by Tami E. Breazeale
|Solitary infant sleeping is a principally western practice which is quite
young in terms of human history. The practice of training children to sleep alone through the night is
approximately two centuries old. Prior to the late 1700s cosleeping was the norm in all societies (Davies,
1995). Today in many cultures the practice of cosleeping continues, with babies seen as natural extensions of
their mothers for the first one or two years of life, spending both waking and sleeping hours by her side.
Cosleeping is taken for granted in such cultures as best for both babies and mothers, and the western pattern
of placing small infants alone in rooms of their own is seen as aberrant (Thevenin, 1987). Comprehensive
studies of western nonreactive cosleeping, defined as family cosleeping from birth as a custom, rather than as
the result of childhood sleep disturbances, are not yet available. However medical and anthropological
evidence suggests the western movement to solitary infant sleeping in the past two centuries may have
consequences in the areas of attachment security and physical safety.
Attachment and sleeping environment
Early work by John Bowlby noted that the mother and baby pair who were continuously together would have a
secure attachment relationship (Bowlby, 1953 cited in Davies, 1995). It is believed that the emotional
security of the baby benefits from skin-to-skin contact during the night (Davies, 1995). In a study of early
childhood cosleeping by Hayes, Roberts, and Stowe (1996) it was found that infants and children who were
solitary sleepers had a much stronger attachment to a security object and were more likely to be disturbed by
that object's absence than cosleepers. In a 1992 study of soft object and pacifier attachments in children
(Lehman, Denham, Moser, & Reeves) 40% of children with dual soft object and pacifier attachments, and 80%
of children with attachments to pacifiers alone were rated as having an insecure attachment relationship with
their mothers by 19 months. Attachment benefits of cosleeping are not limited to mother and child; fathers
also report enjoying additional time to bond with the baby as a direct result of sharing a sleeping area
(Davies, 1995; Seabrook, 1999; Thevenin, 1987). Fathers who share the family bed are likely to experience less
disturbed sleep, because babies do not have to awake fully and cry to get their needs met.
Anthropological evidence of cosleeping societies is abundant. In reviews of literature on cosleeping
societies Thevenin (1987) and Lozoff and Brittenham (1979) noted classic studies which included nearly 200
cultures, all of which practiced mother-infant cosleeping even if in some cultures the sleeping location of
the father was separate. Examples of cultures included in the studies were the Japanese, the Korean, the
Phillipino, the Eskimo Indian, the !Kung San of Africa, and the natives of Okinowa (Lozoff & Brittenham,
1979; Thevenin, 1987). The description of the Okinowan Indian culture included observations both of
parent-child cosleeping until the age of six and unrestricted breastfeeding, as well as of characteristics of
adult behavior that are very consistent with secure attachment histories (Thevenin, 1987). Cosleeping is the
cultural norm for approximately 90% of the world's population (Young, 1998).
An interesting contrast to the abundant anthropological evidence of cosleeping is the Israeli kibbutz
practice of communal nurseries. In Israeli traditional kibbutz communities, infants are raised sleeping in
communal nurseries starting at age six weeks. In a study of the influence on such a sleeping arrangement on
infant-mother attachment Sagi, van Ijzendoorn, Aviezer, Donnell, and Mayseless (1994) found the rate of secure
attachment was diminished significantly by infants sleeping in kibbutz infant houses instead of in their
parents' homes. In their study of 48 healthy infants, all infants spent nine hours a day, six days a week in
small groups with a professional caregiver. All infants also went home for four hours during dinner time, from
approximately 4 to 8 P.M. The infants in the kibbutzim with home-based sleeping would then spend the overnight
hours in the care of their parents while the communal sleeping kibbutzim babies were returned to the infant
houses to be put to sleep and watched overnight by two women who were monitoring several children's houses
from a central location and were responsible for upwards of 50 children between the ages of 6 weeks and 12
years. These "watchwomen" were kibbutz community members who served in this capacity for one week
every six months on a rotating basis and were thus never consistently familiar to the infants. Background data
with regards to quality of day care experiences, mothers' biographical characteristics, mothers' job
satisfaction levels, and infants characteristics were considered essentially the same in both groups. The sole
difference tested was the kibbutz sleeping arrangements. Within the kibbutz home-based infants, 80% were
classified as having secure attachment relationships with their mothers, while among the communally-sleeping
infants, only 48% demonstrated secure attachment relationship with their mothers. Although this has no direct
relationship to cosleeping per se, it is likely that the primary reason the home-based babies had a higher
rate of security was because of the consistency of their caregiver, who was by definition more able to respond
to them quickly than the watchwomen.
