Notes on the Durham University Parent-Infant Sleep Lab Conference

What I took away from the Durham Sleep conference last week 

(https://www.dur.ac.uk/sleep.lab/conference/) 

was that human infants have evolved to be in close contact with their mothers and fed frequently, day and night. Human milk has also evolved to be low in protein and high in lactose, as babies’ brains need to grow fast. However, for the past century or so, since the publication of a very influential book by Emmett Holt in 1894, which recommended long feeding intervals and virtually no night feeding, parents in Western society have been trying to get their babies to behave in ways which don’t suit them physiologically. Our expectations hamper us: it is commonly believed that babies should sleep on their own and will sleep longer if given formula. There is no evidence that this is true. One piece of research showed that formula-feeding mothers over-reported how long their babies slept, the implication being that because they believed that their babies would sleep longer, that was their perception. But when researchers observed the babies, they found no difference in the number of hours breastfed and formula-fed babies sleep. (Montgomery-Downs et all 2010 Infant Feeding Methods and Maternal Sleep and Daytime Functioning:

http://pediatrics.aappublications.org/content/126/6/e1562.short ) 

Nowadays most new parents in the West are surprised when their baby refuses to sleep without being held, wants to feed frequently, and wakes frequently at night. They often think that something is wrong with their baby or with what they are doing. But solitary sleep has a very recent and culturally specific history. In most non-Western societies, mothers get on with their lives while carrying their babies, and they have no idea how often their babies feed at night. They are puzzled when asked how frequently their baby feeds. It’s not a relevant concern, as their expectations are different.

In Japan, shared parent-child sleep, which is called soine, is viewed as a key way to form intimacy through touch, which is called ‘skinship’. It is taken for granted that breastfeeding is a key element of soine. One Japanese mother said that breastfeeding is the best form of ‘skinship’: “I love being close together for a long period of time. That’s mine and my baby’s time, and while we are sleeping, I breastfeed”. A child sleeping between his or her parents, which is called kawa no ji, experiences anshin-kan which means a feeling of contentment, relief and security. In Japan, only 7% of parents report infant sleep problems, whereas in the U.K. and the U.S., 25% to 33% of parents believe their babies have a sleep problem.

Dr Pamela Douglas, creator of the Possums Clinic in Brisbane, Australia, believes that many of the things that parents in Western society have been encouraged to do to get their babies to sleep better are actually hindering their night-time sleep. Parents worry enormously because there is a common belief that babies won’t reach their full cognitive potential if they don’t get enough sleep, but research has shown this isn’t true. It’s also important to realise that babies vary enormously in how much sleep they need. Four systematic reviews have shown that sleep training does not reduce night waking, but it does cause what Dr Douglas calls ‘dialling’ up of the sympathetic nervous system, which means that when babies have been sleep-trained, they struggle more to fall asleep. Babies can’t be taught to go to sleep, it’s a biological function that’s not under their control. It is normal for babies to wake 3 to 4 times in an 8 hour period. She says that big daytime naps disrupt night-time sleep as it affects the baby’s circadian clock. She encourages parents to let ’sleep pressure rise’ rather than putting their baby down for a nap at the first sign of tiredness.  She also says that it’s a myth that babies shouldn’t be overstimulated. She says that many babies are bored by spending too many hours at home and need to go out and experience rich sensory nourishment from early on.

She encourages mums to breastfeed their babies to sleep, and to feed responsively, and she says to forget about burping (I was delighted to hear this). Burping is not necessary and often prevents a baby from falling asleep at the end of a feed.  She discourages mothers from following a feed, sleep, play routine, as it’s not compatible with responsive care (which she calls cued care), which is good for breastfeeding and for a baby’s wellbeing.  

She suggested putting the baby to bed relatively late, say 8.30pm, but in fact the time a baby goes to bed isn’t as important as when the baby wakes up in the morning. She says it’s essential to wake the baby at the same time every day, as this re-sets the baby’s circadian clock. 

In summary, rather than fixing the baby, Prof Helen Ball suggests some alternative strategies to help parents cope:

• Support parents

• Wait it out

• Adjust expectations

• Minimise disruptions: make night waking as effortless as possible

• Harmonise adult and baby sleep patterns

• Work with sleep biology

• Remove cultural pressure: in particular comparison with other babies

• Eliminate anxious thoughts so that mothers can fall back to sleep more easily