Co-sleeping or bed sharing is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. Co-sleeping individuals sleep in sensory proximity to one another, where the individual senses the presence of others. [1] This sensory proximity can either be triggered by touch, smell, taste, or noise. Therefore, the individuals can be a few centimeters away or on the other side of the room and still have an effect on the other. [1] It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used.
Bed-sharing, a practice in which babies and young children sleep in the same bed with one or both parents, is a subset of co-sleeping. Co-bedding refers to infants (typically twins or higher-order multiples) sharing the same bed. [2]
Whether cosleeping or using another sleep surface, it is considered important for the baby to be in the same room as an adult, committed caregiver for all sleeps — day and night — in early life. This is known to reduce the risk of SIDS by 50 per cent. Some organizations such as Red Nose Australia recommend this for the first 12 months of life and others such as the NHS recommend it for the first 6 months.
Bed-sharing among married couples is standard practice in many parts of the world outside of North America, Europe and Australia, and even in the latter areas a significant minority of children have shared a bed with their parents at some point in childhood. One 2006 study of children age 3–10 in India reported 93% of children bed-sharing [3] while a 2006 study of children in Kentucky in the United States reported 15% of infants and toddlers 2 weeks to 2 years engage in bed-sharing. [4]
Bed-sharing was widely practiced in all areas up to the 19th century, until the advent of giving the child his or her own room and the crib. In many parts of the world, bed-sharing simply has the practical benefit of keeping the child warm at night. Bed-sharing has been relatively recently re-introduced into Western culture by practitioners of attachment parenting. Proponents hold that bed-sharing saves babies' lives (especially in conjunction with nursing), [5] [6] promotes bonding, enables the parents to get more sleep and facilitates breastfeeding. Older babies can breastfeed during the night without waking their mother. Opponents argue that co-sleeping is stressful for the child when they are not co-sleeping. [7] They also cite concerns that a parent may smother the child [8] or promote an unhealthy dependence of the child on the parent(s).
Because children become accustomed to behaviors learned in early experiences, bed-sharing in infancy will also increase the likelihood of these children to crawl into their parent's bed in ages past infancy. [9]
Health care professionals disagree about bed-sharing techniques, effectiveness, and ethics. [10] However, safe cosleeping and bedsharing guidelines can be found on Lullaby Trust, where as organisations such as UNICEF outline the primary factors leading to hazardous cosleeping.
Traditional and cultural bedsharing and caregiving practices have also been found to reduce risk of SIDS for certain populations. [11] But this is found to be opposite in others, increasing deaths categorised within SUDI.
There are certain dangerous behaviors that increase SIDS and should be avoided whether placing a baby in a crib or co-sleeping: infants should always sleep on their backs on a firm surface (not waterbeds, pillows, recliners, or couches), mattresses should intersect the bedframe tightly, there should be no stuffed animals or soft toys near the baby, blankets should be light, a baby's head should never be covered, and other SIDS risk factors should be avoided. [12] In addition some parents pose threats to infants due to their behaviors and conditions, such as smoking or drinking heavily, taking drugs, a history of skin infections, obesity, or any other specific risk-increasing traits. [10] [13]
Co-sleeping also increases the risks of suffocation and strangulation. The soft quality of the mattresses, comforters, and pillows may suffocate the infants. [9] Some experts, then, recommend that the bed should be firm, and should not be a waterbed or couch; and that heavy quilts, comforters, and pillows should not be used. Another common advice given to prevent suffocation is to keep a baby on its back, not its stomach. [13] Parents who roll over during their sleep could inadvertently crush and/or suffocate their child, especially if they are heavy sleepers, over-tired or over-exhausted and/or obese. [13] There is also the risk of the baby falling to a hard floor, or getting wedged between the bed and the wall or headboard. A proposed solution to these problems is the bedside bassinet, in which, rather than bed-sharing, the baby's bed is placed next to the parent's bed. [9]
Another precaution recommended by experts is that young children should never sleep next to babies under nine months of age. [14]
A 2008 report explored the relationship between ad hoc parental behaviors similar to traditional co-sleeping methodology, though the study's subjects typically utilized cribs and other paraphernalia counter to co-sleeping models. While babies who had been exposed to behaviors reminiscent of co-sleeping had significant problems with sleep later in life, the study concluded that the parental behaviors were a reaction to already-present sleep difficulties. Most relationships between parental behavior and sleeping trouble were not statistically significant when controlled for those preexisting conditions. Further, typical co-sleeping parental behavior, like maternal presence at onset of sleep, were found to be protective factors against sleep problems. [15]
Co-sleeping can often be regarded as an unnecessary practice that can be associated with issues such as sudden infant death syndrome (SIDS). [16] [17] However, research shows that opinions vary in the association between SIDS and co-sleeping. [1] [18] The most controversial issue regarding SIDS is whether bed sharing is a main cause, and whether it should be avoided or encouraged. [1]