In May 1999, the Consumer Product Safety Commission [CPSC] released a warning against cosleeping or putting
babies to sleep on adult beds that was based on a study of death reports of children under the age of two who
had died from 1980 to 1997. Among the 2,178 deaths by unintentional strangulation in the Commission's study
were 180 young children who had died from being overlain on a sofa or bed. In another analysis of CPSC data it
was found that of 515 deaths in an adult bed, 121 of these were the result of overlying and 394 children died
as a result of entrapment in the structure of the bed (Heinig, 2000). The CPSC statistics resulted in a media
frenzy discouraging cosleeping which, instead of educating the public on how to share sleep safely, chose to
alarm parents. Neither media announcement mentioned the 2,700 infants that died in the final year of that
study of Sudden Infant Death Syndrome [SIDS], formerly called "crib death"; the vast majority of
those infants died alone in their cribs (Seabrook, 1999). Meanwhile, it is interesting to note that the CPSC
media announcements did not release data regarding risk factors other than sleeping location, such as whether
the overlying adult was under the influence of alcohol or drugs or whether the sleeping surface was
appropriate; 79 of the 515 deaths occurred on waterbeds (Seabrook, 1999). Parents must observe safety
guidelines for cosleeping, just as they would for picking out a crib.
Safety while cosleeping is of utmost importance. Parents should take very seriously the importance of
providing their babies with a safe sleeping environment. There are many guidelines, most of which are common
sense (Sears, 1995b; Thevenin, 1987). To start with, the bed must be arranged in such a way as to eliminate
the possibility of the child falling out. This can be done using a mesh guardrail, a special cosleeper crib
(with three sides), or by pushing the bed flush against the wall, making sure there are no crevices which
could entrap the baby. Next, in the early months, parents must be sure to place the baby next to the mother
rather than between the parents as fathers are not usually as aware of their infants as the mothers are at
first. Cosleepers should use a large bed or a sidecar arrangement, with a three-sided crib clamped flush to
the mother's side of the bed and the mattresses set to the same level. They should avoid using heavy
comforters or pillows near the infant. Babies should not be overdressed as the warmth of the mother will be
shared with the child. Infants who cosleep are usually breastfed throughout the night; this is to be
encouraged. Waterbeds, sofas, and other soft surfaces should not be the location for cosleeping (Heinig, 2000;
Sears, 1995b; Thevenin, 1987). Most importantly, parents should not cosleep if they are seriously
sleep-deprived or under the influence of drugs or alcohol. Parents who are smokers should not cosleep as
secondary smoke greatly increases the risk of death from SIDS (McKenna et al., 1993; Sears, 1995b).
Sudden Infant Death Syndrome
Research on cosleeping and SIDS has resulted in remarkable new body of knowledge which many view as
affirming the decision of parents to opt for the family bed. Virtually all SIDS-related infant sleep research
prior to the 1980s was conducted on isolated infants in sleep laboratories. In contrast to these studies,
James McKenna, a medical anthropologist, has conducted several research studies of mother-infant cosleeping.
