Category Archives: Sleep

Cherish Your Dreams with the Best Crib Mattress

baby-sleepEvery couple desires to have a boy like an angel or a girl like a fairy. This is the ultimate happiness for any human being to get a child. Now, as it is the most precious gift in the world, it deserves a great care. There should be no deficiency about taking care of the baby, even a single matter should be considered with high concentrations.

It is one of the first major decisions you will have to make as a new parent that is finding the best pad for your baby’s crib. It is a matter of regret that most parents don’t consider this seriously. They take this matter lightly rather they are more concerned about baby food. Of course baby food is to be dealt with great care, but a mattress can affect baby’s health greatly. So don’t treat this as a simple choice, ignoring the possible effects on your baby’s health. It may cause them to suffocate during sleep or develop back and neck pains. This is why you need to do adequate research before making that trip to the local baby shop. Gathering knowledge from the many crib mattress reviews can be very helpful before rushing to the shop.

Things you should review

Here are the things you ought to consider before making your pick:

  • At first you must select the right size that perfectly fits the crib. Check the dimensions of the two and ensure very little space will remain in between.

Crib-Mattress

  • Secondly, you must consider the stiffness. Irrespective of the type, the mattress you choose must be perfectly firm. Press it with your palm to ensure it is sufficiently firm and quickly bounces back into shape. You can also lift the mattress to be certain about the weights.
  • Take a look for the vents. Ensure that the mattress has vents on the sides. The vents make the pad flexible as the baby bounces on it.
  • Then you should observe the cover. Vinyl covers are the most ideal for any crib. They are easy to wash and do not allow any liquids that spill to sip through. Nylon covers despite being expensive allow tear free stretching of the vinyl.

Variation regarding different components

There are different types of mattress available in the market. Here are the main types you will find in today’s market:
1. This kind of mattress is called Organic. This new line of products includes pads made from natural substances such as cotton, wool and latex. With such a wide variety at their disposal, many parents are left confused on which one to choose for their kid.
2. This is considered as innerspring. These mattresses come with steel coils padded inside a protective cover. They are usually very firm so as to provide optimum support for the baby.
3. Another type is called foam. These pads are made of polyurethane foam stuffed inside a mattress cover. They are the most popular among parents, mainly because they are affordable and readily available.

Buying the best mattress is one of the best gifts any parent can give to their baby. By the right choice every time you set foot in a baby shop, you not only get value for your money but also ensure your child’s health is enhanced.

Understanding and Helping the Toddler Who Won’t Sleep

Please note this is a collaborative post – for a list of authors please see the end of the article.

Every parent has despaired of their toddler’s night waking, no matter where the toddler sleeps and no matter the circumstances surrounding the desperation.  Although there is great disagreement regarding whether infants should be able to sleep through the night, the expectation that toddlers can and should sleep through the night without wakings parents is generally well accepted—with this expectation being what is presented as the “healthy” outcome by many health professionals.

Recent research however shows us how incorrect this expectation is as science tells us that it is normal for toddlers to wake at night well into their second year. Thus, to understand toddlers and what they need during nighttime care, we need to be sensitive to the “why” of their needs, abilities and experiences, and to look for “what” drives behaviours. The same concerns are important at bedtime. Knowing why a toddler is resistant to going to bed or unlikely to remain in bed when they wake at night is key to helping toddlers and parents create a healthy, happy sleep environment. Herein we offer some insight into the whys and whats of toddlerhood and then some practical suggestions about helping infants, and their parents, sleep.  

Toddler Sleep Around the World

One of the primary concerns that parents raise, especially in many Western cultures, is that toddlerhood is the time when independence must be learned and parental responsiveness may hinder this development.  Let us first assure you that the benefits of responsiveness to your child do not end in infancy, but rather that responsiveness to distress remains key to secure attachment and positive social and emotional outcomes for children (for a review, see Grusec, 2011).

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If you have been bed-sharing or co-sleeping, often parents worry that continuing this practice into toddlerhood will lead to negative outcomes for the child.  This is perpetuated by self-proclaimed “experts” who scare parents into believing they must take a hard line.  But is this supported?

