Hertfordshire Safeguarding Children Board.

Apparently it's not new, it has been used for around a year - and it isn't a stand alone piece of "anti bed sharing prophaganda" either.  

On the right below is a poster currently running in Birmingham:

Now on both posters the small print at the bottom clarifies that sleeping with your baby if you smoke, have had a drink or taken drugs is dangerous. 

Is that the message you instantly take from the main pictures?

The ironic thing about this second poster is that the small print confirms that a soft surface like a sofa poses the biggest risk of all - and indeed it does, but that's where mamas end up, sat trying desperately to stay awake.  The trouble is breastfeeding delivers a massive hit of hormones to both parties, which increase at night to relax and induce sleep - this can make it near impossible to stay awake, particularly if you're a tired new mum.  You can read all about the very real dangers of demonising safe bed sharing in a previous blog entry here.

But the one question I keep coming back to about these posters is why?  Why when budgets are tight and Lactation Consultant positions are vamooshing from hospitals, is money being spent on such campaigns.  Of course infant health and SIDS are hugely important, but what I mean is why pick this particular message to send?  

One might reasonably assume that bed sharing must be the biggest risk facing infants, but this simply isn't true - furthermore overlaying ie suffocation is not SIDS; a point that I think it's important to bear in mind.  

A 2009 study found that 54% of deaths occurred while the baby was co-sleeping with a parent. However:

"Although the risk was strong if they had crashed out on the sofa, it was only significant among those in a bed if the parent had drunk more than two units of alcohol or had been taking drugs."

Right so there wasn't an increased risk unless other risk factors discussed were involved.  Why don't the adverts feature a sofa and alcohol, wouldn't that send a clearer message about what is actually dangerous rather than a tiny message at the bottom?
EG:

Oh but wait, 46% of deaths were in a cot right?  

Professor Fleming, author of the research himself commented:

"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"

Quite!  Perhaps Hertfordshire or Birmingham's next campaign should be:

What's also interesting is that women most likely to fall asleep feeding are breastfeeding mothers.  Bottle feeding mums do not get the hit of sleepy hormones - and far fewer bed share anyway, so who exactly is the target audience for this ad campaign?  And what size is this audience?  Won't the vast majority of people pat themselves on the back for using a cot?

But does anyone mind if I mention at this point that non breastfed babies are at double the risk of SIDS.  Why no posters highlighting this key fact?  Perhaps the one below might suit?

No?

Can't see that hitting the surgeries any time soon can you?  Imagine the amount of people that would be upset by that message.  No, the co-sleeping posters are a much safer bet - but it's all about reducing key risks right? Consider how many people don't breastfeed compared to how many bed share and don't use a cot - which message do you think is likely to have the biggest impact on SIDS rates?

Hmmm but sending a message involving breastfeeding might mean the NHS have to step up and actually provide consistent effective support rather than being propped up by the voluntary organisations - and that would never do would it?

For the record I don't think such posters would be effective, I am not seriously putting these forward as "alternatives I would like to see".  I am attempting to highlight how inappropriate and offensive such tactics are.

What those producing posters like those at the top currently in use fail to consider, is that bed sharing is also known to protect breastfeeding rates.  Human infants feed frequently during the night and getting up, feeding, resettling can be exhausting - then we tell mums they have to stay awake when feeding, despite all the biological changes taking place to induce sleep?   Stopping breastfeeding with the belief this will create longer artificial sleep spells can follow, or because they're so scared about falling asleep feeding they mistakenly think a bottle will be "safer".  At what impact to the SIDS rate?

One study found:

Breast-fed babies develop a more energy-efficient and rhythmically functioning autonomic nervous system, which controls infant arousal, than bottle-fed babies, says Philip Zeskind, associate professor of psychology, who studied the sleep-wake patterns and heart rates of breast-fed and bottle-fed newborn infants.

