Cry It Out is OK, Say Researchers

So it turns out that Cry It Out is ok, after all!

I believe that no major sleep expert actually recommends “cry-it-out”. Nevertheless, the term has become attached to a method formally called “graduated extinction“. The method is made most famous by Dr. Richard Ferber in his 1986 classic “Solve Your Child’s Sleep Problems”.

Graduated extinction was criticized by proponents of “Attachment Parenting” styles of sleep training, particularly William Sears. In “The Baby Sleep Book”, Sears makes frequent reference to the relationship between baby crying and elevated levels of the stress hormone cortisol. Lots of crying leads to cortisol going up.  Sears says this leads to all kinds of negative outcomes for baby. For example:

“Science (sic) tells us that when babies cry alone and unattended, they experience panic and anxiety. Their bodies and brains are flooded with adrenaline and cortisol stress hormones. Science has also found that when developing brain tissue is exposed to these hormones for prolonged periods, these nerves won’t form connections to other nerves and will degenerate. Is it therefore possible that infants who endure many nights or weeks of crying it out alone are actually suffering harmful neurological effects that may have permanent implications on the development of sections of their brain?”

It was a rhetorical question. Sears goes on to say that cortisol damages babies brains in all kinds of ways. In extreme cases, I will grant that chronic stress is bad for babies. But the “research” Sears cites has nothing to do with crying at bedtime. No one had ever measured levels of stress hormones at bedtime. Furthermore, no one had tested whether different sleep methods stressed out babies more than other sleep methods. No one had asked whether a particular sleep method damaged (or helped) develop a bond between baby and mother.

Until now.

New Research Says Cry It Out is OK

Investigators in Australia asked mothers in pediatric clinics if their babies had a sleep problem. The doctors recruited 43 babies between 6-16 months of age. They divided the babies randomly into three groups. One was assigned to try “graduated extinction” (AKA “cry-it-out”).  Another group would try “bedtime fading“. This is a technique in which you move bedtime later in the evening to match the child’s “internal” bedtime clock, then gradually move bedtime back to your desired time. For example, if you want your baby to go to bed at 8:30, but she usually does not fall asleep until 10:30, choose 10:30 as his temporary bedtime. Then move bedtime gradually earlier.

A third group in the Australia study was handed a list of sleep instructions. This was the “control group” for comparison to the graduated extinction and the bedtime fading group.

Need a SLEEP COACH?

During the study, investigators had the parents swipe a cotton swab on the inside of their babies’ mouths to measure the hormone cortisol. Motion sensors were given to parents in the study to measure baby’s wakefulness (actigraphy). The parents also filled out questionnaires to measure their own stress and anxiety. Finally, the mothers and babies took a standardized behavior test to measure their level of attachment.

Cry It Out is OK with Respect to Sleep
cry it out is ok

Compared with the control group, babies taught with graduated extinction and bedtime fading took less time to fall asleep (sleep latency, panel A). They also woke up at night less often (panels C). If these babies did wake up, they stayed awake fewer minutes than the control group (panel B).

You can see that the control group showed some improvements across the board. This suggests that sleep education helps. It also could mean simply that babies sleep better as they mature. This is why it is so important to include a control group. To study an intervention like a sleep method, you need to know what the “background” improvement is. Otherwise you’ll never really know if your intervention works.

Babies in the graduated extinction group got more hours of sleep in the early stages of the study. However, these gains appeared to disappear by the end (panel D).

Cry It Out is Ok? What About Stress?

cry it out is ok 6
The central issue in the Australian study was stress. Does graduated extinction really raise cortisol? Does the method damage the relationship between mother and baby? The answer was ‘no’.

Other researchers have shown that minor stressors can elevate cortisol levels in newborns; But this goes effect goes away at about 4 months of age. The Australian study only looked at babies older than 6 months. So you might think that this study misses an important point that Dr. Sears and others were trying to make.

However, the investigators did something clever to get around this limitation. Sears and others insinuate that cry-it-out sleep methods cause chronic increases in cortisol. These investigators measured cortisol twice, once in the morning and once in the afternoon. They saw no difference among groups. This suggests that cry it out is ok from the standpoint of stress as well.

So Cry It Out is OK for Baby: What About for Mom?

Mothers in both intervention groups reported less stress than mothers in the control group. You see this in panels C and D in the second figure I show here. The researchers also looked at mother-baby bonding one year after the study was over. They found no differences in the ability of moms and babies to bond with one another. The levels of attachment between the two appeared to be identical in all groups. Finally, the babies in the cry-it-out groups had no more emotional or behavior problems than the control babies.cry it out is ok 7

This last finding was similar to a much larger study published in 2012. That study, also done in Australia, involved 326 children. These investigators found that sleep method had no effect on attachment, bonding, and behavior. This study was five years after the intervention, suggesting that there was nothing was messed up permanently by allowing your baby to cry at bedtime.

Limitations: Maybe Cry It Out is OK for Some, But Not for All?