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Around the world, toddlers regularly sleep with their parents, and not just out of necessity.  In Bali, children regularly sleep with their mothers until the age of 3 (Diener, 2000).  Mayan children also share their mothers’ bed and often nurse throughout the night until 2-3 years of age (Morelli et al., 1992).  Among the Ifaluk of the South Pacific children sleep alongside their parents until about 3 years of age (Le, 2000).  In Japan, family members traditionally sleep in the same room, with many children even sharing their parents’ bed (Fukumizu et al., 2005).  In Sweden, approximately half of children aged 4-5 are bedsharing with their parents at least part of the time (Welles-Nystrom, 2005).  In Japan, children traditionally sleep with some adult (e.g., grandmother) until adolescence.

Even in North America, long-term outcomes associated with bedsharing outside of infancy support normal, healthy development (Barajas, Martin, Brooks-Gunn, & Hale, 2011).  Notably, at age 5 there were no cognitive or behavioural problems associated with bedsharing between the ages of 1 and 3 in a US sample of low-income families.  Being responsive or even bedsharing will not inhibit and likely promote your child’s independence or emotional growth.  Regardless of your sleep arrangements, the following sections should help you navigate your toddler’s sleep and help you all find solutions to any sleep problems you may encounter.

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Knowing your Toddler

Toddlers are often misunderstood as they try to meet their own needs and the needs and expectations of family and society. Toddlerhood is a time of emotional, biological and social change as the transition from babyhood to a new level of independence and growth occurs. A time matched only by adolescence in level of challenging developmental changes for your child and necessary challenges in childrearing for parents.

Why Sleeping Can be Hard

For toddlers, energy abounds. Toddlers want to ‘do it’ themselves; they love to show you , tell you, direct you and ask you; and most of all, they love your company. So why would a toddler want to walk away from the excitement of being with you to go to sleep? Well, they often don’t! Thus, they do not make or maintain that transition without support and guidance.  It is completely normal for toddlers to wake during the night.; they wake and may reach out for teddy, or something comforting with smells of mom; Toddlers may call out; termed “signalling”. Some toddlers signal once a week, others once a night or numerous times a night, or some not at all (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012) .

A Waking Toddler is a common concern for parents, with research showing that over half of children over one are waking regularly (Scher, 2001) and at least one-third of all parents of toddlers report having a ‘significant problem’ with their child’s sleep (Armstrong, Quinn, & Dadds, 1994). So, worrying or being concerned about your toddlers’ sleep is not unusual. However, just as in infancy, guiding them toward settling and providing comfort at night can help them return to sleep without negative consequences. Not responding can leave toddlers anxious or unsettled.

Most importantly to remember, is a waking toddler is NOT being naughty; they are trying to communicate something with their behaviour.

Many parents respond to toddlers’ waking with discipline (Armstrong et al., 1994)—yet there is no indication that this is helpful in promoting sleep or positive development. Sure, sometimes it is ‘in code’ but with gentle kindness and a sense of someone being there for them, toddlers can find sleep.

Co-Authors

Tracy Cassels, University of British Columbia,www.evolutionaryparenting.com

Sarah Ockwell-Smith, babycalming.com

Wendy Middlemiss, University of North Texas

John Hoffman, uncommonjohn.wordpress.com

Kathleen Kendall-Tackett, Texas Tech University,http://www.uppitysciencechick.com/sleep.html

Helen Stevens, Safe Sleep Space

James McKenna, Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, www.cosleeping.nd.edu

References

Alfano, C.A., Ginsberg, G.S., & Kingergy, J.N. (2007).  Sleep-related problems among children and adolescents with anxiety disorders.  Journal of the American Academy of Child & Adolescent Psychiatry, 46, 224-232.

Barajas, R.G., Martin, A., Brooks-Gunn, J., & Hale, L. (2011).  Mother-child bed-sharing in toddlerhood and cognitive and behavioral outcomes.  Pediatrics, 128, e339-e347.

Cain, N. & Gradisar, M. (2010).  Electronic media use and sleep in school-aged children and adolescents: a review.  Sleep Medicine, 11, 735-742.

Cantor, J. (1998). “Mommy, I’m Scared”: How TV and Movies Frighten Children and What We Can Do to Protect Them. New York: Mariner.

Feshbach, N.D. (1987).  Parental empathy and child adjustment/maladjustment.  In N. Eisenberg & J. Strayer (Eds.) Empathy and Its Development (pp. 271-291).  Cambridge: Cambridge University Press.

Grusec, J.E. (2011).  Socialization processes in the family: social and emotional development.  Annual Review of Psychology, 62, 243-269.

