The Family Bed: An Evolutionary Approach to Family Sleep
by Katie Allison Granju
On the first night after my daughter's birth, I rested soundly with her nestled beside me in my narrow hospital bunk....until I was awakened by the nurse on the overnight shift. She waved a clipboard in my face and insisted I sign a release stating that, if I persisted in bringing my baby into bed with me, I understood I was putting my daughter's life at risk. I groggily signed the form and went back to sleep.
Like most new mothers, I had a lot of concerns about sleep...or lack thereof -- concerns most likely exacerbated by what may be society's number one question of neophyte parents: "How is the baby sleeping?" In an attempt to get their little bundles to sleep safely through the night as early as possible, mothers and fathers seek advice from parenting experts, pediatricians and others regarding the do's and don't's of nighttime parenting.
For decades, the foremost rule of family sleep, as promulgated by mainstream American parenting experts, has been that infants and children should never be allowed to sleep with their parents. This, we've been told, will lead to poor sleep habits, unhealthy dependencies, ruined marriages and even infant suffocation.
Popular parenting manuals such as the "What to Expect" series, and the "Doctors Spock" of the nineties -- T. Berry Brazelton and Barton Schmitt -- instruct parents that sleeping with their children can be physically and emotionally unhealthy. "On Becoming Babywise," the rapidly expanding parenting program espoused by the Christian organization, Growing Families International, describes parents sleeping with their children as "passively abusive." Anxious young mothers inching through grocery-store checkout aisles are accosted by glossy magazines touting articles such as "Teach Your Baby to Love Her Crib" and "The Hidden Dangers of Sleeping With Your Child." Peggy Robin's book, Bottlefeeding Without Guilt, even equates advocacy of parents sleeping with their children with cultist behavior! The message is clear: a conscientious parent doesn't sleep with her child.
Despite such dire warnings and widespread approbation of the "family bed," a growing number of American parents are challenging conventional wisdom each and every night -- with support from a new wave of medical and parenting experts including Dr. William Sears and Minnesota author Tine Thevenin (The Family Bed and Mothering and Fathering), and researchers such as Dr. James McKenna of the University of California, Irvine School of Medicine. Emerging research and anecdotal evidence have demonstrated the many benefits of family sleep-sharing. Scores of modern parents have decided that co-sleeping actually provides a safer, sounder sleep for everyone in the household. While some parents inadvertently fall into the practice after guiltily allowing their kids into their bed and discovering better sleep as the result, others make an informed decision to create a family bed after careful consideration of this controversial nighttime arrangement.
Western society's deviance from the still-widespread human practice of sleeping with one's young is a relatively recent development. Only 150 years ago in the United States, it was generally assumed that young children would sleep with their parents or other relatives. Most families could not afford separate sleep quarters for everyone in the household. Additionally, sharing sleep was a reliable way to make sure that the youngest family members stayed warm.
Today's emphasis on materialism, however, leads many to equate bed-sharing with poverty. A prosperous, modern family, so the theory goes, shouldn't need to engage in this "third world" practice. Consider, for example, the following ad copy from a recent edition of the OneStepAhead baby catalog:
...Nature's Cradle -- the most natural place for your new baby to sleep! This truly revolutionary sleeping and nurturing environment gives baby the familiar, comforting, soothing sensations of the womb, and even includes a maternal heartbeat. Nature's Cradle: Is it magic? Or just a brilliant new way to love your baby? The basic Nature's Cradle looks and feels like...a crib mattress. But it holds a unique secret -- a sophisticated system that simulates a pregnant mother's natural walking motion and rhythm, as well as her internal sounds and the gentle cushioning pressure of the last trimester...the mattress moves in a smooth, rhythmic rocking motion, accompanied by soft "whooshing" similar to the sounds of amniotic fluid and the beat of mother's heart...proven to be the most nurturing, calming place for your new baby to sleep. The Baby Bolster is an essential part of the system...three foam-filled positioning cushions properly swaddle your infant to keep him sleeping safely.
Modern parents can claim the Nature's Cradle as their very own for a mere $400. But even many who recognize the inherent contradictions and general preposterousness of a product such as Nature's Cradle still consider the good old-fashioned crib indispensable. Opinions vary as to what elevated the crib to its modern-day status as an "essential" piece of baby equipment. Some tie the decrease in sleep-sharing to twentieth-century male domination of parenting advice and the depersonalization of society after the industrial revolution. Behaviorist Dr. John Watson, once a popular and frequent contributor to Harper's, McCall's, and Cosmopolitan magazines, wrote in 1928: "No one knows enough to raise a child. The world would be considerably better off if we were to stop having children for twenty years (except those reared for experimental purposes) and were then to start again with enough facts to do the job with some degree of skill and accuracy. Parenthood, instead of being an instinctive art, is a science, the details of which must be worked out by patient laboratory methods."
