Click here for Rules #1-4

Source: The Daily Mail

Source: The Daily Mail

 

Rule #5: Let your baby cry for up to 12 minutes each night before it goes to sleep.

Note: Online it says 5-10 minutes instead of 12: “I do stress that some babies will fight sleep and they should be allowed 5-10 minutes crying down period.”  I don’t see much of a difference in this – it remains a form of CIO.

Well, I have far too many words already written on the cry-it-out (CIO) method which is being advocated here so let’s try for a brief, succinct summary.  First, think about this for yourself: Imagine you crying every night for 12 minutes because you wanted to be held and comforted by someone due to fear, stress, overstimulation, whatever and that person abandoned you.  You may stop crying, but would you stop needing that affection?  I doubt it and the same goes for baby.  Second, we know that the cessation of crying is not related to “self-soothing” but rather infants who stop crying after CIO continue to have high cortisol responses at nighttime (at least in the short term) indicative of continued stress[1].  Third, CIO has been found to disrupt synchrony with the caregiver[1] which is associated with successful and secure attachment[2].  Fourth, prolonged periods of excessive crying (which can happen when this type of crying continues for long periods) is associated with a “stress-reactive” profile in the brain which influences an individual’s ability to cope with and respond to stress[3].  Fourth, this type of behaviour is indicative of non-responsive parenting which is associated with lower empathy and social-emotional development (for a review, see [4]).  Finally, this method ignores that sleep “problems” (and I use this carefully because until six months of age – and even a year – very little constitutes a real sleep “problem” biologically-speaking, see [5] for a review) are often indicative of other problems that the parents should be looking into.  For more information on this, see here.

Better rule?  Put your baby to sleep gently and with compassion.  It may involve nursing to sleep, rocking to sleep, going to sleep with your baby, or putting your baby down half asleep and letting him/her fall asleep on her own.  The key point is to follow your baby’s cues on this and if you have sleep “problems” look into the reasons behind them because it is likely you will find the real cause and be able to treat it.

Rule #6: Avoid making eye contact with your baby after 10 p.m.

Note: This is also supported by Ms. Ford’s comments on her site in which she says, “I suggest avoiding eye contact at 10pm and during night feeds to help you show your baby gently that this is not playtime.”

I can only assume this is the similar type of rule to #3 about not letting baby sleep past 7 a.m.  If you don’t interact, won’t your baby just sleep?  Well, first off, the same things I mentioned in rule #3 about schedules are still relevant here.  However, we also have to add the issue that avoiding eye contact is just downright cruel to a baby or, well, anyone.  Avoiding eye contact is also one way to eliminate teaching our babies as even very young babies use eye gaze and contact to learn about many things in the world, including what our actions mean and what they need to take from it[6].  Granted eye gaze and eye contact are only a couple of the pedagogical cues our children use, but they are important ones.  Furthermore, removing eye contact is one way to stop interactions with our babies and when our babies are not given the type of reciprocal interaction they expect from a loving caregiver, they tend to get even more upset[7].  Notably, touch can reduce the distress at the lack of engagement, but it does not fully eliminate it[8].  So what benefit does it gain to avoid eye contact?  Well, not much that I can think of unless the goal is to try and make your child give up on trying to communicate or engage with you and I fail to see how that’s a good thing at any time.

Better rule?  Use your eye contact and eye gaze to communicate with your baby[6].  Make sure your baby knows you are there for him/her and that you will listen to what your baby is trying to tell you.  Then you set the stage for life-long communication which is something you really do want, especially as your child ages.

Rule #7: Do not cuddle your baby to sleep while it is feeding.

Note: Again, this is mentioned as one of her rules online as she states, “And, crucially, there is a difference between cuddling your baby and cuddling him to sleep. If he gets used to being cuddled to sleep, it will create a dependence that you will have to break at some point – and it is much easier to get him used to settling himself to sleep at three weeks of age than three months or three years.”  Oddly she ignores that actually it’s not “creating a dependence” but following an evolutionary instinct.  

This is one of the more popular pieces of advice given out to parents in Western societies and makes zero sense.  The idea is that you’re creating a “bad habit”.  Forget that this is what babies have been doing for the history of humankind up to a couple hundred years go, it literally makes no sense.  First, for those of us who breastfeed, how do you feed your baby and not cuddle?  I realize it’s possible, but it can be very awkward.  Even those babies on a bottle, are they in charge of holding it themselves as newborns?  Regardless, all this ignores (a) the very real need for infants to feel secure and safe in order to fall asleep and one of the primary ways in which they feel safe and secure is to be cuddled (you can read more on this here) and (b) the role of tryptophan in the sleep cycle.  Trytophan is naturally occurring in breastmilk and occurs in larger doses at night in order to help induce sleep for infants and also leads to serotonin synthesis and development which helps a variety of cognitive functions[9][10][11].  Most babies will need comfort to fall asleep, especially in the early months and to not provide it is to not be responsive to your child’s needs.  Eventually they will all learn to fall asleep independently, but how long this takes will vary child to child, with some doing it at three months, some at three years, and some even later.  So long as this is not a problem for the family, it simply isn’t a problem, and for those for whom it is a problem, early sleep training in the first six months (including this pattern of refusing comfort to sleep) has been found to not only not to reliably work, but also to raise the risk of other problems[5].

