Putting The Puzzle Together Again: A History of NOT Sleep Training
As parents, we do many things for our babies until they are able to do them for themselves. We feed them until they can gather their own food. We carry them until they can walk distances independently. We keep them safe, we protect them. Yet when it comes to sleep, modern culture considers helping infants fall asleep is optional. Infancy is classified as the first 3 years of life, a period of high-dependence. In many traditional cultures, babies are spaced at least 3 years apart to allow for this maternal investment in each infant.
The Industrial Revolution, European Colonisation, Slavery, and the work of missionaries left very few cultures living traditionally in the 21st century. Those who have survived are time-capsule of humanity
1970s: Awareness
In 1975, an American woman Jean Liedloff published her work The Continuum Concept after spending time living among the Ye'kuana people of Venezuela. The book chronicles their way of life, particularly the upbringing of their children. Liedloff saw a stark contrast with the Western parenting philosophies popular at the time.
Liedloff identified several practices she believed to be significant:
Natural birth — A birth experience that unfolded according to nature’s exquisitely evolved process, supported by a culture of trust in the inherent wisdom of the birthing mother’s body.
Breastfeeding — Babies nursed frequently, prompted by their own internal signals, especially during the first year or two, with less frequent nursing often continuing well beyond two years.
Cosleeping — Babies shared their parents’ bed or otherwise maintained direct contact or close proximity to their primary caregivers at night, usually for at least two years before shifting to another configuration (but never to complete isolation).
In-arms phase — During the first six months or so, babies were constantly carried in arms or otherwise in physical contact with caregivers (most often their mothers, but also other family and community members, including older children) while the people carrying them went about their normal activities. This allowed them to absorb the sights, sounds, and movements of the culture into which they were growing. The in-arms phase ends when babies begin creeping and crawling, though they benefit from being carried (less frequently) even after they learn to walk.
Responsive care — Babies developed high levels of emotional intelligence as their caregivers were present, attuned, and responsive to their signals (squirming, crying, etc.) — responding immediately without judgment, displeasure, or invalidation of the babies’ needs, yet showing no undue concern nor making them the constant center of attention.
Great expectations — Children sensed (and fulfilled) their elders’ positive expectations, which were based on the belief that children are innately social and cooperative. Also, parents expected their children’s self-preservation instincts to keep them safe, which allowed the children to develop appropriate levels of caution and high levels of confidence, without the interference of parental anxiety and overprotection.
Unconditional love — Children felt welcome and worthy in the eyes of their parents and caregivers. Having faith in children’s innate sociality, the elders were never tempted to withhold their love and respect as leverage to enforce good behavior.
continuumconcept.org
To many parents today, these might seem quite familiar and hardly controversial. But at the time they were seen as revolutionary. Quite simply, nobody had considered how babies had been raised for the thousands of years before the Industrial Revolution, which disrupted traditional ways of life, which kept mothers and infants together. The Ye'kuana and other people around the world who continued to live a hunter-gatherer or subsistence farming lifestyle, without the influence of European culture, were precious links to our past. From them, we needed to relearn how to be human parents.
1980s: Understanding
When Liedloff’s book was published, Dr William and Martha Sears were among those influenced by her work. So much so, they applied it to how they were raising their own children - they would be the parents of eight in time. In 1982, the Sears published a book of their own, originally titled Creative Parenting: How to Use the New Continuum Concept to Raise Children Successfully from Birth through Adolescence. This book was republished in 1987 as Creative Parenting: How to Use the Attachment Parenting Concept to Raise Children Successfully from Birth Through Adolescence. The Sears coined the term “Attachment Parenting” to describe their paenting approach.
I realized we needed to change the term to something more positive, so we came up with AP, since the Attachment Theory literature was so well researched and documented, by John Bowlby and others.
— Martha Sears
Attachment Theory, a psychological explanation for the emotional bonds and relationships between people, was described by British psychologist John Bowlby in the 1950s. Bowlby describes infant attachment as:
“…the infant and young child should experience a warm, intimate and continuous relationship with his mother (or permanent mother substitute – one person who steadily ‘mothers’ him) in which both find satisfaction and enjoyment."
It is important to clarify there is no suggestion that Attachment Parenting is essential for infants developing secure attachments or that babies reared differently will not develop these bonds.
