Caring For Babies, Caring For Parents: What Human Infants

Really Need And Why

James J.McKenna Ph.D.

Edmund Joyce Professor of Anthropology

Director of Mother-Baby Behavioral Sleep Laboratory

University of Notre Dame

Saturday Scholar Series

Western Perceptions of, and Approaches To, Caring For

Baby?

Whose baby is it, anyway?

How and when did parents give up their rights to make decisions about how they would care for

their infants? Or Did we?

Do we ..abdicate decision making to outside medical authorities?

Why do we seem to care so much that others approve of what we do with our infants? How did

Western parents lose their own confidences in how to be a “good” parent?

“It’s not what we know that gets us into trouble….it’s what we know…that just ain’t so!

From: Everybody’s Friend (1874)

By Josh Billings

Infant Care Is A “Moral Good”The kind and nature of parental care is critically

judged by community members based on societal values..roles of men, women and children…

QuickTime™ and aPhoto - JPEG decompressor

are needed to see this picture.

What’s “good”

parenting?

What is safe?

What problem is worth solving?

if...sleeping alone through the night is “good” for

babies

then “good” babies sleep alone, don’t they?

cultural influences on infant touching

• “ In the western world it is perhaps a great advantage for an infant to have a sensitive skin or diaper rash or some other dermatological disorder, for then, at least, it can be assured of receiving something resembling an adequate amount of cutaneous stimulation” (Montagu :1986:247)

Until recent, western historic periods, no human parents ever

asked:

Where will my baby sleep, how will I lay my baby down to sleep, and

how will I feed my baby?

most human parents still don’t!

For the human infant the three functionally inter-related (adaptive) components of normal, healthy infant sleep include:

• Sleep location – (next to mother for social or co-sleeping behavior

involving on-going sensory exchanges, monitoring and mutual regulation)

• Nighttime feeding – exclusive breast feeding

• Sleep position– Back (supine)

The cultural dismantling of this biological system led to the deaths of

thousands of western infants from, SIDS, accidental asphyxiations and/or other

SUDI (i.e. from social sleep …to solitary infant sleep--

from breast feeding …to bottle-formula feeding

from supine …to prone infant sleep position

American Academy Of Pediatrics New SIDS Prevention

Recommendations

proximate but separate sleep for baby;

no side position sleeping;

cuddling but no bedsharing

pacifers for sleeping infants, after breast feeding is established;

more holding and carrying

Historical Forces Effected Western Infancy and How We Think About Infant Development

• rise of child care experts replace maternal confidence

• emphasis on technology, rather than on bodies to nurture;

• emphasis on “average expectable outcomes” per any given behavioral parenting strategy..one-size-should- fit all;

• emphasis on social values and ideologies (not biology) to guide research and conclusions..medical care of infants;

• social constructions of infancy, not /biological evolutionary;

• “Science” of infant feeding (bottle-formula feeding) and sleep pediatrics became one and the same with…

• mutually reinforcing moral ideas about who infant should be, or become, rather than who they are…and how husbands and wives should relate vis a vis distance, authority and separation from children…also, touch =sex?

Babyhood…….by Paul Reiser

“Getting your child to sleep becomes a blinding obsession. I myself would often loose sight of the larger picture.What is the actual goal here? Constant sleep? No awake time? Zero consciousness?

I mean, we must accept that at some point babies have to be awake.They did not come to the planet just to sleep. Are we determined to get them asleep just so we can get a taste of what life was like before we had a kid?

Because, if we are, then why did we have a kid? Just to lie there to look soft and fuzzy? We could have gotten, say, just a peach. A St Bernard? A narcoleptic houseguest?

Or why not just a chenille bathrobe? Chenille bathrobes are fuzzy and just lie there”?

“…SLEEPING IN YOUR BED CAN MAKE an infant confused and anxious

rather than relaxed and reassured. Even a toddler may find this repeated experience

overly stimulating”

really?

R. FERBER (1886,1999) SOLVE YOUR CHILD’S

SLEEP PROBLEMS

Culture Producing Science Producing Culture: How A Folk Myth Achieved Scientific Validation

“Scientific” validation of solitary

infant sleep as “normal” and

“healthy”

#1: Initial test condition—infant sleeps alone, is bottle fed, and has little or no parental contact

#2: Derive measurements of infant sleep

under these conditions

#3: Repeat measurements across ages, creating an “infant sleep model”

#4: Publish clinical model on what constitutes desirable, healthy infant sleep.

