“HOW DO I GET MY CHILD TO SLEEP THROUGH THE NIGHT?!” is the thinly-veiled message under the surface of many of the emails that I get about sleep. And I don’t blame you. I don’t claim to be a magician in this regard, although I did get incredibly, amazingly lucky – my daughter put in her first eight-hour night at six weeks old, and has regularly slept through the night for longer than I can remember. I’m really genuinely not sure I could parent if things weren’t like this.
But today’s episode is about the data, not about anecdata.
Zoe in Sydney wrote to me:
A hotly debated topic with my friends has been “sleeping through the night.” My daughter never was great at napping and still wakes up once a night, coming into our bed. We have never been able to do controlled crying etc – I would love to know what science says about sleeping through the night! And what is best for your child (vs the parent). My close friend is a breastfeeding counselor and said they are taught that lots of children don’t sleep through until 4 years old! Other mothers I knew were horrified if their child wasn’t sleeping through by 6 months – and the French talk about their children ‘having their nights’ much earlier…
As I started researching this topic it became clear that sleep is driven to an incredible extent by cultural preferences. Some (Western) psychologists advocate for letting children Cry It Out, while people in many cultures around the world see putting a child to sleep in their own room (never mind allowing them to cry) as tantamount to child abuse.
So: can we get our children to sleep more? Is bed-sharing inherently bad? Does Cry It Out harm the child in some way? Let’s find out!
Amoabeng, A.O. (2010). The changes and effect of stress hormone cortisol during extreme diet and exercise. Unpublished Master’s thesis. Boston, MA: Boston University.
American Academy of Pediatrics (2016). SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Author. Retrieved from http://pediatrics.aappublications.org/content/early/2016/10/20/peds.2016-2938
Bernier, A., Carlson, S. M., Bordeleau, S., & Carrier, J. (2010). Relations between physiological and cognitive regulatory systems: Infant sleep regulation and subsequent executive functioning. Child Development, 81, 1739–1752.
Blampied, N.M. (2013). Functional behavioral analysis of sleep in infants and children. In A. Wolfson & H. Montgomery-Downs (Eds.), The Oxford handbook of infant, child, and adolescent sleep and behavior. Oxford, U.K.: Oxford University Press.
Burnham, M.M. (2013). Co-sleeping and self-soothing during infancy. In A. Wolfson & H. Montgomery-Downs (Eds.), The Oxford handbook of infant, child, and adolescent sleep and behavior. Oxford, U.K.: Oxford University Press.
Chess, S., & Thomas, A. (1984). Origins and evolution of behavior disorders. New York, NY: Brunner/Mazel.
Crncec, R., Matthey, S., & Nemeth, D. (2010). Infant sleep problems and emotional health: A review of two behavioral approaches. Journal of Reproductive and Infant Psychology 28(1), 44-54.
Ferber, R. (1985). Solve your child’s sleep problems. New York, NY: Simon & Schuster.
France, K.G. (1991). Behavior characteristics and security in sleep-disturbed infants treated with extinction. Journal of Pediatric Psychology 17(4), 467-475.
Gaddini, R. (1970. Transitional objects and the process of individuation: A study in three different social groups. Journal of the American Academy of Child Psychiatry 9(2), 347-365.
Germo, G.G., Goldberg, W.A., & Keller, M.A. (2009). Learning to sleep through the night: Solution or strain for mothers and young children? Infant Mental Health Journal 30(3), 223-244.
Giannotti, F., & Cortesi, F. (2009). Family and cultural influences on sleep development. Child and Adolescent Psychiatric Clinics of North America 18(4), 849-861.
Hale, L., Parente, V., & Phillips, G.K. (2013). Social determinants of children’s sleep. In A. Wolfson & H. Montgomery-Downs (Eds.), The Oxford handbook of infant, child, and adolescent sleep and behavior. Oxford, U.K.: Oxford University Press.
Healey, D., France, K.G., & Blampied, N.M. (2009). Treating sleep disturbances in infants: What generalizes? Behavioral Interventions 24, 23-41.