Martha Sears also inspired the term “babywearing”:
Because we noticed that cultures throughout the world carried their babies in homemade slings we began fabricating different styles of slings to carry Mathew. I remember one day when Martha fabricated a sling out of material from an old bed sheet and said, "I really enjoy wearing Mathew. The sling is like a piece of clothing. I put it on in the morning and take it off in the evening." Hence the term "babywearing" was born in the Sears household.
Dr William Sears
The Sears family have written many books, including Nighttime Parenting (1985), The Baby Book (1993) Attachment Parenting (2001) and The Baby Sleep Book (2005). Their approach to infant sleep is simple:
“Oftentimes I felt ridiculous giving my seal of approval to what was in reality such a natural thing to do, sort of like reinventing the wheel and extolling its virtues. Had parents’ intuition sunk so low that some strange man had to tell modern women that it was okay to sleep with their babies?”
— William Sears
William Sears states that any sleeping arrangement that a family practices is acceptable as long as it works; but he advises mother to sleep close to the child. He thinks of co-sleeping as the ideal arrangement and refers to it as the nighttime equivalent of baby wearing: co-sleeping supports, in his opinion, the mother-child-attachment, makes breastfeeding more convenient, and prevents not only separation anxiety, but also SIDS
In 1989, Deborah Jackson wrote the book Three In The Bed: The Benefits of Sleeping with Your Baby: “Only since Victorian times has it been standard practice for mothers and fathers to send their babies to sleep alone, away from the parental bed - often in another room. This book reveals how babies who sleep with their parents benefit by getting virtually a full night's sleep. The author explains the advantages of this radical form of baby care, including its benefits for breastfeeding mothers, reviews the history of babies in the bed and, through interviews with parents, explores attitudes to the idea. The book also contains a fresh perspective on the tragedy of cot death, as well as practical advice on how to sustain your sex life, hints on safety in the bed, answers to all the common objections and dealing with the moment when the baby leaves its parents' bed.”
The idea that co-sleeping is inherently dangerous for babies is an urban myth. Generations of parents have been made to feel guilty if they cuddle up to their children at night, even though they may get more sleep, breastfeeding is easier, crying rates are drastically reduced, babies breathe more steadily, sleep hormones are stimulated, baby's core temperature is regulated by skin-to-skin contact, parental confidence is boosted and it becomes possible to react swiftly in a crisis.
Deborah Jackson
1990s: Embracing
Touchpoints: Your Child's Emotional And Behavioral Development Dr T Berry Brazelton (1994) Touchpoints is an evidence-based theory of child development that refers to periods in a child’s life where he or she starts doing something new after an old and predictable behavior stops, i.e., a child starts to walk shortly after he or she stops sleeping through the night. This theory is based on more than sixty years of ground-breaking research by Dr. T. Berry Brazelton and his colleagues at Children’s Hospital in Boston and in communities around the world. When parents understand their child’s development and Touchpoints, they are better prepared for predictable back slides in behavior and can look forward to exciting new steps to come.
Attachment to a baby is a long-term process, not a single, magical moment. The opportunity for bonding at birth may be compared to falling in love – staying in love takes longer and demands more work. — T. Berry Brazelton
T. Berry Brazelton 1918 - 2018
Our Babies, Ourselves; How Biology and Culture Shape the Way we Parent (1998). In this ground-breaking book, anthropologist Meredith Small reveals her remarkable findings in the new science of ethnopediatrics. Professor Small joins pediatricians, child-development researchers, and anthropologists across the country who are studying to what extent the way we parent our infants is based on biological needs and to what extent it is based on culture--and how sometimes what is culturally dictated may not be what's best for babies. Meredith Small is a best-selling author, award-winning anthropologist, Professor Emerita at Cornell University, and Visiting Scholar in the Department of Anthropology of the University of Pennsylvania.
2000s: Educating
In 2002, Elizabeth Pantley published the first of her “No-cry Solution” books, The No Cry Sleep Solution. While gentle in her approach, Pantley’s books have an element of transitioning infants from parent-supported sleep to sleeping on their own. This transition is approached respectfully and with explanations of why babies naturally prefer sleeping in contact with their mother or father. Pantley reminds parents tat a problem is only a problem if it is their problem:
So, your best defense is knowledge. It really is power, as they say...The more you know, the more easily you will develop your own philosophies about child rearing. When you have your facts straight, and when you have a parenting plan, you will be able to respond with confidence to those who are well-meaning but offering contrary or incorrect advice.