Mindell, J.A., Telofski, L.S., Weigand, B., & Kurtz, E.S. (2009).  A nightly bedtime routine: impact on sleep in young children and maternal mood. Sleep, 32, 599-606.

Owens, J., Maxim, R., McGuinn, M., Nobile, C., Msall, M., & Alario, A. (1999).  Television-viewing habits and sleep disturbance in school children.  Pediatrics, 104, e27.

Smith, H.A. (2006). Parenting for primates. Cambridge, MA: Harvard University Press.

Thompson, D.A. & Christakis, D.A. (2005).  The association between television viewing and irregular sleep schedules among children less than 3 years of age.  Pediatrics, 116, 851-856.

Weinraub, M., Bender, R. H., Friedman, S. L., Susman, E. J., Knoke, B., Bradley, R., Houts, R., & Williams, J. (2012).  Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 36 months of age.  Developmental Psychology, 48, 1511-1528.

Welles-Nystrom, B. (2005).  Co-sleeping as a window into Swedish culture: considerations of  gender and health care. Scandinavian Journal of Caring Science, 19, 354-360.

Normal Baby Sleep – Do we have realistic expectations? (PART 2).

NOTE: This is a collaborative post – for an author listing please see the end of the post.

This is Part 2 of a 2 part post, to see part 1 click HERE.

 

“My child wakes up at 2am and is up for 1-2 hours!”

One of us remembers very clearly the first time her daughter ended up doing this.  At around 14 months, she woke up in the middle of the night and simply wasn’t ready to fall back asleep.  We nursed, we read, but nothing worked.  She insisted upon getting up and going to play, which she did for 2 hours before being ready to get back to sleep.  This continued regularly for a couple months.  And then as quickly as it started, it stopped and hasn’t happened again in over The “why” of this is relatively unknown—although researchers are continuing to explore the physiological underpinnings of sleep—but we do know that extended night wakings like these are experienced by many children until around 3 years of age (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).

Many times the wakings are brief and the child settles quickly. Other times settling takes longer. In either case, these wakings do not readily suggest your child has a sleep “problem”.  Increased night wakings, call-outs, and crying are common around 6 months of age or so, and again as infants near 2 years of age. These wakings may simply be one (of many) manifestations of separation anxiety experienced by the child—a normal change resulting from infants learning that they exist separately from their caregivers (for a review, see Middlemiss, 2004).Some argue that night wakings in toddlerhood are reflective of sleep problems, but these opinions are based on criteria that do not necessarily reflect the realities of infant sleep.  Several studies found that night waking is relatively common between age 12 and 24 months (Richman, 1981; Goodlin-Jones, Burnham, Gaylor, & Anders 2005; Scher, 2000; Weinraub et al., 2013).

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Thus, a parent’s perceptions about what constitutes a sleep problem may be triggered by either a disconnect between expectations of uninterrupted sleep and a toddler sleep pattern that arguably falls within the range of normal, or by the impact that night waking has on the parent’s quality of sleep and daily functioning (Loutzenhiser,  Ahlquist, & Hoffman 2012).  However, although changes in sleep patterns may be inconvenient and frustrating, they are normal occurrences in the context of a healthy parent-child relationship. When viewed as indicating problematic, rather than normal, sleep patterns that will come and go, oarents can experience greater stress and worry (Middlemiss, 2004). As we have learned from many parents, understanding that these night wakings are normal can go a long way to making them more bearable.

 

 “My child won’t go to sleep before 10 pm.”

It is not uncommon in our society to assume that infants and young children must be tired by 7 pm and asleep shortly thereafter.  In a posted lecture on infant sleep, Dr. Wendy Hall, a researcher at the University of British Columbia, suggested that no child should be put to sleep later than 9 pm.  Unfortunately, that’s just not the reality for many families and it’s not because parents are negligent in getting their infants to bed, but because some children simply have a different circadian rhythm or a later schedule may work for the family.  Some children will continue this pattern into their toddler years and beyond.

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Cross-cultural data on bedtimes for infants and toddlers shows that later bedtimes are actually quite frequent in predominantly Asian countries (Mindell, Sadeh, Wiegand, How, & Goh, 2010).  Whereas the mean bedtime for children in predominantly Caucasian countries was found to be 8:42 pm, it was a full hour later for predominantly Asian countries (with a mean at 9:44 pm), with the latest mean bedtime being 10:17 pm in Hong Kong.  Notably, the rising time was also significantly later in these countries.  A concurrent finding was that the vast majority of children in predominantly Asian countries sleep either in the parent’s bed or room. Thus children who sleep with their parents may naturally have a sleep schedule closer to their parents owing to the sleeping arrangements.

