AM: Martin, we were talking about co-sleeping.

 

martin_maldonado: is there a general consensus or controversy as I suspect?

 

AM: We have a student with this issue at the moment. There is controversy.

 

AN: Dr. Maldonado...my daughter is 27 months. Her father and I have not agreed on sleeping arrangements her entire life. He is currently taking classes in another state, and my daughter and I have a wonderful routine that involves her sleeping in my bed.  How do we best approach the issue when Dad comes home in 2 months?

 

martin_maldonado: usually the mother is more sensitive to the emotions of the baby, while the father worries about creating a "too dependent" being. I think it might be useful to present the world according to the baby, so to speak.  What I mean is to present the world view of the infant, she wants to sleep with her mother -or parents- I suspect.

 

AM: Also, her family is not supportive of co-sleeping.

 

martin_maldonado: Of course not. This has a long tradition in the "Anglo-Saxon culture". I think it started with the prohibition by a Kaiser in the XVIII century. A Kaiser in Prussia banned co-sleeping because parents very often argued that they had "rolled over the baby" when in reality it was a case of infanticide. That is, parents would give this as the cause of death, when in reality infanticide was widely practiced everywhere when parents were too poor, burdened, etc. In most other countries (Southern Europe, Asia, Africa and the rest of America) this is never an issue for quite some time, simply the baby sleeps with mother at least, or with parents. Particularly in the past, there was high infant mortality, mothers are always worried that their baby will die in the night. It is thought that sudden infant death is very rare in "third world countries." It is also thought that co-sleeping is a protective factor against sudden infant death, which is much more common in countries like Australia and the US.

 

 

martin_maldonado: I think regarding the frequency of sleeping problems, it is hard to answer” scientifically" or empirically, as there are very few studies of the actual prevalence of sleeping difficulties in babies.That is in poor countries. However, it is thought that the baby wakes up more frequently when he /she sleeps with parents, but then goes to sleep readily when he sees /smells the parents.

 

ES: What cultures see co-sleeping as typical?

 

martin_maldonado: I think most cultures. All people in Latin America, Asia, etc. They would think it is unthinkable that a young child would sleep in a separate bed, let alone in a separate room.

 

KB: Do you think that breast fed babies tend to want to eat more when they are sleeping in the bed with the mother?

 

martin_maldonado: Yes. Breastfed babies eat more frequently as a rule than bottle-fed babies. This more convenient for the mother to breastfeed at the bedside than to get up and do it in another room. Many mothers breastfeed while asleep. The brochure from UNICEF makes this point, and this is one of the main reasons why they recommend co-sleeping, to promote breastfeeding.

 

AN: That is when co-sleeping started in our house. I was too exhausted to get up all night. Then I really began to like having our daughter with us.

 

martin_maldonado: I suspect your husband is worried that they would never be able to get the baby out of the bed?

 

AM: We have such a low incidence and short duration of breastfeeding in this country.

 

martin_maldonado: Yes, this is a big problem. The lowest incidence /prevalence is in Afro-American women, who are also the poorest. This is a bad combination.

 

AN: When is the "right" time to move a child to its own room?

 

martin_maldonado: This is a cultural question as well. The Japanese -traditionally- sleep with their children on futons until they are teenagers. This happens in many countries too because there are not many rooms. Traditionally in the US, psychoanalysts recommend that preschool children should start sleeping on their own little beds. One point that I would like to emphasize is that of individual differences between children.  There are some children who from the start will not sleep anywhere else but with the parent or on their parents' body. Other newborns are much more flexible and tolerate quite well to be put elsewhere because of their more easy temperament.

 

AM: In most of the cases I've known the child gradually chooses to move out on their own.

 

martin_maldonado: Yes I would agree. Of course, we get to see many anxious children for whom moving out of the parent’s bed is hard.

 

martin_maldonado: Think of all the traumatized children , those who watch movies like Godzilla, etc. etc. and then are scared.

 

AM: When there are siblings, sometimes they can be a comfort to each other if they sharea  room.

 

AN: So, when a family decides to transition their child, what do you recommend as the best method to ease the transition?

