Tag Archives: cosleeping

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.

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.

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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.

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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.

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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.

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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