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  • Angela Laverick CIMI

Sleep Conference 2018 - Coping with Infant Sleep

Sleep, in particular infant sleep, is a huge area of interest for me. Probably due to the fact that my own children, as babies, were not great at sleeping at night. Child number 2 did not 'sleep through the night' until around three and a half years, yes you read that right YEARS, of age. So the title of this years Parent-Infant Sleep Lab Conference particularly interested me – 'Coping With Infant Sleep'. How DO you cope when you baby wakes frequently during the night? At times my baby woke every 45 minutes. All night. At times she would wake in the night and refuse to go back to sleep for 2-3 hours. She would just sit, eyes open, staring. Uninterested in food, playing, etc., and just seemed unable to get back to sleep, or leave my side. Not what you need when you've got to get up, do the school / childcare run and remain alert all day at work! I often wondered what I was doing wrong.

I survived. I'm still here to tell the tale. But did I cope?

Sleep deprivation is a form of torture. It can reduce you to a blubbering wreck, put a strain on your relationships and leave you feeling like you are struggling to keep it all together. My house was a tip because I physically didn't have the energy to tidy – especially the tidying needed to counteract the mess created by two kids. I struggled, as quite often happens when you are in the thick of it, to see what might help, both with the baby's sleep and with my ability to cope with the lack of sleep. I mean, leave me to it and I'm a 8-9 hours a night girl, I LOVE my sleep. So I didn't take well to regularly getting half of that amount per night.

I knew I didn't want to let my baby cry it out. I'd tried that before with her sister and it was just awful, tears all round and vomit involved – enough said. I wasn't going there again! But other than that, what else was there but to 'wait it out'? She'd sleep eventually... hopefully...

I discovered the Infant Sleep Information Source (ISIS) through a Le Leche League meeting I attended for breastfeeding support. I read on their website lots of facts about normal infant sleep that I'd never heard before. What I read, to an extent, normalized what I was / had experienced with my babies. It lowered my expectations (which I realised had been incredibly high!) and that in it's self helped me to cope as I began to think about sleep differently. Due to this I signpost all of my Baby Massage families to the excellent resource that is the Infant Sleep Information Source. One of my guided discussions during the course is around sleep as it is such am important topic to parents and I am always keep to develop my own understanding of normal infant sleep and how I can help parents cope with it better.

So on a very sunny Thursday, 19th April 2018, I attended the conveniently located Conference at Durham University and listened to a fabulous line up of speakers introduced by Professor Helen Ball, BSc, MA, PhD, who established the Parent-Infant Sleep Lab in 2000.

First up we heard from Dr Alana Rudzick, BA, MSc, PhD, a Biocultural Anthropologist and Assistant Professor of Anthropology at the State of New York College at Oneonta in the United States.

She talked about how culturally-shaped perceptions about the way babies are fed, be it breast of formula, affect sleep for both baby and mother, and also mothers wellbeing, and how this perception may play a role in how women choose to feed their babies. Se also talked about her research examining the development of sleep patterns and hormonal development in exclusively breast fed and exclusively formula fed infants of first time mums. We heard how the findings compared maternal reports of sleep to actual objectively measured sleep and I have to say I was surprised to hear the results!

I have heard many parents say that one of the reasons they stopped breastfeeding was that they had concerns about their own well being and felt breastfeeding contributed to this, maybe due to a perception that their quality of sleep was worse when breastfeeding? Yet the research findings suggest that the quality of maternal sleep whether breastfeeding or formula feeding is very similar and there is no difference in the reports of post-natal depression and maternal well being. How many times do we hear the phrase 'Happy mum, Happy Baby'? It's even now a tag line adopted by some formula companies.

Next we heard from Dr Charlotte Russell, BA, PhD, who is a Researcher in the Department of Anthropology, co-runs the Infant Sleep Information Source and oversees Sleep Lab projects.

Charlotte's talk reflected on the unintended consequences of infant safe sleep campaigns. She highlighted that from an anthropological perspective bed sharing is not a simple modifiable behaviour, however most safe infant sleep education policies treat it as such, advising all parents not to bed share, regardless of individual circumstances, or their ability to comply. She stated that the consequences of this strategy are poorly understood but her research gathering personal experiences and common feeling found that many mums avoid falling asleep with their baby in the bed and will try to stay awake, which often results in unintentional bed sharing which may not be safe. My own experience of this was very relatable.