McKenna postulated that infant sleep physiology evolved in the context of cosleeping and that infant sleep
cannot be fully understood without studying the infant in its normative cosleeping environment (McKenna et
Within Dr. McKenna's research, cosleeping is defined as the child sleeping close enough to another to
"access, respond to or exchange sensory stimuli such as sound, movement, touch, vision, gas, olfactory
stimuli, CO2, and/or temperature" (McKenna et al., 1993, p. 264). McKenna believes that cosleeping also
alters other risk factors of SIDS, such as dangerous bedding, environmental temperature, and infant sleeping
position. Using established polysomnographic recording guidelines, McKenna recorded the sleep, breathing, and
arousal patterns of mothers and their two to four month old infants cosleeping in a laboratory and also
recorded the same information for infants and mothers sleeping alone in adjacent rooms for two nights and then
sleeping together for a third night (McKenna et al., 1994). Preliminary findings of cosleeping research
indicated that cosleeping mothers and infants had a significantly higher levels of partner-influenced arousal
overlap and synchronous sleep patterns. Since there is a suspected relationship between arousal deficits in
infants and some deaths from SIDS (McKenna et al., 1993; Sears, 1995b), McKenna's hypothesis that the
influence of cosleeping on the infant's respiratory patterns, central nervous system, and cardiovascular
systems may have a protective effect seems quite valid.
Intriguingly, in a 1994 study in the United Kingdom of physiological development, infant sleeping, and SIDS
risk in Asian infants, Petersen and Wailoo found that although the Asian babies had several increased
physiological risk factors for SIDS, the SIDS rate is much lower in this population. The authors note that
perhaps this is due to the increased stimulation the infants receive as a result of Asian infant care
practices. These practices include cosleeping, carrying, and other activities which involve the child more in
household life (Petersen & Wailoo, 1994). SIDS rates in Asian countries, where cosleeping is often the
norm, are significantly lower than those in western society (Thevenin, 1987).
Attitudes toward cosleeping
Cosleeping from birth is recommended by La Leche League International, the world's leading breastfeeding
organization (LLLI, 1997), as well as by many professional lactation consultants (Heinig, 2000). The benefits
of cosleeping to the nursing couple include increased access to nursing with less disturbance of sleep for
both mother and infant. According to sleep lab studies, cosleeping mothers actually nurse their infants more
frequently throughout the night, but upon awaking for the morning have little recollection of those
interactions. Despite frequent arousals during the cosleeping studies, the mothers reported that they got more
sleep cosleeping than they did sleeping apart from their babies (McKenna et al., 1994). An additional benefit
of cosleeping and unrestricted night nursing is natural child spacing, as the return to fertility for a
nursing woman whose child nurses exclusively and cosleeps, can often be delayed up to a year after the birth.
Cosleeping is also reported to lead to a reduction in night fears and to the fulfillment of the maternal
protective instinct (Medoff & Schaefer, 1993). Many cosleeping advocates also believe that cosleeping, as
a component of natural, or attachment, parenting ultimately leads to more confident and independent children
(Sears, 1995a; Thevenin, 1987).
Pediatric experts in decades past have described children sleeping in the "parental bed" as
having serious negative consequences on both parents and children. Child care authors and experts such as Dr.