Some research indicates that SIDS risk increases with co-sleeping, particularly bed-sharing; [16] [17] other research indicates that co-sleeping done in an "appropriate and safe" manner reduces SIDS risk. [1] [18] As an example of the latter, the Pacific Islands Families study, conducted in New Zealand, indicated that the adoption of safe bed-sharing and room-sharing practices were saving infant lives, and found no examples of an infant dying from SIDS. [18]
One study reported mothers getting more sleep and breast-feeding by co-sleeping than other arrangements. [19] Parents also experience less exhaustion with such ease in feeding and comforting their child by simply reaching over to the child. As a result, co-sleeping also increases the responsiveness of parents to their child's needs. [9]
It has been argued that co-sleeping evolved over five million years, that it alters the infant's sleep experience and the number of maternal inspections of the infant, and that it provides a beginning point for considering possibly unconventional ways of helping reduce the risk of sudden infant death syndrome (SIDS). [5] [6] [20]
Stress hormones are lower in mothers and babies who co-sleep, specifically the balance of the stress hormone cortisol, the control of which is essential for a baby's healthy growth. [21] [22] [23] In studies with animals, infants who stayed close to their mothers had higher levels of growth hormones and enzymes necessary for brain and heart growth. [24] [25] Also, the physiology of co-sleeping babies is more stable, including more stable temperatures, more regular heart rhythms, and fewer long pauses in breathing than babies who sleep alone. [26] [27]
Besides physical developmental advantages, co-sleeping may also promote long-term emotional health. In long-term follow-up studies of infants who slept with their parents and those who slept alone, the children who co-slept were happier, less anxious, had higher self-esteem, were less likely to be afraid of sleep, had fewer behavioral problems, tended to be more comfortable with intimacy, and were generally more independent as adults. [28] [29] [30] [31]
There are several products that claim they can be used to facilitate safe co-sleeping with an infant however these claims are not evidence based:
A study of a small population in Northeast England showed a variety of nighttime parenting strategies and that 65% of the sample had bed-shared, 95% of them having done so with both parents. The study reported that some of the parents found bedsharing effective, yet were covert in their practices, fearing disapproval of health professionals and relatives. [34] A National Center for Health Statistics survey from 1991 to 1999 found that 25% of American families always, or almost always, slept with their baby in bed, 42% slept with their baby sometimes, and 32% never bed-shared with their baby. [35]
Initial assumptions on co-sleeping may place it in a context of income and socioeconomic status. Generally, families of low socioeconomic status will be unable to afford a separate room for a child while those of high socioeconomic status can more easily afford a home with a sufficient number of rooms. [9] However, statistical data shows the prevalence of co-sleeping in wealthy Japanese families and the ability of poor Western families to still find a separate space for their child, suggests that the acceptance of co-sleeping is a result of culture. [36]
Several studies show that the prevalence of co-sleeping is a result of cultural preference. In a study of 19 nations, a trend emerged, depicting a widely accepted practice of co-sleeping in Asian, African, and Latin American countries, while European and North American countries rarely practiced it. [37] This trend resulted mostly from the respective fears of parents: Asian, African, and Latin American parents worried about the separation between the parents and the child, while European and North American parents feared a lack of privacy for both the parents and the child. [9]
Sudden infant death syndrome (SIDS), sometimes known as cot death or crib death, is the sudden unexplained death of a child of less than one year of age. Diagnosis requires that the death remain unexplained even after a thorough autopsy and detailed death scene investigation. SIDS usually occurs during sleep. Typically death occurs between the hours of midnight and 9:00a.m. There is usually no noise or evidence of struggle. SIDS remains the leading cause of infant mortality in Western countries, constituting half of all post-neonatal deaths.
An infant or baby is the very young offspring of human beings. Infant is a formal or specialised synonym for the common term baby. The terms may also be used to refer to juveniles of other organisms. A newborn is, in colloquial use, an infant who is only hours, days, or up to one month old. In medical contexts, a newborn or neonate is an infant in the first 28 days after birth; the term applies to premature, full term, and postmature infants.
Nocturnal enuresis (NE), also informally called bedwetting, is involuntary urination while asleep after the age at which bladder control usually begins. Bedwetting in children and adults can result in emotional stress. Complications can include urinary tract infections.
The American Academy of Pediatrics (AAP) is the largest professional association of pediatricians in the United States. It is headquartered in Itasca, Illinois, and maintains an office in Washington, D.C. The AAP has published hundreds of policy statements, ranging from advocacy issues to practice recommendations.
Thomas Berry Brazelton was an American pediatrician, author, and the developer of the Neonatal Behavioral Assessment Scale (NBAS). Brazelton hosted the cable television program What Every Baby Knows, and wrote a syndicated newspaper column. He wrote more than two hundred scholarly papers and twenty-four books.
