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Safe Infant Sleep: Expert Answers To Your Cosleeping Questions, A New Book

An Excerpt from the New Book by James McKenna, PhD

About the book

In Safe Infant Sleep, the world’s authority on cosleeping breaks down the complicated political and social aspects of sleep safety, exposes common misconceptions, and compares current recommendations to hard science. With the latest information on the abundant scientific benefits of cosleeping, Dr. James J. Mckenna informs readers about the dangers of following over-simplified recommendations against the age-old practice, and encourages parents to trust their knowledge and instincts about what is and is not safe for their baby.

This book offers a range of options and safety tips for your family’s ideal cosleeping arrangement. These include variations of roomsharing and bedsharing, and introduce the concept of “breastsleeping.” This term, coined by Dr. McKenna himself, is based on the inherent biological connection between breastfeeding and infant sleep, and provides readers with everything they need to know about safely sharing a bed with their baby. Complete with resource listings for both parents and professionals, this book teaches you how to confidently choose a safe sleeping arrangement as unique as your family.

Below You Can Read a Note from the Author, and Chapter One of Safe Infant Sleep

A Note from the Author, James McKenna, PhD

The question of whether or not to sleep with your baby is complicated. It does not lend itself to easy answers or catchy slogans. As new parents, you are typically faced with cosleeping conundrums in the middle of the night when exhaustion is high, and what works for your family may conflict with what you have been taught about sleep safety by your pediatrician. In addition, there are racial, class, social, and political biases that run through cosleeping data, and the advice you get from many healthcare providers is often based on accepted practice instead of accurate, evidence-based research. 

It is a shame that new parents need to read an entire book just to be able to sleep soundly at night, but this seems to be the case. When it comes to sleep, knowing what you are doing and why you are doing it can help everyone feel well-rested, provide physical and emotional benefits for babies, and even save lives. 

Parents ask me for advice all the time, and it is hard to give it because each home is different, each set of parents has different goals, and each child has different needs. I want each family to make the decision that is appropriate for them. I ask that you take the time to read this entire book to fully understand the topic, as well as your options, so you can make safe, informed choices. 

While I have tried to provide comprehensive information and varied perspectives, you may notice as you read that there are many questions remaining that have yet to be researched. Humans can be complicated. When it comes to family sleep, there are a plethora of sleeping arrangements and outside factors that can affect sleep safety. It is frustrating to me that some of the questions parents ask simply do not have answers yet. 

It is up to influential health organizations to decide which questions are worth investigating and, by extension, which research projects deserve funding in order to find answers. When the subject is controversial, like bedsharing or other infant sleep issues, these decisions are subject to systemic bias. Unfortunately, research priorities are based on a flawed infant sleep paradigm that is inherently in conflict with cosleeping, so these organizations tend to ignore the many questions we still have about how to cosleep safely. Most studies simply aim to find evidence that validates the views of those making the decisions. 

Part of the goal of this book, which encourages nonjudgmental discussions about cosleeping, is to open the door for future studies by encouraging health professionals to make the process of deciding research priorities more inclusive. It is my hope that public health authorities will one day be able to address the many questions we still have, and, in doing so, be able to provide the best possible recommendations tailored to individual families. 

The biggest question on your mind at the moment is likely, “Where should my baby sleep?” I hope you will not be disappointed to find that I can’t answer that question for you, and neither can any pediatrician, healthcare institution, or researcher. This decision is only yours to make, and should be based on a thorough understanding of the risks and benefits, your overall family circumstances, and the parameters of your sleep space. External medical authorities don’t know you, your infant, or the needs, wants, and values of your family. 

My sincere hope is that the information provided here will place you in the best possible position to decide the answer of where your baby should sleep for yourself. If this book leads you to understand that you and your family will come to know your baby better than anyone, and that your baby will ultimately teach you what he or she needs to make him or her (and you) healthier and happier, I will view it as a success. 

Safe Infant Sleep, An Excerpt

Part One: Cosleeping Is Normal

Chapter One, Why I Care So Much About This Subject

“There is no such thing as a baby, there is a baby and someone.” 
—Donald W.Winnicott

Many of my friends find it amusing that I spend almost all my waking hours studying what people do when they sleep. It’s true. What people do when they’re asleep fascinates me—and not just people in general, but families in particular. At the University of California, Irvine Medical Center, and as Director of the Mother- Baby Behavioral Sleep Laboratory at the University of Notre Dame, my students and I have had the privilege of documenting information about infant sleep through infrared video recordings and physiological monitoring of mothers and infants sleeping both together and apart. 

Watch Kindred’s New Story Video Collection featuring James McKenna, PhD, on Cosleeping’s Science, History, Public Policy and Parents’ Civil Rights.

Our research was not just for the sake of gathering knowledge, but for helping mothers and infants sleep better, thrive physically and emotionally, and stay as safe as possible no matter where or how they choose to sleep. 

When it comes to parenting, new moms and dads are flooded with conflicting advice from family members, well-meaning friends, medical professionals, the media, the government, and, of course, from other parents. The vast majority of parents want to do what is best for their children, yet this bombardment of information implies that parental wisdom and the capacity of parents to make their own informed decisions is somehow out of their grasp. It’s as if everyone knows exactly what is best for your baby except for you! 

