Notions, theories, and opinions on how to prevent or solve sleep problems abound. Let's look at some published ideas and see how they stand up to the facts about children's sleep habits that we've just explored together in this book.
Proper Association with Falling Asleep
Richard Ferber's Theory
A child associates certain conditions with falling asleep, such as being held in a parent's arms, lying on a living room sofa, or rocking in a swing. When put to sleep in a crib or bed, those certain conditions are missing upon awakening, so the child has difficulty returning to sleep. The progressive approach is to not respond to the baby's cry at night for a brief period of time, say five minutes. After the child has cried for five minutes, the parents return and stay in the room two to three minutes but do not pick up or rock the child. This is thought to reassure the parents and the child that all is well. Parents then leave, whether the child is asleep or not, whether crying or not, and return in ten minutes for the same brief interaction, if needed. After leaving, parents would return again after fifteen minutes of crying for a brief curtain call. They would return every fifteen minutes for a brief encounter until the child fell asleep during one of their fifteen-minute absences. If there is no crying or mild whimpering, then there is no return. If the child awoke later that night with hard crying, parents would repeat the original progressive routine of five, ten, and then fifteen minutes of delay in response time. The second night would be a repeat performance, except the progression would be ten, fifteen, and twenty minutes. The third night would be fifteen, twenty, and twenty-five minutes, and so on. The child learns to associate her bed or crib with falling asleep and returning to sleep.
My Comment
Whether we call this method “developing proper association” or “learning self-soothing skills,” I'm sure it can work. The general problem is that it's very difficult to maintain any time schedule in the middle of the night for several nights in a consistent fashion—frustration and exhaustion often override planning and patience.
Unrestricted Breast-feeding
and the Family Bed
William Sears's Theory
Unrestricted breast-feeding and the family bed are how to get your baby or child to sleep.
My Comment
Beware of writers who have never had the opportunity to study sleeping and who have a strong personal opinion regarding parenting. You are a good parent if you practice “attachment parenting,” which by definition includes “natural mothering,” which is unrestricted breast-feeding and sharing sleep in a family bed. This is in contrast to “detachment parenting,” which involves “escape mothering,” which is the term used for mothers who wish to pursue a career outside the home. The use of these terms is not surprising when you realize that La Leche League International, a breast-feeding support group, published the original book. As a father whose four sons were breast-fed and as a pediatrician in practice with a full-time certified lactation consultant, I certainly support breast-feeding. But there is more to being a parent than just the method of feeding.
Overreliance on vague psychological terms and unsupported psychological mechanisms serves the sole purpose of advancing the author's cause. For example: “An unfulfilled need is never completely erased; it is only temporarily suppressed and will flare up again in a different way.” Advocating unrestricted breast-feeding and the family bed is the main message. To be fair, the author does have one sentence in the entire book where he states, “The sleeping arrangement whereby all three of you (mother, father, and baby) sleep best is the right one for your individual family.” But he basically ignores the enormous individuality of temperament differences, experience of the parents, and age-specific sleep patterns of children.
What does the author suggest you do if “natural methods of nighttime parenting” fail? Try another, presumably “unnatural” method? No! The author says to use the strong hypnotic prescription drug chloral hydrate to knock out your child. Yet there is not one good study that supports this practice.
Summary
The major problems with these other methods are that insufficient or no attention is given to the importance of prevention or treatment of sleep problems by focusing on naps and schedules. There is more to healthy sleep habits than not waking at night. Children who don't sleep well usually have developed this pattern as a result of parental mismanagement. Too much attention, irregularity, or inconsistency in bedtime “policy” and routines can interfere with the development of healthy sleep habits, and accepting this responsibility is the first step in developing a treatment plan.
You may be uncertain as to whether you want to try a gradual, “fading” approach or an abrupt, “cold turkey” extinguishing approach. If I were exclusively a specialist doing research on sleep problems and providing consultative services, I could devote a great deal of time to coaching parents and helping them maintain their resolve to carry through with a gradual approach. As a general-practice pediatrician, though, I find that the time demands of a busy office make it more difficult for me to be as available for this as I would like to be. So when you try to decide between the gradual approach versus an abrupt approach in putting to rights your child's sleep habits, consider not only your own resolve but also the external supports that you know you can count on.
Many parents start with a gradual approach, see partial success, but then get worn down and recognize their evolving inconsistency. Feeling a bit more confident and competent, many parents then shift directions to a more abrupt approach. But some parents cannot even start to correct their child's sleeping problems at all, because the same personal stresses that created the unhealthy sleep habits in the first place—revolving around the child's emerging independence, marital discord, and other problems with the parents—are still present. To maintain or develop healthy sleep habits for your child, have the courage to do what is best for the child. In less time than you think, you will wind up with a loving home, a happy, well-rested child, and well-rested parents.