Hiscock, H., Bayer, J., Gold, L., Hampton, A., Okuomunne, O.C., & Wake, M. (2006). Improving infant sleep and maternal mental health: A cluster randomized trial. Archives of Disease in Childhood 92, 952-958.
Hupp, S., & Jewell, J. (2014). Great myths of child development. New York, NY: John Wiley & Sons.
Jenni, O.G., & O’Connor, B.B. (2005). Children’s sleep: An interplay between culture and biology. Pediatrics 115(1), 204-216.
Lushington, K., Pamula, Y., Martin, J., & Kennedy, J.D. (2013). The relationship between sleep and daytime cognitive/behavioral functioning: Infancy and preschool years. In A. Wolfson & H. Montgomery-Downs (Eds.), The Oxford handbook of infant, child, and adolescent sleep and behavior. Oxford, U.K.: Oxford University Press.
McKenna, J.J., Ball, H.L., & Gettler, L.T. (2007). Mother-infant cosleeping, breastfeeding, and Sudden Infant Death Syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine. Yearbook of Physical Anthropology 50, 133-161.
Meleva-Seitz, V.R., Bakermans-Kranenburg, M.J., Battaini, C., & Luijk, M.P.C.M. (2015). Parent-child bed-sharing: The good, the bad, and the burden of evidence. Sleep Medicine Reviews. Full article available at: https://www.researchgate.net/publication/298427230_Parent-child_bed-sharing_The_good_the_bad_and_the_burden_of_evidence
Mindell, J.A., Du Mond, C.E., Sadeh, A., Telofski, L.S., Kulkarni, N., & Gunn, E. (2011). Efficacy of an internet-based intervention for infant and toddler sleep disturbances. Sleep 34(4), 451-458B.
Neff, J. (2016, February 24). Time to a mobile sleep app – More products in carts. AdAge. Retrieved from http://adage.com/article/digital/j-j-research-led-bath-time-a-mobile-sleep-app/302776/
Pantley, E. (2002). The no-cry sleep solution. New York, NY: Contemporary Books.
Price, A.M.H., Wake, M., Ukoumunne, O.C., & Hiscock, H. (2012). Five-year follow-up of harms and benefits of behavioral infant sleep intervention: Randomized trial. Pediatrics 130(4), 643-651.
Santos, I.S., Bassani, D.G., Matijasevich, A., Halal, C.S., Del-Ponte, B., Henriquez da Cruz, S., Anselmi, L. Albernaz, E., Fernandes, M., Tovo-Rodriguez, L., Silveira, M.D., & Hallal, P.C. (2016). Infant sleep hygiene counseling (sleep trial): Protocol of a randomized controlled trial. BMC Psychiatry 16(1), 307.
Sears, W., Sears, R., Sears, J., & Sears, M. (2005). The baby sleep book. New York, NY: Little, Brown & Company.
Super, C.M., & Harkness, S. (2013). Culture and children’s sleep. In A. Wolfson & H. Montgomery-Downs (Eds.), The Oxford handbook of infant, child, and adolescent sleep and behavior. Oxford, U.K.: Oxford University Press.
Teti, D.M., Kim, B.R., Mayer, G., & Countermine, M. (2010). Maternal emotional availability at bedtime predicts infant sleep quality. Journal of Family Psychology 24(3), 307-315.
Weinraub, M., Friedman, S.L., Knoke, B., Houts, R., Bender, R.H., Susman, E.J., Bradley, R., & Williams, J. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 through 26 months of age. Developmental Psychology 48(6), 1511-1528.