It is not my intention to tell you what to do or how your infant should sleep. British author Christina Hardyment wrote: “Telling mothers and fathers how to bring up their children in books is arguably as silly as sending false teeth through the post and hoping they fit.”

I would never wish to give you ill-fitting teeth, and I certainly don’t wish to give you ill-fitting rules for how to be a good parent, as all families and their circumstances are different. What is good for one family may not be good for another. The purpose of this book is to provide the best information available  in order to help you make your own choice about what sleeping arrangement will be the safest and most beneficial for your family. 

One size does not fit all when it comes to sleeping arrangements.

My wife Joanne and I entered the world of parenting with the birth of our son, Jeffrey, in 1978. Anxious about our new set of responsibilities, we read book after book on parenting. We are both anthropologists and we were quite taken aback at what we found in the childcare literature. When it came to what the experts had to say about feeding patterns and sleeping arrangements, either all our research and training about the universal aspects of human life were wrong, or the pediatric experts were missing or ignoring key information concerning what infants need the most: specialized nutrition from breastmilk, and sustained physical contact both day and night. 

Not only was there nothing in the childcare books that reflected what we know about our primate heritage and sleeping arrangements, there was also nothing that reflected current research on human infant biology and the role that maternal touch plays in promoting infant growth and well-being. We learned that infant care recommendations were not based on empirical laboratory or field studies of infants at all, nor on cross-cultural insights as to how human babies actually live around the world.

Rather, they were based on 70- or 80-year-old cultural ideas, uniquely Western and historically novel. Recommendations followed the social values of mostly male physicians who not only had never changed a diaper, but had never—in any substantial way—associated with, or taken care of, their own infants. These “parenting experts” preferred to define babies in terms of who they wanted the infants to become, and decided what was good for infants based on recent and sometimes arbitrary social values, such as autonomy and independence. They should have been thinking in terms of who infants actually are—little creatures who are very much dependent physiologically, socially, and psychologically on the presence of a caregiver to an unprecedented degree and for an unprecedented length of time compared to other mammals. 

The more we delved into the history and research of infant sleep recommendations, the more we discovered that the prevailing childcare wisdom had little basis in science whatsoever.

This discovery changed my career. 

When you look at the prevalence of cosleeping in the mammal world, and among different cultures and in different eras of human history, it is clear that cosleeping is universal through time and is practiced far and wide in many different ways. 

For hundreds of thousands of years, up to and through our early historic periods, breastfeeding mothers have practiced what Dr. Lee Gettler and I call breastsleeping. Breastsleeping is our new term and concept for the highly integrated system of healthy infant sleep combined with healthy breastfeeding behavior.

The practice of breastsleeping consists of sleeping next to one’s primarily breastfed baby, and lying the infant on his or her back for sleep (which facilitates breastfeeding). This is such a universal and widespread practice that most parents worldwide couldn’t imagine asking where the baby should sleep, whether it is okay to sleep with the baby, what position the baby should sleep in, and how the baby should be fed.

My anthropological training, as well as my own intuition, told me that something this common had to be beneficial, but it has only been through extensive and rigorous scientific study that we have determined why this proves to be the case. 

Breastsleeping is our new term and concept for the highly integrated system of healthy infant sleep combined with healthy breastfeeding behavior.

During the ’90s at the University of California Irvine School of Medicine Sleep Disorders Laboratory, my colleagues Drs. Sarah Mosko, Chris Richards, Claiborne Dungy, Sean Drummond, and I conducted the first research on the physiology and behavior of breastsleeping mothers and babies.

In one intensive three-year study, we examined infant and maternal sleep architecture, nighttime breastfeeding and its relationship with bedsharing, and the differences between infants who cosleep in the form of bedsharing and infants who sleep alone in separate rooms. 

Our two preliminary studies, and subsequent related studies, employed rigorous scientific methods and analysis; our grant proposal earned a near-perfect score from one the most exclusive scientific grants in the U.S., offered by the National Institute of Child Health and Human Development (NICHD). We were also awarded the prestigious Shannon Award from the NICHD for our proposal’s innovations and scientific promise. The research papers were then accepted by some of the most well-respected medical journals in the world. 

Nighttime behavioral studies have continued at the University of Notre Dame Mother-Baby Behavioral Sleep Laboratory, where we have clearly demonstrated the special abilities of both low- and high-risk mothers to respond to their infants’ needs while breastsleeping. Over time, other scientists began to study these same issues, affirming the validity of our research while adding many new insights.

Watching the peaceful sleep of an infant, it may appear that not much happens while they are snoozing; the infant’s body simply requires downtime several times each day. And, yes, downtime functions to help one regain energy, but much more is going on. During sleep, all manner of physical and neurological processes, including developing inter-connections between new cells, are taking place. While infants sleep, the brain is sorting out how many and which brain cells will be retained, and where in the brain they need to go. This affects memory formation as well as intellectual, emotional, and psychological aspects of development. 

