Case Study

A 2-month-old female infant weighing 10 pounds (4.5 kg) presented at a pediatric clinic with a history of frequent awakening (approximately 2 to 4 times per night). The parents of the infant (POTI) noted that following a bottle-feeding at each awakening, the infant would sleep through until the next planned feeding time. However, in the month preceding the clinic visit, the infant had developed a nocturnal cry described by POTI as "louder and more obnoxious than a drunk uncle at a bowling alley," compared to previous more subdued levels that did not "reach a decibel that could shatter glass."

Further questioning elicited the information that POTI had begun placing the infant between them in bed in an attempt to quiet her. They subsequently observed that the loudness of the cries decreased and that the time interval between awakenings (TIBA) increased, a desirable outcome. However, POTI subsequently developed a strong fear that they would "steamroll over the baby in the middle of the night," and became sleep deprived. After this sleep deprivation began to affect the father's work performance, POTI attempted in the two nights before the clinic visit to place the infant back in her crib after feedings. This led to the return of the obnoxious cry, which "would awaken the dog, which began to accompany our baby's cries with howls of his own." At the insistence of neighbors, POTI sought counsel at the Lardeaux Pediatric Clinic.

Survey Methods

A rapid literature search was conducted to obtain insight regarding PBA, but found no information. To supplement the search, an attempt was made to obtain valid information via an oral survey of an random group of participants [2]. The following questions were included in the survey:

1. Have you ever taken your baby into the bed with you during the night to stop her/his caterwauling?
2. (If "yes" to question 1) Did caterwauling cease following such placement?
3. (If "yes" to questions 1 and 2) After how many months were you able to sleep the entire night in your bed without your child?

Survey Results

All 10 participants responded to the survey (100% response rate); in several cases the responses were disturbingly vivid.

Questions 1 and 2: Nine respondents out of 10 (90%) answered "yes" to both questions 1 and 2. One father glared fiercely at the interviewer. This was scored "yes" according to the ad libitum interpretation method (as described previously in the literature by Gore et al.).

Question 3: Instead of the expected numerical answers, most respondents provided detailed statements. The most common response was, "It took months, and we had to try lots of things to get the [spoiled] baby to sleep in his/her own bed," or variations on that theme. Other responses included "Are you kidding? He still sleeps with us" (parent of 4-year-old) and "I became very comfortable with the baby stretched out over my face, thank you very much." Most respondents noted that, if they had actually been able to break their baby of PBA, it had required a long, arduous battle.

Implications for Practice

Based on the case study and subsequent survey, PBA is a prevalent and profound sleep-altering problem. Mechanistically, PBA probably results from endorphin release; it can be hypothesized that the stimulus for the release must be the simultaneous contact of three points - the infant's back to the parents' bed and a parent to each arm. Further research into the mechanism is not indicated at this time, since experimentation on infants would be unethical and since there is no a priori reason to believe the hypothesis is incorrect.

Although therapies have been developed for certain other addictions (e.g., methadone for opiate addiction, disulfiram for alcohol addiction), PBA is a more delicate matter necessitating a different therapeutic approach. For POTI in the case study, establishing a bedtime routine (not including placing the infant in the parents' bed) to persuade the infant to tolerate her crib was the "magic bullet." The infant developed her own comforting mechanisms (i.e., sucking her fingers and clutching a "comfort critter") to facilitate falling asleep, and PBA resolved completely within several weeks. TIBA began to increase again until the nocturnal awakenings disappeared, and there were no signs of PBA relapse upon repeat examination two months later.

In conclusion, although PBA can be a prevalent, devastating disease, nonpharmacologic techniques with the proper amount of TLC [3] can successfully eliminate the condition.