Better rule?  Cuddle and comfort your child as s/he needs it.  Nurse your child to sleep.  If any of these things stop working for you and your family and your child is old enough, you can look into gentle sleep solutions (like here for example) to help your family while respecting your child.

Rule #8: Do not let your baby share your bed.

According to this rule, for most of human history we’ve done things “wrong” and many other cultures still continue to do things “wrong”, but I can’t solely blame Ms. Ford as it’s a common recommendation, but one that needs to be discussed.  First, given the importance of breastfeeding to infant development, one cannot discount how bedsharing facilitates breastfeeding (for a review of the research by Dr. Helen Ball, see [12]).  Second, bedsharing often facilitates greater sleep for mom and isn’t this one of the larger concerns we have in our modern day society?  This image was shared with me by a mom who switched to bedsharing from room-sharing and maps the longest sleep stretch she had:

Photo Credit: Celeste

Photo Credit: Celeste

The longest sleep stretch is important because total duration of sleep does not inform on whether or not a mother received full cycles of sleep which are vital to cognitive functioning.  The disruption of sleep, or rather the disruption of the sleep cycle, is linked to worsened neurobehavioural performance[13] and higher anxiety and depression[14].  Now there are safety concerns that are always brought up in the popular press; however, bedsharing  can be done safely provided one does it with intention and makes sure there is a safe sleep environment for the baby (see here, here, here, and [12] for more information).  Furthermore, some babies simply will not sleep without contact with a parent and telling these parents to not do what is necessary to sleep and stay functioning is asking for parents to take on a burden of exhaustion, depression, and for their babies to take on not being comforted, not sleeping themselves, and for both, hours of tears.

Better rule?  Find a sleep situation that works for you and your family and make sure it is as safe as possible.  What works for one family will not work for another, and that includes bedsharing (if you want to assess whether it’s for you, you can read here for some questions to ask yourself).  Don’t compare your baby to other babies because they are all different and remember to be responsive to your child as it often makes your life easier too.

***

There you go.  Eight rules and eight rebuttals.  As I said, I sincerely hope these are misinterpreted rules but regardless they are ones that pervade our society and deserve discussion.  Remember: Your baby needs you to be responsive and each baby is different.  Don’t place expectations on your baby that s/he can’t meet just because another baby does.  It will be worth it in the end to love and nurture your baby, just as s/he is.



[1] Middlemiss W, Granger DA, Goldberg WA, Nathans L.  Asynchrony of mother-infant hypothalamic-pituitary-adrenal axis activity following extinction of infant crying responses induced during the transition to sleep.  Early Human Development 2012; 88: 227-32.

[2] Feldman R.  Parent-infant synchrony and the construction of shared timing: physiological precursors, developmental outcomes, and risk conditions.  Journal of Child Psychology and Psychiatry 2007; 49: 329-54.

[3] Gunnar MR. Social regulation of stress in early childhood. In K. McCartney & D. Phillips (Eds.),Blackwell Handbook of Early Childhood Development (pp. 106-125). Malden: Blackwell Publishing, 2006.

[4] Grusec JE, Davidov M.  Integrating different perspectives on socialization theory and research: a domain-specific approach.  Child Development 2010; 81: 687-709.

[5] Douglas PS, Hill PS.  Behavioral sleep interventions in the first six months of life do not improve outcomes for mothers or infants: a systematic review.  J Dev Behav Pediatr 2013; 34: 497-507.

[6] Csibra G, Gergely G. Social learning and social cognition: The case for pedagogy. In Y. Munakata, & M. H. Johnson (Eds.), Processes of change in brain and cognitive development (pp. 249–274). Oxford: Oxford University Press, 2006.

[7] Tronick EZ. Emotions and emotional communication in infants. American Psychologist (1989); 44: 112-126.

[8] Stack DM & Muir DW. Adult tactile stimulation during face-to-face interactions modulates five-month-olds’ affect and attention. Child Development (1992); 63: 1509-1525.

[9] Hibberd CM, Brooke OG, Carter ND, Haug M, Harzer G. Variation in the composition of breast milk during the first 5 weeks of lactation: implications for the feeding of preterm infants. Arch. Dis. Child., 1981; 57:658-62.

[10] Delgado PL. Monoamine depletion studies: Implications for antidepressant discontinuation syndrome. Journal of Clinical Psychiatry 2006; 67: 22-26.

[11] Somer E. Eat your way to happiness. New York: Harlequin, 2009.

[13] Insana SP, Williams KB, Montgomery-Downs HB.  Sleep disturbance and neurobehavioral performance among postpartum women.  Sleep 2013; 36: 73-81.

[14] McBean AL, Montgomery-Downs HB.  Diurnal fatigue patterns, sleep timing, and mental health outcomes among healthy postpartum women.  Biological Research for Nursing 2014; doi:10.1177/1099800414528278.