Elizabeth Pantley
Pantley suggests techniques such as “putting babies down drowsy but awake”: “As an example, if your baby relies on having you rock him until he falls asleep, then you would gradually reduce the intensity and amount of time that you rock him until you are holding him motionless in your arms. If you normally rock him in the family room, relocate your routine to the bedroom, moving right next to the crib. This will help your baby get used to the new location. The next step would be to place him in the crib while he is sleepy but still awake and keep your hands on him until he settles to sleep."
In the womb your baby was jostled and rocked all day long. The fluid sway of movement was a soothing sleep inducer. Because of this experience, many newborns find lying on a still surface the least comfortable way to sleep. Over the first few months of life, most babies will adjust to a motionless sleeping surface, but some need a bit more time and help to make the transition.
Elizabeth Pantley
Also in 2002, Dr Harvey Karp published his first book The Happiest Baby on the Block. A pediatrician, Karp brought together traditional methods of soothing babies into what he called “The 5 Ss” : Swaddle, Side or Stomach position, Shush, Swing, Suck. It should be noted that the side or stomach position is to be used to settle babies, who should be moved onto their back for sleeping. Karp openly acknowledges he learned these timeless methods from one of the oldest cultures on earth - the !Kung people of the Kalahari Desert!
Most doctors say that colic (crying for more than 3 hours a day) is a mystery. That’s what I used to say, too, until 1981 when I learned about the !Kung San of the Kalahari Desert, whose mothers usually calm their fussy babies in under a minute! The more I thought about it, the more I realized we could be as successful as !Kung parents, but only if we adopt 2 new ideas:
The 5 Ss were the first approach Karp suggested western parents rediscover. The second AHA! moment Karp had was a much more signifcant contribution to our understanding of newborn infants:
The fourth trimester is a period coined by Dr. Harvey Karp as the first 3 months of a baby’s life after birth. Dr. Karp explains that babies are born too soon! Yes, you read that right. If given the choice, babies would definitely have voted for a few extra months inside the womb. So, the first three months post-birth –the Fourth Trimester – you should think of babies as fetuses outside the womb.
The concept of a fourth trimester, of humans being born developmentally premature due to the limitations of he female pelvis to accommodate the increasingly larger skull required to house the brain of the intelligent Homo Sapien. Basically, for human survival, foetuses must be expelled around forty weeks after conception even though they are vulnerably immature.
Around the same time as Karp was changing the lives of newborns in the US, New Zealand mother and midwife, Pinky McKay was doing the same for babies Downunder. An International Board Certified Lactation Consultant (IBCLC), certified infant massage instructor and sought-after keynote speaker at conferences for parents and health professionals internationally, Pinky McKay is the author of Toddler Tactics(2008), Sleeping Like a Baby(2006) and 100 Ways to Calm the Crying (2002). Her books are approved and recommended by respected bodies such as the Australian Breastfeeding Association, the Australian Association of Infant Mental Health, La Leche League International and the Centre for Attachment (NZ).
McKay described newborns in need of “womb service”: Warmth, Wrapping, Wearing your baby, Water and Womb sounds. Like the 5 Ss of Karp, these instinctive practices were not new but forgotten.
Yvette O’Dowd and Pinky McKay
Dr James McKenna began his research career studying the social behavior of monkeys and apes, with an emphasis on parenting behavior and ecology. However, following the birth of his son in 1978, his research focus shifted. McKenna has stated that, when reading through existing parenting literature, he was surprised to see that it contradicted his years of research and training about the universal aspects of primate life, particularly when it came to feeding and sleeping arrangements. This inspired him to apply the principles of human behavioral evolution to an understanding of human infancy.
“My research on mother-infant co-sleeping began when we learned that my wife was pregnant.
Like most soon-to-be parents, we rushed to buy all the parenting books.
But after reading a few books about how best to care for your new baby we were left with one of two conclusions: either everything we had learned in anthropology, my specialty, was wrong, or all these western recommendations about how best to care for babies had nothing to do with babies at all.