"Our results suggest that the behaviors of breast-fed infants are physiologically more desirable. Feeding infants formula may make them sleep more and may disrupt the smooth running of their arousal systems."

Zeskind looked at babies in all stages of behaviour: deep sleep, dream sleep, drowsy, alert, fussing, and crying. Bottle-fed babies were found more often in the deep-sleep state, and breast-fed babies were more alert. Breast-fed babies also had lower heart rates, indicating better energy efficiency (read more here)

Indeed some sources suggest bed sharing may not be safe for those not breastfeeding - but it's easier to tackle the issue of the small number of people doing that with a blanket campaign, than it is to improve breastfeeding rates right?

As a final note - anyone find it bizarre that the angel baby in the Birmingham poster is wearing a disposable nappy?  It's great they're so gung ho about environmental issues.

RELATED POSTS: 

• Breastfeeding mums don't get less sleep! Myth Busted!
• Why sleep training is like crash dieting.
• Lucky apes can't read

Related Reading Elsewhere Online:

• Why babies should never sleep alone: A review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding

The Duracell Bunny Baby

The Internet at times seems to have two distinct camps - the "expect them to sleep 12 hours" side, and the "it's normal for babies to only nap for half an hour, never want to be put down/sleep on a chest and wake every hour at night" side.

I (as usual) don't fit in either.

I often read from other mothers that very broken sleep must be normal, because their baby does it - some babies, even teeny weeny ones just don't need sleep!  If mums have had several children and some slept great, others not - this reinforces the belief it is personality; and in the past I would have agreed.  We call these babies "spirited" or "high needs", Sears writes a whole chunk about them here; and I think his descriptions are fantastic; but I think we can break it down even further and am not convinced personality is the whole explanation.  Yes babies are meant to be held close on a chest - does this mean that it's therefore normal they never want to lay down?  Babies are meant to sleep next to mum, but did cave woman sleep standing up?

Partly I think this has arisen as direct opposition to the "expecting 12 hours sleep camp", IE embracing baby's cues and being responsive.  But for me responsive parenting can also include exploring if there is a reason baby may be struggling to relax, if the parents feel that's something they need to explore.  That is not the same as suggesting not addressing the reason will lead to "bad sleep habits" or a baby that never sleeps better, babies change a lot as their brains and bodies grow.  Some will naturally iron things out as they mature going into the second half of the first year, some may be nearer 3 or 4 and some may continue to struggle to get to sleep/rise early, although the signs may become more subtle as sleep requirements reduce.

I'm not talking about training them to sleep, leaving them to cry or enforcing strict routines - but really watching baby's body language and cues to see if this is normal personality stuff, or, if he is desperately trying to convey something with constant waking and/or an intense need to suck.

Many parents I have discussed this with are those who have posted seeking advice - and they've mentioned replies are often to co-sleep, sling wear etc; but as they pointed out, what if they're already doing all that and still feel they have an issue?  Some say mum shouldn't ever expect a good chunk of sleep, that this is parenting and again I agree that there will be times baby is fussy and unsettled at night, certainly it's normal for babies to nightfeed - but does that mean therefore that it's typical for a baby to never be settled and sleep for longer than an hour or so?

With a first baby this may be easier, mum can nap when baby naps, head off to bed with baby at 6pm should she fancy - but throw 2,3,4,5 or more other children in to the mix, and/or work outside the home - and things can be very different, some mums are so exhausted they can barely function.

Whilst reassuring mums things are normal can be helpful, and there is a wide range of normal, there is also a range of what parents can cope with -  some may stop co-sleeping/breastfeeding/responsive parenting in a bid to save their own sanity or because their gut instinct is something isn't right, yet they have no idea what.  Whether these "work" in terms of changing behaviour or not is irrelevant, the impact to baby can be significant.

