A brief overview of the sleep process can provide a context for considering parents' challenges with respect to sleep problems as they may appear and resolve, or not resolve, over age. A child's sleep emerges from extremely complex physiological interactions involving many areas of the brain; cardiovascular function; respiratory function; temperature regulation; cerebral metabolism and blood flow; renal, alimentary and endocrine function; as well as the immune system. These processes control and regulate the onset, maintenance and duration of sleep periods - the observable behavioural aspects of sleep that parents cope with and respond to. Not generally seen by parents are constituents of the general state of sleep, REM sleep and non-REM sleep. During REM sleep, respiration is relatively rapid and irregular, with alternating periods of no activity and squirming, stretching, grunting or brief cries, and "rapid eye movements" (REMs) seen as fluttering of the eyelids. Quiet sleep, by contrast, is a period of slower, very regular breathing, with little movement and no REMs. This is the state when the baby is so quiet a parent may look closely and touch the baby gently to elicit a slight movement as assurance that the baby is actually breathing. Over age, with the decrease in total amount of sleep, there is a reversal in the relative amounts of the two

Co-sleeping-infants sharing the mother's sleep space-has prevailed throughout human evolution, and continued over the centuries of western civilization despite controversy and blame of co-sleeping mothers for the deaths of their infants. By the past century, "crib death" was recognized, later identified as Sudden Infant Death Syndrome (SIDS), and generally found to occur more frequently during bed sharing. Pediatricians warned parents of the dangers of SIDS and other risks of bed sharing, and the frequency of bed sharing decreased markedly over the years. However, during recent decades, bed sharing began to increase, though major issues were raised, including: whether bed sharing actually exacerbates or is protective against the occurrence of SIDS, whether the practice facilitates breast feeding, whether bed sharing is beneficial for an infant's development, and other concerns. Dissention may soon be diminished by use of a crib which opens at the mother's bed-side and is becoming a popular approach to mother-and-infant closeness through the night.

OBJECTIVE:Individualized attention for premature infants was assessed from temporal patterns of caregiving at three very different regional NICUs.STUDY DESIGN:Continuous time-lapse video recording of 95 premature infants under 1500 g was made over three 24-hour periods when they were 33 weeks' and 35 weeks' conceptional age.STATISTICAL ANALYSIS:Analysis of variance was used to compare caregiving measures within and across hospitals.RESULTS:The tapes were scored in 5-minute epochs for periods when the infants were in and out of the crib, and when intervention/caregiving was occurring. Despite other differences, the three hospitals did not differ with respect to demographic and risk characteristics of the infant subjects. In all three hospitals, there was more out-of-crib and more caregiving during the daytime than at night; caregiving time showed individual differences over day and night periods; developmental changes in caregiving were observed over the 2 weeks; and more caregiving time was devoted to infants who were at greater risk.CONCLUSION:Temporal patterns of caregiving reliably indicate individual differences, with sensitive and responsive caregiving common to typical NICU nursing environments.

The Breathing Bear, an optional source of rhythmic stimulation for infants, was investigated for its effects on full-term infants and their mothers. The Bear "breathes" like a normal infant at a rate matching the infant's. Previous studies have indicated that premature infants prefer a Breathing Bear over a Non-Breathing Bear, and they show neurobehavioral benefits from the exposure. A Breathing Bear was provided for 35 full-term infants, and a Non-Breathing Bear was provided for 37 infants from 5 weeks to 6 months postnatal age, all of whom were considered by their mothers to be fussy. Mothers' reports of infant crying, ratings of their infants' temperament, and their own stress and depression were assessed during and after the intervention period. Reported crying did not differentiate the groups. After 6 months, the mothers in the Breathing Bear group rated their infant's temperament less negatively and themselves less depressed and stressed than the mothers in the Non-Breathing Bear group. Thus, the Breathing Bear had measurable effects on the mothers and a possible impact on the mother-infant relationship.

BACKGROUND The effect of docosahexaenoic acid (DHA) on the developing fetal central nervous system (CNS) and related functional outcomes in infancy remain unexplored. Sleep and wake states of newborns provide a tool for assessing the functional integrity of the CNS. OBJECTIVE We investigated whether CNS integrity in newborns, measured with sleep recordings, was associated with maternal concentrations of long-chain polyunsaturated fatty acids, especially DHA. DESIGN Plasma phospholipid fatty acid concentrations were measured in 17 women at parturition. On postpartum day 1 (P1) and day 2 (P2), a pressure-sensitive pad under the infants' bedding recorded body movements and respiratory patterns to measure sleep and wake states. RESULTS Maternal plasma phospholipid DHA ranged from 1.91% to 4.5% by wt of total fatty acids. On the basis of previously published data and the median DHA concentration, the women were divided into 2 groups: high DHA (> 3.0% by wt of total fatty acids) and low DHA (</= 3.0% by wt of total fatty acids). Infants of high-DHA mothers had a significantly lower ratio of active sleep (AS) to quiet sleep (QS) and less AS than did infants of low-DHA mothers. Furthermore, the former infants had less sleep-wake transition and more wakefulness on P2. Correlations of maternal DHA status with infant sleep states were consistent with these data. Also, the ratio of maternal n-6 to n-3 fatty acids on P1 was inversely associated with QS and positively associated with arousals in QS. On P2, maternal n-6:n-3 was positively associated with AS, sleep-wake transition, and AS:QS. CONCLUSION The sleep patterns of infants born to mothers with higher plasma phospholipid DHA suggest greater CNS maturity.

