Safe Cosleeping is Better for Babies' Development than Sleep Training

photo by D. Divecha

photo by D. Divecha

Over twenty years ago, when our children were born, my husband Arjun and I had the sleep debate that many American parents still have today: Where should we put the baby to sleep at night? 

 Arjun grew up in India, and though he'd slept apart from his parents, his ayah (nanny) had always slept close by. I, on the other hand, grew up in small-town Minnesota and had slept alone in a crib at the end of a hall. When it came to our own kids, we each argued that the other's experience must have been better. He believed in the superiority of modern, Western ideas, and I was sure that the ancient practice of sleeping together was the natural state of parenthood.

"We'll roll over on her," he worried.

"We'll sleep better," I countered, thinking breastfeeding in bed sounded pretty good.

Last week, a New York Times blog post reignited the discussion for another generation of new parents. "Sleep Training at Eight Weeks: Do You Have The Guts?" it asked. Sleep training is the process of getting a baby to sleep through the night through a variety of behavioral techniques, and in the extreme by letting a baby "cry it out" in a room without a parent's responsive soothing or feeding. After a couple of days, the logic goes, the baby "gets used to it," and "learns" to sleep alone through the night.

Photo by D. Divecha

Photo by D. Divecha

This school of sleep training, based on operant conditioning, runs counter to the current science of infant development. Here are a few examples:

  • Crying in babies is not a misbehavior to be modified; it is a physiological signal that something is wrong. Babies who are picked up when they cry learn that their needs will be met and they cry less over the long run. On the other hand, if a baby's crying is consistently ignored, she can learn that her signaling system is ineffective, undermining the developing sense of self-efficacy. Her natural demands, then, can escalate into more anxious ones. The general rule of parenting infants is that you cannot spoil a baby.

  • Though many Americans want their children to learn to be independent as early as possible, forcing a baby to manage herself alone is not the way to foster independence. Rather, independence arises naturally out of a secure relationship that builds up after many episodes of having her needs adequately met. For a summary of studies on the relationship between cosleeping and later child outcomes, see here.

  • To a helpless baby (and all babies are), crying and being ignored is inherently stressful. Though mild stress can "inoculate" a little one and help her learn to self-regulate her inner states, overwhelming stress--especially in infancy--can be toxic. Toxic stress can interfere with the expression of genes that set a baby's stress regulation levels in the developing brain.

  • Each baby is different, with a unique temperament, yet sleep training is a one-size-fits-all approach. Just because one baby sleeps through the night doesn't mean that all babies can and should. A vital part of parenting involves learning your baby's unique needs.

  • And finally, a systematic review of sleep training programs for babies under six months, published recently in the Journal of Developmental and Behavioral Pediatrics concluded that the strategies have "not been shown to decrease infant crying, prevent sleep and behavioral problems in later childhood, or protect against postnatal depression." In fact, sleep training in the first weeks and months of a baby's life, "risk[s] unintended outcomes, including increased amounts of problem crying, premature cessation of breastfeeding, worsened maternal anxiety, and, if the infant is required to sleep either day or night in a room separate from the caregiver, an increased risk of SIDS."

Cosleeping, not sleep training, is what is "biologically appropriate," says James McKenna, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame. McKenna has studied infant-parent cosleeping for most of his career.

Photo by D. Divecha

Photo by D. Divecha

Technically, cosleeping is defined as any situation where the infant and parent are within sensory range of each other. It has often meant sharing the same bed, but that has some risks as Arjun pointed out. Nowadays, McKenna, and many others in the United States, recommends separate-surface cosleeping, for example, placing the baby in a bassinet within reach or in a small crib next to the bed. 

"There are as many ways to cosleep with your baby as there are cultures doing it," McKenna says.

Here's why keeping babies close is important:

Following birth, babies and caregivers remain physiologically connected to each other in complex ways, and when this bond is supported, babies do better. Breastfeeding, for example, is ideal for brain growth and future health. Babies who are breastfed have lower rates of sudden infant death syndrome (SIDS), diabetes, and other serious health conditions, while breastfeeding mothers have lower rates of postpartum depression, cardiovascular disease, diabetes, and hypertension. Breast milk is low in calories (but easy on digestion) so babies feed every hour and a half to two hours. When babies sleep close to their caregivers, they sleep more lightly, and wake two to three times more often than babies who are further away. The close proximity offers easy access with minimal disturbance.