I'm of the belief there can be several reasons for consistently very disturbed sleep patterns or indeed a spirited/high needs infant, none of which involve bad habits, breastfeeding to sleep or baby needing to sleep in a cot to (say it with me) create positive sleep associations.  My feeling is that frequent wakers seek comfort, not that they wake due to a habit or reliance on said comfort to remain asleep; but what I want to focus on today, because it's a matter close to my own heart is the Duracell Bunny Babies (DBB).

How do you know if you have one of these?

Generally if the comment: "just go with the flow, babies will always sleep when they're tired" makes you laugh out loud, it's a pretty good indication; well they might, but no longer than 35/40 minutes in one nap (consistently), even if exhausted.  In exchange they might take lots and lots of little naps, day and night - or may stay awake for most of the day from a very young age and then wake frequently at night too.

The reality is that some babies do not sleep well despite being tired.  Nope, Nada no way - DBB are called such because they rarely seem to run out of energy!

DBB's according to Sears are:

"HYPERACTIVE"
"This feature of high need babies, and its cousin hypertonic, are directly related to the quality of intensity. Hypertonic refers to muscles that are frequently tensed and ready to go, tight and waiting to explode into action. The muscles and mind of high need children are seldom relaxed or still. "Even as a newborn, I could feel the wiry in him," one mother related."

Whilst many would recognise this in a toddler, being "tense and tight" are not characteristics we typically link with the label hyperactivity.  I like "hyper switched on/hyper alert", as I feel it's more descriptive.  Their muscles are often frequently tensed and tight - their muscles and minds do seldom relax, but is this always easy to recognise this in a baby?  I've put together some of the indicators I think define a DBB.:

Signs of a DBB:

• Baby appears very physically strong - many comment they head their head very early, sometimes from birth.  When they arch and push with their legs they feel strong and many are very early movers.  This is not related to size - baby may appear unusually strong for age/size.
• Baby is very alert from a very young age - being "very alert" is very difficult to describe, but many mums of DBB comment how alert their baby is (and often others have too) they are often described as "very switched on".
• They don't show tired cues - whereas when a typical baby starts to become tired, they slow down start to relax and show tired cues; the DBB is opposite.  They flip from awake to asleep without the relaxing/showing cues/unwinding.  One minute they can be playing happily, the next rubbing their eyes (an overtired cue) and if you have a tool like feeding to sleep/pram at this point, will typically suddenly zonk for a power-nap. Many DBB in my experience use either feeding/motion to sleep - not through habit but because it assists relaxation, they tend to be like marmite when it comes to  prams/carseats/motion, and either love or hate it.
• Hyper when overtired - some have a slightly longer window of doing the stage above than others, some flip straight to the almost hyperactive behaviour a very overtired baby displays.  They may struggle to keep still, fidget, fuss and cry a "tired cry".  Some resume play seemingly full of energy again although they may be short tempered or as one mum described "manic" flipping from laughing to crying in quick succession.  The parent ultimately feels the baby is tired yet wont sleep!
• Struggle to stay asleep - all babies have periods of unsettled sleep, for DBB's it's consistent and persistent month after month and comes with other signs here (as mentioned above babies can have unusually disturbed sleep for other reasons).  Baby may show signs of exhaustion with purple/blue bags appearing under eyes (whilst this may be a sign of food intolerance, lack of sleep will give you them too!) yet still no longer naps or stretches appear.  In fact often the more tired a DBB becomes, it seems the less they sleep!
• Co-sleeping makes no difference - baby still consistently wakes 1-2 hourly, it's likely to be more bearable but DBB's may want to be awake and playing in the middle of the night, regardless of where they are.  Others have an intense sucking need and are described as "Velcro babies who would stay permanently attached given a choice."
• Constantly moving - sit and watch a DBB and you will note they never keep still, even when tired  they do not relax.  A leg may be bouncing, an arm wiggling - but they're in some way always constantly on the move when not asleep.
• Mum feels baby is tired - some mums will acknowledge their baby isn't sleeping the huge stretches many mainstream books state they will, but that they are happy, settled and content with the sleep they are receiving.  Others though have a gut feeling their baby is just not getting enough sleep and desperately want to help them sleep better.
• Baby is very sensitive to mum's emotions - something I've noticed is that if you take an already tense baby, and you add a tense/frustrated mum, a lot of DBB's will become even more tense/unsettled and will struggle even more to settle; for some even just laying there willing baby to sleep seems to be enough to unsettle them!  If you're beginning to feel this way & are holding baby "change of arms" can help IE passing to partner can work, if no spare arms available laying down next to them on your bed or suchlike can be an alternative.  If you're "sleep willing", try and do some relaxation/breathing exercises yourself (great to teach DBB if they're still struggling in toddler hood too) to clear your mind and truly relax yourself, and you can sometimes be amazed how quickly this will help baby to settle too.  If all else fails taking a shower with baby is something many mums comment can be a good stress buster if home alone.
• May cry before sleep or upon waking - especially if tired, some DBB can seem prone to almost needing to cry to settle and again when waking ie they wake fussy and grumpy not happy and well rested.  Parents sometimes say he cries whether I'm holding him or not so I may as well put him down, but crying in arms is very different to crying alone.

