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Source: Unknown

Source: Unknown

So here we are, ready to discuss the crux of why so many families need to be sleep training their little ones: the “newborn sleep problem“.  I was personally unaware we had a newborn sleep problem at all.  I thought newborns did what they do—namely wake—and then we feed them, respond to them, and they return to sleep.  Over and over again.  For most people this takes up a good chunk of the day with their newborn and slowly, with time, it changes and becomes less invasive, but how long that takes depends on the individual child.

Now, I admit I had kind of hoped that you might have been referring to the fact that some babies seem to have severe problems sleeping, and that you would help parents understand that this rarely has anything to do with sleep per se but rather other health or feeding problems[1].  (As an aside, the [1] review also found that all types of sleep training in the first six months were not only ineffective when systematically studied, but also raised the risk of other negative outcomesYou can read a summary here.)

But no.  Sadly you really seem to believe that newborn sleep is inherently a “problem”.  In fact, it seems that there are three main problems that you focus on—parental sleep deprivation, the development of “bad habits”, and the issue of self-soothing—and I think we should take a look at them one by one, followed by a bit of information about the reality of newborn sleep.  Unfortunately, in order to make your points, you all tend to use what you accuse others of doing when they provide information about sleep: Scare Parenting.  You suggest that parents can do as they see fit and you don’t “judge” then turn around and inform them that they will forever ruin their child if they don’t follow your way.  As such, I think we’ll address those types of scare tactics as well.  Let’s begin…

“Problem” #1: Parental Sleep Deprivation

Source: "The Newborn Sleep Book"

Source: “The Newborn Sleep Book”

You’ve all told us these stories a million times, but one from the Newborn Sleep Book in particular will be highlighted: A mother and father of a three-month-old are in your office talking about the severe sleep deprivation that has come with their newborn.  Neither is sleeping more than three hours a night and they are desperate for help as the last time the mom was feeding in a rocking chair, she came to as her baby was slipping out of her hands towards the ground (but she caught him, so know that everyone is okay). Cue the need for sleep training…

I have to admit that at this stage I was thinking of the laundry list of things to get checked out with respect to feeding problems or medical problems.  I would want to know what was happening at night that led to such little sleep.  The idea of nursing in the rocking chair signals they had likely put their baby in another room and mom was having to get up each feed and I would have at least recommended room-sharing as an option so she could just lift baby into bed to feed then put him back again.  However, this isn’t about what I would do, but rather what you all end up doing: Instead of looking for the reasons behind what seems to be severe sleep disruption (instead of the usual), you immediately recommend sleep training.  In fact, most of you don’t even acknowledge the potential influences of other health problems on sleep and if you do, it’s often a gloss-over with repeated mentions of how rare it is (yet in our society in which other feeding schedules are suggested, feeding problems tend to be the main culprit).

The story serves to illustrate two main problems: First, that you are ignoring the fact that severe sleep disruption is often a sign of something wrong instead of being the “something wrong”.  There is quite a bit of research out there on significantly disrupted infant sleep which includes food allergies[2][3][4], breastfeeding issues[1][5], reflux[6], sensory processing disorders or sensitivities[7], and other medical conditions, including Autism Spectrum Disorders[8][9].  The failure to even suggest or look at these before promoting sleep training is, in my opinion, astonishingly negligent.

Second, the story is one of these scare tactics.  You take a rather extreme case of one family’s sleep deprivation likely caused by one of the aforementioned problems as an example of what regular sleep deprivation looks like in most families.  You use these examples to scare families into thinking that if they aren’t there now, they certainly will be.  This scare tactic paints a picture of typical newborn sleep that is unfounded and extreme.  This makes sense if your goal is to sell books, but not if your goal is honesty and helping families and babies.

On this issue of helping families, I get sick of hearing the common rhetoric that families will be happier and warmer by being well-rested and thus the push for sleep training comes out of a place of love.  Perhaps you truly believe this, but have you considered that the alternative implication is that families who don’t sleep train will not create or retain as many of these warm memories?  Do you see the scare tactics being built-in?  It would be one thing if it were true, but according to research[10], parent-centric parenting (what you all propose) is associated with:

(a) More happiness in parenting than those who are relatively more child-centric?
(b) Equal amounts of happiness in parenting than those who are relatively more child-centric?
(c) Less happiness in parenting than those who are relatively more child-centric?