Attachment parenting (AP) is a parenting philosophy that proposes methods aiming to promote the attachment of mother and infant not only by maximal parental empathy and responsiveness but also by continuous bodily closeness and touch. The term attachment parenting was coined by the American pediatrician William Sears. There is no conclusive body of research that shows Sears' approach to be superior to "mainstream parenting".
The Ferber method, or Ferberization, is a technique invented by Richard Ferber to solve infant sleep problems. It involves "sleep-training" children to self-soothe by allowing the child to cry for a predetermined amount of time at intervals before receiving external comfort.
An infant bed is a small bed especially for infants and very young children. Infant beds are a historically recent development intended to contain a child capable of standing. The cage-like design of infant beds restricts the child to the bed. Between one and two years of age, children are able to climb out and are moved to a toddler bed to prevent an injurious fall while escaping the bed.
Swaddling is an ancient practice of wrapping infants in blankets or similar cloths so that movement of the limbs is tightly restricted. Swaddling bands were often used to further restrict the infant. Swaddling fell out of favour in the 17th century.
A bassinet, bassinette, or cradle is a bed specifically for babies from birth to about four months. Bassinets are generally designed to work with fixed legs or caster wheels, while cradles are generally designed to provide a rocking or gliding motion. Bassinets and cradles are distinguished from Moses baskets and carry cots, which are designed to be carried and sit directly on the floor or furniture. After four months, babies are often transferred to a crib or cot. In the United States, however, the bedside sleeper is the prevalent option, since they are generally bigger, recommended up to 6 months, and often used up to a year.
The Safe to Sleep campaign, formerly known as the Back to Sleep campaign, is an initiative backed by the US National Institute of Child Health and Human Development (NICHD) at the US National Institutes of Health to encourage parents to have their infants sleep on their backs to reduce the risk of sudden infant death syndrome, or SIDS. The target age group of the campaign is 0–1 years of age, because this is when babies are at the greatest risk of experiencing SIDS. Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%. However, there has been a rise in infant sleep-related suffocation events. Consequently, the campaign has broadened its goal to focus on safe sleep conditions and further preventative measures.
Tummy time is a colloquialism for placing infants in the prone position while awake and supervised to encourage development of the neck and trunk muscles and prevent skull deformations.
Sleep training is a set of parental intervention techniques with the end goal of increasing nightly sleep in infants and young children, addressing “sleep concerns”, and decreasing nighttime signalling. Although the diagnostic criteria for sleep issues in infants is rare and limited, sleep training is usually approached by parents or caregivers self identifying supposed sleep issues.
Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.
A bedside sleeper, also referred to as a sidecar sleeper or bedside bassinet, is a bassinet or baby cot that attaches to the parents' bed, allowing newborns to sleep next to their parents safely. This is a form of safe co-sleeping, and has little risks associated with sudden infant death syndrome, unlike bedsharing. Bedside sleepers are a component of rooming-in, a practice followed in hospitals to keep the baby by the mother's bed, giving her time to establish a stronger bond with her baby.
Infant and toddler safety are those actions and modifications put into place to keep babies and toddlers safe from accidental injury and death. Many accidents, injuries and deaths are preventable.
Newborn care and safety are activities and precautions recommended for new parents or caregivers. It is an educational goal of many hospitals and birthing centers to promote newborn care and safety as parents take their infant home.
James Joseph McKenna is an American biological anthropologist. McKenna founded and directed the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, studying the physiology and behavior of co-sleeping mothers and infants. He has published over 140 scientific articles in medical and anthropological journals on the topics of co-sleeping, breastfeeding, evolutionary medicine, and SIDS, and is the author of several trade and academic books. He also regularly lectures on specialized topics relating to co-sleeping and breastfeeding, particularly to pediatric medical professionals and parents.
Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.
Infant sleep is an act of sleeping by an infant or a newborn. It differs significantly from sleep during adulthood. Unlike in adults, sleep early in infancy initially does not follow a circadian rhythm. Infant sleep also appears to have two main modes - active, associated with movement, and quiet, associated with stillness - exhibiting distinct neurological firing patterns. Sleep duration is also shorter. As the infant ages, sleep begins to follow a Circadian rhythm and sleep duration increases. Infants nap frequently. Infants are also particularly vulnerable during sleep; they are prone to suffocation and SIDS. As a result, "safe" sleep techniques have been the subject of several public health campaigns. Infant sleep practices vary widely between cultures and over history; historically infants would sleep on the ground with their parents. In many modern cultures, infants sleep in a variety of types of infant beds or share a bed with parents. Infant sleep disturbance is common, and even normal infant sleep patterns can cause considerable disruption to parents' sleep.
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