Maybe it had everything to do with recent western cultural ideologies and social values that more accurately reflect what we want babies to become, rather than who they actually are and what they need.”
McKenna’s books Sleeping with Your Baby: A Parent's Guide to Cosleeping (2007) and Safe Infant Sleep: Expert Answers to Your Cosleeping Questions (2020) provide evidence-based information for parents. McKenna founded and directed the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame, studying the physiology and behavior of co-sleeping mothers and infants. Professor McKenna has published over 139 refereed scientific articles in diverse medical and anthropological journals on co-sleeping, breastfeeding, evolutionary medicine and SIDS, and both here and abroad. He also regularly gives lectures on over 20 specialized topics relating to cosleeping and breastfeeding especially to pediatric medical professionals and parents. Here in the United States he remains a primary spokesperson to the media on issues pertaining to infant-parental sleeping arrangements, nighttime breastfeeding and SIDS prevention. In 2014 McKenna and colleague Lee Gettler “There is no such thing as infant sleep, there is no such thing as breastfeeding, there is only breastsleeping,” McKenna and Gettler use the term breastsleeping to refer to bedsharing with breastfeeding in the absence of all known hazardous factors.
“In fact what constitutes normal and healthy infant sleep cannot be understood independent of nighttime breastfeeding as the two co-evolved and was designed by natural selection to maximize infant health and well-being.”
The Science of Mother-Infant Sleep: Current Findings on Bedsharing, Breastfeeding, Sleep Training, and Normal Infant Sleep Dr. Wendy Middlemiss Dr. Kathleen Kendall-Tacett (2013) The Science of Mother-Infant Sleep is a compilation of recent articles that address important questions. The goal was to bring together recent evidence about the safety of sleep practices so that parents and professionals can make informed, evidence-based decisions. The Science of Mother-Infant Sleep is a collaborative project by an international working group of experts on mother-baby sleep. Wendy Middlemiss, Ph.D., CFLE, is associate professor of Educational Psychology at the University of North Texas. Her work encompasses research examining the effect of different childrearing approaches and exploring how to share this information with families and communities to promote infant, child, and family health. Kathleen Kendall-Tackett, Ph.D., IBCLC, RLC, FAPA is a health psychologist, IBCLC, Fellow of the American Psychological Association, and is President-Elect of APA's Division of Trauma Psychology. Dr. Kendall-Tackett is Editor-in-Chief of Clinical Lactation, Clinical Associate Professor of Pediatrics at Texas Tech University Health Sciences Center, and owner of Praeclarus Press.
The Science of Mother-Infant Sleep is a compilation of recent articles that address these important questions. Our goal was to bring together recent evidence about the safety of sleep practices so that parents and professionals can make informed, evidence-based decisions. The Science of Mother-Infant Sleep is a collaborative project by an international working group of experts on mother-baby sleep. Topics include: -Bedsharing What should parents avoid and how can they make it safe? Does it increase the risk of SIDS? What is its impact on breastfeeding? -Sleep-Training and Cry-It-Out Techniques Do they impact infant health and development? What should parents know? -Involving Parents in Decisions about Infant Sleep What is normal infant sleep? How can parents calm a crying baby?
Child development specialists (and mothers) Anni Gethin, PhD, and Beth Macgregor challenged the wisdom of the “cry it out” philosophy and instead advocated a responsive parenting approach during the day and at night. Mining the latest scientific research, the authors show parents how to practice gentle bedtime techniques that respect a baby’s neurological and emotional development. Their 2009 book Helping Baby Sleep: The Science and Practice of Gentle Bedtime Parenting
“We first became concerned about sleep training in the early nineties when we were at university. Beth was studying psychology; Anni was studying education and adjusting to being a first-time mom to baby Zac. At this stage, all we knew was that sleep training felt wrong—why on earth would a parent be told not to pick up a crying baby? We were curious to find out what child development research said about leaving children to cry for extended periods of time. What we found alarmed us. There was mounting evidence that failing to respond to a crying child can cause stress and harm to that child, yet there was no credible research into the impact of sleep training on children’s emotional well-being or brain development. No one could confidently say “Sleep training does not harm babies.”