What is important to remember is that a late bedtime in and of itself is not a problem.  If it poses a problem for the family as a whole, then parents may want to adjust the bedtime routine (Mindell, Telofski, Weigand, & Kurtz, 2009) or start the routine earlier in small increments in order to gradually move to an earlier bedtime (Richman, 1981).

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 “My child sleeps less (or more) than the recommended amount no matter what I do!”

Most people have seen the “sleep guidelines” about how much sleep our children need at various stages.  Parents are told that newborns should sleep around 16-18 hours, that at two years of age, children require a total of 13 hours sleep, and so on.  When researchers explore questions of how long infants and children should sleep and what are healthy recommendations, the answers are not particularly clear and are often based on examining how much children are sleepingat different times in history (Matricciani, Olds, Blunden, Rigney, & Williams, 2012).

As parents it is important to remember that they arerecommendations. 

Each child is different and the recommendations may not fit every child.  Some will require much more sleep and some will require less.  If a child is truly sleep deprived, there will be noticeable signs.  Signs of sleep deprivation include rubbing eyes, looking dazed and not focusing on people or toys, becoming overly active late at night, and having a hard time waking up in the morning.  By paying attention to your child and his or her cues and behaviours, you will be able to tell if your child is getting enough sleep, regardless of the exact number of hours your child sleeps.  Sleep is important, but there are many ways to get it apart from one long, uninterrupted stretch.

*Interestingly, researchers are now telling us that waking in the middle of the night is common in adulthood and was viewed as normal in past eras—the “first sleep” lasted about 4 hours with an awake period in between followed by a “second sleep” of another four hours (for more details, see here and the book: At Day’s Close: Night in Times Past by Roger Ekirch (Norton 2005).

 

Co-Authors

Tracy Cassels, University of British Columbia,www.evolutionaryparenting.com

Sarah Ockwell-Smith, babycalming.com

Wendy Middlemiss, University of North Texas

John Hoffman, uncommonjohn.wordpress.com

Kathleen Kendall-Tackett, Texas Tech University,http://www.uppitysciencechick.com/sleep.html

Helen Stevens, Safe Sleep Space

James McKenna, Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, www.cosleeping.nd.edu

References:

Goodlin-Jones, B. L., Burnham, M. M., Gaylor, E. E., & Anders, T. F. (2001). Night waking, sleep-wake organization, and self-soothing in the first year of life. Journal of developmental and behavioral pediatrics: JDBP22(4), 226.

Loutzenhiser, L., Ahlquist, A., & Hoffman, J. (2011). Infant and maternal factors associated with maternal perceptions of infant sleep problems.Journal of Reproductive and Infant Psychology29(5), 460-471.

Matricciani, L. A., Olds, T. S., Blunden, S., Rigney, G., & Williams, M. T. (2012).  Never enough sleep: a brief history of sleep recommendations for children.  Pediatrics, 129, 548-556.

Middlemiss, W.  (2004). Infant sleep: a review of normative and problematic sleep and interventions.  Early Child Development and Care, 174, 99-122.

Mindell, J. A., Sadeh, A., Wiegand, B., How, T. H., & Goh, D. Y. T. (2010). Cross-cultural differences in infant and toddler sleep.  Sleep Medicine, 11, 274-280.

Normal Baby Sleep – What to Expect (feeding and development) PART 1.

NOTE. This is a collaborative post, for a list of authors please see the end of the post.

 

Infant sleep problems represent some of the most common concerns reported by parents of young children.  Ask any new parent and most will complain about lack of sleep. Many will also be worried that what they are experiencing isn’t “normal” and believe that their child has a problem that needs fixing.  So they search books, ask friends and family or even their doctors about what to do about a child’s problematic sleep patterns.  And to top it off, they feel immense anxiety and worry about them.

Part of the epidemic of parental angst about children’s sleep is that we live in a culture in which parents are repeatedly told that they need to worry about their child’s sleep, that there will be dire consequences if their child doesn’t get enough sleep. Another problem is that most new parents, having had little experience with children prior to having their own, have little awareness about what truly is “normal” when it comes to infant sleep

Simply being made aware of normal sleep patterns can help alleviate the stress and anxiety parents feel, leading to happier times for the entire family.

