Any new parent will gladly talk to you about sleep — usually about their lack of it — but also about how their baby is sleeping (or not). They are much less likely to talk about whether or not they sleep with their child. The topic, even in our age of oversharing, is taboo.

The taboo is there for several reasons. First of all there is a real worry: around half of SIDS (sudden infant death syndrome) deaths occur while co-sleeping. Depending on where you are in the world, you may receive very strict guidelines on not bedsharing with your infant under any circumstance.

The problem with this is that the risks can actually be higher if we don’t have frank conversations about the safest ways for mothers to breastfeed at night or when they are very tired (and we are tired very often!) as I explored in last week’s newsletter.

I’ve been wanting to interview Cecília Tomori for a long time. She is an anthropologist and public health scholar at John Hopkins who is internationally recognised for her expertise on breastfeeding, infant sleep, and maternal child health.

The idea of talking about breastfeeding together with sleep strangely isn’t discussed much. But it always seemed very relevant to me because a lot of breastfeeding happens at night, and it obviously affects a mother’s sleep.

Talking to Tomori became a priority for me after the death of a newborn in a hospital in Rome, which I wrote about in January. Although the investigation is still ongoing, what emerged is that a nurse found the baby, who was three days old and was apparently healthy, dead next to the mother who was asleep. The story created a lot of confusion and noise, with media and pundits blaming breastfeeding or bedsharing, which means having an infant in the bed with the mother while breastfeeding.

(Since the investigation is still ongoing, I don’t address it in this interview.)

Irene Caselli: Why do we need to look at breastfeeding in connection to sleep?

Cecília Tomori: Humans are mammals. If we look at the evolutionary history of breastfeeding and sleep, these processes are connected. So we don’t necessarily see sleep and breastfeeding as a separate kind of entity to begin with. Among mammals, there are different kinds of lactation strategies.

One of the unique features that humans have in common with primates is that they require a lot of care postnatally. And so the lactation strategy that’s part of humans’ evolutionary adaptations is really about proximity and frequent feeding. Think of primates, who are always carrying their babies.

Human infants are born extraordinarily immature and vulnerable: they have difficulty regulating their temperature, they require this very proximate care — their survival depends on it. Skin-to-skin contact is the foundation of that. Proximate sleep is simply part of this package of intensive postnatal care that occurs, and it is part of the physiological co-regulation that also occurs. So this is the basics of what biological anthropology explains.

Now, if you look at the socio-cultural elements, humans are also extremely adaptable and flexible. And there are many different cultural practices that are involved in this intensive infant care, but cultures around the world generally recognise that this is a really big, important task that people have. Communities are quite aware of this and they tend to provide that approximate contact and they tend to carry infants around during the day and they tend to sleep next to them at night. This is sort of an unquestioned practice that is still a very common model around the world.

It is important to ask why it is that we find proximate sleep so unusual or strange when in fact it is both the evolutionary and the historical and socio-cultural norm for most of our history.

Irene Caselli: So when and how did the idea of babies sleeping by themselves become installed in our society?

Cecília Tomori: A lot of what we now think is normal actually comes from relatively recent Western, white, upper-middle class ideas — mainly developed by white male physicians.
European, mostly white elites, have this idea that babies have to be separate from their mothers. Now, some of those elites relied on other people to take care of babies — usually poor people, not really voluntarily, ranging from enslavement to various forms of terrible servitude and exploitation. So there was someone sleeping next to the baby, and breastfeeding, but essentially not the mother.

Biomedicine takes some of these experiences and starts to make this argument, in the late 19th century, early 20th century, that babies need to regulate themselves, that they need to be apart physically from their parents and that in fact even touch should be limited and that they should not be fed frequently.

Then we see this really, really dramatic decline of breastfeeding and a real prominence and rise of solitary sleep. So those things go hand in hand. Infants start sleeping by themselves in settings where they are also predominantly fed with commercial milk. But in the second half of the 20th century then there was a return of interest in breastfeeding, with lots of new great science, and lots of work in the sleep area as well and the kind of interconnections between these two systems.

Irene Caselli: So then we end up with confusing guidelines for parents.

Cecília Tomori: Not everybody has the same guidance. A good example of this is the United Kingdom, where the guidelines have actually changed over time. They offer guidance to people on how to sleep next to one’s baby in a safe manner and under what circumstances these things are possible.

Even in the United States, things have changed over time, and there’s been more attention to the connection between breastfeeding and sleep. And although the American Academy of Pediatrics continues to be generally not favorable, the Academy of Breastfeeding Medicine actually has guidance that is supportive of breastfeeding and bedsharing under the right circumstances.

So we have this very fragmented landscape where some people are still being told that under no circumstances should they sleep next to their babies, while other people might be given a much more nuanced message.

So what I think we need to think about is what is the contemporary context of sleeping next to one’s baby, right? So clearly in our sort of evolutionary history, we do not have adaptations for how to sleep on a waterbed or with all the many different kinds of possible things that people have invented, some of which indeed are dangerous to babies.

So if we recognise that breastfeeding and sleep are very interconnected, and we understand that babies actually wake up frequently, and they need care and they need to be fed and they need to be close and also, the chances are people will fall asleep while they are breastfeeding, because that is part of our physiology, then we can help people prepare for that scenario.