Individual babies vary in how often they wake, from two to 13-15 times a night. But feeding isn't the only thing that happens more in the frequent wakings. When babies rouse, oxygen levels and heart rates rise, which is good for brain growth and development and immune functioning. The light sleep and frequent stirring also interrupt and stop episodes of apnea, or pauses in breathing, that can be deadly when prolonged. 

And babies aren't the only ones responsible for the wakings. When McKenna observes mother-baby pairs sleeping in his lab, he finds that mothers wake babies about 40% of the time, and babies wake mothers about 60% of the time. The nighttime cameras show that mothers are often simply reassuring the babies emotionally: They "touch, hug, inspect, whisper"--loving gestures that also in turn raise baby's heart rate and oxygen levels. 

"Remarkable to observe," McKenna says. And, not surprisingly, his cameras show that babies spend almost 100% of their sleep facing their mother.

Staying close to the adult's body helps the baby remain at a more stable body temperature. Physical contact, in close cosleeping, helps babies to "breathe more regularly, use energy more efficiently, grow faster, and experience less stress," says McKenna. Babies, too, who are not necessarily breastfed, as in the case of adoption, will also naturally reap the many other benefits of such close contact.

When babies are artificially put into deeper sleep through formula-feeding and the sensory isolation of a separate room, McKenna says, they not only are deprived of this close interaction and its attendant physical and emotional benefits, but the risk of SIDS rises. By contrast, in cultures where co-sleeping is the norm, incidents of SIDS are far lower or even unheard of. 

Not all cosleeping arrangements are safe, though. Parental smoking, drinking, and drug use make parents insensitive to their babies and can be dangerous. The presence of other children and/or heavy duvets that can smother, are also are dangerous. So are places where a baby can get trapped, like gaps between beds or in couches or recliners. (A list of recommended guidelines can be found here.)

Despite the benefits of cosleeping, pediatricians still frequently recommend sleep training to exhausted parents of infants. This is unfortunate, especially for young infants under six months old. Rather than working to harmonize the mother and baby's biological systems, sleep training begins an adversarial emotional relationship between parents and their children. As McKenna points out, it sets us early onto the course of trying to make our children who we want them to be rather than respecting who they biologically are. And ironically, parents' sleep efficiency is not related to the number of times they're woken, but to their overall stress; e.g., mothers who exclusively breastfeed wake more often but have better quality and duration of sleep. McKenna recommends that  pediatricians provide information on all sides of the issue so that parents can make informed decisions.

In our case, with a little practice and encouragement, Arjun got used to babies in the bed. And he'll be first to admit how addictive a baby's scent is.

Photo by D. Divecha

Photo by D. Divecha

Our girls had different timelines for transitioning to separate beds. By the time they were preschoolers, they began the night in their own beds, often ending in ours. But by this time, a family's values and preferences can be safely in play, and closeness happened to be just fine with us.

Time is always on your side, in parenting. Children won't be twenty and still sleeping with you.

Though in the deepest corners of our hearts, we sometimes miss it.


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Family Stress: It's Not All in Your Head

For most of my kids' childhoods, I felt that my ability to guide my family faced direct competition from school, and many forces beyond.

In elementary school, heavy backpacks bent my kids' soft little backs. Homework intruded into playtime, even though research has shown that play is important for cognitive and social development. In middle school, more homework and big projects hijacked precious family weekends--just when my kids needed more sleep, more time to adjust to their rapidly changing brains, and more healthy time with friends, and when my husband and I needed some rest. By high school, the downward pressure from looming college applications threatened to torque my kids' developmental arc.

"Don't do anything for a college resume," I warned. "Make choices because they make sense to you."

As the tsunami of outside competition flooded toward us, I felt like a little mushroom field trying to filter toxins out of a roaring river. The competition over messaging added even more pressure: media was saturated with hypersexualized images, dysfunctional interactions, unrealistic problem-solving, violence, and more. It was hard to stay on top of it all, to teach my kids the difference between our values inside our family versus values in the outside world. This on top of our own adult pressures to manage childcare, two jobs, meals, paychecks, health care and sick days, quality time, extended family, and maybe a few friends.

