Key takeaways for caregivers

• Co-sleeping, typically defined as infants sharing a room or a bed with parents, is common worldwide but varies in acceptability across cultures. It is practiced less in U.S. culture and parents vary widely in how they view it.
• Pediatric organizations (e.g., the American Academy of Pediatrics ) do not endorse bedsharing, and although the AAP does not appear averse to roomsharing per se, research in Western cultures has linked persistent co-sleeping (i.e.., bedsharing, roomsharing, or a combination of both) beyond six months to parent and infant issues.
• Our research found a link between co-sleeping and more sleep disturbances among parents, especially mothers, which may occur in any culture where co-sleeping occurs.
• Co-sleeping was also associated with greater co-parenting distress and poorer quality of bedtime parenting, which may be more likely in cultures where co-sleeping is less accepted.
• Infants’ sleep did not appear to be affected by co-sleeping.
• Decisions about co-sleeping with one’s infant are ultimately personal choices. If practiced, co-sleeping should be done safely, following AAP guidelines, and co-sleeping parents should take steps to nurture their relationship as a couple.

Article contents:

1. Questions about parent-infant sleep arrangements are complex
2. Do infant sleep arrangements relate to infant and parent sleep quality or parenting behaviors?
3. Parent-infant co-sleeping was linked to poorer maternal sleep and parenting issues
4. Effects of parent-infant co-sleeping are likely to be culturally specific
5. Promoting co-parenting and safe and healthy sleep may be most critical

1. Questions about parent-infant sleep arrangements are complex

How parents should structure their infants’ sleep and whether infants should sleep by themselves (in a separate room) or co-sleep with their parent(s) (i.e., in the same room or the same bed as the parent(s)) is a controversial, sensitive, and personal topic. At the heart of the matter are arguments about what is best for babies and beliefs about that vary widely.

These beliefs are informed by cultural prescriptions, recommendations from medical professionals who argue against bedsharing for safety reasons, evolutionary biologists who argue for bedsharing because it protects infants, individual parental beliefs, availability of sleep spaces and other practical considerations (e.g., convenience), and infants’ age.

Adding to the confusion and controversy, in Western cultures, infant sleep arrangements are fluid during the first year, with parents more likely to co-sleep soon after birth than later. This makes it more challenging to identify whether a family co-sleeps.

Photo: Sarah Chai. Pexels.

Choices about where infants should sleep and for how long may not be just about what is best for the baby, but also about what is best for the family.

Some studies suggest that parents who co-sleep with their infants may be at risk for marital and co-parenting distress. Parents, particularly mothers, who co-sleep with their infants also awaken more at night and have more sleep problems than do parents and infants who sleep in separate rooms.

2. Do infant sleep arrangements relate to infant and parent sleep quality or parenting behaviors?

Choices about infant sleep arrangements can be confusing and may be influenced by competing needs and demands. To better understand how parenting and infant and parent sleep affect family life, in our recent study, we examined sleep arrangement patterns across infants’ first six months of life.

We assessed 124 U.S. families when infants were one, three, and six months old. Most mothers and fathers were White (8%), married or living with a partner (95%), and in their 30s; 57% of the infants were girls.

Ninety-nine percent of parents had completed high school and about two-thirds had a bachelor’s degree or higher. Most fathers (89%) and mothers (61%) mothers worked full or part time when their babies were one month old; median yearly family income was $65,000.

To measure participants’ nighttime sleep, we used activity monitors (actigraphs) that parents wore on their wrists and put on infants’ calves at bedtime for seven consecutive days.

We also measured mothers’ emotional availability with their infants (e.g., warmth, sensitivity) during infants’ bedtimes (from video recordings made by parents).

Mothers also completed questionnaires to assess the quality of positive co-parenting (e.g., support and endorsement of one’s partner) and negative co-parenting (e.g., amount of conflict with and undermining by one’s partner). Infant sleep arrangements were determined from the video recordings of the infants at night.

It is parents’ sleep, and particularly mothers’ sleep, that may be affected most by co-sleeping.