#5: To produce “healthy” infant sleep, replicate the test condition

• devoid of the “relational” familial factors (where baby sleeps and feeds as regards parental emotions and goals;)

• devoid of intrinsic (infant) factors (temperament, personality , sensitivities);

• categorizes infant’s inability to follow cultural model as…”disease”, sleep disorder, immaturity, and, thus, infant becomes a “patient”;

• promotes one- size- should- fit- all; • promotes one sleeping arrangement as a moral issue

and gives it a specific set of inappropriate meanings;

The western medicalized model of infant sleep fails miserably!

Who is the infant? What do infants need and why? Who

decides and ..does it matter?

..the behavior of infants is not independent of the theories of human

infancy that parents adoptBased on Leon Eisenberg “The Nature of Human Nature”

pg 165 (1972)

“For species such as primates, the mother IS the environment.”

Sarah Blaffer Hrdy, Mother Nature (1999)

Babies Celebrated, Beatrice Fontanel and Claire D’Harcourt, © 1998 Harry N. Abrams, Inc.

Nothing an infant can or cannot do makes sense, except in light of mother’s body

compared with other primates.. neurological age of the human neonate

at birth is rolled back… hence….

relatively speaking, all human infants might be considered “preemies”, non-

ambulatory, unable to cling, incontinent, unable to speak, keep warm, reason,

discriminate,attach social meaning to on-going events….

Enter…human biology…Guess Who’s Coming To

Dinner?• The human

obstetrical dilemma;

• YIKES!• Human Fetal Head

Size ExceedsOutlet Dimensions With Emergence of Bipedalism

small biological aside…

What is the origin of mammalian breastfeeding

Ahhhh…let’s see..?

Primitive “Mothering” Reptiles

• The antecedents to mammalian parenting was likely an egg laying--dedicated, protective mother who shared a nest, den or burrow--who protected and retrieved, rather than fed.

Female duck-billed platypus

• Incubates eggs safely inside a grass-lined burrow;

• Sealed up with their mother, hatchlings feed on milk dripping from hairs surrounding a teatless milk-producing gland

http://www.bfnews.blogspot.com/ (2004)

But, is this what we mean when we say…..

“he has a good taste in art” ?

Now, this is biology!

Biology of Mother’s Milk Predicts Contact and Cosleeping Behavior

• Feed and Leave Species– (Ungulates)

• High fat• High protein• Low carbohydrate

• High calorie = long

feeding interval;

(to avoid predators nested infants do defecate or cry in mother’s absence)

• Contact, Co-sleeping, And Carry Species– (Primates—Humans)

• Low fat• Low protein• High carbohydrate

• Low calorie = short feeding interval;

(carried infants cry in mothers absence and defecate spontaneously)

Maternal behavior among primates extends throughout an extremely long infant and juvenile period, with prolonged periods of physical contact.

Orang-Utan

Consider the physical intimacy of the maternal-infant relationship

…socially and medically

obscured by western culture

Balinese

Mother and infant

QuickTime™ and aPhoto - JPEG decompressor

are needed to see this picture.

A major basis of maternal-infant attachment is “contact-comfort” (rather

than satiation)…Harry Harlow

“Attachment”:

Unfolding, discriminating bond between parent and infant; genetically-based…..

Immediate survival and protection from predators is main outcome;

Just how ideological is baby care socialization? Consider these “Aboriginal (toy clay dolls ) and mud breasts”

Now Available at Toys R Us ? ……(as if!)

Hidden Regulatory Mechanisms(Myron Hofer/Martin Reite)• a given interaction may be guided and even

determined by processes hidden to observation; nutritional status of infant, heat, smell, touch, vestibular;

• repeatedly delivered sensory regulation may have cumulative effects which influence adult roles and behavior by way of:

• internal state responses by baby to caregiving behavior (blood pressure, satiation, anxiety, breathing, heart rate) may be altered by specific aspects of their relationships (labile traits) like being touched, spoken to, and fed frequently (neuro-developmental, long -term effects)..