Identifying why your baby is struggling to relax is perhaps the hardest piece of the puzzle because it can be several causes or just one, so finding someone to help work through things can be difficult; reasons can range from an undiagnosed tongue tie, food sensitivities, cranial or structural discomfort from birth and so on.  Something I believe can help these babies in the meantime is.....wait for it......*whispers* a rough sleep routine *sharp intake of breath".

Before you hit close hear me out!

Just because baby doesn't show sleep cues, doesn't mean they don't have a window of time in which it is easier for them to settle to sleep.  Some studies have suggested when a baby becomes overtired their bodies produce adrenalin and other "stay awake" chemicals, which is why they can appear to become suddenly energetic.

My own Duracell bunny had a predictable wake up time - OK so it was 5am, but it was predictable.  By playing with the gap from wake up to sleep, rather than watching her cues - I found trying to assist sleep at a particular time had more success than others; with the highest success rate before she showed any sleepy cues at all (the window was so small from this to overtired, she didn't get the "wind down" time she needed).  I started with the morning nap and then worked my way through the day, once I had a rough idea of times I then adjusted accordingly this based on how well she had napped earlier.

Of course the easiest way to do this with a younger baby is sling wearing - most sleep in a sling so they are "in position" for when they start to become tired.  Contact and movement can help many DBB's relax (some resist contact and the sling and arch away) and with many carriers a small adjustment can be made to manoeuvre material, and help cut out visual stimulation for baby (which some DBB seem to really need).  Some slightly older babies seem to prefer a back ride to a front carry; resting their head sideways on the wearers's back to nod off.

If this isn't possible/doesn't work/baby is older and wants to be down playing -  you can try putting baby in the sling at what you've worked out as the "optimum times".  Despite what any book tells you this will be variable for each baby. As an example when my daughter was taking three naps, she needed to be relaxed and ready to sleep two hours after she woke for the first sleep, despite books etc saying she should have a longer gap for her age.  

Clock watching is a total pain - if you have a baby that is happy without, I wouldn't recommend it to anyone!  But if you're struggling it's something you can try and which may help a little..

The last thing I would add is that the DBB can easily seem to get stuck in a cycle when overtired, the less sleep they get, the more frequently they wake.

Something that can sometimes help is "sleep cramming", which is doing anything and everything that works to maximise sleep for a day or two IE laying down with them when they nap, feeding them back off if they stir (and you're breastfeeding) long walks in the sling/pram.  Sometimes helping them catch up during the day can pay dividends at night/early morning wake up time - but with some it can be easier said than done.  White noise, reducing stimulation eg colours, sounds etc can also help "switch off", whilst I would never endorse baby napping in a dark quiet space as important (it's oftenblooming inconvenient)- for some DBB in my experience it does make a big difference; in my daughter even encouraging her to turn and face the wall instead of gazing around her room had a dramatic effect.