2010s: Researching
Helen Ball is Professor of Anthropology and Director of the Durham Infancy & Sleep Centre. She obtained her P hD in Anthropology from the University of Massachusetts, Amherst in 1992. She established the Parent-Infant Sleep Lab at Durham University in 2000, was promoted to Professor in 2007 and served as Head of the Anthropology Department 2013-2016
Helen studies infant sleep and the parent-infant sleep relationship from a biosocial perspective. Broadly defined, her research examines sleep ecology, of infants, young children and their parents. This encompasses attitudes and practices regarding infant sleep, behavioural and physiological monitoring of infants and their parents during sleep, infant sleep development, and the discordance between cultural sleep preferences and biological sleep needs.
Helen has conducted research in hospitals and the community, and contributes to national and international policy and practice guidelines on infant care. She pioneers the translation of academic research on infant sleep into evidence for use by parents and healthcare staff via Basis-- the Baby Sleep Information Source website (www.basisonline.org.uk). She serves as Associate Editor of the journal Sleep Health, and is on the Editorial Board of the Journal of Human Lactation. She is Chair of the Lullaby Trust Scientific Committe, and an elected Board Member of the International Society for the Study and Prevention of Infant Deaths (ISPID).
The aim of Basis (the Baby Sleep Information Source) is to provide access to research based evidence about biologically normal infant sleep, in forms that are accessible to parents and health practitioners, supported by references to research relevant to families in the UK. We conceptualise ‘biologically normal infant sleep’ as being the sleep of babies who are exclusively or predominantly breastfed to at least 6 months of age and cared for in a responsive manner. We do not consider sleep training methods that require leaving babies alone for sleep in the first year of life to be biologically normal.
Basis began as the Infant Sleep Info Source (ISIS) website project, drawing on the combined experience of Professor Helen Ball and her team at the Durham University Parent-Infant Sleep Lab (now the Durham Infancy & Sleep Centre), and senior representatives from La Leche League, NCT, and UNICEF UK Baby Friendly Initiative, all being organisations working directly in the fields of parent-support and health professional training in the UK. All three organisations are experienced in the provision of online information to parents and/or health care providers (midwives, clinicians, health visitors etc.).
Sarah Ockwell-Smith published her first book BabyCalm: A Guide for Calmer Babies and Happier Parents in 2012 and has gone on to write a staggering X more, including The Gentle Sleep Book: For Calm Babies, Toddlers and Pre-Schoolers (2015) and Why Your Baby's Sleep Matters (2016). The first to use the term Gentle Parenting, Ockwell-Smith has is creating a library of books supporting parents at every stage of raising children. Ockwell-Smiths online resources for parents are evidenced-based and address common concerns:
The Rollercoaster of Real Baby Sleep We ('we' meaning society) seem to think that baby sleep is linear. By that I mean we seem to think that it gets better as babies grow older. Or at least we believe it is static, ie. it won't get worse again. The thing is, it's not linear (certainly not in an upwards trajectory) and it's not static. It goes up and down (mostly down in the first year). This is entirely normal and very, very common (that doesn't mean there is anything wrong if your baby's sleep got better and better, you're just in the lucky minority!) I didn't draw the rest of the chart, as it's a bit depressing, but when can you expect 'good' sleep fairly reliably? somewhere between 2-3yrs of age (there is a common dip at about 2.5yrs however). That's a *lot* later than most people think and certainly a lot later than most professionals advise, but it's the reality, it's just such a shame that we've lost touch with reality when it comes to infant sleep! This chart is far more representative of what happens sleep wise in the first 18 months. Yes it is depressing, but it’s realistic and once you know that something is totally normal, not your fault and most importantly *not permanent* it is so much easier to relax a little.
Nighttime Breastfeeding: An American Cultural Dilemma is the 2016 work of medical anthropologist Cecília Tomori. Nighttime for many new parents in the United States is fraught with the intense challenges of learning to breastfeed and helping their babies sleep so they can get rest themselves. Through careful ethnographic study of the dilemmas raised by nighttime breastfeeding, and their examination in the context of anthropological, historical, and feminist studies, this volume unravels the cultural tensions that underlie these difficulties. As parents negotiate these dilemmas, they not only confront conflicting medical guidelines about breastfeeding and solitary infant sleep, but also larger questions about cultural and moral expectations for children and parents, and their relationship with one another.