Adults are stressed, but our kids are stressed, too. A recent survey found that in the United States, teens' stress has now surpassed that of adults. Many young people say that they are overwhelmed, depressed, and sad because of the stress that they, themselves, gauge to be unhealthy. And the mental health of teenagers in this country is declining over time. Many parents are frantic, reaching for whatever levers they can put their hands on: hiring therapists, looking to medications, and trying ancient practices to calm everyone down. If only we could find the right key, we parents think, we can unlock the stress, and our child will thrive. 

photo by Elvin

photo by Elvin

But when the number of kids and families struggling is so large, we have to start asking questions about the systems beyond ourselves. We parents love our children wildly, and ultimately, they're our responsibility. But our ability to care for them successfully also depends in large part on how the wider culture, policies, and values support childrearing. And on that score, America is not doing very well, especially compared to other countries. Last week I published an op-ed in The Washington Post exploring that theme. One of the comments was provocative: "America hates children," it read.

"Just because you're paranoid doesn't mean they're not out to get you," goes the saying. And I'm here to affirm: The stress that you and your kids feel is not all manufactured inside your family. Self-help goes only so far, and sometimes it even deludes us into accommodating to a maladaptive situation. A new election cycle will roll around soon, and it's time to start asking when America will put children first.

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What Happens to Children When Parents Fight

When I was a child, my parents’ fights could suck the oxygen out of a room. My mother verbally lashed my father, broke jam jars, and made outlandish threats. Her outbursts froze me in my tracks. When my father fled to work, the garage, or the woods, I felt unprotected. Years later, when my husband and I decided to have children, I resolved never to fight in front of them.

“Children are like emotional Geiger counters,” says E. Mark Cummings, psychologist at Notre Dame University, who, along with colleagues, has published hundreds of papers over twenty years on the subject. Kids pay close attention to their parents’ emotions for information about how safe they are in the family, Cummings says. When parents are destructive, the collateral damage to kids can last a lifetime.

As a developmental psychologist I knew that marital quarreling was inevitable but I also knew that there had to be a better way to handle it. Cummings confirms: “Conflict is a normal part of everyday experience, so it’s not whether parents fight that is important.  It’s how the conflict is expressed and resolved, and especially how it makes children feel that has important consequences for children.” Watching some kinds of conflicts can even be good for kids—when children see their parents resolve difficult problems, Cummings says, they can grow up better off.

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How to Parent Emerging Adults

Compared to my or my parents' generation, young people today are taking longer to reach adulthood, thanks to the social and economic changes of modern society.  They take more time to explore relationships and to educate themselves for the complex information-based economy. Many face unemployment and have to live longer at home--and if they do work, it is not unusual to change jobs many times before they turn 30. Fewer are getting married and if they do, they marry later and have fewer children. Scholar Jeffrey Arnett, of Clark University in Massachusetts, now calls this period from ages 18- to 29-years old, emerging adulthood, a period so unique it deserves to be considered its own distinct phase of the lifespan.

Parenting this age group is also a new ball game. The biggest challenge--since emerging adults are in some ways grown up and in other ways not--is to figure out when to step in and assert parental authority and when to hold back...all the while remaining emotionally connected and respecting their growing autonomy. Arnett teams up with Oakland, CA writer Elizabeth Fishel to interview parents, professionals, and emerging adults, themselves, in order to gather the best advice on just where to find that parenting line... in areas of romance, job-hunting, communication, the Internet, and more.

I reviewed their book, When Will My Grown-Up Kid Grow Up? Loving and Understanding Your Emerging Adult, on the Greater Good Science Center website.

The important news is that our emerging adults still need our continued parenting. Rest assured, it does not mean that something is wrong. In fact when parents step in and help appropriately, their emerging adults do better in the long run--in their psychological well-being, their self-esteem, and even the standard of living they achieve.

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Parents' Support is Good for Young Adults

Parents often feel guilty or conflicted about offering help to their young adults, ages 18-34. Research shows that both parents and their kids can feel that help at this age is "abnormal," but the young adults who are helped do better psychologically and professionally in the long run than those who don't receive help. Attaining adulthood in today's complex and harsh economy remains a "joint enterprise" between young people and the adults who love them.

See my full article here as part of the Greater Good Science Center's focus this week on Generation Y.

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