The investigators acknowledge that their study has some problems. For one thing, it was relatively small. There were only 43 babies involved. With small studies like this, there’s a chance that you cannot generalize the results to all babies. This includes your own baby! That is why the investigators were careful to compare their results to other similar studies. We can believe in your conclusion more strongly if you do your study in a slightly different way, but come up with the same answers.

They also noted that they didn’t measure cortisol continuously, or even at night when the crying was happening. It’s possible that cortisol does indeed go up in a crying baby. It would be surprising if it didn’t! But the study was looking at chronic elevations. That is, cortisol stays up over time. This, after all, is the accusation that Sears and others hurl at the Ferber method. Here, the investigators have a point: sleep method does not change cortisol long-term.

Implications

The investigators conclude from these data that sleep education alone may not be enough to get your baby to sleep. You may need an intervention if your baby has a sleep problem beyond 6 months of age. They propose an interesting combination of methods: Their results suggest that bedtime fading could be done first. Then graduated extinction could be used to reduce nighttime wakings.cry it out is ok 8

Conclusions

  • Graduated extinction (cry it out) and bedtime fading are both effective.
  • Extinction-based methods do not stress out a baby chronically
  • These methods do no have long-term effects on a baby’s emotional life or her attachment to her mother.

My suggestion: find a sleep method that works for you and don’t worry about it. Show your baby a lot of love and attention and you don’t need to worry about bedtime. Above all, stay consistent: find a routine that works for you and stick with it!

If you need help doing that, go ahead and contact me. I can help.

Premature Baby Sleep Training: When and How

Premature baby sleep training is a special kind of sleep training.

The basic principles of sleep training apply, with a twist. We have to pay attention to a couple key questions. “What is your baby’s corrected gestational age?” and “Does your baby have any special difficulties related to her prematurity?”

I will review some basics about preemies and sleep training. Then I’ll talk about which sleep training methods are best for premature babies and why.

Premature Baby Sleep Training

The most important thing to know about premature babies is the most obvious. They were born early! But it might be better to say that they were born before they were ready. Harvey Karp would argue that even full-term babies are born before they are ready to be here on earth, but that is another subject!

Sometimes a premature baby will be born before her lungs are ready to breathe air on earth. These babies obviously need to stay in the Neonatal ICU (NICU) until they can breathe on their own. Still other preemies are born before they are able to eat on their own. They too need to stay in at least a special care nursery until they can “remember to eat”.

But the most important difference for our purposes is premature baby sleep. Premature babies sleep differently from full-term babies because, just like their lungs and stomachs are immature, so are their brains.

Turn Down the Noise!

An important difference between us grown-ups and babies is that we have a filter. We can filter out sounds, feelings, smells, tastes, and sights that interfere with our ability to focus. Babies can’t do this. They have to pay attention to everything. And so it’s easier for babies to become overwhelmed by too much sensation. This is what we mean by “overstimulation”. When babies get overstimulated they get fussy, they cry more, they eat poorly, and they don’t sleep! Premature Baby Sleep Training 2

How ever you decide to sleep train your preemie, you have to keep this in mind, particularly if she is still younger than her due date. The risk of overstimulation can be too high with babies with a corrected gestational age less than 40 weeks. For these babies it may be best to put off sleep training.

So You Say You’re Ready for Premature Baby Sleep Training?

Maybe so, but is the baby ready? There are a couple of ways to tell. First, does the baby weigh around what a full-term baby weighs? If she weighs less than 5 lbs 8 oz, it may be difficult. She’ll need to do a lot a feeding for catch-up growth. I recommend discussing with the pediatrician if you want to start at a smaller weight.

Does the baby have any problems related to her prematurity? For example, many preemies have reflux. A premature baby with reflux may be fussy and have trouble settling. Other premature babies go home from the hospital needing oxygen. These are babies I might not recommend sleep training until they are breathing room air. Again, this is something to discuss with the pediatrician.

Premature Baby Sleep Training MethodsPremature Baby Sleep Training 3

All the various sleep training methods fit into two broad groups: baby-led and parent-led. Briefly, baby-led methods lean heavily on paying attention to the premature baby sleep cues. These are eye-rubbing, yawning, and beginnings of fussiness. Parent-led methods lean heavily on providing structure for baby sleep. This includes starting meals at the same time every day, and encouraging naps at the same time every day.

The reality of premature baby sleep training is much simpler: it’s a combination of baby-led and parent-led methods. This is sometimes referred to as “combination” sleep training. That is to say that the most successful baby sleep training that I know of involves a combination of following baby’s cues and providing structure. This is the method I recommend in my practice.

I do make a slight exception for premature babies. Because feeding and growing is so important, I lean more toward following her feeding cues. Your pediatrician may have given you target for the number of calories she should have every day. If so, it’s best to do what you can to make sure she gets enough formula or breast milk to do catch-up growth.