Above all remember your baby is not waking to manipulate you or because of anything you have (or haven't) done.   They're not trying to be spirited, or "high needs", or challenging, or whichever term you prefer to use,    in fact they're just as bewildered as you (if not more so).  Instead of being left to cry or trained, these babies in fact need more understanding and sensitivity than your average bear; whilst I've met many mothers who have regretted not responding more, I'm yet to meet one who wishes they had responded less - regardless of what the mainstream books say.

The Dangers Of Demonising Bed Sharing

To bed share or not to bed share - this is the question that is often hotly debated on parenting forums.  Guidelines often state "in a different bed in the same room", ie no sharing; which would appear to support the notion it's generally a risky business.

However what is the evidence behind these guidelines?  Explore it (including new research out this month) and we find a very different and more detailed picture about infant sleep; hence debate ensues.

The trouble is that just like the starting solids guideline - official recommendations have to be a short snappy piece of information that everyone can understand.  A guideline cannot be detailed, discuss different risk factors and provide information so parents can review and act accordingly.

Therefore don't bedshare is considered a "key" message.  A fact FSID don't dispute.

Joyce Epstein, director of FSID, says:

 "If you can get people's attention for more than three seconds you would like to give the whole story every time, but at what point do you lose everybody?"

But I'm not sure the message is actually all that safe - and here's why....

This is what the AAP guidelines actually state if you go beyond the bullet points:

"Bed Sharing 

There are some reports of infants being suffocated by overlying by an adult, particularly when the adult is in an unnaturally depressed state of consciousness, such as from alcohol or mind-altering drugs. Co-sleeping on sofas has emerged as a major risk factor in 1 study. 

Others have shown bed sharing with multiple family members in an adult bed to be particularly hazardous for the infant. Although overlying may be the mechanism in some of these cases, soft sleep surfaces, entrapment, and the likelihood of rolling to the prone position in such circumstances also may have a role. 

The risk of SIDS associated with co-sleeping is significantly greater among smokers.  Some behavioral studies have demonstrated that infants have more arousals and less slow-wave sleep during bed sharing, but no epidemiologic evidence exists that bed sharing is protective against SIDS. (remember the bold bit I will come back to that in a moment)"

But is there any evidence at all to suggest an infant is more likely to turn prone when co-sleeping than when in a cot?  Why don't the AAP tell us what the actual risks of co-sleeping are in a prepared environment ie not on a soft sleep surface (ie waterbed/pillows and heavy bedding near baby) no risks of entrapment/entanglement, no drugs/alcohol, no unplanned cosleeping ie mum falling asleep sitting up, baby next to mum alone and not in the middle of a family bed AND exclusively breastfeeding - where are these figures?

Now scroll down the AAP guidelines to "Proposed Mechanisms of SIDS":

"It is generally accepted that SIDS may be a reflection of a variety of causes of death. A leading hypothesis for a large proportion of SIDS cases is that SIDS may reflect a delayed development of arousal or cardiorespiratory control."

and

"The hypothesis is that certain infants, for reasons yet to be determined, may have a maldevelopment or delay in maturation of this region, which would affect its function and connectivity to regions regulating arousal. When the physiologic stability of such infants becomes compromised during sleep, they may not arouse sufficiently to avoid the fatal noxious insult or condition."

Right - but as nobody has done an epidemiological study to prove bedsharing is protective (remind me again where the studies are proving cot sleeping is protective?  Wasn't SIDS called cot death for long enough?), we don't acknowledge any link here? Has there been a a study proving safe bedsharing isn't protective?

Just this month a study published in Biological Psychiatry found:

"Heart rate variability in 2-day-old sleeping babies for one hour each during skin-to-skin contact with mother and alone in a cot next to mother's bed. Neonatal autonomic activity was 176% higher and quiet sleep 86% lower during maternal separation compared to skin-to-skin contact."

