Book Review: How Babies Sleep

Sleep deprivation is nearly universal for new parents during the first year of a baby’s life and is often a reason why mothers stop breastfeeding prematurely (Ruan et al., 2022). A quick browse through parenting forums and social media shows that the demand for sleep consultants who promise to “fix” baby sleep problems is not only rising amongst breastfeeding parents but also formula feeding families. But why do we find infant sleep so problematic as modern humans?

In her book “How Babies Sleep”, Helen Ball Professor of Anthropology & Director of Durham Infancy & Sleep Centre (DISC) at Durham University sheds light on the parent-baby night-time conflict that parents, particularly in Western societies, have been experiencing over the past century and a half.

In the first few chapters, the author provides evidence- based insight into the evolutionary history and sleep biology of human infancy which helps explain babies’ sleep pattern, their need for closeness and frequent feeding, and their distress at being left alone. During human evolution, the highly dependent nature of our offspring gave rise to a practice called alloparenting where infant caregiving is traditionally shared with others— a strategy that proved advantageous for survival. However, modern humans, particularly in Western societies where people tend to live in nuclear families, may no longer have access to alloparental support. This, paired with the shift of adults sleeping mostly at night since the Industrial Revolution, has created a mismatch with our babies’ biology and a conflict between parental and infant needs.

So that parents and infants can reconcile their needs and sleep as harmoniously as possible with each other, in the next chapters, Professor Ball encourages parents to try out different strategies for daytime naps, bedtime and nighttime sleep to figure out what works for them. The author emphasises that all babies have different sleep needs and that each baby is unique. Strategies may include safe bedsharing for mothers who breastfeed exclusively for the first six month and continue breastfeeding after the introduction of solid foods, and sharing nighttime infant care for non-breastfeeding or combination feeding parents. Because guidelines on bedsharing differ across countries and health authorities, this section also includes research on Sudden Unexpected Death in Infancy, associated risk factors, and guidance on safe bedsharing.

Overall, Professor Helen Ball’s book is an evidence-based breath of fresh air in the largely unregulated infant sleep industry and offers alternatives to the traditional “cry-it-out” method of many sleep training services. However, even when parents have realistic expectations and a good understanding of infant sleep, the suggested approaches, such as adjusting adult sleep rhythms, adapting bedroom environments and finding a supportive “village” for infant care, can be still difficult to implement in modern Western societies.

Reviewed by Regina Kincaid, IBCLC, editorial team member