I rarely fed my babies in bed when they were very young for fear of falling asleep and smothering them. Instead I would get up, go to the living room and sit bolt upright whilst I fed them, then return to bed again. I was terrified by the media reports of babies dying in their sleep, but as Charlotte stated, these media reports are often sensationalist, are only partially reported missing vital details of the circumstances surrounding the tragedy and succeed to do nothing but scaremonger. I remember feeling mortified when, on the first night home with my firstborn, I woke up to find her next to me on my bed. I remember she started to cry at around 9pm when I was going to bed and wouldn't stop. I must have passed out with exhaustion having only had 4 hours sleep in 2 days. Next thing I remember was waking up and seeing her next to me on the bed. I barely dared to touch her to see if she was still breathing, terrified that I had killed my baby by simply sharing a bed! Obviously in these circumstances this was unintentional bed sharing and unsafe due to my exhaustion, but nevertheless, my opinion at the time was that if you sleep with your baby they might die. How sad.

Dr Cecilia Tomori, PhD, MA, author and Assistant Professor of Anthropology at Durham University compared attitudes to infant sleep and night time parenting around the world.

Did you know that in Japan you can buy your futon according to the size of your family and how many kids are going to be sharing it with you? Bed sharing is so normal there!

In Guatemala the Mayans believe that it is the only reasonable way for a baby to sleep, and are shocked by the American (and our) ways. Cecilia highlighted, as she does in her book 'Night time Breastfeeding: An American Cultural Dilemma' (Berghahn 2014) that our low and declining breastfeeding rates are linked inextricably to the lack of support for night time breastfeeding and sleep. She talked also about where it all went wrong and what, who and when it affected our culture. She pointed out how much focus our culture puts on preparing the nursery – a room that separates us from our babies. Although I did chuckle when I thought about how long ours went unused for.

Our culture dictates high expectations of our babies. I thought my first baby would be sleeping through the night by 3 weeks. Yes I was deluded. My expectations were exceptionally high, and by sleeping through I mean 12 straight hours. 7-7. Where did I get such an idea of perfection? A baby book. And tales from parents who proudly stated that their baby slept through from a very early age. Therefore mine would too! People don't tell you that often babies won't sleep unless you are holding them. They don't share that they wake up frequently and need feeding every single time. Why don't they tell you this? Is it because they don't want to scare us with the reality? Don't want to burst our perfect little hypothetical baby bubble? Seriously, I'd have appreciated the heads up on this one thanks! I'd never heard of the 4th trimester.

It was fabulous to see Dr Vicky Thomas speaking at this years conference.

I'd met Vicky several times before at LLL meetings in full mum mode with her own babies. Vicky is a Consultant Paediatrician, MBBS, MRCPH at the Great North Childrens Hospital in Newcastle Upon Tyne and her talk was entitled 'What your paediatrician doesn't know about infant sleep' She showed us what aspects of infant behaviour are covered in the current undergraduate and post graduate medical curricula and what else influences the advice doctors give to parents when it comes to infant sleep. She questioned how doctors learn what is normal in terms of infant sleep and outlined current plans to address the issues with medical education as well as what an ideal support system from the NHS could look like! Fantastic!

Following on nicely Dr Pam Douglas, MBBS, FRACGP, IBCLC, PhD,

travelled half way around the world from Brisbane, Australia to tell us all about the Possums Sleep Program: a new paradigm for optimal parent-infant sleep. Pam founded the charitable organisation, Possums for Mothers and Babies, which provides education for parents and health professionals in community based Neuroprotective Developmental Care. “The Possums Sleep Program is an innovative, evidence based approach to the management of parent-infant sleep problems. It integrates research across multiple disciplines including developmental psychology, sleep science, lactation science, psychological attachment, neuroscience and third wave contextual behaviouralism (popularly known as Acceptance and Commitment Therapy or ACT). The Possums Sleep Programme offers a 'cued-care approach to infant sleep. It empowers parents by providing education about the biology of parent-infant sleep. It repairs and protects against excessive night waking by identifying and removing underlying disruptors such as breastfeeding problems or misalignment of the circadian clock. It also helps parents understand their infants sleep and their responses to it in the context of their parenting values, and to manage the difficult thoughts and feelings that commonly arise during this time of life.” Pam shared some more details about how her parents helps parents and babies and I have to say I was impressed by this well researched and gentle approach. The fact that 'cued-care' and viewing parents as the experts on their baby is part of it fits wonderfully with the IAIM approach to Baby Massage. I learned a lot from listening to Pam and she made so much sense to me. If you would like to find out more about Possums, you can here.

I can't wait to see how Professor Helen Ball translates the Possums Sleep program for UK parents and Practitioners. Watch out for 'Sleep, Baby and You' coming soon!

As Helen pointed out in her talk it is important to consider what health professionals tell parents about normal infant sleep, and how they can be helped to cope when it come to infant related sleep disruption.

What I am most looking forward to is a culture of sleep support that doesn't involve letting babies cry.

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