Educating the Jasseys – Lesson One: Parent-Centric Parenting

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This month I became aware of a new book being published called “The Newborn Sleep Book”.  The book, written by two pediatrician brothers in Long Island, NY – Lewis and Jonathan Jassey – advocates sleep training your newborn.  I have done an Educating the Experts series – one I may refer to a lot in this one – but the sheer gall of suggesting newborns need “training” (and that this training involves not feeding them when they are hungry) required a whole new series, in my opinion.  This is it.

Source: "The Newborn Sleep Book"

Source: “The Newborn Sleep Book”

For those of you unaware of my “Educating the Experts” series, you can check it out starting here.  Although much of what is written there is relevant for the current series, when I picked up a copy of the Jassey’s book, The Newborn Sleep Book, and read through it, I realized so much more needed to be handled.  As such, I start a new series dedicated to this one book.  This one, god-awful, unscientific, parent-centric book.

Given there’s a ton to cover, it will be broken up into “lessons” that will roughly cover one chapter each (sometimes a bit more, sometimes less).  If parents are going to subscribe to the idea that they need to sleep train their newborn baby, they should at least know that it counters all the science we have, despite the doctors themselves suggesting it’s based on scientific evidence (for which they provide none).

Before we begin looking at the content of the book itself, we have to discuss two key things: (1) the role of you as doctor with your patients, and (2) where you practice.  In an online message you suggested that no baby you have seen ever hit failure to thrive using your method.  This is wonderful except I don’t think it speaks to your method and, as I will point out repeatedly, your method is indeed linked with an increased risk of failure to thrive.  You do mention that there are babies you’ve treated for whom you’ve discovered underlying medical issues that kept your method from working.  These are likely the babies for whom, without your monitoring, would have hit failure to thrive, other health problems, or even the loss of the breastfeeding relationship if parents were left to their own devices with sleep training.  You discovered this because you are active doctors (which I will say I actually do think is wonderful and that we need more of in our society); however, and this is a big however, you are now putting a method out to the public where people can access it with no doctor oversight or monitoring, and let’s face it, most sleep training is done without the oversight of a doctor.  As such, your guarantees of success and lack of problems in your own practice no longer matter.  What matters is what the research tells us is more or less likely to happen with these practices per se.

Onto the second point of where you practice. This will inform a lot on the type of patients you have and whether or not they are representative of the population at large for which you are sharing the “Jassey Way”.  Bellmore, NY is a highly affluent, predominantly white suburb of NY.  According to the 2010 Census, Bellmore’s ethnic breakdown was 93.4% White, 1% African American, 0.1% Native American, 3% Asian, and 1.8% Other Ethnicities.  The median home price was $486,000, whereas the median family income was $126,321. Zero – yes ZERO – percent of children under 18 were living in poverty, although 0.6% of families met that criteria.  The financial stats are to die for, but sadly are far from representative of the population.  Merrick, the other part of town you cover, is virtually identical in all elements (though 2% of children under 18 live in poverty there).  Why does this matter?  Throughout your book you talk a lot about the successes you’ve had with your patients as well as what you’ve witnessed with respect to breastfeeding versus formula (and more).  These statements all have to be taken with a pile of salt given the type of population you’ve been looking at.  Again, this is why the research becomes paramount; the risks of various diseases, the parenting situations people find themselves in, and the availability of doctors to monitor child growth and well-being during sleep training all run along socio-economic lines, and you are clearly far over the line.

With that out of the way, where shall we start?  I had hoped to jump right into Chapter One with your self-proclaimed myths and facts about sleep, but we need to start a little earlier… The preface, because it is here you let the reader really know your overall philosophy on parenting which is what I want to start with.  (I know, I know… you’d think we could at least skip the “non-chapters”, but sadly not.)

Your Philosophy: “A happier, more alert parent is a better parent.”