3. Parent-infant co-sleeping was linked to poorer maternal sleep and parenting issues

From the video recordings when babies were three and six months old, we identified three patterns of sleep arrangement:

• Solitary sleeping (infants slept in a room separate from their parents at both ages),
• Co-sleeping (infants slept in the same room or the same bed as their parents at both ages)
• Co-sleeping to solitary sleeping (infants roomed with or shared a bed with a parent at three months and were moved to a room of their own by six months).

Babies who slept in the same room as their parents rarely spent all their time on a sleeping surface separate from their parents, even with a crib in the room. Videos showed that mothers frequently brought their babies to the parents’ bed in response to infants’ distress, with infants falling asleep in the parents’ bed without being immediately returned to the crib.

Consistent with other research, co-sleeping families were more likely than the other two groups to have lower socioeconomic status, be non-White and unemployed, and have fewer years of education.

We also saw patterns relating to duration of breastfeeding and parents’ symptoms of depression and anxiety. We used statistical techniques to consider those patterns and explore specific relations between co-sleeping and both sleep quality and co-parenting, finding that:

1. Mothers had poorer sleep quality if they co-slept. Fathers who co-slept with their infants experienced more varied sleep quality across the week than fathers whose infants slept alone.
2. Infants’ sleep quality was not related to sleeping arrangement at all.
3. Mothers reported less positive and more negative co-parenting, and were observed to be less emotionally available to their infants at bedtime.

Our results are consistent with other work showing that compared to non-co-sleeping, persistent co-sleeping is linked to poorer parental sleep, particularly mothers’ sleep, and with more co-parenting distress and less emotionally available parenting.

Photo: RDNE Stock project. Pexels.

Our finding that infants’ sleep was unrelated to sleep arrangement indicates that it is parents’ sleep, particularly mothers’ sleep, that may be affected most by co-sleeping. This does not bode well for long-term maternal well-being: Chronic sleep problems can increase individuals’ risk for depression, which can affect relationships with other family members.

4. Effects of parent-infant co-sleeping are likely to be culturally specific

Our study was done in the United States, a culture that, by and large, does not support persistent co-sleeping. Parents who engage in persistent co-sleeping in a culture that does not support it may be criticized for engaging in a practice some consider harmful to babies – despite that fact that our study did not find any negative associations between co-sleeping and infant sleep.

Such criticism is based solely on the tendency of members of a culture to accept a cultural prescription as “the right thing to do” without supporting evidence. Researchers should replicate our study in a culture in which co-sleeping is more accepted to determine whether findings are similar or different.

When co-sleeping is culturally embraced, parents who co-sleep are less likely to be criticized by family members and friends.

We suspect that the link that we found between co-sleeping and heightened sleep disturbances among parents, especially mothers, would be culturally ubiquitous, but the links among co-sleeping, co-parenting distress, and reduced maternal emotional availability with infants at bedtime would not.

This is because sleeping near one’s infant is likely to affect parents’ sleep, regardless of the cultural backdrop. In contrast, the association of co-sleeping with heightened family stress should be less likely when co-sleeping is culturally accepted.

For example, when co-sleeping is culturally embraced, parents who co-sleep are less likely to be criticized by family members and friends.

Photo: Kevin Liang. Unsplash.

5. Promoting co-parenting and safe and healthy sleep may be most critical

Do these findings lead us to recommend that parents not co-sleep with their infants?

Assuming parents follow medical recommendations for safe sleep (e.g., the AAP guidelines; i.e., avoiding bedsharing, eliminating loose bedding and clothing, and placing infants in a supine position on the sleeping surface), we do not make such a broad recommendation.

Although our study’s co-sleeping parents as a group appeared to be at higher risk for family distress than were parents who slept without their babies, even when they said they preferred to co-sleep, some parents who co-sleep did not experience heightened co-parenting distress, nor were they less emotionally available to their infants at bedtime than parents of infants who slept alone.

It appeared that these parents were on board with their choice of sleep arrangement. The parents’ relationship with each other was not compromised, which suggests that they took time to nurture their relationship as a couple (e.g., not just in terms of co-parenting but by making time for themselves and each other) and that co-sleeping with their infants did not interfere.