Spock, Dr. Brazelton, and Dr. Ferber admonished parents who coslept that they would be creating negative
habits or sleep disorders in their children, and fostering unhealthy childhood dependency, and that cosleeping
would be harmful to the parents' marriages (Ball, Hooker, & Kelly, 1999). A misunderstanding of the
nonreactive custom of cosleeping from birth compared to the reactive use of cosleeping to solve problems with
older children seem to be at the root of these anti-cosleeping positions. Studies of reactive cosleeping
(Lozoff, Wolf, & Davis, 1984; Rath & Okum, 1995) have found correlations between cosleeping and
childhood sleep disorders and family stress, however cultural differences in Black family cosleeping and that
of whites and Hispanics were significant. In the 1984 study by Lozoff, Wolf, and Davis, a representative
sample of 150 mothers of six-month-old to four-year-old children were interviewed. The rate of reported sleep
problems for white cosleeping children was three times that of the solitary sleepers, but the opposite was
true for Black cosleepers, who had a lower rate of sleep problems than Black solitary sleepers. Cosleeping was
"routine and recent" in 70% of the Black families and 35% of the white families. The results of such
studies have failed to show a causal relationship between cosleeping and sleep disorders (Medoff &
Schaefer, 1993). Also, the fact that the cosleeping white and Hispanic children were older than the cosleeping
Black children in the Lozoff, Wolf, Davis (1984) study, suggests that there is a cultural difference in the
use of cosleeping; namely the Black families were more likely to engage in nonreactive cosleeping than the
white and Hispanic populations. Although significant, peer-reviewed, studies of nonreactive cosleeping are not
yet available, anthropological evidence (Lozoff & Brittenham, 1979; Thevenin, 1987) and research by both
Dr. McKenna (1994) and Dr. Sears (1995b) appears to support the validity of cosleeping as a worthwhile custom,
especially if the mother and child are breastfeeding.
In an article in the popular magazine The New Yorker, John Seabrook (1999) describes his journey
with his wife and newborn son, into the experience of cosleeping. His wife, who coslept with her own parents
and who is nursing their son, intuitively desires to cosleep. The author, however, feels more comfortable
following the anti-cosleeping experts. After months of sleep deprivation and many tries at teaching the baby
to sleep alone, the father relents. He has, in the course of this time, visited the infamous Dr. Richard
Ferber, whose sleep-training method is a Pavlovian, incremental, cry-it-out system that promises the reward of
solitary all-night sleep from babies once they are "ferberized." In the course of the interview, the
author asks Dr. Ferber about cosleeping, and Dr. Ferber, who criticizes cosleeping in his widely popular 1985
book, Solve Your Child's Sleep Problems, recants, instead saying that "there's plenty of examples
of cosleeping where it works out just fine" (Seabrook, 1999, p. 64). After this the father begins to
recognize that the primary reasons most experts give for their anti-cosleeping stances is parental convenience
and a vague idea about the importance of infant independence. Mr. Seabrook learns to respect the sleep
patterns of his young child and he adapts, allowing the cosleeping relationship to blossom into a bonding
experience which the whole family can enjoy.
Ball, Hooker, and Kelly (1999) conducted a study in the United Kingdom to determine a baseline of
nonreactive cosleeping among British parents. It was believed that although cosleeping is not part of the
mainstream of parenting ideology in Britain or America, and although the literature in the field is a mess of
reactive and cross-cultural juxtapositions, this study would open the door to a valid discussion of the
attitudes and practices of nighttime parenting. The study was conducted by enlisting expectant parents in an
economically depressed community in Northern England. Parents were interviewed about expectations of infant
care practices prior to the birth and then about actual infant care practices when the baby was expected to be
two to four months old. Forty families completed both interviews. Both new and experienced parents were
interviewed. None of the new parents anticipated cosleeping with the child although 70% of them actually did
end up cosleeping with their infants at least occasionally. Mothers being interviewed following the births
frequently cited the ease of breastfeeding while lying down in bed and the ease of caring for the child while
cosleeping. Not surprisingly the experienced parents were more realistic in their expectations, with 35%
anticipating cosleeping and 59% actually participating in cosleeping. The vast majority of the first-time
mothers who coslept and all of the experienced mothers who coslept, were also breastfeeding their infants. The
study revealed that despite preconceptions of cosleeping as a dangerous and rare practice, these mainstream
British parents consider it an effective infant care technique and commonly engage in it.
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? 2001 Tami E. Breazeale
Excerpted with permission of the author from "Attachment
Parenting: A Practical Approach for the Reduction of Attachment Disorders and the Promotion of Emotionally
Secure Children", Master's thesis, Bethel College, February, 2001.