The above quote is in a letter penned to new parents in the preface in order to help them feel better about sleep training their newborn.  It’s really the crux of this entire book: The euphemism of happy parent = happy baby.  I’ve said it before and I’ll say it again, this euphemism is often used not as it should be (which I’ll discuss below) but rather to represent a parenting philosophy that tells parents that whatever they do for themselves is what is best, baby be damned; this parenting philosophy puts parents on the side of “parent-centrism” or the tendency to put their own needs ahead of their child’s. In fact, jumping ahead to your testimonials, you told one set of parents:

“You may have heard about people rearranging their lives to adjust to their babies.  But I don’t believe that’s how it should be.  Your baby is new to your lives, and you’re new to his life, but so is everything else right now for him.  Meanwhile, you’ve been living your lives a certain way for years and years.  It’s the baby who should adjust to your life.” (p.154, emphasis theirs)

I’m not sure you could find a better example of parent-centric parenting than this very specific piece of advice.  The key to this adaptation, it seems, is to make sure you don’t have to give up any sleep which will make you a “better parent”.  To tackle this we need to talk about a few things: (1) The implication of this view for all parents; (2) The research on parent-centrism, sleep and parenting; and (3) What does a “better” parent look like?

Implications for All Parents

The point of your statement is to tell parents that sleep training is really the only way to become the “happier, more alert” parent, a sentiment made very clear in this preface.  This means that to not sleep train means to not be happier, to not be more alert, and in turn… not be a “better” parent?  Somehow the idea of responding to your child at night makes you – a worse parent?

I will acknowledge that for all parents, being a certain degree of alert is needed for good functioning.  Parents who are beyond sleep deprived often are irritable, stressed, unhappy, which a good parent does not make.  Not all of them, though, and certainly not ones who understand why they are being kept awake.  I have met parents of children who were chronically ill who therefore didn’t sleep much at all, who were sleep deprived beyond belief, and are also some of the most caring, wonderful parents I’ve met.  They didn’t take it out on their child, they understood where their child was, what was needed, and did what was necessary.

maddy at the boobI also disagree with the idea that the only two options presented here to new parents are (1) horrible sleep deprivation where you walk around in a haze, or (2) sleep training a newborn.  Really?  You honestly believe it’s that black and white?  I experienced neither.  I have never sleep trained my daughter (now 4 and who sleeps through the night barring a pee or two) and when she was a baby, my sleep actually improved.  It was blissful.  Yes, she woke to nurse as babies do and, especially at the newborn stage, I would get out of bed to let her see the world at that time, sometimes letting her nurse and look out the window while I watched Sex and the City, sometimes just staring at and talking to her.  Eventually her wakings turned to dream feeds and we stayed in bed all night (until her two sleep phase which is a different story but will be touched on later when we talk about biologically normal sleep).  Most parents I know aren’t horribly sleep deprived nor do they sleep train.  Some are getting less sleep than usual, some care, many don’t.  Some make up for it in naps, some wait it out, some find gentle solutions.

The fact is that there are many options and many experiences.  Painting a picture of zombie-like sleep deprivation to sell your way is immoral, unethical, and simply unfounded.

Research on Parent-Centrism, Sleep, and Parenting Quality

If you’re going to talk about sleep and parenting and the type of parent-centrism you support, we need to look at what the research tells us is normal or what can be expected both naturally and from this parent-centric attitude.  First, let’s talk about what is normal for babies and new parents with respect to sleep.  Whether you like it or not, most babies will wake throughout the night to feed and this waking is completely normal.  One of the reasons this waking is as frequent as it is, is because at birth, a baby’s stomach can hold a whopping total of a teaspoon’s worth of milk[1].  Breastfeeding babies will nurse even more because the fat and protein content in breastmilk is far lower than in formula (something else we’ll discuss in more detail later on), resulting in it being absorbed far faster and therefore requiring frequent feeds to meet the nutritional demands of growth[2].

What does this mean for parents?  Well, for one, their sleep is going to be different too.  It’s not going to be the consolidated sleep that our current, modern society is used to (because, yes, even this is different from our ancestors[3]).  In a study out of Northwestern University[4] looking at cortisol levels in mothers of six-month olds, it was found that moms who co-slept did not show the “idealized” pattern of a steep decline in their diurnal pattern (though they did show some decline).  The authors of the study suggested co-sleeping presents a health problem for mothers because of this different diurnal pattern; however, there are two key points that are relevant here: (1) The degree of decline has not been associated with any health benefits (only marital satisfaction[5]) and thus the health worry for co-sleeping mothers is simply unfounded; and (2) The research ignores the role of synchrony in infant-mother interactions.