Thus, to the extent that parents are aware that co-sleeping can interfere with their sleep and their relationship as a couple, and take steps to promote each other’s sleep and their relationship with each other, the choice to co-sleep may not be at all problematic. We did not conduct interviews or collect information about this idea and believe it would be an important question to explore.

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• Consider fathers’ health behaviors as well as mothers’,
• Assess and treat fathers’ mental health as well as mothers’,
• Treat family stress and attend to the couple relationship, and
• Provide access for fathers to family leave.

Much research focuses on how mothers-to-be influence babies’ health and development before and during pregnancy – touching on mothers’ environments, emotions, and behaviors. Mothers-to-be are often advised to alter their lifestyles accordingly.

Less attention is paid to fathers, but there is sufficient evidence to make a case for practice and policy to change in this regard.

This research review sets out seven ways fathers influence children’s development during pregnancy, providing a useful tool for planners of prenatal services and policies.

1. Epigenetic and genetic changes: Prior health behaviors

• Obesity is associated with epigenetic changes that predict restricted growth in childhood.
• Alcohol affects the sperm epigenome and is a risk factor for alcohol use and alcohol sensitivity in offspring.
• Fathers’ diabetes and fast-food consumption predict earlier births.

2. Epigenetic and genetic changes: Exposure to environmental toxins

• Exposure to workplace welding fumes is linked with higher prevalence of congenital abnormalities (Egyptian study).
• Fathers exposed to pesticides (e.g., nematocide, dibromochloropropane, ethylene dibromide) are more likely to have suboptimal sperm quality.

3. Epigenetic and genetic changes: Early life stress

• Children of fathers who survived the Holocaust and fathers with post-traumatic stress disorder show epigenetic differences, namely increased DNA methylation in a promoter region of the glucocorticoid receptor. These are linked with increased prevalence of psychiatric illness and reduced cortisol levels in the children.
• Studies of mothers have shown links between their exposure to disasters (e.g., natural disasters, terrorist attacks, COVID-19) and outcomes for their children. No such research exists for fathers but it would likely reveal similar links.

4. Neurobiological and hormonal changes

• First-time fathers with a higher prenatal testosterone level report less effective and positive parenting six months after the birth.
• First-time fathers with a higher prenatal oxytocin level endorse a more nurturing parenting philosophy after the child’s birth.

“This research review sets out seven ways fathers influence children’s development during pregnancy, providing a useful tool for planners of antenatal services and policies.”

5. Influences on expectant mothers’ health behaviors

• Alcohol use by an expectant father is linked to higher alcohol use by pregnant mothers (Ukrainian study).
• Expectant mothers engage more in prenatal health actions such as stopping smoking when their male partners do more caregiving (e.g., listening to baby’s heartbeat, purchasing items for baby, attending prenatal classes).

6. Influences on expectant mothers’ mental health

• A higher quality of couple relationship is associated with expectant mothers’ lower distress, which in turn is associated with more positive temperament of the baby (U.S. study).
• More relationship conflict correlates with greater incidences of medically complex births. Much research links prenatal stress in mothers to premature birth and low birth weight.
• Depression in expectant fathers correlates with depression in expectant mothers. Joint mental health symptoms in two parents prenatally predict the same symptoms in the parents 12 months after the birth, which in turn correlate with children’s executive function problems at 7-8 years (Finnish study).

7. Influences on mothers’ hormones

• A couple’s hormonal levels tend to synchronize and follow similar patterns. Lower testosterone levels in both expectant parents predict greater investment by the father in the parenting relationship after the birth.
• When cortisol levels are lower in both expectant parents, there is likely to be less conflict between them before birth and less depression on the part of the father after the birth.
• Hormonal changes in mothers can affect fetal development and children’s long-term social and emotional development.

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The researchers conclude: “The present study challenges the assumption that women are more suited to primary caregiving than men … fathers and mothers are equally competent at parenting in the primary caregiving role.”