I imagine you want to answer (a) as it fits your theories and the reasons you are using the scare tactics, but it is not.  In fact, (c) is the correct answer.  I suppose, then, that the idea of responding to your child at night is not, in fact, a “problem” anymore, is it?  One down, two more to go…

“Problem” #2: The Development of “Bad Habits”

One of the main concerns about infant sleep that is always brought up is that this “on-demand” parenting is really just a code-word for “bad habits”.  You go so far as to say that if a child isn’t sleeping through by five-six months of age you’re in trouble because it’s hard to undo five months of bad habits.  On-demand breastfeed is described as “misguided” and “unhealthy”, but the worst-case scenario of “bad habits”?  Bringing your baby to bed with you.  (Cue scary violin, horror movie music.)  (Now, in all fairness, some of you “experts” have finally acknowledged bed sharing as something that can work for families, but most of you still cue the horror music to prepare parents for it being a really, really bad idea.)

The proposal that you need to train from the start implies that the habits instilled by training are the only “good” habits that you, as parent, can do.  Will crying be involved?  Of course, but you then suggest it’s just a small amount of crying in the grand scheme of things.  After all, you can have a few weeks of it or years of it, right?  You tell us parents it’s our job to “teach” our children the way of the world; or rather, make them know that they will not be catered to.  (Let me throw out here that I have written on this fallacy of teaching a baby “the way of the world”, but for the time being, I urge you to consider the following quote from the wonderful L.R. Knost, “It’s not our job to toughen our children up to face a cruel and heartless world. It’s our job to raise children who will make the world a little less cruel and heartless.”)

Let’s take a look at what we really have here when we talk about “bad habits”.  First, and foremost, is the evidence.  Many of you argue that on-demand feeding is a bad habit because it’s “unhealthy” when the evidence tells us the oppositeScheduled feeding for infants is hypothesized to be associated with greater incidents of obesity[11], increased risk for cognitive deficits (including generalized intelligence) later in life[12], increased risk for jaundice in the first weeks of life[13], and increased risk of failure of the breastfeeding relationship[14].  “Unhealthy”?  I think we’re looking at the opposite here (at least from a scientific point of view).

What about things like later bedtimes, rocking or nursing to sleep, and bedsharing?  Well, later bedtimes are found in various cultures around the world[15] with children who are healthy and well-adjusted later.  Most Asian countries have infants and children who go to bed significantly later than their Western counterparts, likely due to the co-sleeping arrangements that are more common.  Importantly, the research on bedtimes has found that children who go to sleep later often sleep in as well[15] and as a recent article on sleep talks about, the timing of bed is largely irrelevant so long as an individual’s biological pattern is being respected.  Specifically, a baby (or child or adult) whose circadian rhythm calls for a late-to-sleep and late-to-wake pattern is put to bed early, the quality of sleep is diminished.

Rocking or nursing to sleep are also behaviours that are entirely normal and have a biological basis.  First, babies find the proximity (of rocking or nursing) to a parent to be highly comforting (and I know you’ll pull out the “self-soothing” thing, but we’re getting there – hold on) and can help regulate them physiologically[16].  The movement from rocking is soothing to many newborns as it’s reminiscent of the womb-like environment where movement was ongoing.  Nursing to sleep is as old as human history and for good reason: Nighttime breastmilk contains tryptophan, which is not only a sleep-inducing amino acid, but is essential for the neural development of serotonin receptors[17] which will later help establish sleep-wake cycles naturally and organically[18].  Oh yeah, nighttime breastmilk also contains amino acids that promote serotonin synthesis[19].  In short, these behaviours aren’t “bad habits”, they have co-evolved with humans because they serve important functions.

But what of bedsharing?  The worst-case scenario of bad habits as it will ensure your child will never leave your house and if you want them to go to college you’ll have to follow along to continue bedsharing with them?  Well, bedsharing, when done safely, is totally, utterly normal.  In fact, many cultures around the world with healthy, well-adjusted children regularly bedshare, including in many Scandinavian and Asian countries (for a review, see [20]).  In fact, even in a Western context, research looking at long-term social, emotional, and cognitive outcomes based on bedsharing found no differences between those who were bedsharers (even for extended periods) and those who were solitary sleepers[21][22][23].  Well, I should be clear there was one exception: One study found that planned bedsharing (as opposed to reactive bedsharing, or bedsharing done in response to pre-existing sleep problems) was associated with greater self-reliance and social independence[24].  “Bad habit”?  I think not.  Now, this does not mean it is for everyone, and for a complete examination of the myriad issues surrounding co-sleeping (including physiological synchrony, culture, SIDS, and more), I recommend checking out the work of Dr. James McKenna (e.g., [25]).