The Ideal Age for Premature Baby Sleep Training

So what is the ideal age to sleep train a premature baby? The key is corrected gestational age. If the baby were full term, the ideal age for sleep training would be four months of age. Prior to that age, you have laid most of the groundwork already. You’ve learned baby sleep cues, and you’ve started providing structure to the baby’s day. You might not even need to sleep train at this point! If you’re doing premature baby sleep training, you want to aim for four months corrected. For example, if your preemie were born at 36 weeks (4 weeks early), your goal should be five months of age. At this point the baby can be expected, reasonably, to achieve the sleep patterns of a four month old full term baby.
Premature Baby Sleep Training 4
I say “ideal age” for premature baby sleep training, because this is the age at which I believe you’ll have the most success. Four months corrected is about the age when a girl baby can soothe herself to sleep. You can put these girls down in the crib fully awake. And they can learn to fall asleep without assistance. For boys, the age is somewhat later. Certainly by six months (corrected) a boy can master the self-soothing skills needed to settle himself… and to sleep through the night (if he’s well-fed!)

Summary

  • Premature baby sleep training is just like full-term sleep training, with some exceptions. You need to pay attention to any health issues related to prematurity. And you should lean more towards following her cues.
  • Providing structure is still important. Whichever method you choose to sleep train your preemie, she’ll do better if her day is as regular and as predictable as possible.
  • Expect a girl preemie to sleep through the night at around 4 months (corrected), and a boy by 6 months (corrected)
  • If there are any health concerns at all, please contact your pediatrician.
  • If the baby’s health checks out, you still are having sleep difficulties, I can help!

2-3-4 Nap Schedule

2-3-4 Go!

What is the 2-3-4 nap schedule?

It’s not a guideline. It’s more like an observation. And it’s particularly associated with the 6-month old baby.

The name “2-3-4” refers to the number of hours between naps during the day. It works like this:
[Just a note: What follows is complete fantasy. How we wish every day could be as perfect as the one I’m about to describe! But hey, we can dream, can’t we?]

Need a SLEEP COACH?

Baby wakes up at around 5 in the morning, refreshed from 8 glorious hours of uninterrupted sleep. She’s smiling and cooing in the crib, talking to her mobile. You know it’s time to go pick her up, change her diaper and feed her. Because if you don’t, she’ll become cranky with hungry. Depending on her temperament, she may get really cranky and start to cry. This is to be avoided.

The majority of American mothers have begun feeding the baby solids by six months. So in addition to breast or bottle, she might have 2-4 ounces of pureed vegetables (you’ve made this yourself, right? No? It’s easy. You should try it!)

The “2”

You might dress the baby, play with her. You’re certainly going to talk to her and watch her fascination at this “communication thing” you’re doing. She might even want to imitate you. Then, approaching 7 AM, she’ll start to rub her eyes (yes, babies really do this). You know it’s time for that first nap. You go through your “nap routine”: change diaper, sing her a song, a kiss, then place her down in the crib awake. Two hours have elapsed.

2-3-4
Cat nap (sorry, couldn’t resist)

The “3”

Two hours later, at noon, your little kitten begins to stir and stretch. You know the first nap of the day is over. So you change her diaper, change her clothes, and get ready for the day. Let’s say it’s a gorgeous July day, sunny and breezy. We dress in cool, long-sleeves, making sure to put on the hat to shield her face, and head out in the stroller.

At the park, for some reason, every stay-at-home dad in town has brought a baby to the park, and every one of these men is the spitting image of Cristiano Ronaldo (I said we can dream, can’t we?) You enjoy two hours holding court as each Cristiano takes turns ooh-ing and ah-ing over your sweet angel, who smiles and laughs at each face she sees. You nurse her as well at the park, because this is the 21st century and we can do this, right? At 2-ish, everybody gets back into their strollers and heads home.

By 3 o’clock, baby girl is rubbing her eyes again and it’s time for nap #2. Three hours have elapsed.

The “4”

Exactly 2 hours later, 5 PM, baby girl is up and ready for the home-stretch of her day. You change her diaper and take her into your living room (which has been transformed into the baby’s living room) and watch her play with her toys for a while. She may be sitting up by herself at this point, so you might put her in a bouncy seat and watch a short video with her. At about six, your partner, Cristiano Ronaldo, comes home, delighting baby girl.

At 7 PM, it’s time for dinner. She takes her seat (high-chair) at the table to eat with her parents, family-style. Nursing or bottle, 2-4 ounces of pureed vegetables and fruits.

2-3-4
Do not disturb

At about 8PM, the bed-time routine begins. This is the most regular and predictable part of the day. The baby knows exactly what will happen, and in what sequence. There will be a fun bath, changing into pajamas, then quiet hanging out with parents, a song-and-kiss, and time for bed. She goes down in her crib awake and drifts off blissfully at 9PM. Four hours have elapsed.

Really?

I actually wrote that without laughing. It was tough. Of course no day is as perfect as this one (although, I hope you get at least one, or a few, like this). But roughly speaking, this is the way the 2-3-4 schedule works, with or without the dream-like elements. It isn’t planned. It just turns out that way.

Where did 2-3-4 come from?