Synchrony, for those unaware (and sadly I feel this may be you given what you’ve written) is the correlation between mother and infant physiology, or how “in tune” they are with each other.  Why is this important?  Quite simply put, we want parents to be in sync with their babies as it relates to various positive outcomes, including improved regulation[6] (emotional and physiological) and secure attachment[7].  In short, synchrony is important to both the parent-child relationship and child outcomes.

Copyright: Kirill Federspiel

Copyright: Kirill Federspiel

The aforementioned research is interesting because the mechanism behind the different pattern for co-sleeping mothers may reflect synchrony as their pattern closely resembles that of young infants.  Indeed, infants (up to 17 months of age) have not been found to show this diurnal pattern (of rise in the morning followed by a steep decline)[8] and some healthy children at age 3 are still not showing it[9]; therefore, the development of this “ideal” diurnal pattern is something that takes time (and actually not all healthy people have it).  If mothers are sleeping close to their infants and are thus more “in tune” with them at night, they will likely show a different pattern, one more similar to their infants.  Does this mean non-co-sleeping mothers don’t have synchrony or aren’t “in tune”?  Not at all as it’s influenced by both day and night care, but it highlights that the sleep of mothers with newborns or young children may be seen as qualitatively different from the sleep of non-mothers or even mothers who have older children without saying anything about their parenting skills.

In addition to looking at the relationship between synchrony and diurnal patters, we must also look atthe relationship between sleep training and synchrony, given this is what is being proposed in this book and suggested to be the “better” parenting method.  The only study that has looked at synchrony with respect to sleep training was conducted by Wendy Middlemiss and colleagues and used families in a sleep program in New Zealand[10].  The method was the common “cry-it-out” form of sleep training (one I know you say is not what you propose, but it remains worth discussing because it’s not quite true that you don’t advocate for it at all, but we’ll get to that in more detail later).  At the beginning of the study, despite maternal concerns about infant sleep (i.e., their young babies were not sleeping through the night), the infant and mother showed significantly high levels of synchrony.  However, after only three nights of sleep training, the synchrony between mother and infant was gone both at nighttime and during the day despite the fact that the parents reported feeling much better, not being as anxious or worried about their infant’s sleep, and generally believing things to be better.

This last part is critical to your idea of parent-centric parenting.  Yes, these mothers now felt better: They were sleeping through, their babies weren’t crying at night, and one could say they had achieved what you tell parents is ideal – the “happy parent” in the “happy parent = better parent” equation, especially during the day.  But what of the babies?  The lack of synchrony from sleep training – or perhaps from parent-centric parenting – is concerning when we think of how this may influence things like attachment and self-regulation.  Furthermore, the babies continued to present with high cortisol levels indicative of significant distress, even when not crying, and research tells us that these higher levels of cortisol in infancy are associated with socio-emotional development (including anxiety and depression) as well as poor emotion regulation[11][12].

What we have, therefore, from the research on parenting young babies is that, far from the idea of parent-centrism leading to “better parents”, it in fact may result in more problems in the parent-child relationship.  Indeed, if one thinks about the history of humankind and the way in which we have survived/thrived as a species, intense maternal care in the early months has been a critical component to our survival.

What of the later years?  Although just looking at human history (and even modern societies that have responsive, on-demand care as the norm for babies), we can see that children who have this on-demand care grow up to be well-adjusted and independent in ways many of our kids don’t[13].  However, the cultural differences that exist make exact comparisons impossible as we not only differ on how we treat our babies, but our older children as well.

What does the research on parenting with older children tell us about how different parenting styles influence development in our Western culture?  The rise of expert books and baby training books from the 1970s to today suggests a society that is moving more and more towards a parent-centric parenting philosophy in general.  The fact that a book such as The Newborn Sleep Book can not only be written, but have parents ask you to write it, tells us how far away from responsive parenting we are getting (despite a push from the “other side” to get people to realize the importance of child-centric care).  A study out of Yale University looking at the amount of touch infants are getting across cultures, including our own, found that infants in the USA are being touched only 12-20% of the time, and by a year, that number drops to below 10% compared to between 95-99% in other tribal cultures[14].

