Co-sleeping: Addressing a Parent’s needs (My research paper, rough draft)


Abstract

Co-sleeping is often vilified in the media and by local governments whenever there is a high rate of infant mortality. They are quick to point fingers in an attempt to make it look like they are taking action instead of addressing the real issues behind infant mortality rates. Many scientific studies are no better when it comes to offering caretakers factual and well defined advice. Studies often combine many different actions under the term co-sleeping. This can easily mislead anyone doing research on the topic, causing them to make false judgments. I believe that if localities and scientific studies clarified terminology and addressed the needs of the public instead of merely dictating to them, that more people would use the information given and infant mortality rates would drop as a result. It is my intent to show that co-sleeping can in fact be a safe, beneficial and preferred parenting practice.

Co-sleeping is the single most controversial topic related to pediatric sleep (Goldberg & Keller, 2007, p. 457). Many anti co-sleeping campaigns assume that the public requires simple slogans and term, yet at the same time they expect the public to read into headlines like “babies sleep best alone” and figure out that they really mean babies sleep best alone near their mother. Tactics like this go against the very thing they are trying to accomplish, trying to reduce infant mortality (Getter & McKenna, 2010, p.74). Despite warnings against co-sleeping, there is an increasing awareness in the scientific field as well as with the public that many parents continue to co-sleep. Almost half of the mothers in the United States and in Great Britain who breastfeed, routinely bring their child to bed with them (Getter & McKenna, 2010, p.71). In 2005 long time co-sleeping critic Richard Ferber (as cited in Goldberg & Keller, 2007), changed his stance on the subject to say that co-sleeping can and should be done as long as it is done safely and in the best interest of the family (Goldberg & Keller, 2007, p. 467).

In order to alleviate the confusion between risky sleeping arrangements the first step to studying Co-sleeping is to define all variations of the practice. Bed sharing (which is often generalized by many studies as co-sleeping) should never be confused with parents and children sleeping on separate surfaces (Goldberg & Keller, 2007, p.459). In Western cultures, bed sharing includes the parents and on occasion any siblings, who all share a family bed (Goldberg & Keller, 2007, p. 461). Goldberg and Keller (2007) went on to define co-sleeping as the presence of at least one sober caregiver sleeping close enough to the child for the exchange of at least two sensory stimuli to occur (p. 495). Reactive co-sleeping is defined as a child who co-sleeps, despite parental preference for solitary sleeping, due of difficulties with sleep behaviors or routine. Reactive co-sleeping tends to vary between co-sleeping and solitary sleeping, and is further characterized by children who begin co-sleeping after being solitary sleepers for an extended length of time (Sobralske & Gruber, 2009, p. 475). Children who engage in co-sleeping after infancy, tend to awaken more to seek out their parents. Children who co-sleep, even part time, tend to wake less during the night than children who sleep alone (Hayes, Fukumizu, Troese, Sallinen, and Gilles, 2007).

            One of the important milestones in a child’s life is characterized by decreased night time waking, over all sleep habits, and differences in the child’s temperament (Hayes et al., 2007). According to Sobralske and Gruber (2009), a child should be able to sleep separate from the parents and exhibit self soothing behavior by the age of 4 (p. 475). It is normal in the United States and other western cultures for infants and children to sleep in their own rooms. However, in countries where co-sleeping is the norm, sleep problems are rarely an issue (Goldberg & Keller, 2004, p. 369). Hayes et al. (2007) provided further insight that shows that western cultures actually are more prone to having their infants sleep in close proximity, yet on separate surfaces.

            In 2005, it was recommended by the American Academy of Pediatrics that an infant should never sleep outside the proximity of an adult (Getter & McKenna, 2010, p. 72). It has also been shown that a parent’s values, beliefs, and ways of expressing affection ultimately help decide parental choices, regardless of expert opinion (Goldberg & Keller, 2007, p. 465). Many experts in the pediatric field link co-sleeping to dependency, to them; solitary sleep is the sign of independence. On the other hand, parents and experts who support co-sleeping feel that it benefits both the parent and the child. Co-sleeping allows for more sleep, increases breastfeeding, boosts a child’s self esteem and creates a closer connection to the parents. It also has been shown to lessen fears and increase security and independence in children (Goldberg & Keller, 2004, p. 373). The ability for a child to become independent has become a developmental marker of early childhood; therefore parents who value autonomy tend to use techniques that promote choice and decision making. This encourages children to regulate their own behavior and act with purpose and creativity instead of just being dictated to. The main argument for solitary sleeping is that parents want to promote their child’s independence, while parents who co-sleep cite security and connectedness as their reasoning (Goldberg & Keller, 2004, p. 371). Ball (cited in Goldberg & Keller, 2007) discovered that mothers who had returned to work often chose bed sharing as a way to make up for lost time with their child (Goldberg & Keller, 2007, p. 464). McKenna and Volpe (as cited in Goldberg & Keller, 2007) discovered that hearing impairments, in either the child or the parents, often lead to co-sleeping in order to be more aware of night time waking. They also found that the primary reason for co-sleeping was breastfeeding (Goldberg & Keller, 2007, p. 464). Around 720 infants die in the United States because they were not breastfed. It was shown that the chance of an infant dying before the age of 1 was reduced by 80% when the infant was breastfed vs. being formula fed. Breastfeeding has been shown to reduce ailments such as respiratory and ear infections, as well as other diseases. Co-sleeping and breastfeeding have been clearly proven to work together. When the infant slept closer to the mother there was a greater frequency of feedings, to prevent loss of sleep this increase in feedings often led to bed sharing. Bed sharing mothers were prone to breastfeeding for more months than mothers who did not bed share (Getter & McKenna, 2010, p. 72). Overall co-sleeping promotes breastfeeding, proper sleep positioning, and maternal monitoring, as well as regulates circadian rhythms (Sobralske & Gruber, 2009, p. 475).

