3.2: Infant Sleep

Figure \(\PageIndex{1}\). Sleeping newborn. Image source.

A newborn typically sleeps approximately 16.5 hours per 24-hour period. This is usually polyphasic sleep in that the infant is accumulating the 16.5 hours over several sleep periods throughout the day (Salkind, 2005, Barry, 2021a). The infant is averaging 15 hours per 24-hour period by one month, and 14 hours by 6 months. By the time children turn two, they are averaging closer to 10 hours per 24 hours. Additionally, the average newborn will spend close to 50% of the sleep time in the Rapid Eye Movement (REM) phase, which decreases to 25% to 30% in childhood.

Sudden Unexpected Infant Deaths (SUID): Each year in the United States, there are about 3,500 Sudden Unexpected Infant Deaths (SUID). These deaths occur among infants less than one year old and have no immediately obvious cause (CDC, 2019). The three commonly reported types of SUID are:

• Sudden Infant Death Syndrome (SIDS): SIDS is identified when the death of a healthy infant occurs suddenly and unexpectedly, and medical and forensic investigation findings (including an autopsy) are inconclusive. SIDS is the leading cause of death in infants 1 to 12 months old, and approximately 1,400 infants died of SIDS in 2017 (CDC, 2019). Because SIDS is diagnosed when no other cause of death can be determined, possible causes of SIDS are regularly researched. One leading hypothesis suggests that infants who die from SIDS have abnormalities in the area of the brainstem responsible for regulating breathing (Weekes-Shackelford & Shackelford, 2005).
• Unknown Cause: The sudden death of an infant less than one year of age that cannot be explained because a thorough investigation was not conducted, and cause of death could not be determined. In 2017, 1300 infants died from unknown causes (CDC, 2019).
• Accidental Suffocation and Strangulation in Bed: Reasons for accidental suffocation include: Suffocation by soft bedding, another person rolling on top of or against the infant while sleeping, an infant being wedged between two objects such as a mattress and wall, and strangulation such as when an infant's head and neck become caught between crib railings. In 2017, 900 infants died from accidental suffocation and strangulation. The 2017 percentages of infants who died based on each of the three types are listed in Figure \(\PageIndex{2}\).

Figure \(\PageIndex{2}\). Breakdown of sudden unexpected infant death by cause in the US in 2017.

As can be seen in the next graph (Figure \(\PageIndex{3}\)), the combined SUID death rate declined considerably following the release of the American Academy of Pediatrics safe sleep recommendations in 1992, which advocated that infants be placed for sleep on their backs (nonprone position). These recommendations were followed by a major Back to Sleep Campaign in 1994. However, accidental suffocation and strangulation in bed mortality rates remained unchanged until the late 1990s. In 1998 death rates from accidental suffocation and strangulation in bed actually started to increase, and they reached the highest rate at 24.6 deaths per 100,000 live births in 2017 (CDC, 2019).

Figure \(\PageIndex{3}\). Graph of the trends in SUID, as categorized by cause, in the US between the years 1990 and 2017.

Should infants be sharing the bed with parents? Colvin et al. (2014) analyzed a total of 8207 deaths from 24 states during 2004-2012 that were contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The results indicated that younger victims (0–3 months) were more likely to die by bed-sharing and sleeping in an adult bed/on a person. A higher percentage of older victims (4 months to 364 days) rolled into objects in the sleep environment and changed position from side/back to prone. Carpenter et al. (2013) compared infants who died of SIDS with a matched control and found that infants younger than three months old who slept in bed with a parent were five times more likely to die of SIDS compared to babies who slept separately from the parents but were still in the same room. They concluded that bed sharing, even when the parents do not smoke or take alcohol or drugs, increases the risk of SIDS. However, when combined with parental smoking and maternal alcohol consumption and/or drug use, risks associated with bed sharing greatly increased. In June 2022, the American Academy of Pediatrics (AAP) updated the recommendations for reducing infant deaths and stated, "the AAP is unable to recommend bed sharing under any circumstances" (Moon et al., 2022, p. 11).

Figure \(\PageIndex{4}\). Baby sleeping on an adult's chest. Image source.

The studies discussed above were based on American statistics. What about the rest of the world? Co-sleeping occurs in many cultures, primarily because of a more collectivist perspective that encourages a close parent-child bond and interdependent relationship (Morelli et al., 1992). In countries where co-sleeping is common, however, parents and infants typically sleep on floor mats and other hard surfaces which minimize the risk of suffocation that can occur with bedding (Nelson et al., 2000). There are other considerations raised by anthropologists across the world about whether and how these recommendations should be reconciled from data across the world (Barry, 2021b).