In addition to the scientific evidence not backing you up, there is the very erroneous assumption that simply because a baby does something, that something will continue forever.  This seems to be the cornerstone for the “newborn sleep problem” that you all propose.  We see it in the argument against on-demand feeding because it seems that if you don’t schedule food right away, babies will become adults who are gluttonous pigs.  Babies who need to be rocked to sleep will forever not sleep.  Yet it simply makes no sense.  We are humans and we develop with time.  With development we change and what was a need at one age will fade away at another.  The only constant in life is that we need love, care, and to feel safe and secure, which comes from responsive parenting.

So… two “problems” down and one to go.

“Problem” #3: The Issue of Self-Soothing

Before I share summaries of some already written pieces on the topic that I will guide you to, let’s see again the type of Scare Parenting you seem so fond of.  Some comments about “self-soothing” from some experts:

  • “A sleepless infant might have trouble self-soothing later on in life—might be a less well-adjusted person.”
  • “Self-soothing is one of the earliest and most important independence milestones that a baby must reach.”
  • “Children who never learn to self-soothe tend to struggle with future milestones of independence, such as sleeping alone, potty training, parental separation, and beyond.  Then before you know what happened, that child is reaching a milestone you never anticipated: being cast on Bravo’s Princess: Long Island.

Quite the damning comments, yes?  Think you might be scaring parents into thinking that the only way to learn “self-soothing” is by being sleep trained?

As I’m sure you can guess, this one also falls in the “completely untrue” pile.  There are three long and scientific responses to this notion of self-soothing that I’m going to share here with some key highlights, though I really think you owe it to yourselves and any future client/patient to reach them thoroughly yourself.

I’ll start with my own simply because I know it best…

Educating the Experts – Lesson Four: Self-Soothing.  The take-home point here is that the idea of self-soothing is really another term for emotion regulation.  It is definitely a goal that we have for our children, and an important one at that, but what does the research say about it?  Well, it says that emotion regulation is a skill that is learned over years and that it develops by being modeled by those who care for us, not by being left.  You may say you tell parents to “teach” their child self-soothing by shushing them when they are hungry and walking with them, but this ignores one of the other key points – it has be developmentally appropriate.  Babies don’t have the neurological capability to understand you are showing them means of handling distress.  They just know they’re hungry and you won’t feed them.

Furthermore, responsiveness is critical to the development of regulation of negative emotions specifically.  Responsiveness here is not only to acknowledge the feeling, but to comfort and to remove the source of the distress when possible.  If parents are not responsive when their child is in distress at night – presumably under the guise that they will be “better” parents and warmer as well-rested parents – they will have failed in this critical period.

Self-Soothing. Possibly the Biggest Lie Ever Foisted on Parents, by John Hoffman. This piece is just plain wonderful, so I strongly recommend you read it in its entirety; however, in case you don’t here’s the breakdown… First, Mr. Hoffman is in the unique position to share, from the horse’s mouth, what “self-soothing” was meant to mean from the researcher who coined the term.  Dr. Thomas Anders, said researcher, writes that the term was used just to contrast it to signaling waking and that he does not imagine any active self-soothing is actually taking place.  So we have doctors, researchers, and parents assuming something that has not only not been shown to be happening, but the researcher who coined the term actively admits it’s not likely that’s the case.  At the end of this piece is a link to a follow-up piece about what self-soothing is and how it develops (research based).  In this second piece, you will find that based on the research into emotion regulation, or self-soothing, the process of sleep training actually would serve to disrupt the process instead of help it.  A must-read for anyone promoting sleep training for self-soothing purposes.

Self Settling – What Really Happens When You Teach a Baby to Self-Soothe, by Sarah Ockwell-Smith. The final piece – another gem – is from Sarah Ockwell-Smith, the author and founder of BabyCalm and ToddlerCalm.  Through her programs, she too has worked with thousands of families and comes to some startlingly different conclusions than you on self-soothing.  Indeed, given hers is based on the research instead of scare tactics, one might say her opinion carries more weight.  As to the piece here, she covers how humans handle emotion regulation in distressful circumstances (approach, attack, avoid) and how infant behaviours seeking comfort are actually highly beneficial and helpful to later emotion regulation.  She covers the neurological development of the brain and the areas activated during sleep training, or teaching “self-soothing”, and how our idea of “teaching self-soothing” can have later negative consequences on neurological development.  Finally, she tells you what kinds of behaviours we know do lead to later self-soothing or emotion regulation, and what you are actually teaching your child when you think you’re teaching self-soothing.

I will say that if you can read these pieces, the science behind them, and still tell me that if you don’t teach your child to sleep through the night as a newborn that you’ll have a spoiled brat who can’t regulate on your hand, then we have a larger problem about your comprehension of what “scientifically sound” means.

So there we go: three “problems” that really aren’t problems at all!

