Biologically Designed For Physical Contact: A Review of James McKenna’s “Safe Infant Sleep”

I am reminded of the number of times my South American undergraduate students sheepishly come up to me after my lectures on cosleeping to whisper their stories that they could never tell to their peers for fear of ridicule…

~ Dr. James McKenna

The above quote is from Dr. McKenna’s first book on infant sleep & that passage broke my heart when I read it. In an age where we supposedly embrace multiculturalism, we have somehow managed to be extremely closed-minded when it comes to a sleep practice that people all over the world embrace, is culturally healthy, and (when practiced safely) doesn’t lead to higher SIDS or smothering deaths, even though American parents hear a different story.

Although I liked the book, it was also a bit slim and over a decade old. So when I heard about his new title, “Safe Infant Sleep,” I knew I had to read it. This newer book is more thorough and has the advantage of additional years of global research & the perspective of someone who has been in this field for a long time.

How deeply involved in the field? McKenna founded & directed the Mother-Baby Behavioral Sleep Laboratory at Notre Dame University & worked there for over two decades before accepting an endowed professorship in California. His career centers around studying how infant physiology affects sleep & breathing, what makes a difference in SIDS prevention (breastfeeding! A smoke free household! baby being placed on their back!). McKenna is no rogue professor, either; his work is endorsed by Peter Fleming, a British pediatrician & epidemiologist whose work in the 1980’s significantly reduced SIDS deaths the world over (there’s a neat article about Fleming here).

This is part of Fleming’s endorsement: “…I can strongly support the ideas presented by Dr. McKenna in this debunking of much of the arrogant, ill-informed, and misleading advice that has in the past been given to parents by professionals who should have known better.”

Oh, wow. No British reserve there, huh? What “ill informed & misleading advice” is he talking about? The advice that says bedsharing is always a dangerous & negligent parenting decision. As McKenna says: “current recommendations for infant sleep originated mainly from white men, many of whom never cared for their own infants, and based their conclusions not on empirical or scientific research, but on their ideological beliefs.”

Quite frankly & to get to the point, the so-called research stacked against bedsharing is shoddier than many realize. Studies that purport to to show how unsafe it is routinely include in their data situations common-sense would dictate excluding: going to bed drunk, for instance. McKenna cites the example of a health official who condemned bedsharing after a mother drank eighteen beers, stumbled into bed with her infant, and suffocated him. This is not bedsharing; this is drunk parenting, and it is scary.

Another factor most studies don’t account for when looking at supposed co-sleeping death is how often these deaths occur on couches & sofas. These are terrible places to fall asleep with an infant and should not be used to terrify a breastfeeding mom who is considering putting her baby on a flat surface beside her while she feeds her baby at night. But when we scare mothers into thinking they can’t do that, they end up falling asleep due to exhaustion somewhere else.

And it is this distinction that McKenna really wants parents and providers to understand; in fact, he argues for a change in terms, with breastsleeping to describe the relationship where a mother-infant dyad share the same sleeping surface if that is helpful for breastfeeding success.

Repeated studies of sleeping mothers and babies show how very protective and reactive a mother is of her baby, even while asleep. She faces the baby and is responsive to even her baby’s slightest movements in her sleep. What’s weird (and cool!) about this is that mothers who cosleep actually report better sleep than mothers who don’t. Getting up to trek across the hallway several times a night (we’ll get to that in a moment) is not as restful as having your baby beside you, able to attend to their nursing needs right away.

When parents do the hallway trek routine, they soon start to think that their baby must need to sleep more at night… but this is contradicted by science. What small babies actually need is frequent wakings & feedings. As McKenna puts it:

“While most babies do not have sleep problems to solve, their parents do. Parents have the problem of thinking something must be wrong if their baby won't sleep alone or until the morning. They try to impose a model of sleep for which infants are not designed, especially the breastfeeding infant. Western cultures... have all but pathologized the natural sleep patterns of breastfeeding infants. An infant's most important job in the first year of life is to wake up all night to breastfeed.”

Babies need frequent wakings to help develop and strengthen their respiratory system. They have tiny stomachs and breastmilk digests quickly, which facilitates more frequent feedings. Some babies might sleep solidly several hours through the night on their own, but should not be the expectation when they are young.

And this point goes deeper than anything related to cosleeping. No one who says that bedsharing can be done safely is saying that everyone should do it. There are many cases where it is not safe (these are discussed in the book). But McKenna wants to encourage parents to have realistic expectations about infant sleep & dietary needs, and to have the confidence to make the best decisions possible for their family, not to feel trapped by the unrealistic expectations so often promulgated in America today.

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Related: What To Expect When You Bring Your Newborn Home From the Hospital