Hello and welcome to the Your Parenting Mojo podcast. Before we start today, I just wanted to take a minute and mention what happens around here on the weeks when you don’t hear an episode, because I have a suspicion based on my download patterns that most of you are subscribed to the show through iTunes rather than through my website, which means you’re kind of missing out. On the weeks when I don’t publish an episode, I send out a newsletter instead – and this is not just any old newsletter. I keep track of new research and articles related to both child development and education over the previous couple of weeks, and I select the best of them for the newsletter. Then I don’t just tell you about the new studies and articles, but locate them in the rest of the literature on the topic by helping you to understand how the new work adds to our understanding, and what we’re still lacking. I also post calls for questions on topics I’ve already decided to do episodes on (and your questions not only get onto the list of questions that I end up asking the interviewee, but also help me to decide which interviewee to ask in the first place), and mention ideas I’m considering for future episodes to see whether you all are interested in them or not. Finally, I also use the newsletters to do a Q&A on difficult or controversial topics – so after I did the episode on potty training recently, listeners emailed me with their questions and I answered them in a newsletter a few weeks later. Pretty often I end up in an email conversation with the people who write to me about the topics they’re interested in, which I really enjoy and I hope is useful to them as well. So if you’re really interested in this research and in having me do all the work in terms of keeping on top of it for you, you really should head over to yourparentingmojo.com and enter your email address in the box at the top of the screen to subscribe there. As I’ve mentioned before, if you’re only subscribed through iTunes I never get your email address and I actually never even find out that you subscribed, so there’s no way for me to send a newsletter to you. So head on over to yourparentingmojo.com and subscribe to the show!
Seems like we’re on a roll lately with topics that I’ve resisted doing for a while – we did an episode recently on potty training, or ‘toilet learning,’ as I prefer to call it. And I’ve been getting quite a lot of questions over the last few months about sleep – mostly around how to get more of it. I’d resisted doing an episode on this for much the same reason as the potty training episode – there are books out there on this topic as well, and Facebook groups, and plenty of people making a living from doing nothing but advising parents on how to get their children to sleep. But the questions kept coming! And so we’re going to talk about them today. We’ll do what we usually do with these kinds of episodes – take a tour through the anthropological literature and find out just how weird our Western, Educated, Industrialized, Rich, Democratic societies are, and from there we’ll reframe how we look at children and sleep before we discuss ways that we can all get more of it. And I should say that as is typical with the show, we’ll look at sleep primarily through the lens of caring for toddlers and preschoolers. We’ll detour perhaps a little more than usual into learning about younger babies just because that’s the population on whom a lot of research has been done, but we’ll focus primarily on the types of problems that parents of toddlers and preschoolers tend to have, and what we can do about them.
Let’s talk just a little first about why children sleep – it’s because they really do need to do it! Just a couple of the amazing things that happen during sleep is that memories are consolidated, stabilized, and perhaps enhanced (which has obvious implications for a child’s performance in school), and memories may actually be assimilated into the child’s cognitive matrix, which allows a cohesive view of the individual’s world to develop. Pretty cool stuff. Sleep problems in childhood are associated with memory and learning impairments, difficulty in regulating mood, attention and behavioral problems, as well as hyperactivity and impulsivity. Short sleep duration is associated with overweight in childhood, although I should caution that for many of these issues we aren’t sure whether sleep problems cause these effects or whether these effects cause the sleep problems. So not getting enough sleep is a problem because when you don’t sleep as much you miss out on all the benefits of sleep that we’re really only just starting to understand.
So the first place I looked when I wanted to learn more about how children sleep in other cultures was David Lancy’s book The Anthropology of Childhood, and I was absolutely shocked to find that there’s nothing at all in it about sleep. Luckily there is some published literature about it and all the studies seem to pretty much give the tour of the same cultures and their approaches to sleep.