Based on this finding, they recommend: “The high quality of parenting demonstrated by the primary caregiver fathers suggests that more fathers should be encouraged to be highly involved parents. To do so, policies facilitating this, such as shared parental leave and flexible work, including more part-time employment options, need to be widely promoted both by governments and by individual organizations.”

Previous research on primary caregiver fathers has often focused on gay fathers who became parents through adoption and surrogacy. These studies also found that children’s adjustment was positive. This study extends the research to heterosexual parent couples.

“The high quality of parenting demonstrated by the primary caregiver fathers suggests that more fathers should be encouraged to be highly involved parents.”

The study took place in the United Kingdom between 2017 and 2019,  and involved 41 primary caregiver fathers, 45 primary caregiver mothers, and 41 dual earner couples (both mother and father). The primary caregiver mothers and fathers had been the primary caregivers for at least 6 months, with children from 3 to 6 years old. Their partner was the primary wage earner; some primary caregivers (fathers more than mothers) were also employed part time or worked flexibly from home, but they spent more time caregiving than working. In the dual earner families, both parents were in paid employment and many worked full time. The families were mostly White and highly educated, and had no serious financial difficulties.

Through questionnaires and interviews, the researchers used previously tested measures to assess depression, anxiety, stress, social support, marital quality, the coparenting relationship, parental acceptance/rejection of the child, parenting quality, and children’s behavior. When assessing children’s behavior, the children’s preschool or schoolteacher also completed a questionnaire.

This research confirms a large body of earlier research showing that the parenting behaviors of fathers and mothers are similar, as is their influence on children’s development. Primary caregiver fathers typically describe their role in nurturing terms as fostering a close bond with their child.

In one study, compared to primary earner fathers, primary caregiver fathers showed higher emotional tone and their 12-month-olds showed more positive mood. In another study, very involved fathers had a more playful interaction style than the mothers, though both these mothers and fathers smiled more and imitated their child more than less-involved fathers. In other studies, primary caregiver mothers were more affectionate with their 3-month-olds and their 8- to 12-month-olds than primary caregiver fathers.

Other studies have found that primary caregiver fathers face particular social pressures – social isolation in a mother-dominated world of playgroups and playgrounds, the stigma of adopting a non-traditional role, and less social support. However, in this study, the fathers reported positive well-being. Perhaps the strong marital relationships and coparenting arrangements were enough to compensate for any additional social pressure.

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Study has found that mothers prone to anxiety, stress, guilt and frustration are more likely to be harsh parents if the father is not supportive.

Mothers who are prone to anxiety, nervousness, stress, guilt, frustration and anger are likely to be harsher parents to their children only if the father is not supportive of their parenting, according to a study of 182 dual-earner couples in Ohio, USA.

This is perhaps not surprising. In the presence of an undermining coparent, an anxious and frustrated mother is unlikely to handle parenting well. Conversely, a supportive coparent can mitigate the impact of the mother’s difficulties, allowing her to parent without being harsh and intrusive.

The study did not find the influence the other way round. There was no link between a father being prone to anxiety and stress and his parenting, either when the mother was supportive of him or not.

Earlier research shows that harsh parenting – angry, hostile, intrusive and controlling – is associated with poorer child development. On this basis, the researchers recommend that those who support families should address not only the mother’s personality, but the coparenting relationships in her family. If a mother is prone to anxiety, her partner may need more help to perform a positive coparenting role.

The parents in this research, however, were a nonclinical sample, without high needs. The levels of undermining coparenting and harsh intrusive parenting among them were low, though there was ample variability on each measure. They were married, dual-earner, different-sex couples who were the biological parents of the children; 75% of the mothers and 65% of the fathers had a university degree, and 86% were white.

Researchers use the term “neuroticism” to describe the combined tendencies towards anxiety, nervousness, stress, guilt, frustration and anger. Neuroticism was measured in both mothers and fathers during the third trimester of pregnancy. They were asked to rate statements like “I feel inferior to others”, “I often feel tense and jittery” and “I often feel helpless and want someone else to solve my problems”.