During the first three to four months of life, the prefrontal cortex is invaded with young neurons taking shape and finding their place based on what the infant experiences on a daily basis.18 The young brains of human infants need to “prune,” or reduce, the nutrient demand of cells that don’t seem to be used very often, so that vital nutrients can be shifted to more active cells. Your baby’s engagements with you, even in this early time, are as developmentally important as going to school. They are learning and shaping their brains every step of the way, even while they sleep. 

Without stimulation from contact and social interactions— including nighttime sensory exchanges—neonatal brain cells are potentially lost forever. This has led some developmental psychologists to argue that infants are far more threatened by what they do not receive in terms of neurological excitation than by what they do receive, since “pruned” infant brain cells are not retrievable at a later date. Minimizing contact with the mother’s body can make an infant’s neurological scaffolding less stable and effective, weakening the structures that provide the basis for the infant’s rapidly growing communication skills, emotionality, and ability to effectively regulate and respond to his or her own needs.

It is unfortunate that, in light of all of this new information, parents who sleep with their infants are often considered needy or deficient, or sometimes even irresponsible, by medical authorities. When we hear about babies who do not or cannot sleep alone through the night, rarely do we hear: What a good baby! even though that is exactly what is in a human infant’s biological best interest. 

The good news is that, as of 2016, the American Academy of Pediatrics (AAP) recommends that infants never sleep in separate rooms from their caregivers. The bad news is that they argue against sleeping in the same bed. Herein lies the controversy. 

I wrote my first book on cosleeping in 2007, and now I want to offer an updated version with a bit more science in it. I want to share with you what I (and others) have learned about various forms of cosleeping and breastfeeding in the years since then, and why a combination of the two refuses to go away in spite of anti- bedsharing recommendations. I want families to understand how much happens during cosleeping, including critical communication between infants and mothers (and other caregivers) through touch, scent, sound, and taste. This unconscious sensory communication is part of the way our species has evolved to maximize health and survival. It is likewise an intrinsic part of the way parents communicate and experience love for and with their infants and each other. A baby sleeping on his or her own, outside the supervision of a caregiver, is deprived of this vital communication and, as scientific studies prove, is at risk on many different levels. 

Cosleeping is not only normal, common, and instinctive, but it can also be in the best interest of a family when it is adopted for purposes of protecting and nurturing infants, when safety is given priority, and when the right kind of cosleeping is chosen for and by each unique family. 

That being said, one cannot be naïve regarding the different ways in which people live. Families make different decisions and things don’t always go according to plan. Good intentions can be waylaid by fatigue and shifting circumstances. While the ideal cosleeping environment is an exclusively breastfeeding mother sleeping on a flat surface that has been maximized for safety (we’ll dig into this later), this ideal is not always the reality. There is no guarantee that anything we do with infants will necessarily be done in a safe way. Cosleeping in the form of bedsharing is no different. It is quite true that bedsharing can be practiced in ways that are dangerous. Bedsharing is generally a more complex and less stable practice than crib sleeping, which itself has both advantages and disadvantages for babies.  

I want to teach families to avoid known risks in any sleeping arrangement. Being aware of where dangers lie and what can and cannot be modified is critical. One size 

does not fit all when it comes to sleeping arrangements, and where households exhibit risk factors for dangerous bedsharing, I encourage alternative sleep practices. 

No sleep environment is completely risk free, but the fact that a bedsharing environment cannot be made 100% risk free is no more an argument for a global recommendation against all bedsharing than it is an argument for a global recommendation against all crib sleeping—because crib sleeping incurs risks too, evidenced by the continuing epidemic of Sudden Infant Death Syndrome (SIDS). 

To use a different example, consider that thousands of people die from choking while eating every year, even though eating is normal, common, and instinctive. In order to minimize the risks, adults are not advised to stop eating (which would be silly) but instead are instructed to learn the Heimlich maneuver, as well as specialized food preparation and feeding techniques for young children. Similarly, we learn with great effort how to properly use and place infants in car seats, yet many babies die each year in cars due to some parents’ disregard for ways to minimize car travel risks. Still, it would be impractical and unreasonable to ban automobile transportation for children altogether. 

This book is intended to provide a balanced, comprehensive, and holistic perspective on cosleeping and bedsharing. It is intended to provide safety information and reassurance to those families who are considering or who currently choose to sleep with their babies. Enjoying every minute with your baby—whether you are awake or asleep—is important. Though it might not seem like it at first, our time with them is very short. 

I hope that this book will enable you to feel comfortable holding, carrying, and responding to your baby, and will help you feel good about your caregiving choices. I know I am not alone in wanting to help you and your family thrive and enjoy experiences that can be cherished forever. 

My intention is not to convince everyone to bedshare. The point is simply that the real answer to the question of whether or not any particular family should bedshare is always: It depends. While it is safe and appropriate to recommend that no infant should sleep alone in a separate room from an adult caregiver, this is just the starting point. Beyond that, there are many factors to consider before choosing a sleeping arrangement. I hope this book will give you the specific knowledge you need to make an informed decision, as well as the confidence to assess your conditions and circumstances in order to choose both what feels right and is safe for you and your family. 

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