Good question. The earliest mention of it I could find in a Google search occurs on December 12, 2005 at AskMoxie.org:

Once babies hit 6 months or so, many of them will settle into a 2-3-4 pattern. That means that they’ll take their first nap 2 hours after waking up in the morning. They’ll take their second nap 3 hours after waking up from the first nap. They’ll go down for the night 4 hours after waking from the second nap. Not all kids do this, but a surprising number of them seem to.

Moxie had said at the opening of her post that this idea is not “unique”, by which she may mean “not original”. I believe her, but since I can’t find an earlier reference, I’ll credit Moxie with coining the term.

Problems with 2-3-4

Moxie is careful to note that babies “settle into” a 2-3-4 pattern. It’s not set for them by their parents, but neither is it entirely baby-led. Any kind of pattern like this is a result of what I call the “follow her cues but provide structure” approach to sleep scheduling. The pattern that emerges is a neat observation, not a prescription.

The two hour interval seems a bit long to me. Dr. Weissbluth might agree. He says that the first nap should be though of as a continuation of the night’s sleep, complete with REM phases and all the rest. At six months of age, one and a half hours after waking in the morning sounds about right. Some will stay awake longer, some less.

The period of a baby’s life where she’ll nap with this pattern is really very brief. It may start around 4 months and last until 9 months at the longest. Most 9-month olds nap only twice per day.

When 2-3-4 might be useful

This is not to say that the expression is completely useless. If you have a six-month old whose nap schedule is all screwed up for whatever reason, and you need a guideline to get back on track, 2-3-4 may be the way to go. It may require nudging nap times around a little. I would only do this in small quantities: 15 minutes at a time. I do not recommend waking up a sleeping baby to try to achieve any nap pattern. That’s a sin!

But say your 6-month is fighting sleep at 8PM and she’s only been up for three hours. Think 2-3-4.

How Much Should My Baby Nap?

Parents often ask me how often the baby should nap, and for how long. Often what they’re really asking is “Am I doing this right?”

Sometimes they ask because their friend’s baby is the same age as yours and she’s napping three times per day and yours is only napping twice. Or maybe it’s the other way around.

Behind all these questions is the very real and important question: “Is my baby getting enough sleep?”

How Much Sleep Does My Baby Need?

I’m indebted to my colleagues at “Get Your Baby to Sleep” for creating the tables and charts below (so that I didn’t have to make them!!!)

Baby Age Nighttime Sleep Daytime Naps Total Sleep
Newborn to 2 months 2-4 hours between feedings 4-5 naps 16 to 18 hours
2 to 4 months 4 hours between feedings 3 naps 14 to 16 hours
4 to 6 months 5-8 hours 2-3 naps 14 to 15 hours
6 to 9 months 8-10 hours 2 naps About 14 hours
9 to 12 months 10-12 hours 2 naps About 14 hours
12 to 18 months 11-12 hours 1-2 naps 13 to 14 hours
18 to 24 months 11-12 hours 1 nap 12 to 14 hours

 

I should emphasize here that not every baby has “read the book”, or even “Googled it”, as I guess I should say these days: these are averages. Some babies sleep more than others. That’s why I like to provide ranges and use terms like “about”.

Need a SLEEP CONSULTANT?

Total Hours of Sleep

For readers who prefer graphs (as I do) this one gives a better idea of how total sleep decreases through the first year of life. Out of a 24 hour period, the average newborn (0-30 days) will sleep 18 hours! This will gradually decrease to 12 hours, or half the day, by a year of life. Take home message: babies sleep a LOT!

Nap
Total Hours of Sleep per day, by age

How Many Times Per Day Should the Baby Nap?

In some ways the question begs another question: what do you mean by “nap“? The indispensable Dr. Weissbluth (see below) explains that, starting around 4 months of age, the first of the day’s three naps is basically a continuation of the previous night’s sleep! This nap is rich in REM sleep, when we believe the baby does much of her learning and processing of all the information she’s been receiving during the brief times she’s awake. The three naps per day generally decreases to two naps by 6 months of age.

nap
Number of naps by age

 

When Am I Going To Sleep Through the Night Again???

The answer to this question, as with so many other parenting questions is “it depends”. In this case, it depends on what you mean by “through the night”.  Some parents define it to mean the usual 8 hours they enjoyed before baby came in to their lives.  They should be so lucky! To other parents, “through the night” means  “the baby wakes up once to feed but the whole thing lasts five minutes so I don’t even count it”. For me, “through the night” means six hours straight, followed by the delightful early morning awakening which lasts 1-2 hours, followed by a few more hours of blissful sleep. This schedule can be achieved at about 6 months for most babies (see the table above).

nap
Uninterrupted sleep, by age

 

Well, How Did I Get Here?

One of the joys and fascinations with baby sleep is that the tables and graphs I’ve shown you do not depend at all on the type of sleep method you employed to get your baby to sleep! Whether you are an on-demand feeder, a baby-led scheduler, a parent-directed feeder, a contented baby enthusiast, a Baby Whisperer, or an attachment parent, all methods seem to lead to the same result: by one year, baby sleeps 10-11 hours and takes two naps!