Given the importance of touch to infant development[15], this is highly worrying and may help explain why, despite parents listening to all these “experts” that promote detached and parent-centric parenting, we have seen a decrease the number of children who are securely attached.  At the end of the 1970s, approximately 70% of children were deemed “securely” attached to their primary caregiver[16], but a more recent examination of attachment at age 1 has found only 59% of children are securely attached[17].

In a review of the scientific literature, the ability of parents to respond to distress or model “sensitive” (i.e., child-centric, relatively speaking) parenting has been linked to all sorts of positive outcomes for children, including higher levels of empathy, emotion regulation, and lower levels of internalizing and externalizing behaviours[18].  The key to this type of parenting, however, is to be in tune with one’s child, to be sensitive, and to respond to their needs.  As put by Dr. Joan Grusec, in summarizing the literature on parenting and development: “[C]hildren whose parents respond to their distress by soothing, comforting, and removing the source of that distress become securely attached.” [18, p.249]  The problem with parent-centric parenting is that it often ignores this distress in favour of “teaching” the child to deal with it oneself.

In addition, recent research out the University of British Columbia looked at parental outcomes in different styles of parenting[19], particularly the degree to which parents placed their children’s needs over their own (parent-centric versus child-centric).  In your preface, you argue that you want parenting to be a joy for parents, and that you believe this idea of forcing a child to bend to the parents’ life is just the way to do that.  This particular line of research examined child-centrism versus parent-centrism on parental happiness.  What did they find?  That relative child-centrism is associated with greater levels of parental joy and happiness in child rearing and that parent-centrism is associated with less joy.  Indeed, the results fit with a growing body of evidence that what makes us happy isn’t concern with ourselves and having others conform to that, but that well-being comes from investment in others.

I hope it is clear that what we see from a large body of evidence is that parent-centrism is not the key to being a “better parent” (or even a happier parent), but instead comes from the ability to put your baby’s needs ahead of your own more often than you place your own ahead of theirs and respond to them when they need you.

What Does a “Better” Parent Look Like?

Tracy MaddyPersonally I think it’s pretty clear.  A “better” parent is not defined by the amount of sleep that parents gets, but rather how responsive that parent is to their child while balancing their own needs.  It’s important to note that the research on “child-centrism” did not suggest or support that parents only concern themselves with their child’s needs, but rather the degree to which they put their child’s needs ahead of their own.  When your babies are small, that will look very child-centric and it will shift more towards an equilibrium as your child ages and people in the household learn to take turns in handling their needs and those of others.  But if we want children who are empathic, attached, have appropriate self-regulation and have parents who are happy as parents and enjoy the process of being with their children (something that kids do notice), parent-centric parenting is not the answer.  It just isn’t.

Breastfeeding versus using formula, bedsharing versus room-sharing, babywearing versus using a stroller – these thing will only matter insofar as they help you respond to your child, but will by no means dictate what kind of parent you are.  A baby who is highly reactive and requires constant parental touch will do better bedsharing and babywearing, but that doesn’t mean all babies will as some will be equally content and responded to in their own cot and in a stroller (provided they are getting enough touch otherwise).  Responsiveness and being a good parent is about knowing your child and not neglecting or dismissing your child.  Perhaps if more parents followed this, we might get our secure attachment rates up and stop the upward trend of rising mental disorders in both children and adults.

Some Final Points

There was so much in the preface alone to talk about but I wanted to focus on the parent-centric philosophy because I think it’s most important to discuss.  However, it doesn’t mean other gems weren’t thrown out there that need to be addressed.  Here are a few of the things you mention that I simply couldn’t let slide:

You argue that babies are resilient because they survived “the Stone Age” when a laptop wouldn’t.  Beyond the sheer ridiculousness of the comparison, you fail to address why they survived.  For that you have to look at the type of care they received.  Do you think we’d be having this discussion or debate if nighttime care was not a standard part of human history?  If babies were not kept close to parents at night, responded to, and nursed on demand?  You wouldn’t because we wouldn’t be here.  Indeed, as I have written on elsewhere, given the dangers of life in historic times, the fact that loud, infant signalling (i.e., crying) remained an adaptive trait highlights how important responsiveness actually is to it.  If babies cried for no reason, there would be no reason for that trait to be apparent today.