In basic terms this means separating mother and baby caused significantly more "anxious arousal" and less "quiet sleep".

Dr Bergman, co-author states:

"What is desirable for newborns is to have 'sleep cycling,' which means an even distribution between active sleep and quiet sleep, in periods of about one hour," 

"In our study, sleep cycling in separated babies was mostly absent, and in six of 16 babies that did show some quiet sleep when separated, it was shorter and shallower."

The scientists also noted concern that the disrupted sleep patterns and stress to the heart could make it difficult for them to form relationships.

This research addresses a strange contradiction: In animal research, separation from mother is a common way of creating stress in order to study its damaging effects on the developing newborn brain.

Dr Bergman added:

"When babies are smothered and suffer cot deaths, it is not because their mother is present.  It is because of other things: toxic fumes, cigarettes, alcohol, big pillows and dangerous toys."

 Dr. John Krystal, Editor of Biological Psychiatry, commented on the study's findings:

 "This paper highlights the profound impact of maternal separation on the infant. We knew that this was stressful, but the current study suggests that this is major physiologic stressor for the infant."

This larger study echoes what Dr Sears found when he conducted a very small experiment of his own:

"Our study revealed that Lauren breathed better when sleeping next to Martha than when sleeping alone. Her breathing and her heart rate were more regular during shared sleep, and there were fewer "dips," low points in respiration and blood oxygen from stop-breathing episodes. On the night Lauren slept with Martha, there were no dips in her blood oxygen. On the night Lauren slept alone, there were 132 dips. The results were similar in a second infant, whose parents generously allowed us into their bedroom."

Dr Mckenna has written extensively on the subject as to why he feels infants are more at risk sleeping alone - yet mainstream media and literature barely gives a nod to these significant findings.

He states:

"Mechanical breathing teddy bears placed next to apnoea-prone human newborns, which replicate what the mother’s body provides, have the effect of reducing infant apnoeas sometimes by as much as 40–60%, in addition to physically drawing infants to sleep next to them.39

Many studies similarly show that infant mammals, including human infants, appear to be pre-sensitised to receive sensory signals linking them to a co-sleeping partner.40–43  All have been shown to change infant physiology, including heart rate and breathing patterns including increased arousals yet the cessation of excessive night-time crying.

Until recently, all human infants experienced access to at least one cosleeping adult body, usually the mother 45,46 so it is not surprising that maternal contact stimulates a variety of significant ‘hidden regulatory processes’ that are clinically advantageous to infants."

Dr Mckenna has also noted the mother's sleep patterns differ when separated from her infant:

"We found that bed-sharing infants face their mothers for most of the night, and that mother and infant are highly responsive to each other's movements, wake more frequently, and spend more time in lighter stages of sleep than they do while sleeping alone.  Co-sleeping makes it easier for a mother to detect and respond to an infant in crisis."

Interestingly mum also hits more restful sleep phases for longer.

So here we have internationally recognised doctors (not just a random unqualified baby tamer who has written a book) stating actually co-sleeping may be protective against SIDS.  That cot sleep may in fact be more risky?

This all seems rather a far cry from "don't bedshare" doesn't it?

However, people are comfortable demonising bed sharing....

On 14th July 2009 here is what hit the news:

"Co-sleeping dangers.  54% of cot deaths due to co-sleeping! More than half of cot deaths happen when a baby is sleeping with a parent, a study has revealed."

At a glance that leaves many parents content they use a cot and off they go..

But even if we take this statement at face value and look no further - it's surely immediately obvious that if 54% of infants were co-sleeping, 46% were in a cot?  Hardly a compelling demonstration of cot safety?

The professor involved with this study was not happy at the headlines however. He hit back in a Guardian article days later. They reported:

"Yes – the study found that 54% of cot deaths occurred while the baby was co-sleeping with a parent. But although the risk was strong if they had crashed out on the sofa, it was only significant among those in a bed if the parent had drunk more than two units of alcohol or had been taking drugs."