Other observers point out that the family bed's loss in popularity paralleled the shift to bottle-feeding and away from breastfeeding. Even today, a breastfeeding mother who sleeps with her nursling need only turn to her child in the night in order to feed him, with neither mother nor child fully awakening. Although some evidence suggests babies who sleep with their mothers nurse more frequently at night than do babies who sleep alone, this behavior may be biologically based: frequent night nursings significantly impact the delay of fertility, hence co-sleeping served an important function in family planning prior to widely accessible methods of artificial birth control.
Today's family-bedders adopt this age-old practice for a myriad of reasons. Most commonly, parents claim their children simply "sleep better" in a family bed, meaning fewer night wakings for modern mothers and fathers who often must head to work early in the morning. This was the case for Marsha Franklin of Grinnell, Iowa, the married mother of eighteen-month-old Sasha. In the beginning, Sasha slept in the expensive and well-appointed crib that Franklin and her husband had carefully chosen. The crib bedding matched the elaborate nursery's decorative theme, and hanging above all was an infant mobile "guaranteed" to stimulate a newborn's developing senses. Despite her parents' earnest efforts, Baby Sasha wanted nothing to do with the crib, and Franklin says that prior to adopting the practice of co-sleeping, bedtime was always a battle.
"My only experience with babies had been what I saw on TV. You know, where the mother puts the still-awake baby down in her crib and tiptoes out of the room to allow the baby to fall asleep on her own? Well, this is what I expected my own child to do and I was completely frustrated when she wouldn't stay in her crib," remembers Franklin. This exhausted mother got out of bed as many as six times a night to comfort her daughter and put her back in the crib. When Sasha became old enough to crawl, Franklin was forced to buy a special net to put over the top of the crib so that the anxious infant wouldn't climb out and hurt herself.
"One night, after I had gotten up about four times to put Sasha back in her crib, I was crying, she was crying, and it suddenly occurred to me that I had been trying to get my baby to sleep in a cage! It even looked like a cage with the net on top and the bars. I took her out and brought her into bed with us. The very next night, after she fell asleep nursing in our bed, she slept seven hours straight! I couldn't believe it!" reports Franklin, who is now a confirmed family-bedder.
Franklin and other working parents recommend the family bed as a way to reconnect with young children after being away from them all day. Julie Graves Moy, MD, MPH, is a family-practice physician in Austin, Texas and the mother of a toddler. She urges the working parents she sees to give co-sleeping a try. "The family bed gives working families extra time together," explains Dr. Moy. "If you are away for nine or ten hours at work (with commuting time), when do you hold the baby? Also, working moms need to get all their sleeping done at night because they don't get those wonderful afternoon naps with baby."
Theories abound as to why most children sleep more soundly with their parents. The fundamental reason may be quite simply that children feel more relaxed and secure when they are close to the most important people in their lives. Although a majority of parents are able to accept a young child's strong dependency needs during the day, American culture expects even the tiniest infant to "shut down" at bedtime for a period equaling the average adult's nightly sleep requirement -- in spite of the fact that most adults, given the choice, prefer not to sleep alone.
Katherine Dettwyler, Ph.D., award-winning anthropologist, infant nutrition specialist, and co-editor of Breastfeeding: Biocultural Perspectives, contends that in the United States, "Parents want to promote independence in children at the earliest possible age. Parents are always being encouraged to leave their baby with sitters and get him to sleep through the night. People want to be able to essentially turn their children off at seven or eight p.m. and not have to deal with them until the next morning."
According to Dettwyler, American parenting culture appears to resent the amount of time it takes to properly nurture a child, particularly if that child has needs when a parent would rather be asleep. However, according child development experts who favor family sleep-sharing, parents who put their children in a crib down the hall and expect them to stay there quietly until morning may be risking their child's emotional health. A child who does not receive warmth and reassurance when she asks for it can develop a range of attachment and trust disorders, whether the parents' failure to respond comes at noon or midnight."I am my daughter's parent twenty-four hours a day," says Marsha Franklin. "I can't expect her to adhere to a predetermined schedule for needing a hug or a drink of water."
Common sentiment among sleep-sharing parents is that the urge to sleep alongside their little ones feels "instinctual" or "primal." According to James J. McKenna, Ph.D., an anthropologist and internationally-known expert on infant sleep, this parental urge may stem from the thousands of years of human evolution during which family co-sleeping was the standard. In a winter, 1996 article in Mothering magazine, McKenna summarizes his views on the anthropological relevance of family sleep sharing, noting that "..nighttime parent-infant co-sleeping during at least the first year of life is the universal, species-wide normative context for infant sleep, to which both parents and infants are biologically and psychosocially adapted...Solitary infant sleep is an exceedingly recent, novel and alien experience for the human infant."