You mention that you don’t think parents who decide not to follow your advice are “bad” parents; however, I will return to this in the type of comments you make about various other techniques and styles of parenting.  The implications of your later comments counter this early statement.

You speak of not wanting parents to do “scared parenting” and yet you do nothing but present worst-case scenarios.  I’ll address them as we get to them, but we’ve already talked about how you put parental sleep as one of two options: Sleep deprivation or sleep training.  This also includes telling parents that not sleep training means their child will likely always have sleep problems until you sleep train and that co-sleeping is not only unsafe but will result in emotionally and socially stunted children.  I’ll address the research on this (that completely counters your ideas) but what is the point of these incorrect statements if not to scare new parents?  Isn’t thinking of your child growing up stunted or with constant problems a scare tactic?

In talking about the development of your method, you state, “[T]he Jassey Way wasn’t developed from studies, or lab tests, and it hasn’t been ‘proven’ by them either.” I should give you full credit for acknowledging that your way has ZERO scientific backing… but wait?  Didn’t you say the method was “proven”?  Didn’t you say it was “scientifically sound”?  As I hope will become clear, this caveat is what should be printed in large font on the cover, along with a statement that not only has it not been proven, but that it counters most of what we know about infant development and biology.

One final aside… in case you haven’t noticed, I have more peer-reviewed, scientific citations in this one lesson than you do in your entire book.  How’s that for “scientifically sound”?

Remember, we’ve only tackled the preface, you can click here for the next lesson on what you describe as “The Newborn Sleep Problem” (i.e., the Introduction).

_________________________________

[1] http://kellymom.com/blog-post/your-newborns-stomach-day-1-10/

[2] Ball HL.  Bed-sharing and co-sleeping: research overview.  NCT Digest 2009; 48: 22-7.

[3] Ekirch AR.  At Day’s Close: Night in Times Past.  New York: WW Norton & Company, Inc. (2005).

[4]Simon C.  Study presented at the American Public Health Association’s 2012 Annual Meeting.

[5]Vedhara K, Tunistra JT, Miles JN, Sanderman R, Ranchor AV.  Psychosocial factors associated with indices of cortisol production in women with breast cancer and controls.  Psychoneuroendocrinology 2006; 31: 299-311.

[6]Feldman R.  From biological rhythms to social rhythms: physiological precursors of mother-infant synchrony.  Developmental Psychology 2006; 42: 175-88.

[7]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.

[8]Bright MA, Granger DA, Frick JE.  Do infants show a cortisol awakening response?  Developmental Psychobiology 2012; 54: 736-743.

[9] Watamura SE, Donzella B, Kertes DA, Gunnar MR.  Developmental changes in baseline cortisol activity in early childhood: relations with napping and effortful control.  Developmental Psychobiology 2004; 45: 125-33.

[10]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.

[11]Gunnar M, Quevedo K.  The neurobiology of stress and development.  Annual Reviews in Psychology 2007; 58: 145-73.

[12]Essex MJ, et al. Influence of early life stress on later hypothalamic-pituitary-adrenal axis functioning and its covariation with mental health symptoms: a study of the allostatic process from childhood into adolescence.  Developmental Psychopathology 2011; 23: 1039-58.

[13]Gross-Loh C.  Parenting Without Borders: Surprising Lessons Parents Around the World Can Teach Us.  New York: Penguin Group (2013).

[14] Hewlett BS. Diverse contexts of human infancy. New York: Prentice Hall (1996).

[15] Field T. Infants’ need for touch. Human Development (2002); 157: 1-4.

[16] Ainsworth M, Blehar M, Waters E, Wall S.  Patterns of Attachment.  Hillsdale, NJ (1978): Erlbaum.