Co-sleeping proponents consider the practice to be "natural" and a potential protection against sudden infant death syndrome (SIDS); others consider the practice of an infant sleeping in the parents' bed for prolonged periods at night to place an infant at risk for harm or death. For this study, co-sleeping was investigated from a different perspective, that is, as a significant early experience to investigate as it may have implications for the infant's development. The sleep of 101 normal, full-term infants was recorded nonintrusively in the home for 24 hr periods when they were 5 weeks and 6 months old. Infants were assigned to three groups: short-term co-sleepers, long-term co-sleepers, and non-co-sleepers. Their sleep states and wakefulness were compared at the two ages and over age. At 5 weeks and 6 months, the long-term co-sleeping infants differed significantly from the non-co-sleepers on a number of measures: At 5 weeks, they showed more quiet sleep and longer bouts of quiet sleep; and at 6 months, they also showed less active sleep, fewer arousals in active sleep, and less wakefulness. Each of these differences indicates a markedly lower arousal level in the long-term co-sleeping infants. This sleep pattern has been repeatedly found to be an indicator of stress. We infer that a major source of stress for these infants is the experience of sleep disturbance documented for infants when they were co-sleeping. Based on extensive evidence for long-term effects of early stress, we conclude that co-sleeping should have significant implications for infants' neurobehavioral development.

This study investigated the accuracy of mothers' reports of their babies' crying. The crying of babies, 5-16 weeks old, was recorded by means of a wire-less, miniature microphone contained within a terry cloth belt worn by the baby. Crying was transmitted to a voice-activated recorder with a range of 500 feet. Thirteen 24-hour recordings were obtained from seven infants while, at the same time, the mothers kept a Cry Log of their baby's crying. The number of minutes of crying and the number of bouts of crying obtained from the two procedures were highly correlated, although the amount of crying reported by the mothers was less than that obtained from the recorder. The mothers reported fewer bouts of crying. The results suggest that maternal cry reports are valuable for obtaining relative amounts of crying of infants within a group, as well as information on mothers' perceptions of their infants' crying, whereas audio recordings offer a more precise method for obtaining the amount and temporal patterning of infant crying.

Direct behavioral observation and motility monitoring procedures provide reliable data, and both are appropriate for sleep/wake state measurements starting immediately after birth. Using these procedures, newborn rats, rabbits, and humans were found to have a greater amount of quiet sleep on the day of birth rather than 24 hr later. Changes in active sleep and wake were inconsistent across the 2 days. The quiet sleep findings are contrary to the developmental course which increases with age. The findings are interpreted as a temporary adaptive response to the stress of the birth process.

The rhythmicity of bouts of quiet sleep (QS) was assessed, starting immediately after the baby's birth. The subjects were 58 healthy fullterm, single-birth, newborn infants, 26 females and 32 males. Using a non-intrusive recording procedure, their sleep was monitored for 24-h periods on the 1st and 2nd postnatal days in the hospital, then for 2 days in the home at 6 months. The cyclicity index permitted determination of the degree of periodicity as well as whether the recurrence of QS bouts showed significant periodicity. The number of subjects with significant cyclicity increased from 34% of the group on postnatal day 1 to 73% at 6 months; cyclicity scores (CS) increased from 0.71 to 0.86; and mean cycle length increased from 51 to 57 min. Infants with significant cyclicity on day 1 had lower mental scores at 6 months; but infants with significant cyclicity at 6 months had higher mental scores at 1 year. In addition, the infants with significant cyclicity on day 1 had lower birth weights and were born to younger mothers; but these relationships were also reversed at 6 months. Finally, cyclicity scores at 6 months were significantly correlated with 1-year mental scores, but the function of this relationship was quadratic. Thus, while significant cyclicity was found from the first postnatal day, the results suggest that regularity in QS cycles in the newborn period has negative implications for development, while such regularity at 6 months has positive implications-although excessive rigidity in rhythms at the later age, in terms of extremely high cyclicity scores, was also an indicator of developmental compromise.