James McKenna and Breastsleeping

Dr. James McKenna spoke at the LLL of Georgia’s Breastfeeding and Parenting Conference in November. This is an excerpt from Leader Today (the LLLI journal for Leaders) about the concept of “breastsleeping.”

“Dr. McKenna emphasizes that until recent history (in Western industrialized societies), “….no human (primate) ancestral or modern infant ever slept separated from its caregiver…” Human infants are contact seekers for a number of reasons based in evolutionary science. When our ancestors moved from walking on all fours to walking on two legs (bipedalism), pelvic openings became smaller to accommodate this innovation. Humans evolved to have the largest brains of any primate, so with this change, infants needed to be born “earlier”—partly due to the need to fit through the birth canal and partly due to the placenta’s inability to sustain such huge brain growth. The result is that human neonates are by far the most helpless at birth of any animal and require constant nourishment and care for the first few months of life.

More evidence for this comes from mother’s milk itself. Nesting or cache animal species (those animals that hide their young in camouflaged locations) have milk that is high in fat and protein and low in carbohydrates, enabling the mother to leave her young for extended periods. The milk of contact/carry/co-sleeping species is opposite in composition, necessitating very frequent feeds. In addition, constant contact requires infants to be attractive to their caregivers—babies are cute for a reason! Big eyes, chubby cheeks, soft skin and cooing all attract parents emotionally and convince them to invest time and energy in child rearing.

In the current issue of Acta Paediatrica, 1 Dr. McKenna and Dr. Lee Gettler propose the concept of breastsleeping, because;

…”neither normal human healthy infant sleep, nor normal human optimal breastfeeding is understood independent of the other…”
Breastsleeping refers to a sober, breastfeeding mother sleeping with her baby on the same surface in the absence of all hazardous factors. In his research, Dr. McKenna has found that breastsleeping dyads synchronize their breathing and sleep cycles so that baby latches on and mother adjusts coverings, kisses baby’s head, etc. without either waking up fully. Breastsleeping babies also maintain higher body temperatures and breastfeed double or triple the number of times during the night compared with solitary sleeping infants. Both increased nighttime arousals and breastfeeding protect against Sudden Infant Death Syndrome (SIDS).”

“Public health campaigns promote solitary sleep
In the United States, the American Academy of Pediatrics (AAP) recommends that babies sleep in the same room as their parents, but not bedshare. Public health campaigns routinely promote solitary crib (cot) sleeping as the only safe form of infant sleep, often including the tagline

Alone. Back. Crib – No Exceptions.
However, Dr. McKenna points out that other groups, such as the World Health Organization and the Academy of Breastfeeding Medicine, support bedsharing when it is done safely. The AAP recommendation is based on epidemiological data that is not controlled for such risk factors as formula feeding, soft surfaces, and parental alcohol and drug use.

Rates of bedsharing are increasing
In addition, case controls (observational studies where cases with a certain outcome are compared with cases that do not have the outcome) are difficult to verify. UK sleep researcher Dr. Helen Ball 2 has found that parents often under-report bedsharing, stating instead where they think a baby is supposed to sleep (crib/cot) or reporting where the baby began the night, even if the baby was later brought into the parents’ bed. According to Dr. McKenna, other studies with appropriate controls have found that bedsharing is dangerous for infants only in the presence of hazardous factors and is actually protective against SIDS for babies over three months old. Because rates of bedsharing are increasing in the U.S. despite public health warnings, Dr. McKenna believes that efforts must be refocused on telling parents how to do so safely. Messages that simply emphasize “no bedsharing” may increase the risk when it results in exhausted parents falling asleep with their babies on such unsafe surfaces as sofas and chairs.

Breastsleeping is biologically normal
Much of the emphasis on solitary infant sleep in the U.S. is based on Western cultural values, including early independence, the sanctity of the marital bed, and moral judgments of what makes a “good” baby. When an infant sleeping alone is seen as “normal,” a baby protesting sleep isolation is considered a problem to be solved. On the other hand, viewing breastsleeping as biologically normal considers a baby who wakes at night to breastfeed as well adapted. Dr. McKenna stresses that much of Western sleep research is flawed because it uses a cultural construct as its base and focuses on infant sleep consolidation (i.e., “sleeping through the night”) at the expense of breastfeeding—both of which (fewer arousals and artificial baby milk feeding) are risk factors for SIDS. The millions of years of evolution that have shaped parent/infant biology and instincts also contradict this Western cultural idea.

According to Dr. McKenna, U.S.-based “Safe to Sleep” campaigns are being imported to other parts of the world. These public health messages, some of which compare same surface co-sleeping to putting a baby to bed with a metal cleaver or rolling pin (truly!), are both scientifically incorrect and create unnecessary fear among breastfeeding families. He believes that these hierarchical dictates by medical “authorities” must be counteracted by a “bottom-up” groundswell of parents asserting their rights to make informed decisions about where babies sleep.

Dr. McKenna encourages parents to talk openly about their nighttime sleeping arrangements, particularly with their health care providers. Breastsleeping is biologically normal and should be treated as such. “After all,” emphasizes Dr. McKenna, “the mother’s body remains the only environment to which the human neonate-infant is adapted.”

Breastsleeping Facebook group
Anyone interested in Dr. McKenna’s concept of breastsleeping is welcome to join a new Facebook group called Biologically Normal Infant Sleep. Please send an email to mary.frsh@gmail.com with a sentence about why you want to join the group. For more information, consult Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family by La Leche League International, Dr. Helen Ball’s Infant Sleep Information Source (https://www.isisonline.org.uk/); and the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame (cosleeping.nd.edu).
1 McKenna J J and Gettler LT. There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping. Acta Paediatrica 10 October 2015; (105)1:17-21.
2 Ball HL, Hooker E, Kelly PJ. Where will baby sleep? Attitudes and practices of new and experienced parents regarding co-sleeping with their newborn infants. American Anthropologist 1999; 101(1):143-151.
Blair PS, Sidebotham P, Pease A, Fleming PJ. Bed-sharing in the absence of hazardous circumstances: is there a risk of Sudden Infant Death Syndrome? An analysis from two case-control studies conducted in the UK. PLoS ONE 2014; 9: e107799.”

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