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So what is normal?

In this series of posts, we’ll tackle some of the more common sleep concerns parents have with the hope that they can see them as normal, developmental stages for their child.

 

“My child wakes every hour, all day and night, to feed”

Whether it’s every hour, or every two hours, or even three, parents are often concerned when their young infant is waking regularly for feedings.  This concern is not surprising given the focus on “sleeping through the night” that our culture pushes. But sleeping through the night is not biologically normal, especially for a breastfeeding baby.

At the time of birth, a baby’s stomach can only hold a teaspoon’s worth of milk, meaning that he or she will need to feed frequently to meet the many demands for energy that accompany this period of growth.   Although the stomach grows relatively quickly, the fat and protein content in human breastmilk is much lower than in the milk of other mammals and thus infants are required to feed often, resulting in greater night wakings (Ball, 2003; Ball, 2009).

Human breastmilk, being designed for infants who need to feed on cue day and night, is easily and quickly digested.  Formula, however, is typically made from the breastmilk of another species – cows – and is higher in fat while also containing myriad additives which make it more difficult, and thus slower, to digest.  This can affect infant sleep, resulting in unnaturally deeper infant sleep (more time spent in stage 3-4) (Butte, Jensen, Moon, Glaze, & Frost Jr., 1992), a stage of sleep from which it is most difficult to arouse to terminate breathing pauses (especially for arousal deficient infants), thereby potentially diminishing the infant’s capacity to maintain sufficient oxygen.  Even so, formula use does not necessarily provide parents with more sleep overall (Doan, Gardiner, Gay, & Lee, 2007).

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). However, regardless of feeding status, many infants wake regularly during the night (Weinraub, Bender, Friedman, Susman, Knoke, Bradley, et al., 2012).  Waking through the night is normal and biologically adaptive.  In fact, though it is often reported that sleep patterns consolidate in the second year, the pattern differs in breastfed children.

Breastfeeding moms may wake more often, but report greater total sleep.  For example in a study following breastfed children for 2 years, it was found that these children continued to wake frequently throughout the second year of life, a pattern more in line with cultures in which co-sleeping and full-term (aka “extended”)  breastfeeding are more common (Elias, Nicolson, Bora, & Johnston, 1986).

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Night wakings serve to protect the infant.

Night wakings have been reported as being more common in infants who bedshare with a parent, yet the wakings and bedsharing (when done safely) may actually protect the infant from SIDS (Mosko, Richard, & McKenna, 1997; Mosko, Richard, McKenna, & Drummond, 1996).  The critical period for SIDS is up to 8 months of age (with the peak at 2-3 months) and night wakings may serve as a protective mechanism.  In fact, if we look at parenting historically and cross-culturally, frequent night-wakings coupled with co-sleeping and breastfeeding are the norm for which we should be comparing other infant sleep behaviours.

 

“My child was sleeping through the night and suddenly it’s stopped.”

Imagine you’ve been waking regularly with night feeds and arousals, but as time passes they are decreasing.  Then you realize you’re now sleeping in nice, long chunks.  Hours of sleep all at once!  And it’s wonderful.  Then suddenly, as quickly as it came, it’s gone.  Your wonderful, sleeping-through-the-night child is suddenly waking again.  This experience, which is a reality for many, can cause frustration and despair accompanied by the feeling that you’ve done something wrong, or that you must do something get their uninterrupted sleep back again.

But here’s the thing: You didn’t do anything.  A return to night waking after periods of sleeping through the night is entirely normal.  Many children’s sleep will cycle like this for a while.  In fact, researchers looking at sleep patterns have found that often between 6 and 12 months, infants who had previously been sleeping long stretches suddenly start to wake more frequently at night (Scher, 1991; Scher, 2001).  In fact, in one long-term study looking at child sleep between 3 and 42 months found that there was no stability in night wakings or even sleep duration during this time (Scher, Epstein, & Tirosh, 2004).

What causes the change in sleeping pattern?