Dr Pamela Douglas published her book The Discontented Little Baby in 2014. The original book was dubbed an 'essential guide for expecting and new parents with babies.' The book offers a range of practical and evidence-based strategies for helping parents and babies get more in sync. This book has now been revised to incorporate Dr Douglas's latest research. Dr Pamela Douglas is founder of Possums, a general practitioner since 1987, and researcher. She is an Associate Professor (Adjunct) with the Maternity and Family Unit, Centre for Health Practice Innovation at Griffith University, and a Senior Lecturer with the Discipline of General Practice, The University of Queensland. She first qualified as a lactation consultant in 1994, and has developed a uniquely holistic, non-judgemental, and empowering approach to breastfeeding support (gestalt breastfeeding).
The Possums Infant Sleep Program is a cued care approach to infant sleep, responding to infant cues in a flexible manner, dialing down the infant's sympathetic nervous system. The program works with infants natural systems which regulate sleep and waking: the homeostat system which builds up “sleep pressure” to a point where we must go to sleep. The circadian rhythm is our body’s hormonal response to light in the morning and dark in the evening. We wake up with the release of cortisol, powering us to start the day and we wind down at the end of the day with the release of melatonin, which helps us prepare for sleep. Douglas suggests that strict routines around infant care, with the expectations of long naps in the daytime (at home, in room unnaturally darkened by blockou blinds and curtains) reduces the build up of sleep pressure and making night time sleep more difficult. Instead, she suggests allowing babies to sleep naturally during the day, with baby-led naps while mother and baby go about their day together. The Possums approach has been widely recognised globally.
In February 2023, Dr Pamela Douglas resigned from the Possums organisation. She continues to teach her Neuroprotective Developmental Care (Possums) program privately.
Lyndsey Hookway is a passionate believer in gentle, responsive parenting that never compromises infant mental health or feeding, Lyndsey works to educate professionals and families about strategies that are protective of the parent-child bond. Her knowledge and experience supporting families with sleep without leaving infants or children to cry alone is why she is trusted by breastfeeding and gentle parenting advocates around the world.
Holistic Sleep Coaching: Gentle Alternatives to Sleep Training for Health and Childcare Professionals (2018) Lyndsey Hookway
Infants are probably sleeping no differently now than they were 1000 years ago. However, parenting has changed. We are dealing with the paradox of parenting information overload, coupled with time-poverty. Parents know more than ever about the importance of love, attachment and security to young children. They may know about good nutrition, stress management, toxins, skin to skin, breastfeeding, one-to-one time, emotion coaching and organic food. Parents are bombarded with appliances that are supposed to make their lives easier, and yet end up confused about what is really necessary. At the same time, modern parents are leading busy, expensive lives, and have jobs that they love or need. And within all this, their babies are still sleeping the same as they always have.
Some sleep experts are quick to suggest quick fixes to lengthen infant sleep, but there is growing concern that techniques such as extinction may have negative outcomes for infants as well as being stressful for parents. Holistic Sleep Coaching is a multi-dimensional approach that looks at the big picture and recognises that babies' needs are not just physical but psychological, emotional and relational. Holistic Sleep Coaching provides an evidence-based overview of how to optimise sleep without leaving babies and children to cry for health and child care professionals.
Let’s talk about your new family’s sleep (2020)
Many parents worry about their child’s sleep, and parents of new babies are often exhausted – but there is hope.
My realistic, reassuring, and refreshing guide to sleep looks at sleep for both parents and children, and aims to empower and encourage parents to feel calm, confident and compassionate in their parenting. I strike a balance between prioritising infant and child mental health and attachment, and being compassionate about the reality of raising a family in today’s society, with social support and understanding often in short supply.
With practical and easily implementable ideas, and clear explanation of the many myths surrounding infant and baby sleep, my gentle and holistic guide is sure to allay many parents’ fears and help everyone in the family get the rest they need.
Professor Amy Brown is a professor of maternal and child public health at Swansea University based in the department of public health, policy and social sciences where she is director of the research centre 'LIFT' which stands for Lactation, Infant Feeding and Translation and she also leads their MSc in Child Public Health. She describes her work as:
I research everything to do with becoming and being a new parent, with a particular focus on infant feeding, mental health and normal baby behaviour. The ultimate aim of my research is to change society and culture, which turns out not to be an overnight job. I want to see a future where women and families are respected, valued and supported in growing, birthing and caring for their babies.