I believe that all methods end up like this for a very important reason: Sleeping, and napping, are natural parts of a baby’s life. Given the right combination of reading the baby’s cues and providing structure, every parent can have a happy, healthy baby who sleeps well!

More from Dr. Weissbluth:

Cry It Out: Is There Such a Method?

Cry It Out: You read so much about it on the internet, you’d think it’s a thing.

Is it?

Cry it Out IS a Thing. Sort of.

Every day, on internet forums, there will be dozens of discussions of “CIO”, as it’s referred to. Almost without exception, CIO is help up as a sinister element that lurks out there in the world. I’m almost tempted to read CIA.

Sometimes I wish I could send a group message to the tens of thousands of mothers (and fathers): STOP IT!

Need a SLEEP CONSULTANT?

But then I have to stop myself and think: Thousands of mothers on the internet refer to CIO, so whether I like it or not, Cry It Out exists. Sort of.

cry it out
We have ways of making you sleep

Cry It Out did exist. Once upon a time. 1894, to be exact, with the publication of “The Care and Feeding of Children” by Luther Emmett Holt. Here is what Holt had to say on the subject, in its entirety:

How is an infant to be managed that cries from temper, habit, or to be indulged?

It should simply be allowed to “cry it out.” This often requires an hour, and in extreme cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary. Such discipline is not to be carried out unless one is sure as to the cause of the habitual crying.

Note that Holt places the expression in quotation marks. This suggests to me that the phrase had some currency in the late 19th century. Perhaps CIO was the preferred method? But now read closely: Holt recommended CIO only in the case of an infant who already has a sleep problem that was the result of what we’d call today a bad “sleep association“. I’m speculating as to the meaning of  “temper”.

Okay, so this is now the 21st century. Does any modern sleep expert recommend Cry It Out as a sleep training method? Again the answer is ‘No. Sort of.”

Meet Gina Ford

Gina Ford, the author of over 30 parenting books, is a Scottish-born former maternity nurse. In 1999, she published “The Contented Little Baby Book“. The major distinguishing feature of “CLB”, as it became known, was Ford’s recommendation of strict scheduling, down to chunks of five minutes. Despite scathing criticism, CLB has become a best seller. The closest Ford comes to recommending Cry It Out is her reference to something called “crying down”.

It’s a Scottish Thang

Prior to reading Ford, I was unaware of the expression crying down  as a troubleshooting method. Perhaps it’s a Scottish phenomenon. I can’t be sure. Here’s what Ford has to say about “crying down”:

Crying down can be particularly helpful when feeding problems have been resolved and a baby or toddler has only mild sleep association problems or has difficulty falling asleep because he is over-tired or over-stimulated… Reassurance must be kept to a maximum of one to two minutes. Parents should then wait a further 10– 15 minutes before returning. For this technique to work it is essential that the baby is not picked up and that he is allowed to settle by himself in his cot… Provided a baby has been well fed and is ready to sleep, I believe he should be allowed to settle himself. [Crying down] works not only for over-tired babies but also for babies who fight sleep…

It is my belief that, in the long-term, allowing your baby to develop the wrong sleep associations and therefore denying him the sound night’s sleep he needs in order to develop both mentally and physically is a worse option than hearing him cry for a short while. Allowing your baby to learn to go to sleep unassisted is your aim, and it is important to remember that this will prevent much greater upset and more crying if waking in the night is due to your baby not knowing how to go back to sleep after having woken in light sleep (emphasis added).

I’ve quoted Ford at some length because I wanted to highlight three things. First,  Ford’s similarities to Holt’s advice (already cited) emphasizing that crying to sleep might be necessary only for a baby with a bad sleep association or who was overstimulated (I regard “over-tiredness” and overstimulation as the same thing). Second, Ford emphasizes that neither a hungry baby, nor a baby who is not tired, should be put down to sleep. Finally, Ford places herself firmly in favor of good sleep associations, over most other considerations.cry it out

So is there really such a thing as “Cry It Out”?

Gina Ford tells us, correctly in my view, that crying down should not be necessary in the first place. Ford identifies the “need” crying down as bad sleep associations and allowing a baby to become overstimulated. She believes both could be avoided if the baby were put on a schedule from the get-go. Ford truly does not want your baby to cry to sleep. I don’t believe anyone want this, including Luther Emmett Holt.

In fact, if you read closely, Gina Ford is more of a “combination scheduler” than you might think at first blush. It’s true that she advocates a fairly strict schedule. But notice also that Ford insists that you make sure the baby is well fed. Notice also that she doesn’t recommend putting down a baby that isn’t tired!

Slightly Different

Just as virtually all 21st century sleep experts, Gina Ford joins the consensus about baby sleep, if perhaps in slightly different form. Like Baby Wise, Ford might say: Provide structure, but follow the baby’s cues. Sears and Spock might say “Follow the baby’s cues, but provide structure”.