            Night waking is often cited as a problem with co-sleeping. Much of this is due to the fact that the close proximity increases awareness to the child’s movements and sleep behaviors. Another reason is that different people perceive typical night behavior versus sleep problems in different ways. Families who purposely chose to co-sleep did not see their child’s night time waking as a problem, while reactive co-sleepers reported more negative sleep behaviors. Another misconception of co-sleeping is that the child will not want to transition to solitary sleeping as they get older. In fact, the opposite was reported by mothers who said that the transition was a smooth one and they believed that co-sleeping had aided in a creating happier, healthier, and more secure child (Goldberg & Keller, 2007, p. 465- 466). There are claims that co-sleeping can increase the chance of Sudden Infant Death Syndrome (SIDS), however there is very little evidence to support any negative effects of safe co-sleeping (Sobralske & Gruber, 2009, p. 474). Most of the concerns about co-sleeping have resulted from inconsistent definitions of bed sharing. Deaths as a result of sleeping with an infant on couches or recliners are generally classified as co-sleeping and lack the relevant information stating the actual cause of death (Getter & McKenna, 2010, p. 73). A Chicago study indicated that the risk of SIDS significantly increased when the child slept with a non parent. This places the problem on whom the child sleeps with and not where they sleep. The study further stated that future studies should clarify who the infant was sleeping next to (Goldberg & Keller, 2007, p. 462).

            Three main elements were studied by Super and Harkness (as cited in Keller and Goldberg, 2004), the daily environment of the child, the cultural customs in regards to child care and the psychology of the caretaker (Goldberg & Keller, 2004, p. 370).  In regards to the role of caretakers it was found by Hayes (as cited in Goldberg and Keller, 2007) that maternal behaviors with their infants helped shape the infants preferences when they reached early childhood (Goldberg & Keller, 2007, p. 462). It was also found that perceptions of sleep issues and over all feelings about co-sleeping differed by culture. Schachter, Fuchs, Bijur and Stone (as cited in Goldberg and Keller, 2007) conducted a study in 1989 that compared Latino families to Caucasian families. The Latino families showed a higher rate of all night co-sleeping than Caucasian families did (Goldberg and Keller, 2007, p. 460). In china, 58% of parents reported co-sleeping with their children (Sobralske & Gruber, 2009, p. 476). A study of toddlers in Japan, where co-sleeping is the norm, found that 60% of the children exhibited frequent night crying. The night crying seemed to be remedied by a consistent sleeping pattern (Hayes et al., 2007). Despite the night crying, Japanese parents, as well as Korean parents, did not associate co-sleeping with the night crying or bedtime protests. When surveyed, 70 % of African- American families participated in co-sleeping and also did not perceive night waking as a problem. Appalachian families, who reported co-sleeping for the first 2 years of the child’s life, did not see night waking as a problem and had positive feelings about their co-sleeping. Along with them Caucasian- American parents, British parents, Mayan Guatemalan parents and fathers in general, all reported co-sleeping as a means to a good night’s sleep and as a satisfying and rewarding bonding experience (Goldberg & Keller, 2004, p. 370).