There are likely a variety of reasons, unique to each child.  For some, it may be a growth spurt or teething.  For others, it may be a cognitive leap that has them buzzing more so than usual or the appearance of separation anxiety.  Just recently a study reported that babies tend to wake more often when they are learning to crawl.   And for some, we may never know the actual reason.  But as children age and each develops a circadian rhythm, they will go through cycles of sleep – some more convenient for parents than others.  Parents need to be aware that these changes are entirely normal, even though they can be frustrating. Hopefully once you know that changes are to be expected, you can be better prepared or at least not add anxiety to the sleep disruptions you are forced to deal with once again.

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For Part 2 of this post please CLICK HERE.

Co-Authors

Tracy Cassels, University of British Columbia,www.evolutionaryparenting.com

Sarah Ockwell-Smith, babycalming.com

Wendy Middlemiss, University of North Texas

John Hoffman, uncommonjohn.wordpress.com

Kathleen Kendall-Tackett, Texas Tech University,http://www.uppitysciencechick.com/sleep.html

Helen Stevens, Safe Sleep Space

James McKenna, Mother-Baby Behavioral Sleep Laboratory, University of Notre Dame, www.cosleeping.nd.edu

References

Ball, H. L. (2003).  Breastfeeding, bed-sharing, and infant sleep.  Birth, 30, 181-188.

Ball, H. L. (2009).  Bed-sharing and co-sleeping: research overview.  NCT New Digest, 48, 22-27.

Ball, H.L, & Volpe, L.W. (2013).  Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location –Moving the discussion forward. Social Science & Medicine 79, 84-91

Butte, N. F., Jensen, C. L., Moon, J. K., Glaze, D. G., & Frost Jr., J. D. (1992).  Sleep organization and energy expenditure of breast-fed and formula-fed infants.  Pediatric Research, 32, 514-519.

Breaking News: New Study does NOT show ‘Sleep Training Babies Causes no Lasting Damage’

The study opens with this paragraph:

“Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship. “

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression.”

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Potential Methodology Issues Not addressed in the Study:

  • Sleep problems were ‘parent reported’, at 7mths a questionnaire was given with the question “Over the last 2 weeks has your child’s sleep generally been a problem for you?” 47% of respondents answered ‘yes’ and thus became eligible for trial inclusion. The ‘problem’ was not elaborated upon and I would have liked to have seen more questioning to ascertain exactly what the problems were, what had been tried until that point, what information the parents had received and what support had they received up until that point in those first important 7months as this time period could have a big effect.
  • The sample (out of those reported sleep problems) was selected by the researchers, I can find no mention of how they were selected and what other criteria was looked into in terms of the infant’s/family history/psychological wellbeing until that point.
  • Parents must have been open to the idea of sleep training to agree enrollment in the study, would this therefore mean that their opinions/beliefs were reflected in other parenting practices?
  • Training was carried out on babies 8-10months of age so cannot be applied to any infants younger than this. It also does not tell us the effects of training on older children/toddlers.
  • Parents were able to choose the type of sleep training used – either gradual extinction (what you and I know as controlled crying) or gradual withdrawal (parent starting out sitting with child and moving further away but involving no crying) – though no distinction was made between the type of sleep training used and later impact in the results.
  • Control/Intervention group allocation was blinded only to researchers not parents (understandably it would be tricky to be blinded to parents – but I wonder how knowledge that they were in the intervention group affected parental perception).
  • The control group visited the same nurses and were free to ask for sleep advice, but the nurses in these control groups were not trained to offer specific sleep training advice, however what advice did they give? Pretty much any parent I know could give controlled crying instructions without special training, do we know that they didn’t give similar advice to the intervention group? I cannot find this information out and to me from this point in the study loses all credibility for me – Do we know what the control group did sleep wise? We know they reported that they had had a problem with their child’s sleep in order to enter the study, so it’s pretty likely that they would want to do *something* – were they followed up and questioned and asked exactly what they did do? Again I can find no mention – How do we know that a large majority of the control group DIDN’T sleep train?
  • Outcomes were measure by cortisol samples, taken at 6yrs of age (why on earth would they take them at 6year of age?! I find this very confusing and not at all relevant? From what I can see the first follow up – and potential cortisol testing was at 10 months, yet the concerns over stress to infants from sleep training is during and in the immediate aftermath of the training, a sample taken 2 months up to 5 years later seems bizarre? Where is the cortisol sample DURING and IMMEDIATELY after the training? This is the one that matters IMO).
  • Child emotional questionnaires and ‘quality of life’ questionnaires were parent reported (and occasionally child reported) – meaning that parents filled in the questionnaires giving their own opinions. We know questionnaire reporting is notoriously unreliable with two main factors – 1) wanting to tell the investigator what they want to hear and 2) sticking to ‘middle of the road’ answers, i will add in 3) here – what parent will want to report that they feel their child has an emotional/behavioural difficulty? Especially not when they have been enrolled into a trial looking into the effects their early parenting may have had upon these. I find it very hard to determine whether the measures of psychological wellbeing were all parent reported as the results are very vague, but if I were to make an assumption I would guess that the majority were parent reported. Child reporting surely would include bias – what child would say negative things about their parents in front of said parents?
  • In terms of parenting style (and thus I presume eluding to bonding too?) the researchers appear to feel that “authoritative parenting” (high warmth, high control) is optimal parenting whereas what they call permissive parenting (high warmth, low control) is sub-optimal. I would argue that having “high control” over children is NOT optimal parenting, or indeed respectful parenting and am not convinced at all that highly controlling parents are those exhibiting the most healthy parenting style. I would like to see how they define “high and low control” and look to see how many initial “permissive parents” morphed into “authoritative parents” from the intervention group as a result of the training undertaken, this information though is not provided.
  • Nearly a third of the sample were lost to follow up (31%) – that’s a BIG number and a major limitation – what if they didn’t agree/respond to follow up because they found the intervention traumatic/it didn’t work for them/it went against their instinct?

