Mother–infant cosleeping, breastfeeding and sudden infant death syndrome: What biological anthropology has discovered about normal infant sleep and pediatric sleep medicine

Abstract

Twenty years ago a new area of inquiry was launched when anthropologists proposed that an evolutionary perspective on infancy could contribute to our understanding of unexplained infant deaths. Here we review two decades of research examining parent-infant sleep practices and the variability of maternal and infant sleep physiology and behavior in social and solitary sleeping environments. The results challenge clinical wisdom regarding ''normal'' infant sleep, and over the past two decades the perspective of evolutionary pediatrics has challenged the supremacy of pediatric sleep medicine in defining what are appropriate sleep environments and behaviors for healthy human infants. In this review, we employ a biocultural approach that integrates diverse lines of evidence in order to illustrate the limitations of pediatric sleep medicine in adopting a view of infants that prioritizes recent western social values over the human infant's biological heritage. We review what is known regarding infant sleeping arrangements among nonhuman primates and briefly explore the possible paleoecological context within which early human sleep patterns and parent-infant sleeping arrangements might have evolved. The first challenges made by anthropologists to the pediatric and SIDS research communities are traced, and two decades of studies into the behavior and physiology of mothers and infants sleeping together are presented up to the present. Laboratory, hospital and home studies are used to assess the biological functions of shared mother-infant sleep, especially with regard to breastfeeding promotion and SIDS reduction. Finally, we encourage other anthropologists to participate in pediatric sleep research using the unique skills and insights anthropological data provide. By employing comparative, evolutionary and cross-cultural perspectives an anthropological approach stimulates new research insights that influence the traditional medical paradigm and help to make it more inclusive. That this review will potentially stimulate similar research by other anthropologists is one obvious goal. That this article might do so makes it ever more possible that anthropologically inspired work on infant sleep will ultimately lead to infant sleep scientists, pediatricians, and parents becoming more informed about the consequences of caring for human infants in ways that are not congruent with their evolutionary biology. Yrbk Phys Anthropol 50: 133-161, 2007. V

Sudden Infant Death Syndrome (SIDS) risk reduction and infant sleep location – Moving the discussion forward

“…It was hypothesized this would help certain infants resist the arousal deficits thought to contribute to SIDS (McKenna 1986). McKenna combined evidence from infant physiology, human evolution, ethnographic reports, polysomnographic studies (McKenna 1990a,b;McKenna and Mosko 1990), and pursued sleep laboratory research to examine the effects of co-sleeping (for review see McKenna et al 2007). McKenna's work generated tremendous popular and clinical interest, prompting epidemiologists to more closely examine infant sleep location in SIDS case-control studies.…”

SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment

“…Cosleeping is when parent and infant sleep in close proximity (on the same surface or different surfaces) so as to be able to see, hear, and/or touch each other. 139,140 Cosleeping arrangements can include bed-sharing or sleeping in the same room in close proximity. 140,141 Bed-sharing refers to a specific type of cosleeping when the infant is sleeping on the same surface with another person.…”

Discussion of Extinction-Based Behavioral Sleep Interventions for Young Children and Reasons Why Parents May Find Them Difficult

“…13,18,22,25 Some researchers, clinicians, popular authors and parenting organizations express these concerns and advocate against cry-intensive methods. [37][38][39][40][41] However, other researchers and clinicians do not support these concerns and defend the safety of extinction. 1,3,13,42 Parents are able to obtain summaries and discussions of the academic literature via media releases, social media and online parenting groups, thus they may make parenting decisions based on what they interpret to be evidence-based practice.…”