            Families that began co-sleeping after the child’s first year, as a result of bed time struggles and sleeping problems, reported co-sleeping to be stressful. Families, who began co-sleeping in the infant stage, reported it to be a desired and preferential practice. Reactive co-sleepers saw night waking as more problematic that the others and reported more bedtime struggles than early co-sleepers (Goldberg & Keller, 2004, p. 371).  Sleep consistency was greater among families that practiced independent transitioning vs. interdependent transitioning. Transitional objects are often synonymous with solitary sleeping and independent sleeping is often paired with attachment to the transitional object. Solitary sleepers were more likely to use a security object at bedtime while co-sleepers were more likely to attempt reactive co-sleeping and less independent in transitioning to sleep overall (Hayes et al., 2007). Infants who co-slept after feedings tended to exhibit parent seeking behavior in early childhood. Meanwhile, infants who slept in a separate room were more likely to self soothe and there was a greater delay in parental intervention. It is likely that the reason for delay is that parents are less aware of the infant waking and therefore they delay in reacting. It was also found that when the crib was still in the parent’s room at 12 months of age, the children were more likely to continue to co-sleep at 2 to 4 years of age (Hayes et al., 2007).

A significant link between co-sleeping and child independence was found. Early co-sleepers exhibited a greater amount of independent behaviors than reactive or solitary sleepers did, although no significant difference was found in either group in regards to potty training.  Mothers of early co-sleepers were more supportive of their child’s autonomy and reported their children as being more self reliant and as more socially independent (Goldberg & Keller, 2004, p. 379). An 18 year study by Okami, Weisner and Olmstead in 2002 (as cited by Sobralske & Gruber, 2009), showed that there is no evidence to support that co-sleeping contributes to psychological dependency, psychosexual confusion or sleeping problems. However, it was cautioned that school aged children who still participated in co-sleeping may suffer from separation anxiety and may require intervention such as counseling (Sobralske & Gruber, 2009, p. 475).

            A study by Ateah and Hamelin (as cited in Getter & McKenna, 2010), showed that 89% of participants thought of co-sleeping as a risky behavior, yet 72% of participants still reported regular co-sleeping with their child. Many of the parents reported they felt an increased safety from aggressive siblings, fires and monitoring for SIDS when they co-slept with their child. Participants also reported that risk reduction suggestions were more helpful than general recommendations against co-sleeping. Evidence shows that it is more effective to recommend against dangerous sleeping conditions instead of recommending against it all together. It was proven that there was a greater benefit to recommending having the infant sleep in proximity of the parent instead of sharing the same sleeping surface (Getter & McKenna, 2010, p. 73- 74).  It is also highly important to distinguish between safe and un-safe bed sharing practices. Bed sharing should not occur if the parents are smokers or have consumed drugs or alcohol. There should be no extra bedding and there should be precautions taken to make sure the infant does not roll off the bed or get stuck between the bed and the wall. Infants should always sleep between the mother and a barrier and not the mother and another person. In addition pets should never be allowed onto the bed with an infant present (Sobralske & Gruber, 2009, p. 477 – 478). The best approach to reducing infant deaths is one that will reach the most caregivers by not only reflecting what professional want but by addressing the needs of the caregiver themself (Getter & McKenna, 2010, p. 74).

            From the articles that I have read it is clear that despite all warnings parents are going to co-sleep if they feel that it is what is best for their family.  Unfortunately many attempts by local governments and health departments to educate the public are only half truths. Most ad campaigns against co-sleeping leave out vital information and expect the public to fill in the blanks. They dictate to parents instead of offering real solutions or addressing the parent’s needs. Very few of the studies performed on co-sleeping properly define the differences between bed sharing and co-sleeping. They tend to just lump them all together under the term co-sleeping. Co-sleeping is also the term used anytime a study refers to a caretaker and a child sleeping together, no matter if it was in the correct location or not, i.e. anywhere but a safe shared surface, or crib in close proximity. Future studies should be clear as to what they are studying and when talking in terms of infant mortality, they should provide all the details related to the death. Most studies will simply say the child died as a result of co-sleeping, instead of stating the child died as a result of being smothered by an intoxicated parent. This type of generalization creates unnecessary fear and uneducated propaganda surrounding a perfectly safe and preferential practice.  I can only hope to see more studies in the future that eliminate these issues, so that localities can start addressing the real needs of their citizens and start to actively reduce the infant mortality rate.

References

Hayes, M., Fukumizu, M., Troese, M., Sallinen, B., Gilles, A. (2007). Social experiences in

infancy and early childhood co-sleeping. Infant and Child Development, 16, 403 – 416

Sobralske, M., & Gruber, M. (2009). Risks and benefits of parent/ child bed sharing. American

Academy of Nurse Practitioners, 21, 474- 479

Getter, L., & McKenna, J. (2010). Never sleep with baby? Or keep me close but keep me safe:

Eliminating inappropriate “safe infant sleep” rhetoric in the United States. Current

Pediatric Reviews, 6, 71- 77

Goldberg, W., & Keller, M. (2007). Co-sleeping during infancy and early childhood: Key

findings and future directions. Infant and Child Development, 16, 457 – 469

Goldberg, W. & Keller, M. (2004). Co-sleeping: help or hindrance for young children’s

independence? Infant and Child Development, 13, 369- 388

 

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