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Perhaps the most interesting part of this research is this:

“There was no evidence that a population based targeted intervention that effectively reduced parent-reported sleep problems and maternal depression during infancy had long-lasting harmful or beneficial effects on child, childparent, or maternal outcomes by 6 years of age. Thus, this trial indicates that behavioral techniques are safe to use in the long-term to at least 5 years.”

Read that again, I’m pretty certain I dispute their claim that it has no long lasting harmful effects given the parental reporting, strange timing of cortisol testing, lack of information on what techniques the control group used, promotion of authoritative/controlling parenting as the optimum type, lack of information of life before 7 months of age (or in fact not much about life afterwards aside from financial questioning – what about childcare for a start) and lack of in-depth information about bonding (why no Ainsworth ‘Strange Situation’ type testing?). No the most interesting part to me is even with all of the above limitations in mind this research tells us there are NO LASTING BENEFITS to sleep training……Now which paper picked up on that then?! No, thought not.

So what DOES the research tell us?

  • There is still NO evidence that shows controlled crying under 8 months of age has no ill effects
  • The results did NOT differentiate between the different types of sleep training used (e.g: No Cry V Crying related options) in the results, therefore we do not know about the individual methods and their outcomes, only ‘sleep training’ as a broad label of many different types of training.
  • That sleep training does NOT have lasting positive effects on a child’s sleep behaviour
  • That nearly 50% of parents still have problems with their baby’s sleep by 7months of age (hey, perhaps that’s because it is NORMAL infant sleep and our expectations are incorrect)
  • That 31% of parents for some reason did not agree to follow up with the researchers
  • That parents tell researchers that they did not feel that sleep training affected their child negatively (tell me something new).
  • That controlled crying DOES work in the short term (I don’t think this has ever been disputed?).
  • That concerns over the effect of controlled crying on babies are still very valid, particularly in light of the recent Middlemiss study (that measured cortisol levels DURING training, not 5yrs later!) – A good summary of the concerns of sleep training can be read HERE.
  • That a whole lot more health professionals and  ‘baby experts’ are going to use this as arsenal to tell parents that there are no concerns with sleep training involving baby crying, that it’s a good thing to do, even if it feels wrong to them, as parents, to do it.

Sigh………..

Sarah (Founder of BabyCalm)

You can read more of Sarah’s articles HERE.

 

Reference:

Price. A, Wake. M, Ukoumunne. O and Hiscock. H. ‘Five-Year Follow-up of Harms and Benefits of Behavioral Infant Sleep Intervention: Randomized Trial’ Pediatrics;  September 10, 2012;

Should bedsharing/ co-sleeping only be for breastfed babies?

I think it’s time to look at this issue a little more, of all the things I write about unbelievably the most contentious is my suggestion that only mothers who are breastfeeding should share a bed with their baby. In fact I have received a fair deal of angry backlash in response to this, mostly by mothers who think I am being “anti formula feeding” and spreading incorrect information, so I think the time has come for this idea to have it’s own blog post.