So far, Brown has written nine books for parents referencing evidence-based research. Her website lists more than 30 research papers to date. Of paricular note is her work with V. Harries: The association between use of infant parenting books that promote strict routines, and maternal depression, self-efficacy, and parenting confidence (2019)
'If mothers found the books useful, they were not at increased risk of depression or low confidence. However, if mothers felt worse after reading the books, they were at greater risk.
Unfortunately, far more mothers found the books had a negative impact than a positive one.
Whilst 22% reported that they felt calmer after reading the books, 53% felt more anxious"
Sweet Sleep: Nighttime and Naptime Strategies for the Breastfeeding Family (2014) was written for breastfeeding families. Published by La Leche League International. Founded in 1956 by seven intrepid women, La Leche League now has more than 7,000 accredited leaders in sixty-eight countries. LLLI brought together several experts to produce a book which speaks to the needs of breastfed babies. Diane Wiessinger is an American breastfeeding advocate, author and researcher who is known for her essay "Watch your language!", which asserts that breastfeeding is normal, not superior. Wiessinger became a La Leche League Leader in 1985. In 1990 she became an International Board Certified Lactation Consultant. Diana West is a leading lactation consultant and author specializing on the topic of breastfeeding. In her 2001 book, Defining Your Own Success: Breastfeeding After Breast Reduction Surgery, West discusses the effects of breast reduction surgery on breastfeeding and provides practical advice to women in that situation. Linda J. Smith, MPH, IBCLC, FACCE, FILCA, is a lactation consultant, childbirth educator, author, and international consultant on breastfeeding and birthing issues. She was a founder of IBLCE, founder and past board member of ILCA, and serves on the United States Breastfeeding Committee. Smith is the author of Comprehensive Lactation Consultant Exam Review, a key resource for those studying to certify or recertify as Internationally Board Certified Lactation Consultants (IBCLC). Teresa Pitman, is also the co-author for The Womanly Art of Breastfeeding and Jack Newman's Guide to Breastfeeding, and has 35 years of experience as a La Leche League Leader.
“If there could be a little blue light on the rooftop of every home in your town where a mother is awake when you are, the town would be lit with little blue lights, coming on and off, but always lots of them. It might even help to picture it when you're feeling awake and alone in the middle of the night.”
Diane Wiessinger
Sweet Sleep recognises that bed-sharing is the optimal arrangement for breastfeeding mothers and infant. The authors defined The Safe Sleep Seven as a tool for parents.
If you are
a non-smoking mother who is
not taking drugs or medications that interfere with normal awareness, and is
breastfeeding – that is, your breast is your baby’s food and comfort spot, day and night –
And if your baby is
healthy – full term with no major health issues,
on his or her back when not nursing,
not swaddled or overheated,
And if you are both
on a safe surface
then you have eliminated all the major SIDS risks, and have hugely reduced or eliminated suffocation risks.
2020s:
As I write in the post-pandemic world of 2023, I have been unsuccessful in my search for anything actually new in the multi-million dollar baby sleep book industry. Unfortunately, all the books referenced in my previous article: A Timeline of Horrors: the history of sleep training can be found easily online and in bookshops. All the books listed above can also, thankfully, be sourced easily.
However, as parents around the world become more overwhelmed by modern lives, the demands on women to be productive in the workforce and raise children who fit societies mould of “well-behaved” - which includes sleeping long hours at night without disurbing their tired parents - change will be slow. The demand for books promising to solve infant sleep problems will be high unless we move away from seeing normal infant sleep behaviour as a problem. It doesn’t matter that each book, each consultant visit, each stay at residential sleep school fails, because there is a follow-up for the next stage conveniently offered. At second-hand markets and on the shelves of charity shops, we see endless supplies of the same titles, promising the Holy Grail of undisturbed sleep.
Societal change must begin with the health system, with practioners who have time to listen to tired mothers and reassure them their children’s waking is developmentally normal. Government funded sleep training in any form should be required to give evidence of no harm - to infants, not just stating the benefits to parent’s mental health.
The Australian Association for Infant Mental Health Ltd (AAIMH) is a not-for-profit organisation of professionals from a range of disciplines including health, education and welfare dedicated to the field of infant mental health.