The Reality of Newborn Sleep

 “Seven hours of uninterrupted sleep is an exceedingly achievable goal for a newborn. It is not only exceedingly achievable; it is exceedingly beneficial, for baby and parents alike.”
– The Newborn Sleep Book (emphasis mine)

As lovely as seven hours sounds to most new parents who often struggle with a mish-mash put-together of 5-6 hours a night for a period, it’s just dangerous to be speaking in this way.  These notions of sleeping through or sleeping long stretches before a child is biologically ready has consequences that you seem to ignore or gloss over.  In many cases, delaying feeds is a critical component to trying to get a child to sleep longer, yet infants need frequent feedings and if one is breastfeeding, this type of schedule is absolutely not beneficial for the breastfeeding relationship.

stomach capacity 1Important to this feeding issue is the size of a newborn’s stomach.  The stomach of a newborn can hold a solitary teaspoon.  When this is filled with breastmilk, which is easily digestible (more so than formula), this stomach is empty quite quickly.  Even at one month, the infant stomach has a maximum capacity of between 2.5 and 5 oz (see image to right).  When that is full of breastmilk, it’s also going to be emptied rather quickly (though longer than that of the newborn stomach).  This is why breastfeeding has to be a consideration when talking about “normal” infant sleep.  There is research that formula-fed babies sleep longer stretches from the start because of the longer duration of digestion[29], but even with that it rarely reaches a straight seven hours.

This notion of extended sleep also ignores the reality of SIDS.  Infants who are deep sleepers and sleep alone (or who are trained to sleep that way) look to be at a higher risk of SIDS[26][27].  This is why many doctors, midwives, and other care professionals recommend parents of deep sleepers wake them every 3-4 hours at night—it helps keep them alive.  Now you may argue that the absolute risk of SIDS is low, and you’d be correct, but it ignores that this type of deep sleep may indicate a type of problem that would predispose the infant to being of higher risk for SIDS as is.  Infants at high risk for SIDS may have an arousal deficit which results in longer sleep stretches and solitary sleep is one factor that may put infants at higher risk[28].  Co-sleeping (which is often dismissed, as mentioned above), for these infants, may provide a type of protection by increasing the number of arousals experienced.  Regardless of co-sleeping or not, trying to push this type of schedule on an infant may actually be putting them at risk.

Many of you speak of the children that are sleeping through at say, 4 or 5 months of age.  In fact, in one study nearly 50% of infants were sleeping an eight-hour stretch at five months of age[30].  Now, most of you use this type of data to question what the other 50% are doing wrong when I would suggest you look at it in another way: Perhaps just 50% of kids are developmentally at a stage where they are ready to sleep longer stretches at five months.

The use of this type of data to suggest half of the parents are doing it wrong suggests the same problem as discussed in the “bad habits” section: The assumption that because a baby is doing something at one point, she will continue to do it forever.  Or in this case: Because she is doing something later, she should be able to do it earlier.  If this were the case, we wouldn’t have “development”.  We would come out ready to do all the things we are supposed to.

But we don’t.

A baby at five months has had five months of a growing stomach capable of holding more milk to allow babe to sleep longer as well as a naturally developing circadian rhythm.  For many infants, that may be enough to develop a sleep-wake cycle that allows longer stretches of sleeping through.  However, research has found that it can take up to nine months for a regular circadian rhythm to develop[31].  Not only that, but even children at 3 years of age may not show the normal diurnal patterns that adults do[32] – this development is so highly individual that to make any declaration of what infants or children “should” be doing or are “capable” of doing ignores the evidence that such statements have no basis in fact.

This last sentence is the key point here: What is “normal” is so variable that to hold one child to another child’s standard isn’t biologically or scientifically suggestible.  If you want to read up more on what is “normal” for infant sleep, I suggest the following series which was written by myself and several other researchers in the field of infant sleep and feeding.  You know, scientists.

In short: Newborns don’t inherently have a “sleep problem”.  In fact, infants in general don’t have a sleep problem because they are infants.  Some will have a problem, and it’s why I have written this piece and it’s why there are resources like this out there to help families when facing certain problems.  Sleep training – especially a newborn – is NOT a solution to a problem and it’s even more distressing to see it promoted as a “preventative” technique.  If you truly value the well-being of your clients, you’d do well to continue to educate yourself on the biology of infant sleep and feeding so that you can truly help families that need it.

You can read the rest of the Educating the Experts Series here:

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[21] Abel S, Park J, Tipene-Leach D, Finau S, Lennan M.  Infant care practices in New Zealand: a cross-cultural qualitative study.  Social Science & Medicine 2001; 53: 1135-48.

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