[17] Princeton University, Woodrow Wilson School of Public and International Affairs. “Four in 10 infants lack strong parental attachments.” ScienceDaily. ScienceDaily, 27 March 2014. <www.sciencedaily.com/releases/2014/03/140327123540.htm>

[18]Grusec JE.  Socialization processes in the family: social and emotional development.  Annual Reviews in Psychology 2011; 62: 243-69.

[19] Ashton-James C, Kushlev K, Dunn EW.  Parents reap what they sow: Child-centrism and parental well-being.  Social Psychology and Personality Science (in press).

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Comments

  1. says

    Thank you for tackling this book in such a step by step manner. I have written as we will publish a general response to the book from my perspective as a pediatrician tomorrow. I have so many points of agreement with your article it doesn’t make sense to go through then all. One other thing from the preface that annoyed me is their insistence that babies are so resilient you can do anything to then but they do nothing to credit the amazing resistance of a parent of a newborn who wants to care for their child. I firmly believe that bonded parents could go with almost no sleep for days and do a better job than a completely distant parent.

    • says

      Please do share your response once you’ve written it! I would love to share it on FB for people to read as well and know that these guys are not representative of all pediatricians!!!

      I touched briefly on the resiliency but you are correct to talk about the resiliency of parents too! (I wish I’d thought of that!!!)

      • says

        Yeah I didn’t have the space to talk about the resiliency of parents and I won’t be able to come back to it so if it fits with a later chapter, feel free to use it. I will definitely lead you to the link when it’s active. I hope it’s something you feel worthy of sharing!! So thankful for all you do. One of my favorite (and best) parents alerted me to you and I appreciate all you do.

        • says

          Thank you! I’ve shared it on my FB page after reading it through – my favourite is: “Parenting is about facing inconveniences. are ways to help your child fit into your life better than others, the very premise of this statement offends me. I’m sorry if your little baby woke up and tried to bother you at night for something to eat. I hope it wasn’t too much of an inconvenience.” This whole notion of not being inconvenienced as a parent baffles the mind. What did people expect? A plant?

  2. says

    These kind of books are so dangerous, They set an expectation that babies can and should be sleeping through the night. Even if you are the most loving parent, having this expectation can lead you to trying the method. Thank you. hope more parents find your website and read this.

  3. Vancat says

    I don’t know the best way to get your blog posts to the Jassey’s, but I really hope they read them somehow!

  4. Trin says

    I love this part…

    “This also includes telling parents that not sleep training means their child will likely always have sleep problems until you sleep train and that co-sleeping is not only unsafe but will result in emotionally and socially stunted children.”

    I co-slept with my son until he was 5. He was nursing every night pretty much every two hours until he was two. At 5.5, he made a nearly seamless transition to his own bed, and sleeps like a rock. He’s smart, friendly, and compassionate. Goodness knows how he survived without being sleep trained. *eyeroll*

  5. says

    Love this article and the amazing points you have made. I am currently in early pregnancy with my second and am not able to respond to the needs of my nearly 2 year old as well as I have in the last 2 years (thanks to nausea and fatigue) and thats making me miserable.
    A responsive parent is a happy parent indeed!

  6. Hannah says

    Thank you, great piece. I think you are spot on about our society validating parent-centric parenting – and that is deeply troubling.

  7. Tina says

    What a load of BULLSHIT!!
    Are babies are NOT robots & programmed to fit into mummy & daddy’s lifestyle as of when it suits them. They have needs & feelings. Like us adults. So depriving them of food when newborn will be NEGLECT. They have been fed all hours in your womb so why not now? They have to wake up to know mummy is still there or they need some thing ie nappy changed, hungry, thirsty or wanting a cuddle to feel safer again. I hope this book gets shredded. Amen

  8. says

    “Indeed, the results fit with a growing body of evidence that what makes us happy isn’t concern with ourselves and having others conform to that, but that well-being comes from investment in others.”

    Spot on. I bet Mother Teresa and so many other joyful souls would agree.

  9. Melody says

    I was definitely and still am sometimes very sleep deprived. However, I do my best to get the support I need but I don’t have family nearby. It’s been pretty challenging. I had a baby with colic and food allergies and those first 21 months were very, very challenging BUT, I would not have done it differently. I would still NEVER sleep train, and especially after figuring out part of our son’s issues were food allergy related.

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