1 1 Lactationinthe!Kung Lactationinthe!Kung Lactationinthe!Kung - - PDF document

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Lecture18:Mothering/Parenting Lecture18:Mothering/Parenting

• FieldStudiesofLactation

FieldStudiesofLactation

• Neoteny

Neoteny

• Mother

Mother InfantBonding InfantBonding

• TheRoleof

TheRoleofOxytocin Oxytocin

• DifferentialMaternal

DifferentialMaternal Investment Investment

• Neglect

Neglect

• PostpartumDepression

PostpartumDepression

• Fathering

Fathering

• Ethnopediatrics

Ethnopediatrics

• Crying

Crying

• InfantHolding

InfantHolding

• Parent

Parent InfantCo InfantCo sleeping sleeping

BehavioralBiologyofWomen,2007

FieldStudiesofBreastfeeding FieldStudiesofBreastfeeding

Months

2 2

Lactationinthe!Kung Lactationinthe!Kung

• Longinterbirthintervals

Longinterbirthintervals

• 44.1

44.1mths mths

• Patterningoflactation

Patterningoflactation

• 4.06bouts/hour

4.06bouts/hour

• 7.83min/hour

7.83min/hour

• 1.92min/bout

1.92min/bout

• Aschildgetsolder

Aschildgetsolder— — increaseinlength increaseinlength

• bouts

bouts

Lactationinthe!Kung Lactationinthe!Kung

• Lowerestradioland

Lowerestradioland progesteroneinnursing progesteroneinnursing mothers mothers

Lactationinthe!Kung Lactationinthe!Kung

• Lowerestradioland

Lowerestradioland progesteroneinnursing progesteroneinnursing mothers mothers

• Correlatedwithageof

Correlatedwithageof infantandmeantime infantandmeantime betweennursingbouts betweennursingbouts

Lactationinthe!Kung Lactationinthe!Kung

• Lowerestradioland

Lowerestradioland progesteroneinnursing progesteroneinnursing mothers mothers

• Correlatedwithageof

Correlatedwithageof infantandmeantime infantandmeantime betweennursingbouts betweennursingbouts

• Suggestedinter

Suggestedinter bout bout intervalkeyvariablein intervalkeyvariablein lactation lactationsubfecundity subfecundity

(Konner&Worthman)

Prolactin&NursingBoutLength Prolactin&NursingBoutLength

Prolactin Nursing Bout

Prolactin,#NursingBouts,&Time Prolactin,#NursingBouts,&Time

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EdinburghStudyofBreastfeeding EdinburghStudyofBreastfeeding

• EdinburghStudy

EdinburghStudy

• Studied27breastfeeding

Studied27breastfeeding and10bottlefeeding and10bottlefeeding mothers mothers

• Lactation/supplementation

Lactation/supplementation diaries diaries

• Measuredurinary

Measuredurinary hormones hormones

• Measureprolactininblood

Measureprolactininblood

Supplementation&OvarianFunction Supplementation&OvarianFunction ResumptionofOvarianFunction ResumptionofOvarianFunction EdinburghStudy EdinburghStudy

• Lactatingwomenresumedovarianfunctionlater

Lactatingwomenresumedovarianfunctionlater postpartumthandidbottlefeedingwomen postpartumthandidbottlefeedingwomen

4 4

EdinburghStudy EdinburghStudy

• Lactatingwomenresumedovarianfunctionlater

Lactatingwomenresumedovarianfunctionlater postpartumthandidbottlefeedingwomen postpartumthandidbottlefeedingwomen

• Frequencyofovulationincreasedwithtimeas

Frequencyofovulationincreasedwithtimeas lactationwasphasedout lactationwasphasedout

EdinburghStudy EdinburghStudy

• Lactatingwomenresumedovarianfunctionlater

Lactatingwomenresumedovarianfunctionlater postpartumthandidbottlefeedingwomen postpartumthandidbottlefeedingwomen

• Frequencyofovulationincreasedwithtimeas

Frequencyofovulationincreasedwithtimeas lactationwasphasedout lactationwasphasedout

• Rapidresumptionofovarianfunctioninbottle

Rapidresumptionofovarianfunctioninbottle feeders;gradualresumptioninbreastfeeders feeders;gradualresumptioninbreastfeeders

EdinburghStudy EdinburghStudy

• Lactatingwomenresumedovarianfunctionlater

Lactatingwomenresumedovarianfunctionlater postpartumthandidbottlefeedingwomen postpartumthandidbottlefeedingwomen

• Frequencyofovulationincreasedwithtimeas

Frequencyofovulationincreasedwithtimeas lactationwasphasedout lactationwasphasedout

• Rapidresumptionofovarianfunctioninbottle

Rapidresumptionofovarianfunctioninbottle feeders;gradualresumptioninbreastfeeders feeders;gradualresumptioninbreastfeeders

• Importanceofintroductionofsupplementary

Importanceofintroductionofsupplementary foods foods

EdinburghStudy EdinburghStudy

• Lactatingwomenresumedovarianfunctionlater

Lactatingwomenresumedovarianfunctionlater postpartumthandidbottlefeedingwomen postpartumthandidbottlefeedingwomen

• Frequencyofovulationincreasedwithtimeas

Frequencyofovulationincreasedwithtimeas lactationwasphasedout lactationwasphasedout

• Rapidresumptionofovarianfunctioninbottle

Rapidresumptionofovarianfunctioninbottle feeders;gradualresumptioninbreastfeeders feeders;gradualresumptioninbreastfeeders

• Importanceofintroductionofsupplementary

Importanceofintroductionofsupplementary foods foods

• Womenwhoconceivedwhilenursingdecreased

Womenwhoconceivedwhilenursingdecreased thefrequencyto3orfewertimes/day. thefrequencyto3orfewertimes/day.

Lactation&Supplementation: Lactation&Supplementation: TheGambia TheGambia

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SupplementationandBreastMilk SupplementationandBreastMilk

• Gave130womensupplementincreased

Gave130womensupplementincreased caloriesfrom1568to2291+vitamin caloriesfrom1568to2291+vitamin

• Noeffectonbreastmilkvolume!!

Noeffectonbreastmilkvolume!!

SupplementationandBreastMilk SupplementationandBreastMilk

• Gave130womensupplementincreasedcalories

Gave130womensupplementincreasedcalories from1568to2291+vitamins from1568to2291+vitamins

• Noeffectonbreastmilkvolume

Noeffectonbreastmilkvolume

• Proteincontentslightlyincreased(6.6%)

Proteincontentslightlyincreased(6.6%)

• Milkfatincrease(7.9%)

Milkfatincrease(7.9%)

• Lactosedecrease(

Lactosedecrease( 7.6%) 7.6%)

• Nochangeincalories

Nochangeincalories

• Vitaminincreasefromsupplement

Vitaminincreasefromsupplement

Prolactin&Supplementation Prolactin&Supplementation GambianStudy GambianStudy

• Supplementationhadonlyasmalleffecton

Supplementationhadonlyasmalleffecton quantityandqualityofbreastmilk quantityandqualityofbreastmilk

• Supplementationhadadramaticeffecton

Supplementationhadadramaticeffecton prolactinlevels prolactinlevels

Prolactin Prolactin& & Lactational Lactational Amenorrhea Amenorrhea

• Highlevelsof

Highlevelsof prolactin prolactinassociatedwith associatedwith reducedabilityforeggtoproduce reducedabilityforeggtoproduce estradiol estradiol (inculture) (inculture)

TheToba:PositiveEnergyBalance TheToba:PositiveEnergyBalance andHighNursingFrequency andHighNursingFrequency

6 6

BreastFeedingHypotheses BreastFeedingHypotheses

• Howtoexplainvariationindurationof

Howtoexplainvariationindurationof postpartumperiodofinfecundity postpartumperiodofinfecundity

• NursingIntensityHypothesis

NursingIntensityHypothesis

• MetabolicLoadHypothesis

MetabolicLoadHypothesis

Valeggia&Ellison

NursingIntensityHypothesis

Nursingintensityhypothesis: Nursingintensityhypothesis:

• Relativemetabolicloadhypothesis:

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Physicalactivitypostpartum Physicalactivitypostpartum

• !"!#
• n=70women

Focalsampling

8 8

$ $%

• %

& &% $ & % ' ( $$ $& $% $' $( )*!+, ))-./01

Toba Tobawomenremainwell womenremainwell nourished nourished duringtheentirepostpartumperiod duringtheentirepostpartumperiod

• WHO’s“normal” range

1.0 0.8 0.6 0.4 0.2 0.0 0.2 0.4 151413121110 9 8 7 6 5 4 3 2 1 0 1 2 3

Monthsto1stmenses

MeanKBMI(±SE)

• Changesinenergybalanceinrelationto

timetofirstpostpartummenses

Firstmenses Averagen=45

• Meandurationofpostpartumamenorrhea

Meandurationofpostpartumamenorrhea 10 10 ( ( 4)months 4)months(n=122 (n=122) )

!Kunglikenursingintensity USlikenutritionalstatus

Lactational LactationalAmenorrheainToba AmenorrheainToba

• Mean=10.3months

Mean=10.3months

Valeggia&Ellison

Lactational LactationalAmenorrheainToba AmenorrheainToba

• Mean=10.3months

Mean=10.3months

• Highnutritionalstatusandhighnursing

Highnutritionalstatusandhighnursing intensity intensity— — leadstoshortperiodsof leadstoshortperiodsof lactational lactationalamenorrhea amenorrhea

Valeggia&Ellison

9 9

Lactational LactationalAmenorrheainToba AmenorrheainToba

• Mean=10.3months

Mean=10.3months

• Highnutritionalstatusandhighnursing

Highnutritionalstatusandhighnursing intensity intensity— — leadstoshortperiodsof leadstoshortperiodsof lactational lactationalamenorrhea amenorrhea

• Thus,nursing

Thus,nursing intensityaloneisinsufficient intensityaloneisinsufficient explanation explanation

Valeggia&Ellison

Lactational LactationalAmenorrheainToba AmenorrheainToba

• Mean=10.3months

Mean=10.3months

• Highnutritionalstatusandhighnursing

Highnutritionalstatusandhighnursing intensity intensity— — leadstoshortperiodsof leadstoshortperiodsof lactational lactationalamenorrhea amenorrhea

• Thus,nursing

Thus,nursing intensityaloneisinsufficient intensityaloneisinsufficient explanation explanation

• Interactionbetweennursingintensityand

Interactionbetweennursingintensityand nutritionalstatus nutritionalstatus

Valeggia&Ellison

Whydowerespondtobabies? Whydowerespondtobabies? Whydowerespondtobabies? Whydowerespondtobabies? TheEvolutionofMickeyMouse: TheEvolutionofMickeyMouse: Neoteny Neoteny

10 10

Neoteny Neoteny

Gould

Neoteny Neoteny MaternalInstinct? MaternalInstinct? MaternalBehavior MaternalBehavior Oxytocin Oxytocin:Mother :Mother Infant Infant Bonding Bonding Oxytocin&Bonding Oxytocin&Bonding

• Females:Releasedduringorgasm,parturition

Females:Releasedduringorgasm,parturition andbreastfeeding andbreastfeeding

11 11

Oxytocin&Bonding Oxytocin&Bonding

• Females:Releasedduringorgasm,

Females:Releasedduringorgasm, partuition partuitionand and breastfeeding breastfeeding

• Males:Releasedduringorgasm

Males:Releasedduringorgasm

Oxytocin&Bonding Oxytocin&Bonding

• Females:Releasedduringorgasm,

Females:Releasedduringorgasm, partuition partuitionand and breastfeeding breastfeeding

• Males:Releasedduringorgasm

Males:Releasedduringorgasm

• Insheepandratsnecessaryformaternalbehavior

Insheepandratsnecessaryformaternalbehavior

Oxytocin&Bonding Oxytocin&Bonding

• Inratsseemstoinhibit

Inratsseemstoinhibit sometypesofmemory sometypesofmemory

• Mayplayarolein

Mayplayarolein erasingmemoryof erasingmemoryof painfulchildbirth painfulchildbirth

• Somestudiesofwomen

Somestudiesofwomen suggestthatwomen suggestthatwomen “ “forget forget” ” thepainof thepainof childbirth childbirth

DifferentialMaternalInvestment DifferentialMaternalInvestment

• Trivers

Trivers Willard WillardHypothesis Hypothesis

“ “Wherevariationinreproductivesuccessis Wherevariationinreproductivesuccessis greaterinonesexthanfortheotherand greaterinonesexthanfortheotherand wherematernalinvestmentcanhavean wherematernalinvestmentcanhavean affect affect— — mothersingoodconditionshould mothersingoodconditionshould favorthesexwiththegreatestvariancein favorthesexwiththegreatestvariancein reproductivesuccess,mothersinpoor reproductivesuccess,mothersinpoor conditionshouldfavorthesexwiththeleast conditionshouldfavorthesexwiththeleast variance variance” ”

SexBiasedInvestmentinIndia SexBiasedInvestmentinIndia

12 12

SexBiasedInvestmentinIndia SexBiasedInvestmentinIndia

• Womenmustmarry

Womenmustmarry ‘ ‘up up’ ’= =‘ ‘hypergyny hypergyny’ ’

• Bridesmustbringa

Bridesmustbringa dowrycommiserate dowrycommiserate withsocialstatus withsocialstatus

• Sonscanhavemultiple

Sonscanhavemultiple wives wives

SexBiasedInvestmentinIndia SexBiasedInvestmentinIndia

• Womenmustmarry

Womenmustmarry‘ ‘up up’ ’= = ‘ ‘hypergyny hypergyny

• Nowherefordaughtersto

Nowherefordaughtersto ‘ ‘go go’ ’

• Bridesmustbringadowry

Bridesmustbringadowry commiseratewithsocial commiseratewithsocial status status

• Dowriesextremely

Dowriesextremely expensive expensive

• Sonscanhavemultiple

Sonscanhavemultiple wives wives

• Sonshadveryhigh

Sonshadveryhigh reproductivesuccess reproductivesuccess Inhighestsocialgroups: Inhighestsocialgroups:

SexBiasedInvestmentinIndia SexBiasedInvestmentinIndia

• Result:

Result:

• Sonshadmultiplewives

Sonshadmultiplewives from from‘ ‘lower lower’ ’ socialgroup socialgroup eachofwhomwould eachofwhomwould bringadowrytothe bringadowrytothe family family

• Thus

Thus

• Investmentinsons

Investmentinsons

• Femaleinfanticide

Femaleinfanticide Inhighestsocialgroups: Inhighestsocialgroups:

Oppositepattern(preferencefordaughters)onbottom Oppositepattern(preferencefordaughters)onbottom

• !""
• “Manygirlshaveloveaffairswithyoungboysbefore

theyreachpuberty,andatonetimechildrenbuildplay houses,afterthemanneroftheCewa,wherethey pretendedtobeadultsplayingatcookingand copulation.TheCewa encouragedthisamongtheir

• wnchildrenandatpubertyCewa girls,ifnotalready

deflowered,hadtheirhymenforciblyrupturedina prescribedmanner.Wehaveseenthatthe[patrilineal] Ngoni formerlyexpectedgirlstobechastebefore marriage.WhilsttheCewa believedthatifagirldid notcopulateatpubertyshewoulddie.” Source‘ Marriageinachangingsociety’ JABarnes 1950.(retheNgoni movingintoaChewa area)p.33

13 13

Birthstoppingbehaviours:post Birthstoppingbehaviours:post reproductive reproductive womenwhosechildrenareallofonesex womenwhosechildrenareallofonesex

2

3! 3!!

*

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• %
• &
• $
• 4

(RuthMace)

PostPartum PostPartumDepression Depression PostpartumDepression PostpartumDepression

(Hagen1999)

4080%ofwomenexperiencepostpartummoodchanges ElationorDepression

PostpartumPsychiatricDisorders PostpartumPsychiatricDisorders

• MaternityBlues:mild

MaternityBlues:mild mooddisturbancethat mooddisturbancethat resolveswithinafewhours resolveswithinafewhours toafewdays;1in2births toafewdays;1in2births

• PostpartumDepression

PostpartumDepression (PPD):1in5births (PPD):1in5births

• PostpartumPsychosis:1in

PostpartumPsychosis:1in 1000births 1000births

(Brockington,2004)

ClinicalDefinitionofPPD ClinicalDefinitionofPPD

• Nodifferentclinicallyfromotherformsofdepressionexceptfo

Nodifferentclinicallyfromotherformsofdepressionexceptforits rits “ “postpartumonset postpartumonset” ” (fromimmediatelyafterbirthto4weeksafter (fromimmediatelyafterbirthto4weeksafter birth) birth)

• ForadiagnosisofPPD,5ofthefollowingsymptomsmustbe

ForadiagnosisofPPD,5ofthefollowingsymptomsmustbe presentfor2weeksandrepresentachangefrompreviouslevels presentfor2weeksandrepresentachangefrompreviouslevelsof

• f

functioning(atleast1ofthesymptomsmustbeeitherdepressed functioning(atleast1ofthesymptomsmustbeeitherdepressed moodordiminishedinterestorpleasure): moodordiminishedinterestorpleasure):

• Depressedmood,nearlyeverydayduringmostoftheday

Depressedmood,nearlyeverydayduringmostoftheday

• Markeddiminishedinterestorpleasureinalmostallactivities

Markeddiminishedinterestorpleasureinalmostallactivities

• Significantweightloss(whennotdieting),weightgain,orach

Significantweightloss(whennotdieting),weightgain,orachangeinappetite angeinappetite

• Insomniaor

Insomniaorhypersomnia hypersomnia(excesssleep) (excesssleep)

• Psychomotoragitationorpsychomotorretardation

Psychomotoragitationorpsychomotorretardation

• Fatigueorlossofenergy

Fatigueorlossofenergy

• Feelingsofworthlessnessorinappropriateguilt

Feelingsofworthlessnessorinappropriateguilt

• Impairedabilitytoconcentrateorindecisiveness

Impairedabilitytoconcentrateorindecisiveness

• Recurrentthoughtsofdeath,recurrentsuicidalideationwithout

Recurrentthoughtsofdeath,recurrentsuicidalideationwithout aspecificplan, aspecificplan,

• rasuicideattemptoraspecificplanforcommittingsuicide
• rasuicideattemptoraspecificplanforcommittingsuicide

Cross Cross CulturalIncidence CulturalIncidence

• PPDwasoncethoughttobeaculture

PPDwasoncethoughttobeaculture bound bound illnessfoundonlyinWesterncountriesbecauseof illnessfoundonlyinWesterncountriesbecauseof theabsenceofasocialsupportstructure(Sternand theabsenceofasocialsupportstructure(Sternand Kruckman Kruckman,1983) ,1983)

• However,mountingevidencesuggeststhatwomen

However,mountingevidencesuggeststhatwomen aroundtheworldexperiencePPD,withprevalence aroundtheworldexperiencePPD,withprevalence ratesrangingfrom0%to40% ratesrangingfrom0%to40%

14 14

PPDRiskFactorsinSample PPDRiskFactorsinSample Populationin PopulationinGoa Goa,India ,India

• Maternalemployment

Maternalemployment

• Antenatalpsychiatric

Antenatalpsychiatric morbidity morbidity

• Unplannedpregnancy

Unplannedpregnancy

• Problemswithbreast

Problemswithbreast

• feedinginfant

feedinginfant

• Infanthospitaladmission

Infanthospitaladmission

• Sadnessaboutinfant

Sadnessaboutinfant’ ’s s gender gender

PPDProtectiveFactors PPDProtectiveFactors

• MaternalEducation

MaternalEducation

• PaternalEmployment

PaternalEmployment

HypothesesexplainingPPD HypothesesexplainingPPD

• Dysregulationofmechanismsunderlyingnormalmood

variation

• “PsychologicalPain” Hypothesis:negativeaffectis

associatedwithsocialcircumstancesthatwere reproductivelycostlyinancestralenvironments; motherswilltakeactionstoreducetheirlevelsof psychologicalpain

• Accountsforminordepression,butnotmost

debilitatingsymptomsofdepression

• SocialNavigationHypothesis:depressioninduces

cognitivechangesthatfocusandenhancecapacitiesfor accurateanalysisandsolutionofkeysocial problems=socialruminationfunction;costsassociated withdepressioncanpersuadesocialpartnersto providehelp=socialmotivationfunction

Fathering Fathering HormonalChangesinFathers HormonalChangesinFathers

• StudyDesign:

StudyDesign:

• 34couples

34couples

• watched5min.videoofbreastfeeding

watched5min.videoofbreastfeeding

• Heldadollin

Heldadollin‘ ‘used used’ ’ blanket blanket

• Listenedtotapeofdistressednewborn

Listenedtotapeofdistressednewborn

• Postnatalgroupfathersheldown

Postnatalgroupfathersheldown babies babies

• Highest

Highestprolactin prolactininLate inLate prenatal prenatal group group

• Highest

Highestcortisol cortisolinlateprenatal inlateprenatal stage stage

(Storeyetal.,2000)

HormonalChangesinFathers HormonalChangesinFathers

• Highest

Highestprolactin prolactininLate inLate prenatal prenatal group group

• Highest

Highestcortisol cortisolinlateprenatal inlateprenatal stage stage

(Storeyetal.,2000)

FathersChangedhormonallevels FathersChangedhormonallevels evenbeforebecamefathers! evenbeforebecamefathers!

15 15

HormonalChangesinFathers HormonalChangesinFathers

• Highest

Highestprolactin prolactininLate inLate

• prenatalgroup

prenatalgroup

• Highest

Highestcortisol cortisolinlate inlate prenatalstage prenatalstage

• Dropintestosteronefrom

Dropintestosteronefrom prenataltopostnatal prenataltopostnatal period. period.

(Storeyetal.,2000)

TestosteroneandFatherhood TestosteroneandFatherhood

• !"

# $ %& ' ( )

• )

(Grayetal.,2002)

Fathershadsignificantlylower Fathershadsignificantlylower eveningtestosteronelevels eveningtestosteronelevels

TestosteroneandFatherhood TestosteroneandFatherhood

• !"

$ %&

' () )

(Grayet al.,2002)

Ethnopediatrics Ethnopediatrics ResponsetoInfantCrying ResponsetoInfantCrying

• America,Holland&Kung

America,Holland&Kung San:babiescriedwith San:babiescriedwith equalfrequency equalfrequency

• Differenceisdurationof

Differenceisdurationof crying crying

ResponsetoInfantCrying ResponsetoInfantCrying

• Colic=Excessivecryingthoughttobe

Colic=Excessivecryingthoughttobe causedbygas causedbygas

• 10

10 20%ofwesternbabiesdescribedas 20%ofwesternbabiesdescribedas colicky colicky

• Korea

Korea studyof160Koreaninfants,none studyof160Koreaninfants,none couldbeclassifiedascolicky couldbeclassifiedascolicky

16 16

ResponsetoInfantCrying ResponsetoInfantCrying

• Americanmothersdidn

Americanmothersdidn’ ’trespondtocrying trespondtocrying in46%ofepisodesthefirst3monthsof in46%ofepisodesthefirst3monthsof baby baby’ ’slife slife

Infant Infant‘ ‘Handling Handling’ ’ Practices Practices InfantCarrying InfantCarrying TimeBabiesSpendAlone TimeBabiesSpendAlone

17 17

Effectsof Effectsofbabywearing babywearing

• Quickerday/nightregulation

Quickerday/nightregulation

Effectsof Effectsofbabywearing babywearing

• Quickerday/night

Quickerday/night regulation regulation

• Stimulatesvestibular

Stimulatesvestibular system system

Effectsof Effectsofbabywearing babywearing

• Quickerday/night

Quickerday/night regulation regulation

• Stimulatesvestibular

Stimulatesvestibular system system

Effectsof Effectsofbabywearing babywearing

• Quickerday/nightregulation

Quickerday/nightregulation

• Stimulatesvestibularsystem

Stimulatesvestibularsystem

• Lesstimecrying/fussing

Lesstimecrying/fussing

Effectsof Effectsofbabywearing babywearing

• Quickerday/night

Quickerday/night regulation regulation

• Stimulatesvestibular

Stimulatesvestibular system system

• Lesstimecrying/fussing

Lesstimecrying/fussing

• Soothesbaby

Soothesbaby

Effectsof Effectsofbabywearing babywearing

• Quickerday/night

Quickerday/night regulation regulation

• Stimulates

Stimulates vestibularsystem vestibularsystem

• Lesstime

Lesstime crying/fussing crying/fussing

• Soothesbaby

Soothesbaby

• Visual/auditory

Visual/auditory stimulation stimulation

18 18

Parent Parent InfantCo InfantCo sleeping sleeping

• Of186non

Of186non industrialcultures industrialcultures— — 100%ofbabiessleepinsame 100%ofbabiessleepinsame placeastheirmothersatleast placeastheirmothersatleast until1yearofage until1yearofage

Parent Parent InfantCo InfantCo sleeping sleeping

• Of186non

Of186non industrialcultures industrialcultures— — 100%ofbabiessleepinsame 100%ofbabiessleepinsame placeastheirmothersatleast placeastheirmothersatleast until1yearofage until1yearofage

• Of172societies,allinfantsslept

Of172societies,allinfantsslept withmothersatleastpartofthe withmothersatleastpartofthe night night

Parent Parent InfantCo InfantCo sleeping sleeping

• Of186non

Of186non industrial industrial cultures cultures— — 100%ofbabies 100%ofbabies sleepinsameplaceastheir sleepinsameplaceastheir mothersatleastuntil1year mothersatleastuntil1year

• fage
• fage
• Of172societies,allinfants

Of172societies,allinfants sleptwithmothersatleast sleptwithmothersatleast partofthenight partofthenight

• TheUSstandsoutinthat

TheUSstandsoutinthat babiesarenormallyplacedin babiesarenormallyplacedin

• therrooms
• therrooms

AmericanPediatricians AmericanPediatricians Recommendations Recommendations

• !

"# #!

• $"#

%#%# #!

Co Co SleepinginEnglishParents SleepinginEnglishParents

• &#!

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WhatisSIDS? WhatisSIDS?

• SuddenInfantDeathSyndrome

SuddenInfantDeathSyndrome

• Nocharacteristicstodetectit

Nocharacteristicstodetectit babiesstop babiesstop breathing breathing

• InU.S.1.5/1000livebirths

InU.S.1.5/1000livebirths

• HongKong:0.4/1000livebirths

HongKong:0.4/1000livebirths

19 19

DoesCo DoesCo sleepingProtectagainst sleepingProtectagainst SIDS? SIDS?

• Culturesinwhichmotherssleepwithbabieshave

Culturesinwhichmotherssleepwithbabieshave lowerSIDSrate lowerSIDSrate

DoesCo DoesCo sleepingProtectagainst sleepingProtectagainst SIDS? SIDS?

• Culturesinwhichmotherssleepwithbabieshave

Culturesinwhichmotherssleepwithbabieshave lowerSIDSrate lowerSIDSrate

• Positionofthebaby

Positionofthebaby proneposition proneposition

DoesCo DoesCo sleepingProtectagainst sleepingProtectagainst SIDS? SIDS?

• Culturesinwhichmothers

Culturesinwhichmothers sleepwithbabieshave sleepwithbabieshave lowerSIDSrate lowerSIDSrate

• Positionofthebaby

Positionofthebaby

• proneposition

proneposition

• Mother

Mother’ ’sbreath(CO2) sbreath(CO2) stimulatesbreathing stimulatesbreathing

DoesCo DoesCo sleepingProtectagainst sleepingProtectagainst SIDS? SIDS?

• Culturesinwhichmothers

Culturesinwhichmothers sleepwithbabieshavelower sleepwithbabieshavelower SIDSrate SIDSrate

• Positionofthebaby

Positionofthebaby prone prone position position

• Mother

Mother’ ’sbreath(CO2) sbreath(CO2) stimulatesbreathing stimulatesbreathing

• Skin

Skin to to skincontact skincontact increasesskintemperature increasesskintemperature

DoesCo DoesCo sleepingProtectagainst sleepingProtectagainst SIDS? SIDS?

• Culturesinwhichmothers

Culturesinwhichmothers sleepwithbabieshavelower sleepwithbabieshavelower SIDSrate SIDSrate

• Positionofthebaby

Positionofthebaby prone prone position position

• Mother

Mother’ ’sbreath(CO2) sbreath(CO2) stimulatesbreathing stimulatesbreathing

• Skin

Skin to to skincontact skincontact increasesskintemperature increasesskintemperature

• Contactstabilizesinfant

Contactstabilizesinfant heartrate heartrate

DoesCo DoesCo sleepingProtectagainst sleepingProtectagainst SIDS? SIDS?

• Culturesinwhichmotherssleep

Culturesinwhichmotherssleep withbabieshavelowerSIDS withbabieshavelowerSIDS rate rate

• Positionofthebaby

Positionofthebaby prone prone position position

• Mother

Mother’ ’sbreath(CO2) sbreath(CO2) stimulatesbreathing stimulatesbreathing

• Skin

Skin to to skincontactincreases skincontactincreases skintemperature skintemperature

• Contactstabilizesinfantheart

Contactstabilizesinfantheart rate rate

• Wakeupmorefrequently,avoid

Wakeupmorefrequently,avoid deepsleepstages deepsleepstages

20 20

DoesCo DoesCo sleepingProtectagainstSIDS? sleepingProtectagainstSIDS?

• Culturesinwhichmotherssleep

Culturesinwhichmotherssleep withbabieshavelowerSIDS withbabieshavelowerSIDS rate rate

• Positionofthebaby

Positionofthebaby prone prone position position

• Mother

Mother’ ’sbreath(CO2) sbreath(CO2) stimulatesbreathing stimulatesbreathing

• Skin

Skin to to skincontactincreases skincontactincreases skintemperature skintemperature

• Contactstabilizesinfantheart

Contactstabilizesinfantheart rate rate

• Wakeupmorefrequently,avoid

Wakeupmorefrequently,avoid deepsleepstages deepsleepstages

• Moreattentionfromparent

Moreattentionfromparent

Nexttime... Nexttime...

• Menopause&Aging

Menopause&Aging

• ChangeswithFemale

ChangeswithFemale statusandage statusandage

• Evolutionoflong

Evolutionoflong lifespaninhumans lifespaninhumans