Dettwyler agrees with McKenna, claiming American attitudes about how and where a baby sleeps are unique. "Mothers who are co-sleeping still make up the majority of the world's parents," she comments. "In other societies, it isn't viewed as expected or normal for a baby to sleep by himself."
What, then, about safety? Haven't strong admonitions against the family bed been rooted in fear of smothering in the literal as much as the figurative sense? The worry that a sleeping mother will "overlie" her baby and cause his death dates back to a Biblical reference found in the Book of Kings. Pediatricians and others often advise new mothers to avoid sleeping with their babies as a protective measure against infant suffocation. However, parents who enjoy a family bed and doctors who advocate its use point out that the same internal signals that prevent a sleeping adult from rolling out of bed and injuring herself will also prevent a parent from rolling on top of her infant. In the rare cases where overlying has occurred, it has generally been the result of inappropriately soft bedding or a parent whose sleeping awareness was impaired by alcohol or medication. "The average, typical parent sleeping on a good mattress will be very aware and will not roll over on (her infant)," asserts Dettwyler.
In fact, the family bed may even offer protection against infant death. In his latest peer-reviewed medical research conducted at the University of California, Irvine School of Medicine and funded by the National Institutes of Health, Dr. McKenna theorizes that infants who sleep alone are at a significantly increased risk of Sudden Infant Death Syndrome (SIDS). According to the National SIDS Alliance, one in every 500 American infants, or 7,000 to 8,000 babies a year, die of this still-mysterious phenomenon. This number represents a larger proportion of the U.S. infant mortality rate than cancer, heart disease, pneumonia, child abuse, AIDS, cystic fibrosis and muscular dystrophy combined.
McKenna and co-researcher Dr. Sarah Mosko, a psychobiologist and sleep specialist at the University of California Sleep Disorders Laboratory, performed two pilot projects on the physiological influences that sleep-sharing mothers and babies exert on one another. McKenna monitored the breathing patterns, heart rates, brain waves, and chin and eye movements of mothers and their infants in various sleeping arrangements, and, using infrared cameras, videotaped mothers' and infants' sleeping behavior. Results from these tests showed that mothers and babies who sleep together are extremely attuned to one another even while asleep. Neither partner disturbed the other's rest. Mothers and babies seemed to move simultaneously through the various sleep stages, and yet co-sleeping infants spent less time overall in the deepest state of sleep -- the period most dangerous to SIDS-vulnerable infants. In one of the observed pairs, the infant spent eighty-seven percent of her time within twelve inches of her mother's face. This behavior allows co-sleeping babies to breathe in some of the parent's expelled carbon dioxide. According to McKenna, when this carbon dioxide is mixed with oxygen, it induces stable breathing.
McKenna's studies demonstrate that American parents may heighten the risk of SIDS by expecting their babies to sleep alone at too tender an age. Vulnerable infants, he posits, need to "learn" safe sleep habits, such as moving through varying sleep-states and breathing patterns, or they risk falling into a period of heavy, uninterrupted slumber from which they might not awaken. McKenna's research suggests it may be through sleeping alongside an adult that an infant develops these skills and receives the continuous contact and stimulation that can protect against SIDS. Additionally, a mother who sleeps with her infant has been shown to be keenly aware of her child's breathing and temperature throughout the night, and is thus able to quickly respond to any significant changes.
Data collected from other countries supports McKenna's theory. In Hong Kong, Japan and China, where mothers almost always sleep with their infants, SIDS rates are a fraction of what they are in the United States. SIDS rates remain low among communities of Asians who immigrate to the United States. However, the number of SIDS deaths rises in direct relation to the amount of time an Asian parent lives in the United States, possibly due to the adoption of American-style customs, such as separate sleeping quarters for mothers and babies.
Joseph Gilhooly, M.D., newborn specialist and advisor to the Oregon SIDS Alliance, views the emerging research on co-sleeping and SIDS as promising, stating, "We have to wake up and look at family sleeping customs. It's a natural way to be. Babies have slept beside a parent for millions of years. Other mammals sleep with their parents -- it's unique for humans to force infants to be independent, like babies being forced into a strict feeding schedule."
Dr. William Sears strongly concurs in his recent top-seller, SIDS: A Parent's Guide to Understanding and Preventing Sudden Infant Death Syndrome. Sears contends that based on his experience as a physician and the father of eight children, a family bed is the safest place for an infant to sleep.
