sleeping

sleeping sickness

Protozoal disease transmitted by the bite of the tsetse fly. Two forms, caused by different species of the genus Trypanosoma, occur in separate regions in Africa. The parasite enters the bloodstream and invades the lymph nodes and spleen, which become swollen, soft, and tender. Irregular fever and delayed pain sensation develop. In the Rhodesian form, the patient soon dies of massive toxemia. The Gambian type progresses to brain and spinal cord invasion, causing severe headache, mental and physical fatigue, spastic or flaccid paralysis, chorea, and profound sleepiness, followed over two or three years by emaciation, coma, and death. Some patients develop a tolerance but still carry the trypanosomes. The earlier drug treatment begins, the greater the chance of recovery. Sleeping sickness is still prevalent in parts of Africa despite efforts to control it.

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Co-sleeping, also called the family bed, is a practice in which babies and young children sleep with one or both parents. It is standard practice in many parts of the world outside of North America, Europe and Australia, and even in the latter areas a significant minority of children have shared a bed with their parents at some point in childhood. One 2006 study of children age 3-10 in India reported 93% of children co-sleeping. Co-sleeping was widely practiced in all areas up until the 19th century, until the advent of giving the child his or her own room and the crib. In many parts of the world, co-sleeping simply has the practical benefit of keeping the child warm at night. Co-sleeping has been relatively recently re-introduced into Western culture by practitioners of attachment parenting. A 2006 study of children in Kentucky in the United States reported 15% of infants and toddlers 2 weeks to 2 years engage in co-sleeping.

Proponents hold that co-sleeping saves babies' lives (especially in conjunction with nursing), promotes bonding, lets the parents get more sleep, facilitates breastfeeding, and protects against sudden infant death syndrome (SIDS). Older babies can breastfeed during the night without waking their mother.

Opponents argue that co-sleeping is both stressful and dangerous for a baby, pointing to evidence that co-sleeping may increase the risk of SIDS, They also cite concerns that a parent may smother the child or promote an unhealthy dependence of the child on the parent(s). In addition, they contend that this practice may interfere with the parents' own relationship, by reducing both communication and sexual intercourse at bedtime, and argue that modern-day bedding is not safe for co-sleeping.

Safety and health

Co-sleeping can trigger conflicting advice among health care professionals. The U.S. Consumer Product Safety Commission warns against practicing it with babies, but many pediatricians, breast-feeding advocates, and others have criticized this recommendation.

Advantages

One study reported mothers getting more sleep by co-sleeping and breastfeeding than by other arrangements.

It has been argued that co-sleeping evolved over five million years, that it alters the infant's sleep experience and the number of maternal inspections of the infant, and that it provides a beginning point for considering possibly unconventional ways of helping reduce the risk of SIDS.

Stress hormones are lower in mothers and babies who co-sleep, specifically the balance of the stress hormone cortisol, the control of which is essential for a baby's healthy growth.

In studies with animals, infants who stayed close to their mothers had higher levels of growth hormones and enzymes necessary for brain and heart growth.

The physiology of co-sleeping babies is more stable, including more stable temperatures, more regular heart rhythms, and fewer long pauses in breathing than babies who sleep alone.

Co-sleeping may promote long-term emotional health. In long-term follow-up studies of infants who slept with their parents and those who slept alone, the children who co-slept were happier, less anxious, had higher self-esteem, were less likely to be afraid of sleep, had fewer behavioral problems, tended to be more comfortable with intimacy, and were generally more independent as adults. However, a recent study (see below under dangers) found different results if co-sleeping was initiated only after nighttime awakenings.

Dangers

Co-sleeping is known to be dangerous for any child when a parent smokes, but there are other risk factors as well. Some common advice given is to keep a baby on its back, not its stomach, that a child should never sleep with a parent who smokes, is taking drugs (including alcohol) that impede alertness, or is obese. It is also recommended that the bed should be firm, and should not be a waterbed or couch; and that heavy quilts, comforters, and pillows should not be used. Young children should never sleep next to babies under nine months of age. It is often recommended that a baby should never be left unattended in an adult bed even if the bed surface itself is no more dangerous than a crib surface. There is also the risk of the baby falling to a hard floor. Parents who roll over during their sleep could inadvertently crush and/or suffocate their child, especially if they are heavy sleepers and/or obese.

A recent report suggests that co-sleeping initiated after night awakenings and other parenting behaviors, such as holding a baby until it falls asleep or remaining in the room until a baby sleeps, interferes with a baby's abilities to learn to comfort itself. Babies who had been exposed to co-sleeping or related parental behaviors had significant problems with sleep later in life. These difficulties with sleep were associated with increased health risks in older children .

Products for infants

There are several products that can be used to facilitate safe co-sleeping with an infant.

  • bassinets that attach to the side of an adult bed, and which have barriers on three sides, but are open to the parent's side.
  • bed top co-sleeping products designed to prevent baby from rolling off the adult bed and absorbing breastfeeding and other night time leaks.
  • side rails to prevent the child from rolling off the adult bed.
  • co-sleeping infant enclosures which are placed directly in the adult bed.

Prevalence

A study of a small population in Northeast England showed a variety of nighttime parenting strategies and that 65% of the sample had bedshared, 95% of them having done so with both parents. The study reported that some of the parents found bedsharing effective, yet were covert in their practices, fearing disapproval of health professionals and relatives. A National Center for Health Statistics survey from 1991 to 1999 found that 25% of American families always, or almost always, slept with their baby in bed, 42% slept with their baby "sometimes", and 32% never co-slept with their baby.

Further reading

  • Jackson, Deborah. Three in a Bed: The Benefits of Sharing Your Bed with Your Baby, New York: Bloomsbury, 1999.
  • McKenna, James J. Sleeping with Your Baby, Washington, D.C.: Platypus Media, 2007.
  • Morelli, G.A., Rogoff, B., Oppenheim, D., & Goldsmith, D. (1992). Cultural variation in infant's sleeping arrangements: Questions of Independence. Developmental Psychology, Vol. 28, No. 4, 604-613.
  • Thevenin, Tine. The Family Bed, New Jersey: Avery Publishing Group, 1987.
  • Simard, V., et al. (2008). The Predictive Role of Maladaptive Parental Behaviors, Early Sleep Problems, and Child/Mother Psychological Factors. Archives of Pediatric and Adolescent Medicine Available at: http://archpedi.ama-assn.org/cgi/content/short/162/4/360

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References

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Footnotes

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