AAIMH’s primary focus is to draw attention to the importance of the healthy social and emotional development of infants (0 to 3 years) in Australia.
This is achieved by assisting families, professionals and communities to build nurturing and strong relationships with their children, and to be aware of the causes and signs of mental, physical and emotional stress in infants.
The AAIMH believes the following principles should be applied to all infant sleep interventions:
• Any intervention used to support infant sleep should not compromise the infant’s developmental and emotional needs. A comprehensive assessment as detailed above should be conducted with all families.
• It is normal and healthy for infants to wake through the night and to need connection with caregivers. This need not be labelled a problem or disorder. There is a wide variation in how quickly infants settle and ‘sleep through the night.’ Early and realistic information about what to expect and ways to support infants should ideally be available to all caregivers to help understand their infant’s state of mind and appropriately engage with their infant’s sleeping patterns. This includes supporting caregivers to have a sound understanding of the drivers of infant sleep, and variation in normal healthy infant sleep patterns.
• Recognition that caregivers often struggle to adopt extinction based behavioural sleep interventions because they contradict their innate desire to respond promptly to their infant’s distress, their own parenting beliefs, or a belief that they may cause the infant harm.
• There is room for human error in responsive caregiver-infant relationships. Caregivers do not need to be perfect; they just need to be good enough. Caregivers will learn to respond sensitively only through close observation of their infant, and trial and error. Caregivers do not need to get this right all the time.
• Responding to an infant’s needs/crying will not cause dependency but will contribute to the infant’s sense of security and developing regulatory capacity.
• Strategies based on an understanding of the infant’s emotional world and their communication strategies should always be discussed with caregivers as preferable options to extinction-based strategies.
• Alternatives to extinction-based sleep interventions need to be made more readily available to caregivers. Caregivers need to be provided with a range of sleep interventions from a variety of theoretical perspectives so they can make an informed choice based on their family’s individual circumstances.
• Extinction based behavioural sleep interventions are not appropriate for use before the infant has a real understanding of the meaning of the caregiver’s words; the infant needs to know that the caregiver will return and needs to feel safe when the caregiver is absent.
• AAIMH supports the use of ‘responsive’ based approaches to addressing infant sleep concerns. Such approaches should be attachment informed and tailored to the developmental needs of the individual infant. These approaches should be based on understanding, recognising, and responding to the infant’s communication cues in a sensitive and consistent manner that supports their emotional needs and development.
• Culturally appropriate and SIDS informed approaches to co-sleeping need to be discussed with caregivers as potential options to support infant sleep
• AAIMH supports a coordinated effort to develop the evidence base for response-based sleep interventions as an alternative option for caregiver’s concerned with their infant’s sleep.
• AAIMH supports both universal and tertiary level service providers having increased exposure, access to, and training in a range of sleep interventions to meet the needs of individual families.
All parents AND infants have the right make informed choices about nighttime parenting. Outdated behaviour modification modaliies have no place in the 21st Century. Parents continue to be fed the opinions of “men of science” born during the reign of Queen Victoria. It is time the voices of women and men of science today are heard. The work of experts like Professor Helen Ball and Dr James McKenna needs to scaffold the care of infants and parents.
"The way in which we sleep now in the 21st Century is kind of odd, in an evolutionary sense, because we weren't evolved to sleep like we're dead for an eight-hour period, and not wake up, in total silence and total darkness," says Helen Ball, professor of anthropology at Durham University and the director of the Durham Infancy and Sleep Centre. "But that's what people in Western societies have become accustomed to.
"And that affects the way in which we think about what babies should be able to do, and how babies should be treated." The Science of Safe and Healthy Baby Sleep
Reading my collection of books about supporting normal infant sleep gently and responsively has been a less stressful task than my reading for the previous article on sleep training. But only to a point. My grandchildren are growing beyond infancy and in the coming decades I can anticipate great grandchildren. But we have seen the sleep advice popularised when my grandparents were born in the 1890s is still popular today, so I am not confident my grandchildren won’t be exposed to it as parents. Will I, in my 80s ad 90s, still need to defend the rights of infants described by McKenna as:
Stone age babies in a space age world
Welcoming my third grandchild in the midst of pandemic August 2020