Irene Caselli: So how do we create an environment that is the least likely to potentially cause harm?

Cecília Tomori: For example, we can help people look at the surfaces where they might fall asleep. And one of the the pivotal problems that I think we’ve had in the United States, for example, is that when you have a guideline that says never do x and you have physiology, that actually is doing something very different.

What you may end up doing is you might drive people to surfaces that are actually much more dangerous. So couches and sofas present multiple times the risk of sleeping on a regular bed next to an infant, because they tend to be fluffier and they have entrapment hazards as well. So they’re actually very dangerous.

Similarly, some of the nursing chairs that people really like, because they can be really comfortable. That might be really nice. But because we’re tired, and we’re feeding the baby regularly during the day and night, people end up falling asleep in those and that can also present serious hazards because of the entrapment that can occur in the chair.

So rather than telling people these things that then end up driving them to hazardous situations, the better option is to help people make decisions that might actually reduce their risk. So, before a baby’s born, we want to check in and see, you know, let’s make sure that the parents are not sleeping on a waterbed because that is actually super dangerous.

Let’s make sure that the bed isn’t doesn’t have multiple layers of squishy stuff, because that is indeed super dangerous. Let’s make sure that the bedding isn’t going to be covering the baby, which is also extremely dangerous. If those steps are taken, then what happens is breastfeeding mothers adopt this C-shape position that protects their babies and facilitates breastfeeding and sleep.

Irene Caselli: So the norm should be that new parents’ sleep is highly disrupted by the needs of a newborn, and that we should actually support families in that transition, right?

Cecília Tomori: After birth, we need to care for a baby intensively, and that means that we don’t sleep the way that we would normally sleep. So we need to normalise this: taking care of an infant changes the way we do things and that’s not abnormal, but actually expected. Whichever way you’re feeding the baby, they wake up frequently, they need to be fed frequently. They require that close care.

However we have a mismatch between cultural expectations and the physiological realities of caring for infants, which has to do with our complex history. We are talking about colonialism (so relying on others to do that hard work), biomedicalisation and capitalist practices, which hand-in-hand transformed the way that we think of human bodies, families, societies and infant care.

It is virtually impossible for many families to have a break from work if there’s no paid leave. So these policies that support families and caregiving should be at the forefront of the policy agenda. You need policies that help people provide the care that meets a new baby’s needs and that doesn’t turn the whole situation into a sort of heroic exercise.

If you’re interested in more resources about baby sleep, this is great.

What I’ve been reading

I thoroughly enjoyed this BBC piece about how archaeologists are trying to figure out what exactly children played with in antiquity, and whether they played at all. Some of the oldest objects that have been found are believed to be toys (think of button-like objects or dolls) that date back thousands of years — but for decades, archaeologists wondered whether they were toys at all. The big problem was that — surprise surprise! — childhood was mainly ignored by academics, including archaeologists. But understanding how children played is important to understand what role children played in the past.

What I’ve been listening to

I listened to this episode of Parenting Translator, by U.S. psychologist Cara Goodwin, whose work I tend to link to quite often. It is an interview with Julia Schechter, co-director of the Duke Center for Girls and Women with ADHD. The interview is very interesting because it looks at what Attention Deficit Hyperactivity Disorder (ADHD) is, how it can be diagnosed among the youngest children, and why boys tend to be diagnosed sooner and better than girls (it’s partly because of our stereotypical idea of ADHD is a little boy who has a lot of energy and difficulty sitting still at school). But girls also suffer from ADHD, often with symptoms of anxiety. The interview goes into what the red flags for a parent should be from early childhood and how to help a girl who suffers from ADHD.

What I’ve been watching

For some light relief, I have gone back and watched this TikTok video over and over again. It is on Recess Therapy, an account by U.S. comedian Julian Shapiro-Barnum, who interviews very young kids with very great ideas. This video in particular is about love (or “wuv”), and the five-and-a-half-year-old kid in it says it is impossible to hate Valentine’s Day. It is a social media classic now, but I first came across it thanks to Shaun, this newsletter’s editor. 

Who’s been inspiring me

This great campaign by CoorDown, the leading Italian non-profit that promotes and protects the rights of people with Down syndrome, looks at all the ridiculous excuses that families with a member with Down syndrome have heard for being excluded from education, sports, jobs, and other opportunities. From “we don’t have any more chairs” to “we already have one of them kids”, the short films are based on real-life testimonies of children who shared their experiences of exclusion with CoorDown.

What members have been saying

Thanks to all those of you who filled in the survey I put out recently. I am still processing the feedback, but I was happy to hear that you are interested in reading more essays and interviews too. That is why I have a Q&A this week, and I will try to have at least one a month from now on. Those who answered the survey by 5 March were part of a draw and I have already announced the two winners. So, Hanny and Jessica, check your emails, and enjoy the complimentary book and the free membership you received! If you are interested in completing the survey, you still have time.

With love and care, 

📣 The First 1,000 Days is edited by community member and friend, Shaun Lavelle. Thanks to Nabeelah Shabbir for providing another set of eyes this week!

Photo credits and alt-text: freestocks on Unsplash, baby crib

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