A local integrative healthcare practitioner weighs in on the cultural differences of sleep solutions for small children, and the ever-controversial co-sleeping debate.
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November 9, 2022
4:30 PM
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I didn’t set out to co-sleep with my child. It just sort of happened.
In that early postpartum haze, I was a nursing machine with a ravenous babe who fed every hour and a half for at least 45 minutes at a time. Because I was so sleep deprived (Google search phrases included “Can you die from lack of sleep?”), I slowly let all societal bedtime expectations go out the window and began embracing the fact that he was going to be my bedtime buddy. If I wanted to be a functioning human, then that was just simply going to be the choice. Looking back, it probably saved me. But I had to dodge a lot of questions and judgments. Chief among them was: When are you going to sleep train him?
Sleep training is an umbrella term that refers to a number of different approaches used to teach Baby to fall asleep and stay asleep through the night with, eventually, little to no crying. The goal is to help your child learn how to self-soothe so that when she inevitably stirs or wakes up through the night, she’s equipped to put herself back to sleep, reducing the need for constant intervention from Mom and Dad. Examples of self-soothing include sucking (with or without a pacifier), rolling around to find a comfortable position, making contact with a blanket or lovey [FTR, the American Academy of Pediatrics recommends keeping all soft bedding out of the crib until 12 months], humming, singing, or babbling.
This idealized method didn’t work for my family, no matter how many times I tried enforcing it. When I learned just how many fellow parents had sleep-trained their children, I began to feel self-conscious: Am I doing this all wrong? Have I somehow stunted his growth and development? I felt like I was in the minority. Then I decided to explore what sleep standards for small children look like outside of Western culture.
“Sleep training is more of a twenty-first-century construct,” says Amy Schreiner, assistant professor at the college of chiropractic at Northwestern Health Sciences University. “It is not frequently practiced in other cultures. Other cultures work together as an extended ‘family’ and assume there is more than just a mother or father helping with the baby during the day or night.”
Thanks to the booming business of mommy bloggers, sleep training is often conflated with CIO (cry it out) methods. But sleep training isn’t a binary—it exists on a spectrum. Crying it out means closing the door to Baby’s room and not returning until the following morning. That’s not generally recommended by experts, and the science on CIO is still mixed. Some groups say it doesn’t provoke adverse stress responses or long-term attachment issues while others maintain that CIO can be damaging to a developing psyche.
The Ferber method is a popular sleep training technique—otherwise known as check and console—that was introduced in the mid-’80s when Dr. Richard Ferber’s book, Solve Your Child’s Sleep Problems, circulated the mainstream, outlining a gentler way to wean nighttime feedings. Parents are encouraged to put the baby in the crib and comfort her with gentle pats or rubs and soothing words. They leave the room and don’t return until crying resumes, checking in on Baby at timed intervals.
And then there’s the chair method which is exactly how it sounds: Taking up residence in a chair alongside your child’s crib until she falls asleep. The parent is instructed to move the chair further away from the crib every few nights until you’re completely out of the room. This technique requires about two weeks of coaching—and a magnanimous attitude.
The rise of the nuclear family in America—a family model made up of two biological parents and their children—resulted in fewer extended family living arrangements and smaller households. Unless you have hands-on, able-bodied parents or relatives who live nearby and are willing to help shoulder the burden of caregiving, help can be hard to come by. Add to that, we live in one of six countries with no national standards on paid family leave, and childcare here is grossly unaffordable. One study found that the average annual cost of a childcare center pre-pandemic for one child in Minnesota was around $11,000. That number has since jumped 60 percent. Because of these hindrances, breastfeeding is less common here than in other cultures. Data from UNICEF shows that only 26 percent of infants zero to five months in Northern America are exclusively breastfed. (This, compared to 60 percent of infants being exclusively breastfed in South Asia.)
And nursing mothers make up the largest group of co-sleepers.
“Many other cultures embrace co-sleeping as a normal way of life,” says Schreiner. “Breastfeeding is much more common in other cultures and co-sleeping is easier for nursing—these cultures view this as a method for bonding as well as protection. It is much more taboo in our society with the increased concern for sudden infant death syndrome (SIDS).” On the contrary, studies show that breastfeeding for at least two months could cut the risk of SIDS nearly in half.
Of course, co-sleeping isn’t done in just one way. Take the Philippines or Vietnam, for example, where parents sleep with their baby in a hammock alongside the parents’ bed. This sling, usually made up of fabric or rope, isn’t used primarily for sleeping; it’s also used for swinging or resting. In Japanese culture, at least 70 percent of infants reportedly co-sleep with their parents on bamboo or traditional rice straw mats on the floor, and, most commonly, in the side-lying position. In India, it’s socially acceptable for children to bedshare with their parents until they’re six or seven years old.
These practices go starkly against the American Academy of Pediatrics guidelines, which says bedsharing under any circumstances is not recommended. It notes that bedsharing should be avoided “at all times,” citing risks that include SIDS, accidental suffocation, and accidental strangulation. The CDC says there are about 3,400 cases of SIDS in the United States each year.
Parenthood feels like being air-dropped into chaos with no instruction manual to guide the way. While there is no shortage of (some really amazing!) parenting books out there, and expert advice on the internet, sometimes the way you do things is based on instinct and what simply feels right for you and your family.
Jodi Mindell, a psychologist at Children’s Hospital of Philadelphia, who’s helped thousands of babies and parents get more sleep over the past 20 years, says that it’s impossible to say one sleep approach works better than the other. For some children, more soothing or check-ins are necessary and for other babies, fewer check-ins may work better. And the precursor to getting there is setting up a good bedtime routine. Schreiner recommends the following for babies and small children:
It’s important to note that baby should sleep in your room with you for at least six months and, if possible, up to one year—this helps to decrease the risk of SIDS.
Sleepless nights are, of course, a rite of passage when you enter parenthood. But that doesn’t mean you have to be a martyr! 
Located in Bloomington, Northwestern Health Sciences University is a premier integrative health institution that prepares the next generation of healthcare professionals deliver and advance healthcare, offering 11 areas of study. Its clinics and TruNorth Wellness Hub are open to the public to support healthier, better lives for all. Bloomington Clinic specializes in whole-family care, providing chiropractic treatment, acupuncture, Chinese medicine, massage therapy, naturopathic medicine, nutrition, and cupping. Sweere Clinic offers comprehensive care for complex pain conditions and trauma. The Biomechanics Lab and Human Performance Center support proper movement and recovery through gait analysis, rehabilitation, and strength and conditioning.
See more content from Northwestern Health Sciences University. 
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Jamie Korf is a deputy editor for Studio MSP at Mpls.St.Paul Magazine.
November 9, 2022
4:30 PM
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