By Heather John
January 5, 2013
Few topics get as much airtime with new parents as the subject of sleep, or lack thereof, and few topics are as polemic as sleep training. Los Angeles is home to some of the country's most noted pediatricians, but they don't all agree on how, when or even if to train your child to sleep. A study out of Australia about the effects of sleep training on children has experts and parents talking on both sides of the debate.
Published in the September issue of Pediatrics, the study looks at the levels of the stress hormone cortisol in children's brains.
Opponents of sleep training such as Dr. Bill Sears, associate clinical professor of pediatrics at UC Irvine and author of 30-some parenting books, cite spikes in cortisol levels that may harm a baby's brain development if they are left to cry. The new study, however, indicates that there are no long-term emotional harms to sleep training. "Sleep training is safe around 4 months when children are able to start to self-soothe," says Dr. Scott Cohen of Beverly Hills Pediatrics, and author of "Eat, Sleep, Poop." Cohen concurs with the study, whose findings show that babies allowed to cry for short periods of time are no more stressed out than those with parents who camped out with them.
Still, many believe that frequent waking for babies and parents is par for the course. "We have such an incredible cultural bias toward sleep when, in fact, nobody sleeps through the night," says Jay Gordon, a Santa Monica-based pediatrician and advocate of attachment parenting, a philosophy in which babies remain physically close to caregivers, who respond to the baby's needs and signals.
"What I tell people is to wrap your life around a baby rather than trying to adjust a baby to your life," Gordon says. "Let everything happen as naturally as it possibly can. There are age-appropriate times for a child to learn to sleep in a way that makes more sense for preschool and a family. But mindless sleep-training, a one-size-fits-all approach can be somewhat dangerous."
Taking individual families into account is key.
"Over half of new mothers say exhaustion is their No. 1 complaint," says Los Angeles-based Harvey Karp, a pediatrician and author of the bestselling "Happiest Baby" series. "Studies have shown that cumulatively sleeping less than six hours a night results in the equivalent alertness of a legally drunk driver."
But Karp also says it's a myth that at one particular age all children should sleep through the night.
Babies and adults move through a sleep cycle every 90 minutes to two hours, waking and returning to sleep, a Temple University researcher said in a recent study published in the journal Developmental Psychology. Some babies "cry and call out when they awaken, and that is called 'not sleeping through the night,'" said Marsha Weinraub, a Temple psychology professor. Her study of more than 1,200 babies ages 6 to 36 months, she said, supports the idea that infants are best left to soothe themselves. So what is a parent to do?
Here is a quick look at five popular approaches to sleep training.
Co-Sleeping: The practice of having the baby sleep close to one or both parents. Some families create a "family bed" for parents and baby. "I'm a proponent of safe family co-sleeping, which is redundant unless the parent is inebriated. Co-sleeping is virtually almost always safe," says Dr. Jay Gordon. "Babies sleep in a natural pattern, which is to sleep, awaken, see what they can get, which might be cuddling and nursing, and then it's back to sleep. The longer you respond to the absolute maximum to your baby, the better. When you start diminishing your response level to your baby, you are decreasing the size of your relationship and bond to your baby."
Get the Book: "Good Nights: The Happy Parents' Guide to the Family Bed" by Jay Gordon and Maria Goodavage
Wake and Sleep: The concept here is to teach babies how to self-soothe and calm themselves back to sleep. Dr. Harvey Karp recommends starting a bedtime routine with white noise, feeding your baby, and then swaddling and rocking before placing the baby in the crib. "When Baby falls asleep in your arms, gently put her down and just jiggle the crib," says Karp. "Usually she will open her eyes and go right back to sleep. In that five to 10 seconds, babies begin to learn they can go back to sleep, and in a few weeks your little one will be much better at self-soothing. The beauty is if you train your child to self-soothe, you are much less likely to do crying-it-out sleep training."
Get the Book: "The Happiest Baby Guide to Great Sleep" by Harvey Karp
Pick Up/Put Down: This no-tears method, first outlined in the late Tracy Hogg's internationally bestselling "Secrets of the Baby Whisperer," offers a gentle approach to teaching a baby to self-soothe, in which parents respond to fussing by picking up and comforting a crying baby. When the baby stops crying, place the baby back in the crib. If the baby starts fussing again, pick her up, repeating the cycle as necessary. This method requires a lot of patience and is not recommended for children under 4 months of age.
Get the Book: "The Baby Whisperer Solves All Your Problems," by Tracy Hogg and Melinda Blau
CRYING IT OUT
Extinction: Chicago-based pediatrician Marc Weissbluth is known for advocating the "extinction" method, or the cold-turkey approach of putting your baby down to cry indefinitely at bedtime as the most efficient way to teach a child to self-soothe. However, Weissbluth emphasizes that starting your child's bedtime routine at an early hour will produce the best results. Infants and children who repeatedly cry at bedtime might need to begin their routine up to an hour earlier. Experiment with moving a child's bedtime 15 minutes earlier each night until you reach a time where there is little or no fussing.
Get the Book: "Happy Sleep Habits, Happy Child" by Marc Weissbluth.
Graduated Extinction: Delaying response time to a child's cries at bedtime is known as graduated extinction, a method most famously advocated by Dr. Richard Ferber, author of the 1985 seminal book "Solve Your Child's Sleep Problems." The term "ferberize" has become synonymous with this approach. Today, Cohen, of Beverly Hills Pediatrics, recommends a gentle graduated extinction. "If your baby is crying when you put them down in the crib, you can touch the baby, talk to them, make sure they are not hurt or stuck, but spend a minimal amount of time in the room," he says. "If you leave the room and they are still crying, touch, talk and leave first for five minutes, then 10 minutes, then 15."
Cohen also has empathy for parents: "It's easy to say to a family to go ahead and sleep train, but I know as a parent of two daughters it's very difficult."
Get the Book: "Eat, Sleep, Poop" by Scott W. Cohen
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