Coparenting was assessed later, when the baby was three months old, by observing parents changing the baby’s onesie together. The parents were asked to divide the task of removing the onesie and putting the new one on between them. Supportive coparenting was measured by the degree to which the parents helped each other with their respective tasks, displayed affection to each other and took pleasure in watching the other interact with the baby. Undermining coparenting is characterized by the opposite: criticism, disparagement, competition for the child’s attention and disregarding the other parent’s competence or authority.

Finally, the quality of individual parenting was assessed when the baby was nine months old. Each parent was asked to play separately with the child for five minutes, using either a shape sorter or stacking rings. Intrusiveness is characterized by the parent being more self-centred than child centred, and by a failure to understand and recognize the child’s effort to gain autonomy. Harshness is characterized by being abrupt with the child and calling the child names.

These findings did not fully back earlier research showing a direct association between a mother’s neuroticism and her harsh intrusive parenting. There is much less research on fathers ,and the results of earlier research on paternal neuroticism and harsh parenting are inconclusive – some finds a link, some does not.

This suggests more research is needed on fathers, which could lead to a similar recommendation as for mothers: when services find a father prone to neuroticism, the mother should be given help to be a supportive coparent.

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Positive coparenting leads to more father involvement and more father involvement leads to positive coparenting. It is chicken-and-egg.

We know from both research and real–life experience that there is a link between the father-mother relationship and how involved the father is in caring for his child. When couples coparent well – working as a team with good communication and valuing and respecting each other’s role – fathers tend to be more involved in caring for their children. Though it’s challenging, positive coparenting can continue even after a romantic relationship has ended or if the parents live apart.

Parenting is part of a family system. Every relationship influences every other relationship. For example, the quality of a couple’s relationship influences fathering over time.

Because these things tend to go together, researchers have asked the chicken-and-egg question: what comes first? Does positive coparenting lead to more father involvement or does more father involvement lead to positive coparenting?

In recent research from the USA, mothers and fathers in 3,464 couples were asked at three different times to assess the quality of coparenting and the extent of father involvement – when the child was one, three, and five. The researchers then applied a sophisticated statistical analysis to find links.

They found that both coparenting and father involvement at one point in a child’s life predict more of each other at a later time point, with some interesting details.

Better coparenting predicts more father involvement later

If either the mother or father reported better coparenting at one time point, then both parents reported more father involvement at the next time point. However, the link between a mother’s report of coparenting and a father’s later report of involvement, and vice versa, was only found for resident couples. The researchers speculate that perhaps non-residence is a barrier between effective coparenting and later father involvement in care.

More father involvement predicts better coparenting later

If either the mother or father reported more father involvement at one point, then both parents reported more positive coparenting at the next point. There was one exception: When fathers reported they were more involved when the child was one year old, mothers were on average less likely to report positive coparenting two years later. One possible explanation for this is that fathers are overestimating the level of their involvement, and this lack of agreement between the parents may later lead to a less favourable assessment of coparenting on the mother’s part.

This research builds on earlier evidence of influences in both directions. Studies have shown that when mothers do not support coparenting, fathers engage less with their infants. Positive coparenting is also a robust predictor of nonresident fathers’ future involvement. Similarly, there is evidence that when fathers are more involved in caring, their relationship with the child’s mother is better.

The new research from the USA involved, 3,464 couples; 42% of the fathers were black, 28% were white and 25% were Hispanic. The study focused primarily on unmarried couples in large American cities. Between the first measurement (child one year old) and third measurement (age five), the quality of couple relationships declined overall. The proportion of coresident couples dropped from 65% to 50%, and the proportion of parents in a romantic relationship dropped from 40% to 18%. Also over this period, the level of father involvement dropped off, according to both mothers and fathers.

Coparenting was measured by asking each parent questions like “does the mother/father support the way you want to raise your child?”, “does the mother/father talk with you about problems with raising your child?” and “does the mother/father respect your rules for the child?”. Father involvement was measured by asking about activities like reading/telling stories, playing inside the house and singing with the child.

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The coparenting study contributes to our growing understanding of how complex family systems operate, with different relationships influencing each other.

When parents work well together as a team – known as “coparenting” – fathers tend to be more involved in caring for the children, according to a new study of disadvantaged parents in the USA. 

It is easy to understand why positive coparenting could promote more father engagement, and why more father engagement could promote a better parental relationship. This finding suggests that when it comes to help with raising young children, it’s important to support both mothers and fathers. A federal program in the USA, Healthy Marriage and Responsible Fatherhood, which began in 2005, provides exactly this kind of support among low–income families. The study of coparenting and father engagement was part of the evaluation of this program.

Whilst coparenting and father engagement are linked for all fathers in the ‘here and now’, the study also found a link across time. Resident fathers were more likely to beactively involved in care when a child was 36 months old if both the mother and the father reported better coparenting when the child was 15 months old. This link was not found among non-resident fathers, perhaps because their inconsistent presence means that what happens at one time point in the family has less effect on what happens at another.

The link between coparenting and later father involvement was not found in relation to fathers playing more with children—perhaps because fathers may engage in play regardless of the quality of the coparenting relationship with the mother.

In the study, involving 1,908 families, mothers and fathers were interviewed by phone when their child was 15 months old and again when 36 months old. Fathers were classified as resident if they lived with the mother most or all of the time, and non-resident if none or only some of the time. 

Coparenting was measured with ratings like “My child’s other parent and I communicate well about our child” and “I feel good about my child’s other parent’s judgment about what is right for our child.” Both parents’ responses were combined into a single measure of coparenting quality.

Involvement in caring was measured by asking fathers how often they did things like dress and feed the child or change diapers. Engagement in play covered activities such as singing, reading, telling stories and playing games.

The study contributes to our growing understanding of how complex family systems operate, with different relationships influencing each other.

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The concept of a “community of care” should be adopted in relation to the care of children, extending beyond just mothers to include grandparents and others. “Family resilience” should be supported.

A review of 206 studies of care by grandparents has proposed a more coherent framework to analyse and understand how care by grandparents contributes to children’s development and health.

The research identifies:

• two types of care by grandparents
  • custodial care in skipped generation families (no parent present)
  • care within multigeneration families (one or both parents present)

• three measurements of involvement of grandparents
  • contact – e.g., co-residency, visit frequency
  • behavior – e.g., feeding, washing, transport
  • support – e.g., school fees, home expenses

• two types of contextual factor that influences care by grandparents
  • personal – e.g., age of child/grandparent, health of child/grandparent, gender of child/grandparent, cultural norms of family care, the parental relationship (status/quality)
  • structural – e.g., race, class, neighbourhood, situations of conflict or crisis, available of care in the community, income, loss of parental care through death or incarceration

• three types of child outcomes from care by grandparents
  • physical health – e.g., health, diet, growth, accidental injury
  • socioemotional health – e.g., mental health, behavior, substance use
  • cognitive development – e.g., academic achievement, language development, school readiness

In addition to making recommendations about more systematic research in the future, the researchers offer directions for policy and practice.

1. The concept of a “community of care” should be adopted in relation to the care of children, extending beyond just mothers to fathers, grandparents, friends, neighbors, siblings, other relatives, paid caregivers, teachers and pastors. Policy should promote networks of support and “family resilience”. More evaluations are needed of interventions that engage with communities of care.
2. Better support in practice and policy directly to grandparents in “family-level care”, including financial assistance, health, education and housing support.
3. Attention to gender bias in how grandmothers and grandfathers are viewed, similar to perceptions of mothers and fathers. Male carers are often framed in more negative terms than female carers.

Grandparental care is increasing around the world. Extended lifespans, decreasing family size, increased maternal employment, higher divorce rates, more single-parent households, economic stagnation and increasing drug use are all expanding the caring role of grandparents. Grandparents are often the first to assume caring of children when parents are unable to do so.

In the USA in 2018, 7.8% of 0-18 year olds lived with both a parent and a grandparent in three-generation families, and 2.3% lived with a grandparent without a parent present in skipped-generation families. In a study of several East European countries, 29.7% of households contained at least one grandparent; the figure in Western European countries is 5.5%. In Asia, a huge number of children in rural areas live with their grandparents because their parents have gone to cities to find work. And although Africa has a strong tradition of multigeneration care of children, it is also seeings an increase in care by grandparents in the wake of the HIV/AIDS epidemic and parental migration.

Research interest in grandparents has increased recently, and we’ve also seen some developments in support programmes that target grandparents who have custody of children. In the USA, the Supporting Grandparents Raising Grandchildren Act was signed into federal law in 2018, largely in response to the opioid crisis, which is affecting parental care. Support for grandparents includes information about school systems, access to mental health services and building community support networks.

Of the 206 studies of grandparents reviewed, 68 were from Africa, 60 from the USA, 32 from Europe, 17 from Africa, 12 from Latin America, three from Australia and two from Israel. Twelve were multi-country studies.

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Research shows that the quality of the parenting of both parents the child lives with influences joint custody outcomes – higher quality parenting is associated with fewer child problems.

Two recent studies from Arizona State University recommend that when considering joint custody, family courts should carefully consider the quality of parenting of both the mother and the father, including in high-conflict situations.

The research shows that the quality of the care provided by each parent influences child development; specifically higher-quality parenting is associated with fewer behavioral and mood problems on the part of the child. Moreover, parenting quality is not fixed: more parenting time may be linked to higher parenting quality. These findings were consistent in both high-conflict and lower-conflict situations.

The findings contradict the idea that in high-conflict situations, joint custody automatically leads to worse outcomes by exposing the child to more conflict.

Earlier research on joint custody has confirmed repeatedly that children do better when post-divorce parenting is of better quality, whether on the part of the mother or the father. Comparing the experiences of children in different families, the new studies found that the combination of more parenting time and lower-quality parenting produced poorer results, and that less time with such parents—whether they were mothers or fathers—was associated with better outcomes.

This issue is significant. In the first study, involving 472 mothers and 353 fathers (all from different families), 34% of the mothers and 18% of the fathers were in the more-time, lower-quality-parenting category, the category associated with the lowest child outcomes.

The second study producing more findings of direct interest to family courts determining joint custody arrangements. For example, in high-conflict cases, the quality of the father’s parenting is generally higher if he spends more time with the child—but only until he reaches around 12 days per month with the child, after which this relation no longer holds true. Meanwhile, if the child spends more than about 10 days per month with the father, the quality of the mother’s parenting starts to fall. That means there is an optimum point: around 33%-40% of the time with one parent and the rest with the other.

This study also produced a warning for joint custody parents who draw their children into the middle of covert conflicts (for example, making disparaging comments about the other parent, or making the child carry messages). If either parent does this, the child rates that parent’s parenting quality lower and the other’s parenting quality higher.

The first research project took place in 2015-16 in Arizona, with a sample of parents diverse in ethnicity and education who were not involved with child protective services. Four things were measured:

• Parenting time: parents were asked how often in the past 30 days they had spent two or more hours with the child when both were awake, and how many overnight stays the child had in their home.
• Parental conflict
• Parenting quality: this was assessed through four measures – acceptance/rejection of the child, consistency of discipline, quality of communication with the child, and maintenance of family routines.
• Child outcomes: parents were asked about behavioral problems (externalising) and the mood problems (internalising).

The second research project involved 141 9- to 18-year-old children who were experiencing high-conflict divorce, accessed through a family court program for high-conflict separating parents. Similar things were measured:

• Parenting time: number of overnight stays with father in last 30 days.
• Parental conflict: this was measured in two ways: the frequency and intensity of overt conflict and the extent to which the child felt caught in the middle of more covert conflict.
• Parenting quality: the child was asked to assess discipline, acceptance and how much they felt they mattered to their mother/father.
• Child outcomes: for this measure of behaviour and mood problems (externalising/internalising), parental reports were also sought.

These studies provide valuable new evidence that family courts can use when dealing with high-conflict divorce and separation and determining joint custody arrangements.

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When mothers report fathers as being responsive to their needs, exclusive breastfeeding is more likely, the parental relationship is stronger, and early childhood development is better.

A team parenting support program in Vietnam has shown positive results in three areas: the parental relationship, exclusive breastfeeding and early childhood development. The programme encouraged two things: support by fathers of mothers’ breastfeeding and direct father-baby interaction.

The primary researchers, Lynn Rempel and John Rempel, looked at different ways that fathers can support breastfeeding and found that these ways were differently linked to breastfeeding, relationship quality, and early childhood development outcomes.

Using a 25-point “Partner Breastfeeding Influence Scale” developed and tested earlier by the researchers themselves, the scale identifies four types of support by the father:

• Seeking out and conveying knowledge about the value and means to achieve successful breastfeeding – termed “savvy”
• Being together and working directly with the mother in ways that support successful breastfeeding – termed “presence”
• Active physical caretaking for the mother and baby that facilitates breastfeeding – termed “helping”
• Being sensitive to what the mother needs and responding in ways that support breastfeeding – termed “responsiveness”.

“Helping” and “responsiveness” were found to be particularly linked to positive outcomes. The Rempels suggest that these two types of support describe a “teamwork” approach around breastfeeding, where fathers are not too directive and do not try to provide support when it is not needed. In a team of only two, both partners must have a generalised, flexible skillset and be sensitive to the moment and ready to adjust to changes. Much health research has found that family support can sometimes have negative effects if it is not delivered sensitively and responsively to the recipient’s needs – that is, if it undermines their sense of efficacy and personal control.

The program, which was tested in Vietnam in 2014 and involved 390 families, consisted of five elements:

• Prenatal groups for fathers on the topic of breastfeeding
• Home visits before the birth and in the three months after (at one, six and 15 weeks)
• Public messages broadcast over community loudspeakers each week
• Peer-led fathers’ clubs to enhance peer support
• A friendly public fathers’ contest between clubs to demonstrate fathers’ knowledge

(For a more detailed description of the program, based on an earlier published article by the researchers, see Supporting fathers to bond with and love their babies improves early child development and breastfeeding (Vietnam))

Through all these activities, three messages were delivered to fathers, and to the wider community, through the two public activities:

• The importance of exclusive breastfeeding
• The importance of parenting teamwork
• How and why to build an early father-infant relationship.

The program delivered improved outcomes in all three domains:

• The exclusive breastfeeding rate at one month was 35%, compared to 6% in a comparison group.
• For mothers, relationship quality from before birth to four months after the birth showed a significantly smaller decline in the program group than in the comparison group. Meanwhile, fathers reported an increase in relationship quality instead of the decline found in the comparison group. The relationship quality measure assessed intimacy, satisfaction, trust, and commitment.
• Improved child development scores at nine months in all areas – motor skills, personal-social abilities and, particularly, language skills.

All these improvements were partially explained by an increase in fathers’ breastfeeding support. All forms of father support, as reported by both fathers and mothers, were associated with longer exclusive breastfeeding, better relationship quality, and higher levels of infant language development.

In addition, two forms of support contributed over and above the others. Mothers’ assessment of fathers’ responsiveness to their needs stood out as a particularly strong predictor of positive outcomes in all three areas. And father’s own reports of their responsiveness more strongly predicted improved relationship quality and, to a lesser extent, infant language development.

Although ratings of fathers’ helpfulness did not have a standalone effect on exclusive breastfeeding, there were other important effects. Fathers’ reports of their own greater helpfulness predicted better motor and personal-social development in their infants; mothers’ positive assessment of fathers’ helpfulness was linked to better relationship quality and improved infant motor development.

Overall, fathers seemed to be more aware of the tangible help they were providing, and mothers were more influenced by the father’s sensitivity and responsive acts of caring.

In addition, the Rempels found that higher relationship quality predicted improved developmental outcomes for children. Mothers’ reporting a better relationship was linked to higher language scores; fathers’ reporting a better relationship was linked to higher scores on all early childhood development measures.

In Vietnam, as in many other low- and middle-income countries, cultural norms are in transition, and fathers are now expected to be more involved in caring for infants and young children. As this is a recent cultural change, however, fathers have limited information and experience. Vietnam has among the highest rates of child undernutrition and the lowest prevalence of exclusive breastfeeding in the world.

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