Either way we end up with a method that recognizes a broader consensus about all of human behavior. We are not just a bunch of genes (the “Nature” part of “Nature vs. Nurture”). But neither are we blank slates, requiring inscription by good parents (the “Nurture” part). We all are born with certain biological traits that are then molded and shaped by our environments. And for virtually all babies ever born, the first and most important “environmental factor” is mom.

CIO2 CIO1

Attachment and Sleep: Dr. Sears is Wrong

Sears, W, et. al. “The Baby Sleep Book”. New York: Little, Brown, & Company, 2005, or “Attachment Theory Takes a Holiday”

Attachment Theory: It’s about the Baby, not the Mother

Lots of people talk about “Attachment Parenting” (AP), but not a lot of people know what it is. I’m not sure the Sears family knows either.

attachment

We owe Attachment Theory mostly to John Bowlby and Mary Ainsworth, two psychologists working in the mid-20th century. Put simply, the theory says that infants need to develop a relationship with at least one caregiver in order to learn to regulate their own feelings. On the “Nature vs. Nurture” spectrum, Bowlby and Ainsworth fit solidly on the “Nurture” end. Their type of theory is what we’d call “behavioral”.  Behaviorism stands opposite the “Nature” end, what we’d call “biological determinism”, or “your genes explain everything”.
The truth probably lies somewhere between.

Parents do a more or less good job of helping babies learn to regulate their emotions, according to Attachment Theory.  That’s the whole theory in a nutshell. Nowhere in this theory is there any suggestion that babies should remain physically attached to parents for as long as possible. Nor does the theory say anything about sleep. Or even breastfeeding! The theory is not even about parental behavior; it’s about infantile behavior. That is, it was only about the baby, until the Sears family got a hold of the theory.

Need a SLEEP COACH?

Attachment, Sears Style

I suspect that William Sears (the father of the clan) read “attachment” and took the word literally. Bowlby and Ainsworth only meant the term figuratively. And yet, Sears appreciates that attachment is a subtle and nuanced thing. Here’s how he describes it in his sleep book:

…[A]ttachment parenting (AP) is not a new way of raising children that we and others have dreamed up. It’s what mothers and fathers would do instinctively if they were raising their baby on a desert island

attachment
Attached

Note that Sears is careful not to say that parents have always been this way. He knows enough anthropology to know such a suggestion is wrong. But he does say that attachment behavior is instinctive. Where he gets this idea is a mystery. Perhaps attachment theory predicts the way that modern parents would raise a child on a desert island, far away from parenting books, pediatricians, and pop psychologists. But it is not the way aboriginal parents ever raised children for all but an eye-blink of human history. According to this research it’s doubtful that mothers developed close emotional bonds with their babies, because of the extremely poor chances that the baby would survive infancy! It was not until infant mortality plummeted in the developed world (in the 20th century!) that mothers developed the inclination to bond with their babies. Such a bond is certainly not instinctive, not on the part of the mother anyway.

So what if attachment parenting is a modern invention? So what if it’s a peculiar distortion of Attachment Theory. Is Sears wrong to recommend it?

Yes, He’s Wrong

The sleep book opens its defense of AP with this stunner:

A frequent criticism of attachment parenting is that it puts baby, rather than parents, in control. But can parents actually control their babies anyway? Parenting your baby at night forces you to come to terms with the realistic fact that you can’t control your child’s behavior

You can’t control your child’s behavior? One wishes, in vain, I fear, that Sears doesn’t really mean this. But let’s suppose for the moment that this incredible “realistic fact” were true: how is this going to help us get our baby to sleep? Sadly, Sears never really tells us. In fact, Sears goes on to explain that parents really ought to nudge babies in the right direction. This is what all good so-called “combination schedule” advocates claim. By the way, are “realistic facts” different from other kinds of facts?

When in Doubt, Cry It Out

Sears goes on at length to criticize what he claims to be a virtual army of baby sleep books that allegedly recommend the cry-it-out (CIO) method:

The dictum “let your baby cry it out” has been standard advice in childcare books for more than a century starting with Emmett Holt in 1894

Sears does not provide any examples of this “standard advice”. This is for a very good reason: apart from Holt and experts of his era, there are no such examples. No modern sleep expert recommends CIO. Even Ferber, as I’ve pointed out elsewhere, explicitly rejects CIO. Why Sears constructs this straw man (or should I say “straw pediatrician?) is a mystery.

attachment
Attach THESE, Bill!

A particularly precious argument against the phantom CIO is offered by Sears the Younger (Bob). Dr. Bob tells a story of a mother who lets her 1 month old cry himself to sleep. Years later it turns out the boy has ADHD. Leave aside the the absurdity of letting a one-month old cry himself to sleep: no one who knows anything about infant development would recommend such a thing. How can Dr. Bob draw such a connection? Wait, it gets worse.

