What is Normal Infant Sleep: the view from Anthropology
By Helen Ball. Durham University: Department of Anthropology
This is a synopsis of this webinar. Nothing can be better than the real thing so if you wish to watch her public lecture please click on the YouTube clip at the end of this post.
Here is my take on what was discussed.
What is considered normal can be contentious. There are 2 types of normal: culturally normal and biologically normal.
Culturally normal expectations are that:
- “Good” babies sleep/feed all the time and that a good baby means a good parent.
- Self-soothing is considered normal, and rocking or cuddling your baby to sleep prevents this.
- Babies will be spoiled if picked up.
- Babies must get the prescribed average amount/hrs of sleep to be considered ‘normal’.
- Babies need 3x 2 hour naps a day for optimal cognitive development.
Biologically normal expectations are that:
- Human babies are mammal babies, with an in-built set of needs. All mammal babies feed on their mothers’ milk and are intensively cared for after birth. Human babies are unique amongst mammals because they cannot walk or cling at birth. They are unusually helpless.
- Mother and baby are an evolved unit with an entwined biology
- Babies are born with a set of physiological needs that must be met by their carers
- Biology drives infant sleep. It is not a ‘learned’ skill.
- Babies can’t tell night from day. As babies cannot cling to us like primates, they like to be held day and night.
- Babies sleep very differently from their parents. They need much more sleep than adults. Babies are born without a circadian clock (a natural internal process that regulates the sleep/wake cycle), which takes a few months to develop.
- 24 hour sleep duration for babies is hugely variable (8-22hrs total sleep time).
- Only between the ages of 1-2yrs does consistency of sleep pattern develop.
- Sleep disrupted parents are more likely to think their baby has a sleep problem.
- In japan parents only perceive 7% of their babies have sleep problems. In the UK its 25-33%.
- Babies begin producing their own cortisol and melatonin around 3-4months, which starts affecting day/night rhythm. However baby’s brain is still developing. Developmental leaps around this time can cause increased disruption, and then they settle again.
- Overtiredness: according to the biological perspective, babies can’t get overtired. They build up their ‘sleep pressure’ until they are ready to fall asleep. If barriers to sleep are removed (such as overstimulation, baby being left on his/her own to fall asleep) baby will sleep. Remove things/strategies that emotionally wind up baby. Move baby to a different environment, help baby to dial down the things that are stopping him/her from going to sleep, and provide comfort and cuddles.
- Enable babies to nap when they want to, rather than trying to make them go to sleep.
So why do we expect babies to sleep through the night
After the 1920’s doctors and scientists began medicalising pregnancy, childbirth, and child growth and development. The theory was espoused that child rearing should promote independence, self-control and self-reliance in infants and children. In the 1950’s poor research led to the presumption that sleeping through the night = midnight to 5am. Sleeping through the night became the expectation, and it was thought that ignoring the baby was better for the baby, in the short and long term. Letting the baby cry it out was considered good parenting. It was also around this time that prepared infant formula’s became more widely available and were prescribed by doctors and available in pharmacies.
Breastfeeding became negatively associated with infant sleep, and now there are 2 competing parental views:
- The view that formula helps reduce night waking
- Parents should go with the flow and adapt themselves to meet their baby’s needs.
Sleeping like a Baby Study
So, Durham University decided to do their own research looking at how breastfed and formula fed babies’ sleep patterns develop, and how parents perceive their babies’ sleep. The study involved 50 mother-baby pairs that were chosen from the postnatal ward and were only accepted if they had already chosen their feeding method (either breast or formula), and were doing that exclusively from 4-18 weeks. Mums were asked to log their babies sleep, and babies wore actiwatches to monitor their amount of sleep.
The results showed very little difference in the number of minutes of sleep between breast and formula fed babies. How babies are fed doesn’t make a difference. However, parents’ perceptions of their babies sleep is quite inaccurate and more inaccurate when they are formula fed as opposed to breast fed.
There is a perception that because breastfed babies wake frequently, mums do too and so both get less sleep, but that is not supported by the research. The research showed that parents of formula fed babies tended to overestimate the amount of sleep their baby was getting compared to how much their baby was actually getting.
Where do we go from here?
New parents feel confused about infant sleep and feel they receive conflicting information, which they do. They are often told by parents and grandparents that ‘tough love’ is the right approach and “sure it didn’t do mine any harm”. Yet for many parents that approach doesn’t feel right. They spent their entire pregnancy nurturing and growing this beautiful baby, who depends on them for virtually everything. Their baby always seems so happy and content when they are with their moms and dads. It feels wrong to expect them to self-soothe, and deny them the comfort of their parents whenever they need/want them.
However, new parents tend to be very unprepared about the realities of normal infant sleep. What they are told will happen is not what happens, therefore they become anxious about night waking after a few weeks/months, and perceive their baby to have a ‘sleep problem’, and this impacts on their self-efficacy and belief in their parenting skills. Parents seek remedies or medications or training for a sleep problem that is not a problem for the baby but is a perceived problem for the parent.
We need to change 2 things:
- How we educate parents on normal infant sleep
- The way we talk about infant sleep
- Is baby sleeping through the night?
- Is she/he a good baby?
- Is baby waking often?
- How are you coping with the sleep disruption?
- Do you have any help?
Some parents find that they can work around their babies sleep needs. They can adjust. They go with the flow and there is no magic wand. Parents who are aware of this do better generally.
Common Strategies that will help:
- Wait it out: most babies will find their own pattern
- Adjust expectations. In fact try not to have expectations.
- Ensure parental education about normal sleep patterns
- Minimise sleep disruption
- Harmonise sleep patterns- align parent and baby sleep
- Eliminate anxiety- keep negative thoughts under control. When you are tired/sleep deprived it is easier to descend into a negative thought spiral.
- Sleep training options can work: But they should only be used after 6-12 months old. They are hard to implement without support. Their effects may not be permanent and you may need to sleep train again after the initial training.
- What works for each baby will be different. A one size fits all approach is unhelpful.
Conclusion (not part of the webinar)
Babies operate according to their own internal rhythms. Parents need to be reassured that frequent night waking is the biological normal for babies. They are undergoing huge growth in the first year, therefore they need to feed often and sleep where they feel safest. This does not mean that your baby will be sleeping on you or with you forever. The process is two steps forward, one step back, and every child is individual. Some days may feel like you are making no progress, but when you look back you realize how far you’ve come from those early days of feed, sleep, feed, sleep.
If your baby is 6-12 months old and you feel a little sleep training is needed, that’s ok. Do your research and find the approach that suits your parenting style. Talk to other mothers and parents who are going through this process also. Empathetic conversations and a cuppa are often the most invaluable tools in learning how to parent.
For more evidence based guidance on normal infant sleep, and safe co-sleeping, visit https://www.basisonline.org.uk/
Here is the full webinar: