Sleep problems in young children can be upsetting and exhausting for parents. When a child sleeps poorly, parents may have concerns about why this occurs. Parents also lose both personal time and sleep when a child has difficulty falling asleep or sleeping through the night. Parents may try a variety of strategies with varying degrees of success and may be frustrated by the time they seek professional advice.
Health care providers frequently assume that cosleeping (sometimes referred to as "the family bed") contributes to sleep problems and typically advise against it as both a preventive and treatment strategy. However, some degree of cosleeping is common in families of young children, and recent media reports suggest that increasing numbers of parents are choosing this option. Additionally, in some cultural groups and at lower socioeconomic status (SES) levels, cosleeping is fairly prevalent.
Lozoff and colleagues (1996) examined differences in the relationship between cosleeping and sleep problems in young children in white higher SES, white lower SES, black higher SES, and black lower SES families. The sample of 186 urban families, each with a healthy 6- to 48-month-old child, was fairly evenly divided among the four groups. Cosleeping was defined as parent(s) and child "sleeping in body contact with each other for all or part of the night." Stressful sleep problems were defined as the regular occurrence of bedtime protests and/or night wakings accompanied by "conflict, frustration, or distress for the child or parents."
Families were interviewed to determine actual sleeping practices and patterns, child behavior, and family structure in the preceding month. Data on cosleeping was collected in several categories: 1) never or unique/extraordinary circumstance (e.g. a thunderstorm); 2) occasional (between three times a week and once a month); 3) regular part-night (three or more times a week for part of the night); and 4) regular all-night (three or more times a week for all of the night). Information was also obtained on the presence or absence of sleep-related behaviors, including a regular bedtime; a bedtime routine; the child falling asleep alone; firm handling of protests and night waking; and location of the child's bed outside the parent's room.
As has been noted in other studies, Lozoff and colleagues found that the prevalence and pattern of cosleeping differed by ethnic group and, among whites, by SES. A markedly higher percent of black families (57 percent) than white (17 percent) reported some all night cosleeping although the proportions reporting some part-night cosleeping were similar (23-26 percent). Among whites, the proportion of regular cosleeping was higher among lower SES families. Absence of the father did not affect the results. Ethnic and SES differences were noted in other sleep-related behaviors examined as well.
Increased reports of night waking were associated with cosleeping in all groups studied. It is not clear whether night wakings are actually more frequent or parental awareness of typical common wakings (associated with the transition between REM and non-REM sleep) is greater with cosleeping.
In this and other studies, bedtime protests were also more common among cosleeping black children than those not cosleeping, although this was not the case in the lower SES black group.
Finally, stressful sleep problems were more likely to be reported by white than black cosleeping families. Among black families, cosleeping was not associated with an increase in reports of stressful sleep problems. Lozoff and colleagues suggest that the pattern and frequency of cosleeping, and its association with other parental values and childrearing practices may be factors affecting the perception of "stressful sleep problems."
While research on the benefits or drawbacks of cosleeping is sparse, this and other studies suggest that night waking and difficulty falling asleep at bedtime may be more common with cosleeping. For this reason, parents who find these variations upsetting may prefer not to cosleep with the child.
However, cosleeping should not necessarily be discouraged. Lozoff and colleagues argue convincingly that both cosleeping and night wakings should be considered "normal" for several reasons: they have been universal throughout human evolution; they are common in many cultures today; and they are common among various ethnic and SES groups in the United States. Thus, health care professionals should respect family choices. If families choose to cosleep, a variety of other approaches cited in this article can be used to support parents in individualized management of sleep problems in their young children.
Lozoff B, Askew GL, Wolf AW: Cosleeping and early childhood sleep problems: effects of ethnicity and socioeconomic status, J Develop Behav Pediatr 17(1):9-15, 1996.
See Chapter 12 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 10 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002