Later, Sears suggests that “research” points to a connection between CIO and ADHD. The study in question is about “persistent crying”, not “CIO methods”. There’s an obvious chicken and egg problem here. Are hyperactive 8-10 year olds the way they are because they cried a lot as babies? Or are we looking at a group of children with a biological vulnerability to cry as babies and fidget as school children? The biggest weakness of the study was the finding that these children’s parents but not their teachers saw a difference between the behavior of the supposedly hyperactive group and the control group. Teachers are often much more likely to label a child hyperactive than are parents.

There is much more “neuromythology” dispensed on the subject of crying and ADHD about which I will say only this: just because they’re doctors doesn’t mean they know what they’re talking about. No one has any idea what neurotransmitters have to do with behavior. Don’t believe anyone who claims to know.

Attachment and Co-sleeping

attachment
OOH! These will attach things!

Though Sears claims he believes that babies can sleep anywhere, he clearly prefers that babies sleep in bed with the parents. I wonder if anyone but a board-certified pediatrician could get away with making such a suggestion? Regarding studies demonstrating the dangers of bed-sharing, Sears argues “when there is a conflict between scientific studies, or between science and common sense, suspect that somewhere there’s a fault in the science”.

There is not a word of that sentence that is true. Scientific studies often give variant results. Why should it be otherwise? The bit about common sense is too precious: Common sense suggests that the earth is flat and that the sun revolves around us. When scientific studies demonstrate that the opposite is true, is the “fault in the science?”

The American Academy of Pediatrics has issued several strong warnings about bed-sharing, which is a risk factor for sleep-related infant deaths. Perhaps the Sears book indemnifies itself by going on at length about safety and sleep. But this hardly mitigates the dangerous recommendation. There are an almost infinite variety of sleeping arrangements and devices that parents can use, such as co-sleepers.  Sears comically suggests that, for safety, parents buy the largest king-size bed available. This assumes the reader a) can afford such a bed and b) has the space for one.

attachment
This’ll work too

But Sears isn’t done with the “science”. He suggests that babies are “physiologically safer” when they co-sleep. One has to take his word for it. I will not. It’s a nonsensical suggestion. Sears even claims that babies are protected from SIDS because carbon dioxide is protective and parents exhale carbon dioxide. Nonsense piled upon nonsense. I won’t have any more of this. Neither will epidemiologists. No amount of pseudoscientific piffle will make bed sharing any safer.

The worst part of all of this is that you don’t have to sleep with your baby in your bed in order to develop attachment.

Sex and the Sleeping Baby

Here’s an obvious objection: Dr. Sears, many folks would really rather have sex without another person in the room. Call it bourgeois if you must, but that’s a fact. How does Dr. Sears suggest you accomplish the feat? First suggestion: put the baby in the crib first. Okay, great idea! To which I reply, why not leave her there? Second suggestion: play “musical beds”. In other words, have sex with your husband with the baby in another room. This includes keeping the baby in your room and having sex in the den, or the nursery! Finally, the most puzzling suggestion: morning sex. What, the baby disappears in the morning? I don’t get it. Finally, Sears tips his hand. He’s okay with you having sex in front of your baby. Fine for him and Martha (I really could do without descriptions of Sears’ own sex life). We Philistines value our privacy.

Sears the Lumper

Much as he tries to squeeze baby-led sleep schedules out of his Attachment Parenting system, at the end of the day, Sears can’t do it. He’s a combination-scheduler as much as Ferber, Spock, and Tracy Hogg, the Baby Whisperer. The place where Attachment Parenting falls down is its failure to appreciate the dangers of developing bad sleep associations. I’ll qualify that statement. If mothers and their sleeping partners are okay with a toddler who shares their bed wakes up every three hours to nurse at night, then God bless them!  Who am I to judge? But when they come to me for help them get the child to sleep through the night, I do indeed have an an argument. An argument with Dr. Sears.

The Baby Whisperer and Combination Schedules

What are “Combination Sleep Schedules“?

They are considered to be compromises between “Parent-led” and “Baby-led” methods. According to Babycenter.com, “…combination schedules provide the consistency that babies and parents need without the hassle of a more rigid, timed-to-the-minute routine.”

The best example of the method is Tracy Hogg’s “Secrets of the Baby Whisperer“, co-written by Melinda Blau.

combinaiton
Word to the Whisperer

I argue (here, and here, for example) that pretty much everybody in the baby sleep world offers some kind of compromise between both camps. It’s only a matter of degree. But Hogg (who left us far too early in 2004) provides us with the best explanation of a common-sense baby care, spun in a Yorkshire accent.

Combination or Common Sense?

I will not be the first reviewer to point out that, for all it’s acronyms and British accents, “Baby Whisperer” essentially offers good old-fashioned common sense. As such, Hogg places herself in the tradition of Ben Spock. Hogg concludes her book, in part, like this:

My wish for you is to relish every moment, even the tough ones. My goal is to give you not merely information or skills, but something even more important: confidence in yourself and in your own ability to solve problems.

Sound familiar? It should. It’s a version of Spock’s famous “Trust Yourself” formula that rocked the parenting world fifty years prior. By 2001, it was old-fashioned advice!