Other criticisms of the family bed abound, however. Some, such as T. Berry Brazelton, M.D., does on a Pampers web site (www.pampers.com), claim that when children sleep with their parents "sexual abuse is more likely (Freudian emphasis)..." Family-bedders are incensed and offended by this unsubstantiated accusation.
"I have heard people say this and frankly, I find it absurd," says James Wilshok, a married father of two from Boston, Massachusetts. "My wife and I have been sleeping with our kids since they were babies and being close to them at night is no different than hugging them close during the day." Wilshok and other parents say that sharing sleep with children simply calls for moving the marital relationship out of its traditional locus and into other areas of the house. Many couples claim the necessity of seeking alternative locations for intimacy adds creativity and spontaneity to their lovemaking.
The late Robert Mendelssohn -- well-known pediatrician and author of several books -- noted that when confronted by mental health specialists who feared sexualization of the family bed, he sarcastically agreed that "psychiatrists should not take their children to bed with them, but it is quite all right for everyone else!"
But what about the long haul? Western opposition to co-sleeping has always been rooted in the perceived need to promote autonomy and independence. Isn't it true that an older child who has been allowed to sleep with parents won't ever want to move into his own bedroom? Won't you regret it if you allow your baby or young child into your bed now? "You probably will," surmises Brazelton, aptly reflecting what has been the dominant school of thought on the matter, "and it may be harder to wean her from your bed later. But it is difficult to make that decision these days. Our culture really doesn't accept co-sleeping even though most other cultures do. In Japan, mothers have a big futon and all children sleep with her. The father sleeps alone in another part of the house. In our culture, there are taboos...but I find working parents who are away all day can't stand to give their babies up at night...Parents today feel we are pushing our children too hard and they need the comfort of being close at night...You must decide which path to follow. I must warn you that giving them up later becomes more and more difficult."
Although no substantive studies have looked at this issue, long-term family-bedders say this concern is without merit, and springs from the same obsession American society has with rushing children through developmental milestones such as weaning and toilet training. Children who sleep with their parents leave the family bed when they are ready: earlier for some children and later for others, just as with other stages of maturity. "Of all the families we know who sleep with their kids, I have never seen a teenager who still wanted to sleep with her parents on a regular basis," notes James Wilshok.
For families opting for the family bed, practical solutions for sharing sleep are numerous. Many parents invest in the largest size bed available and everyone sleeps together there. If the children are infants or toddlers, the bed is pushed firmly against the wall, leaving no space into which a baby could roll. A bedrail is then fastened to the other side of the bed. If a bed is very high, the frame can be packed away until the children are older and the boxsprings and mattress can sit directly on the floor.
Other parents of younger children employ a "sidecar" arrangement by securely attaching a crib to one side of the parents' bed, usually next to the mother. Three sides of the baby's crib are left intact, but the side next to the parents' bed is lowered or removed so that mother and baby have easy access to one another. Some larger families or households with older children place futons or mattresses all over the bedroom floor so that everyone has plenty of room to stretch out. As with all bedding for infants, family beds should be firm and smooth, without an excess of blankets, pillows or stuffed animals.
When parents remain undecided about a full-scale family bed, but wish to have their children nearby at night, family members can sleep in separate beds in the same bedroom. An infant's bassinet or crib can remain within an arm's length of resting adults. Another version of the "modified" family bed provides a child with her own bedroom, but allows free access to the parents' bed at any time. For every household in which the children spend the entire night in the family bed, there is another in which children start their overnight hours in a separate sleep-space, but are welcomed into the parents' bed after a night waking.
Co-sleeping is often discussed as if it were a discrete, all-or-nothing proposition (i.e., should baby sleep with parents?)," Mckenna writes in a recent report entitled, "Rethinking "Healthy" Infant Sleep." He goes on, "Many parents fail to realize that infants sleeping in proximity alongside their bed, or with a caregiver in a rocking chair, or next to a parent on a couch, in a different room other than a bedroom, or in their caregiver's arms all constitute forms of infant co-sleeping. I studied the location of infants and parents in their homes between six p.m. and six a.m. and found more infant-parent contact than parents describe." McKenna prefers to conceptualize infant-sleep arrangements in terms of a continuum ranging from same-bed contact to the point where infant-parent sensory exchanges are eliminated altogether, as for example, infants sleeping alone in a distant room with the door closed. "We might want to question," McKenna concludes, "why infants protest sleep isolation. They may be acting adaptively, rather than pathologically. Perhaps these infant "signalers"...have unique needs and require parental contact more than do some other infants. It's worth considering."
Copyright, 1997, 1998, Katie Allison Granju.