Professor Fleming himself commented:

"You can say that half the deaths occurred while babies slept with their parents. You could also say that half the deaths occurred while babies were alone in their cots, he says, but: "I don't see anybody saying, 'Don't put your baby in a cot.'"

Quite!

When babies are shown to have suffocated due to a fabric comforter - the guidelines are updated to say don't use comforters.  Ditto cot bumpers and duvets/pillows under one year old.  Yet when a baby has been shown to become entangled and suffocated on inappropriate bedding when bedsharing, the guideline isn't "address the problem",  but "don't bedshare!"

There is also an underlying assumption cots are safe. This article highlight two strangulation deaths of infants with the electrical cords from baby monitors. This the risk of blind cord strangulation when unsupervised (including in cots) I have read stories of babies pulling heavy or dangerous items in on top of themselves, or worse this poor boy who died after becoming entrapped when climbing out.  Yet nobody ever suggests not using a cot, instead parents are advised to ensure appropriate measures are taken to make the area safer.

Furthermore going back to the study, if only 54% were co-sleeping to start with, once you remove known risk factors and compare the revised figure with those sleeping in a cot, the picture is very different.

What's really interesting is that same study found ONE QUARTER of infants were swaddled. A whole 25% - yet where was the news article highlighting this? Why are popular parenting books who are so anti cosleeping, still promoting swaddling without any mention of this? (nor is this the only study that has demonstrated a link as the second half of this article highlights)

Even if we move the debate away from the simple argument of which location is safer in terms of statistical outcome. We also need to consider the knock on effect, and therefore possible risks associated with where parents place their baby to sleep.

We know that when we tell parents co-sleeping is unsafe, many decide their baby will sleep in a cot. The very real danger with this is that a parent falls asleep sitting up in bed, or on a sofa. Something the above study found was a massive risk factor with regard to SIDS. Every parent of course believes they would never fall asleep when feeding - yet nature delivers a huge hit of sleepy hormones when mum breastfeeds (strange if mum isn't supposed to be sleeping on the job ;)) and despite best intentions many many mums report accidentally falling asleep - including myself (who didn't co-sleep due to ignorance and official guidelines with my first).

One mum commented she had to play with her iphone to ensure she stayed awake, others try moving from bed to an upright chair to prevent temptation.

The knock on effect of this may be minimal if you have a baby who only rouses infrequently.  Throw a frequent waker into the mix however and there is a good chance the mum will a) become overly tired which in itself is listed as a SIDS risk, b) give up breastfeeding believing she needs more sleep to function than the current (PITA) night ritual provides.

Yet not breastfeeding is not only linked with SIDS but other significant health outcomes too.  In fact the one significant risk factor the vast majority of studies fail to adjust for is feeding method ie breastfed, breastmilk or formula.  Those that have demonstrate a compelling link - therefore any that do not, are potentially fundamentally flawed from the start?  The definitions of co-sleeping and bedsharing are often blurry, known risk factors not adjusted for and so are parents really getting the big picture?

Professor Fleming shares the same concerns with regard to the "no bedshare" message::

"The study showed that sleeping with the baby on a sofa really is a risk. Yet seven of the parents whose baby died say they had gone to the sofa to feed, aware that bedsharing is said to be dangerous, and had fallen asleep.

Any advice to discourage bedsharing may carry with it the danger of tired parents feeding their baby on a sofa, which carries a much greater risk than co-sleeping in the parents' bed," 

To sum up a quote from Dr Mckenna:

"The possible hazards of co-sleeping must be assessed. Is the environment otherwise safe, with appropriate bedding materials? Do the parents smoke? Do they use drugs or alcohol? (These appear to be the main factors in those rare cases in which a mother inadvertently smothers her child.) Since co-sleeping was the ancestral condition, the future for our infants may well entail a borrowing back from ancient ways."

  UNICEF Bedsharing Guidelines