For something that is such a biological NEED as sleep, I was surprised to find the extent to which sleep patterns are culturally determined. I’m sure many of you are aware of the differences in sleep patterns between Japanese and Western societies – in the West, we encourage children to sleep in their own beds in their own rooms from a very young age, while children in Japan share a bed with one or both parents for many years. Bed-sharing is typically frowned on in Western cultures; I regularly see signs on buses in my town discouraging parents from bed-sharing, which is more common in African American than white communities in the U.S. In 2011 the Milwaukee Health Department ran an advertising campaign that showed a beautiful sleeping baby with a large knife lying next to her, with the tag line “your baby sleeping with you can be just as dangerous.” The American Academy of Pediatrics specifically recommends that infants sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants, ideally for the first year of life, but at least for the first six months. The recommendations go on to list a variety of bed-sharing arrangements that increase the risk of SIDS or unintentional injury or death while bed-sharing, including the child’s age being less than four months, bed-sharing with a current smoker, with anyone who is not the infant’s parent, including nonparental caregivers and other children, and with soft bedding accessories like pillows and blankets. If we follow the AAP’s guidelines, which I have to say are extremely well-referenced, we’d all be terrified of bedsharing and we would think that nobody in the world would ever do it. Which would be rather strange, because it turns out that a lot of people in the world do do it, probably in part because bed sharing was very much the norm as our species evolved. Infants have a need for food (which was historically delivered solely from the mother’s breast) at regular intervals as well as the sensory maternal-infant exchange involving touch, smell, movement, sound, and taste – together, this package represents the only physiological and behavioral environment that the infant is adapted to. This is not to say that infants aren’t resilient and can’t adapt to new circumstances but we should acknowledge that it’s a cultural shift in Western countries that has precipitated a desire to have children sleep through the night in their own rooms. So when we read studies that discuss giving parents literature to read that discusses “normal sleep patterns at 6-12 months,” we should be very cognizant that the definition of “normal” is culturally-bound, and that in many cultures what we think of as “normal” is actually thought of as “not normal” and even “unkind.”
Perhaps we shouldn’t be surprised to find that there’s a link between cultures that value interdependence between people and co-sleeping, and cultures that value independence and individualism and sleeping alone. In non-western countries, cosleeping is very much more common than in western countries. Ninety-three percent of Indian children aged 3 to 10 years cosleep, as do 80% of Japanese infants, who typically stay in the parental bed until at least school age. 45% of Korean children aged between 1 and 7 bed share, as do 45% of Egyptian families where the bed typically has up to four sleepers. Cosleeping is common in Brazil: from isolated communities of indigenous people to the urbanites in Sao Paolo, not less than 80% of children under 10 years of age co-sleep with parents. So in almost all cultures around the world, babies sleep with an adult, while older children sleep with parents or other siblings.
I should also be clear that I’m not for or against co-sleeping; we didn’t do it in our household primarily because I found I couldn’t sleep with my daughter in our bed. She spent her first four months in a bassinet right next to our bed and most of the time she could be lifted back into it after nursing in the night. Occasionally in the early mornings she would fuss and seem like she might not settle so I would leave her in bed with us, with her taking up over a third of the bed next to the bed rail, my husband taking up over a third on the other side, and me jammed in the middle unable to move for fear of waking someone up or squashing them. I could sleep with just her in the bed if my husband was out, but he’s not really the type to relocate himself out of the marital bed so we stuck with the bassinet.
So why the huge disconnect between Western cultures and the rest of the world when it comes to bed sharing? Well, there are a number of factors at play which are reviewed in an excellent paper by Professor McKenna at the University of Notre Dame, who holds pretty interesting dual appointments in the Department of Anthropology as well as in the Behavioral Sleep Laboratory. He tells the following story: apparently during the last 500 years in major European cities, a relatively sizeable number of poor women with no access to birth control confessed to Catholic priests that they had deliberately laid on and smothered their infants as a way of controlling their family size. The priests threatened excommunication, fines, and imprisonment, and infants were at some point in this period “banned” from parental beds. The legacy of these events have converged with other changing customs and values such as the rise of privacy, self-reliance, and individualism that support the children’s place of rest being in a different room and not just a different bed in the parental bedroom. The rise of romantic love made a further contribution to prevent the child from intruding on the conjugal bond; Freud was a proponent of the idea that children should not watch their parents’ sexual activities, although more recent research has shown that children are not harmed by seeing these activities early in life. The role of fathers shifted as well, as the father-figure became authoritarian figures who engaged in limited physical contact with their children. In the early part of this century, psychologists, pediatricians, and new-found ‘parenting experts’ promoted allegedly science-based sleep patterns that were compatible with the western cultural values of individualism and autonomy.