So – why do I believe that mothers should only share a bed with their baby if they are breastfeeding? Particularly when most of the safe co-sleeping/bedsharing guidelines omit this point.

Let me start by saying I believe this is an area that is in desperate need of further research, I am still saddened that bedsharing research misses the most important points, it is VITAL that well constructed research is undertaken accounting for all of these variables, but most importantly accounting for feeding method.

Before I go further I would like to quickly point out the following:

Bedsharing – sharing a bed with your infant

Co-Sleeping – sharing a room with your infant

I have used the term co-sleeping in the title of this post purely for SEO purposes.

cosleep

The following are reasons you may want to think again if you you formula feed and share a bed with your baby:

1) Formula fed babies are at greater risk of SIDS than breastfed babies (wherever they sleep). See here for more. It makes sense to me then to be warier of introducing anything that may further compound this risk, with this in mind alone it is vital that if sharing a bed with a formula fed baby every single safety recommendation for bedsharing is followed exactly.

breastisbestor1

2) Formula fed babies are in general less arousable than breastfed babies during certain phases of sleep, this means that babies who are formula fed tend to awaken less readily than those who are breastfed if there is a threat to their life during certain sleep phases (this may be in part a reason for point 1 above). In particular this difference is seen the most during active sleep states at 2-3mths, which is the peak SIDS risk period.

bfsleep1

3) Mothers who breastfeed experience different sleep to those who formula feed and awaken more regularly than formula feeding mothers during the night. Breastfeeding mothers seem to be more in tune with their baby during the night and as such may be more arousable than mothers who formula feed and may be more likely to awaken if there baby stops breathing/falls etc.

I guess the problem comes when we feed our babies via another method than nature intended – nature understandably does not then provide the same protection and it is important we respect that.

To quote from University of Notre-Dame’s Sleep Lab’s website:

“all else being safe, bed-sharing among nonsmoking mothers who sleep on firm mattresses specifically for purposes of breast feeding, may be the most ideal form of bed-sharing where both mother and baby can benefit by, among other things, the baby getting more of mother’s precious milk and both mothers and babies getting more sleep – two findings which emerged from our own studies.”

Here’s a great video interview with Dr. James McKenna where he speaks more about breastfeeding mothers bedsharing and SIDS:

4) Mothers who breastfeed are far more likely to adopt a cradling/side laying position with their baby (the advised position to adopt when sharing a bed with your baby) and are more responsive to their baby’s movements in the night – this is currently being researched by two centres – Durham University sleep lab in the UK and James McKenna’s sleep laboratory in the University of Notre Dame.

bedshare

For all of the reasons above I personally only feel confident in advocating bedsharing if the mother is breastfeeding, however unpopular my opinion may be, it has nothing to do with my opinions on breastfeeding V formula feeding (for the record I don’t have one – I have 4 kids, one was breastfed for 4mths, then moved onto formula, one was breastfed for 8wks, then moved onto formula, one was breastfed until 6mths and the last I breastfed for 4yrs!) and everything to do with keeping babies safe.

by:

Sarah (Founder of BabyCalm)

You can read more of Sarah’s articles HERE.

 

References.

  1. Horne RSParslow PMHarding R. Respiratory control and arousal in sleeping infants. Paediatr Respir Rev. 2004 Sep;5(3):190-8.
  2. McKenna JJ, McDade T. Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatr Respir Rev. 2005 Jun;6(2):134-52.
  3. http://www.nd.edu/~jmckenn1/lab/articles/USBC-SIDS-PR-10-17-2005.pdf
  4. Parslow PMFerens DWatts AMAdamson TM. Comparison of evoked arousability in breast and formula fed infants. Arch Dis Child. 2004 Jan;89(1):22-5.
  5. http://pediatrics.aappublications.org/content/100/2/214.abstract
  6. http://jhl.sagepub.com/content/16/1/13.short
  7. Kahn AGroswasser JFranco PScaillet SSawaguchi TKelmanson IDan B. Sudden infant deaths: stress, arousal and SIDS. Early Hum Dev. 2003 Dec;75 Suppl:S147-66.
  8. http://www.ibreastfeeding.com/content/newsletter/nighttime-breastfeeding-and-maternal-mental-health
  9. http://www.nd.edu/~jmckenn1/lab/articles/Canada%20safe%20Sleep.pdf