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We note with interest the conclusions made in the longitudinal cohort review published by Cook et al1 linking frequent night wakings in infancy with emotional disorders in later childhood. Our analysis of the paper questions whether the medical profession is overmedicalising normal sleep behaviours without fully identifying what is within normal limits.
Multiple potential confounders were not adjusted for in the analysis, including but not limited to: method of feeding, neonatal and infant medical history, sleep environment (co-sleeping and bedsharing) or the proportion of parents implementing sleep training methods. Additionally, statistical significance for these conclusions was reached by comparing the babies labelled with with ‘persistent severe sleep problems’ (19.4%) with those classed as ‘settled sleepers’ (23.7%), rather than the 56.0% of babies labelled with ‘moderate sleep problems’. Over half of the cohort were repeatedly waking at night, confirming that this is a common feature of normal infant behaviour. This paper provides a much-needed opportunity to discuss our social expectations of infant sleeping patterns and the increasing risk of overmedicalising normal sleep behaviours.
Modern western culture necessitates that adults sleep at night in order to function at work during the day. Societal changes over the last century have normalised the idea that babies too should sleep through the night, and this has slipped into the id...
Modern western culture necessitates that adults sleep at night in order to function at work during the day. Societal changes over the last century have normalised the idea that babies too should sleep through the night, and this has slipped into the idea that a baby who is wakeful at night is somehow abnormal.
The concept that babies should self-settle away from caregivers and sleep through the night, is not the biological norm.2 These ideas, although now mainstream, ignore the fundamental role of the mother-baby dyad and the need for regular physical contact on neonatal development. It is entirely normal for babies to wake overnight, either to feed or for comfort.3
To better support the emotional challenges of early parenthood, the medical profession must appreciate the normal spectrum of neonatal and infant sleep patterns.4 By studying and understanding the social confounders around infant sleep, we can prevent the propagation of potentially unnatural and harmful ideas related to infant behaviour and development.
1. Cook F, Conway LJ, Giallo R, et al, Infant sleep and child mental health: a longitudinal investigation. Archives of Disease in Childhood 2020;105:655-660.
2. Bartick, M, Tomori, C & Ball, HL. Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Maternal & Child Nutrition 2017; 14: e12544 doi: 10.1111/mcn.12544.
3. Figueiredo B, Dias CC, Pinto TM, Field T. Exclusive breastfeeding at three months and infant sleep-wake behaviors at two weeks, three and six months. Infant Behav Dev. 2017;49:62-69. doi:10.1016/j.infbeh.2017.06.006
4. Marinelli, K. A., Ball, H. L., McKenna, J. J., & Blair, P. S. (2019). An Integrated Analysis of Maternal-Infant Sleep, Breastfeeding, and Sudden Infant Death Syndrome Research Supporting a Balanced Discourse. Journal of Human Lactation, 35(3), 510–520. https://doi.org/10.1177/0890334419851797