3-day separation:induces physiological changes (immune,system, heart rate,sleep, cortisol, loss ofbodytemperature..

anaclitic depression:•hyperactivity•conservation-withdrawal;•death or recovery

Breathing mechanical Teddy Bear!

(reduces infant apneas by 60%)

(Evelyn Thoman 1985)

Percent Parents Who Bedshare (USA)

Source: National Center For Health Statistics 1999

• Almost Always... Sometimes…Never• Alaska 38.5 39.1 22.5• Alabama 32 38,7 31.4• Colorado 14.4 48 37.5• Oregon 34.4 41.7 23.4• West Va. 20.4 37.1 42.5

• Willinger et al. in press…as high as 50%;

• McCoy et al.(2000) 22% (always), to 50% (sometimes);

Who Bedshares?“There are two kinds of people in the world…those who sleep with their children and those who lie about it!”

Rob Cordes M.D.

Until recent historic periods, no human parents ever asked:

Where will my baby sleep, how will I lay my baby down to sleep, how

will I feed my baby?

most human parents still don’t

(Co-sleeping with breast feeding are inevitable and inseparable for most

contemporary people)

The Complex History of Infant Sleeping Arrangements In Western Industrial Societies Is Reduced To Simple Understandings Congruent

With Present Cultural Beliefs:

• inevitable suffocation/overlying/SIDS

• inevitable psychic damage to infant

• inevitable rupture to conjugal (husband/wife) relationship

• inevitable prolonged dependency of infant/ child

• inevitable lack of autonomy in infant/child

– NOTE: not one controlled scientific study documents the benefits of solitary infant sleep, or the alleged deleterious social/psychological/physiological consequences of safe cosleeping with breast feeding

1.Dis-articulated from mother…

No touch;

No smells;

No sounds

No movement;

No body heat’

No breadth exchange

Diversity of Co-sleeping(requires taxonomic distinctions)

Co-bedding twins

(within sensory range)

partial, mixed

bedsharing with Dad

Parent -infant co-sleeping is biologically and psychologically expectable, if not inevitable.

What Co-sleeping Looks Like

Maori, New Zealand

recliner co-sleeping (unsafe)napping desert Aborigine

Koala

University of Notre Dame

Mother-Baby Behavioral

Sleep Laboratory

first time mothers, at risk teens

Research funded by

NICHD RO1

Variations of Safe/Unsafe Sleep PracticesInfra-red Video Studies: Crib-Solitary and

Bedsharing ( HD 39456-01 )

QuickTime™ and a decompressor

are needed to see this picture.

QuickTime™ and a decompressor

are needed to see this picture.

Examples:

1.Solitary-crib baby placed prone, face down;

2. Neck-wrap, head covering, pillow, solitary, crib baby;

3.Bottle-feed bedshare between pillow, teen mom ,lack of maternal response;

4.Breast feeding mothers, high level of responsivity to infant;

Does “Normal” Human Infant Sleep Biology

Really Matter?Is It Still Relevant For An

“Advanced” Society ?

Distribution of Number of Feeds Received by Infants Per Group Per Night

1 2 3 4 5 6 7 8 9 10 11 12012345678

# of infants

1 2 3 4 5 6 7 8 9 10 11 12

# of Breast Feeding Episodes

1 2 3 4 5 6 7 8 9 10 11 12012345678

# of infants

1 2 3 4 5 6 7 8 9 10 11 12

# Breast Feeding Episodes

1 2 3 4 5 6 7 8 9 10 11 120

1

2

3

4

5

6

# of infants

1 2 3 4 5 6 7 8 9 10 11 12

# Breast Feeding Episodes

1 2 3 4 5 6 7 8 9 10 11 12012345678

# of infants

1 2 3 4 5 6 7 8 9 10 11 12

# Breast Feeding Episodes

RB-SN

RB-BN

RS-SN

RS-BN

And why do you suppose, 45-60% of American infants….

Have “sleep problems to solve”?

Mother and Infant Bedsharing Orientation on BN

MFI

MFA

IFM

IFA

*FEO

050

100150200250300350400

MFI

MFA

IFM

IFA

*FEO

RB-BNRS-BN

(in min)

From: Richard et al.,Sleep 19 (9) 1996

(Face Each Other)

Number of Maternal Arousals With Temporal Overlap

MomFirst

BabyFirst

SameTime

Total0

10

20

30

40

50

60

MomFirst

BabyFirst

SameTime

Total

RB-BNRB-SNRS-BNRS-SN

*note sensitivityof routinebedsharing motherwaking to infant arousal (no habituation!)

Face-to-Face: Maternal Contribution to

Infant CO2 Environment • 1) 12 RB mother-infants on bedsharing

night (BN) spent 64% of their time face-to-face with infant at distances less than 20 cm. 2) concentrations of CO2 in air were measured in six young women at distances of 3, 9, 18, and 21 cm. Room was .04 % CO2 concentration and 2.36% (3cm) and < 4% (under a blanket).

• Mosko, McKenna et al 1998– Amer Jour Phys Anthro

Photo :Max Helwig-Aquilar Discover Magazine 1992

Why Do Babies Co-sleep?

because they are supposed to…!

Study Design4-site prospective longitudinal study of a population-based, representative sample of 400 adolescents and their children and an ethnically matched sample of 400 adult mothers and their children (160 low- education and 160 high-education)

TOTAL SAMPLE400 TEENS

320 ADULTS

100 teens80 adults

100 teens80 adults

100 teens80 adults

100 teens80 adults

Kansas City Washington, DC

Birmingham South Bend

University of Kansas

Kansas City, KS

University of Notre Dame

South Bend, IN

University of Alabama at Birmingham

Birmingham, AL

Georgetown University

Washington, D.C.

USA (The Four Research Sites)

Nighttime Sleep -Activities Study

TOTAL SAMPLE400 TEENS

320 ADULTS

100 teens80 adults

100 teens80 adults

100 teens80 adults

100 teens80 adults

Kansas City Washington, DC

Birmingham South Bend Target Sleep Lab Sample:

50 TEENS30 ADULTS

Adolescent and Adolescent and high-education high-education adult mothers adult mothers recruited to recruited to participate in participate in sleep lab study.sleep lab study.

Data collection Data collection points at 4 and points at 4 and 8 months.8 months.

→→

Measured Variables InformantMethodContact

Consistency (in Parenting)

Encouragement

Celebrations

Protect

Stimulate

Regularity (in Routines)

Unhappiness

Affectionate

Rigidity

Child Abuse Potential

Responsiveness

Protective/RiskyPositional

Relatedness

Response Latency

Punitive/Rejections

Impulse Control

Verbal Encouragement

Confidence

Verbal Accessibility

Responsivity

Sleep Lab Behaviors

Cellular Phone Data

Mother

Other

Maternal- Child Characteristic Scale

Mother-Child Play

Human milk composition, carrying behavior, supine infant sleep and co-sleeping: An

integrated adaptive system

0

10

20

30

40

50

60

70

Prone Supine Right Side Left Side

RB-BNRB-SNRS-BNRS-SN

Infant Sleep Position And Sleeping Arrangement

All-night sleep-wake histograms for five (A-E) cosleeping pairs. Mosko, McKenna et al (1993). Journal of Behavioral Medicine 16 (6).

Mom

Baby

Wake

Sleep

Mom

Mom

Baby

Mom

Baby

Mom

Baby

Baby

Wake

Sleep

Hidden regulatory mechanisms.. calming a baby by “shhhhh..ing”

A universal practice! • prenatal sensory experiences--fetus hears

rhythmic “shhoosh--sha” as blood pulses by infant’s ear every .10 of a second following maternal heart contraction..

– “chamosh (Urdu) “shuu” (Vietnamese)– chutee (Serbian), “soos” Armenian– Hush-silence (English), “stille” (German),– “hushket” (Arabic),”sheket (Hebrew)– “Shuh-shuh” Chinese, “toosst” Swedish

(From H.Karp 2002)

Evidence -Based Science:

Infants sleeping alone in a room by themselves are at least twice as likely to die from SIDS than are infants sleeping in the

company (same room) as a committed adult caregiver…

Sources: Great Britain (Blair et al 1999), New Zealand (Mitchell and Scragg 1995), and European

Collaborative Study (Carpenter et.al.in press, Lancet)

Public Health Tips

• Infants encounter several different sleep environments ..regardless of how the parents classify themselves…need safety information on all of them, including safe bedsharing

• “safe “ bedsharing is not an oxymoron…(despite claims to the contrary…)there is an enormous range of safety factors that differentiate bedsharing environments…