 

martin_maldonado: One can try to praise the young child for being "big" and sleeping on their own little bed and reward them for it. The Australian academy of Pediatrics has made an official recommendation now to at least have the child sleep in the same room. One can hear if the baby is choking, vomiting, upset, etc. readily if he /she is in the same room.

 

AM: Until what age, or do they specify?

 

martin_maldonado: Yes, I think they recommend the first year of life. The highest risk for sudden infant death.

 

AW: What about during naps. If the child co-sleeps during the night, what should happen during naps?

 

martin_maldonado: most babies do not mind sleeping somewhere during naps in the day time. It is harder to go to sleep alone in the dark.

 

martin_maldonado: Another thing that is odd is that American sleep researchers do not recommend to have the child fall asleep in your arms, but to first put them in their bed before they actually fall asleep.

 

JM: I work with a family that wants their 17 month old to sleep in his own bed, but keep "giving in" to him because he screams and cries for hours, how do you help them?

 

martin_maldonado: I would like to know why the baby screams for hours. I would not let a child scream for hours. I would give in and then try to figure out what is going on. The official recommendation from many sleep researchers is to let the child cry. They are mostly men and neurologists, not mental health people.

 

AM: Many people believe in letting them”cry it out.”

 

martin_maldonado: There is even a condition in the sleep disorders classification called " limit setting disorder."

 

JM: The parents tell me that he is screaming and crying because he wants to sleep with them.

 

martin_maldonado: Of course. That is what the baby wants. The baby has an ethological bias to want to sleep with parents. As I said, some babies insist on honoring this evolutionary tradition no matter what.

 

JM: If he wakes up in the middle of the night and they are not there with him, he cries until they put him in bed with them.

 

martin_maldonado: Sometimes there is also anxiety in the picture, separations, stressors. Therefore the child feels quite insecure without the parents. I would soothe the child and then as I noted, try to find out what is going on. Of course, some children have a sleep disorder, i.e. waking up during the night and finding it hard to go to sleep. Many autistic children, children with regulatory disturbances, etc. etc. have marked sleep problems.

 

JM: They seem to really want him to sleep in his own room. Is there any way to make this transition easier?

 

martin_maldonado: If the child is quite insecure, the solution might be to promote a sense of security and calm, rather than just ignore it , or let the child cry and "swallow" his fear knowing that no one will pick him up. I think that particularly in the case of an infant or toddler, to do this is somewhat cruel.

 

martin_maldonado: Yes, there are many ways to make the transition easier.One can place a shirt of the mother or father next to the baby.Also a picture of the mother or father in the crib. A transitional object if the child is old enough.

 

martin_maldonado: One can , as Klaus Minde suggests, do a gradual extinction program. First one does whatever it takes to calm the child, and then few days by few days, one "scales down" from this slowly. First by, let us say, carrying but not talking. Then not carrrying, but being right there and touching the child. Then not touching, but only being there by the child, etc. etc. All this should help the majority of children, but there are a few children with whom this will not work.

 

 AM: Elizabeth Pantley has a book called the "No-Cry Sleep Solution" that provides some of these strategies for parents. It is very intensive in terms of the record keeping she gets parents to do to make them observe and keep track of what is happening.
 

martin_maldonado: Sometimes just keeping track makes things change quite a lot.

 

martin_maldonado: The thing I see is that parents are very afraid to "give in" to even very young children.

 

AM: Yes, it is all part of a fear of "spoiling."

 

martin_maldonado: That is another cultural tradition I am afraid, rooted in protestant ethics. People are supposed to be strong and not to depend on others.

 

AM: Do you think that if the 0-3 classification system is widely used, there will be better data on the incidence of sleeping problems?

 

martin_maldonado: I sadly think that the Zero to three system is not used hardly . It is used in very few centers that I know of. Hardly at all in the US, largely because there is no reimbursement for it in most places. It is used in Florida I think and in a couple more states.

 

AM: I spoke to a clinical psychologist the other day who was very against any sort of diagnosis for babies.

 

martin_maldonado: Yes, I understand and in general I think one should be cautious about "diagnosing", particularly to communicate diagnoses to parents as if their children had "diseases." I think the diagnoses are most useful to communicate between clinicians, researchers, etc. and to learn about the problems that babies have. Of course, it is very tempting to deny the whole issue of diagnoses in babies, nobody likes to think they have problems but they do...