Need a SLEEP CONSULTANT?

But the book is not entirely derivative, and there is even a fair amount of innovation (Hogg’s acronyms, E.A.S.Y., and S.L.O.W. (see below) are unique, as far as I know). Her major contribution to the field is her emphasis on parents paying attention to their babies, engaging them in a kind of conversation. Hogg is on to something here. It is almost certainly the case that human communication begins at a very early age, perhaps the earliest of ages. Hogg is right to suggest to parent that they appreciate the “messages” that their babies send them, and to communicate back in real human language.

Baby Talk

My only quibble with Hogg’s suggestion is her tendency to echo an annoying pattern of speech in which parents refer to themselves in the third person. “Mummy will be right back”. “Mummy doesn’t like it when you do that”.

Pronouns are hard. Pronouns are hard for anybody learning a language, even their first language. Anybody learning a new language knows that you understand more than you speak at every point along the learning curve. Children understand you when you say “I” and “me”. They will muff the pronouns when they try them out, but they understand you. For heaven’s sake, people, if we are to converse respectfully with our children, let us respect their ability to understand pronouns!

S.L.O.W. Down and Take it E.A.S.Y.

Hogg doesn’t say this explicitly, so I just did it for her: Baby Whisperer philosophy is based on slowing down, taking deep breaths, and listening to your baby. Both acronyms, as corny as they sound, help anxious hurried parents get to know their babies.

S = Stop; L = Listen; O = Observe; W = What’s up? (Hey, she needed a “W”, right?)  In other words, absorb what you’ve heard and seen and evaluate what’s going on for your baby. It’s a bracingly simple and effective tool. I wish I had such an acronym to recite while walking the floor with my colicky first-born! Cleverness aside, it’s important to remember that your baby is a human being that is learning to interact with the world via communication. Hogg reminds us we do better to start early.

combination
Yet more possible combinations

Another of Hogg’s contributions to the baby sleep literature is her clever E.A.S.Y. acronym. E = Eat; A = Activity; S = Sleep; Y = You. The innovation is the insertion of activity between eating and sleeping. This way, parents will avoid the temptation to allow their babies to develop bad sleep associations. To do this, it’s important to separate feeding from the moment of sleep. The activity needn’t be anything stimulating: to the contrary, stimulation prior to sleep is never a good thing. Hogg recommends changing the diaper, singing a song, reading a book, etc.

As for the “Y”, I suspect Hogg needed another letter to spell a nice word. Otherwise, I can’t see why she included it. Hogg really doesn’t need to tell mothers to eat, take a shower, sleep, etc. She doesn’t go as far as Baby Wise Gary Ezzo, who recommends “Date Night” for parents. Indeed, for parents without extended family or disposable income to pay a baby sitter, the latter really isn’t possible. Hogg’s Hollywood clientele could afford it perhaps, but not us normal folk. Surely mothers need to care for themselves, otherwise they’d soon be incapable of taking care of their babies. I’m just not sure they need to be told this. I’m going to stick with the suggestion that she needed the letter “Y”.

One More Abbreviation

Hogg ends the book with an excelling “troubleshooting” chapter, featuring the mnemonic ABC. A = Antecedent. What came before the sleep problem? (Kudos to Hogg for using the word “antecedent”: it’s a dying word, I fear). B = Behavior. What is your baby’s part in starting this sleep problem? C = Consequences. What was kind of pattern resulted from A and B? Usually, the problem to be solved is a bad sleep association, and Hogg walks us through the disassociation process. But I suspect that the ABC method could help unpack other sleep problems as well.

Finally

As I’ve said before, I’m a lumper and not a splitter. And as such I’ve argued that we’re all basically “combination schedulers” now. I say this because experts from Ezzo at the parent-led end of the spectrum, to Sears at the baby-led end, all recommend following a baby’s cues, but providing her with structure. To Tracy Hogg’s credit, she says this explicitly.

We’re all Baby Whisperers now. Or we should be anyway.

combination2 combination1

Baby Wise: Parent-led Schedules

Ezzo, Gary, and Bucknam, R. “On Becoming Baby Wise”. Mount Pleasant, SC: Parent-Wise Solutions, 2012

Gary Ezzo is a lucky man.

“On Becoming Baby Wise”, as of this writing, ranks #1 for sleep disorders in Amazon Books. This fact speaks volumes for the message, especially in light of the fact that the messenger, Mr. Ezzo, has been the recipient of some withering criticism for his parenting advice, but especially for his religious beliefs. Some of that criticism, sadly, comes from Ezzo’s own church, or I should say former church. Despite all this, the Ezzo collection has grown to nine volumes. That’s impressive.

baby wise X

When I read “Baby Wise” for the first time, I detected no hint of any religious world-view whatsoever. I did not know of the controversy surrounding Mr. Ezzo and I’m glad I didn’t. I appreciate that the first edition of the book expressed this world-view explicitly. Not so with subsequent versions.

My ignorance allowed me to judge the “Baby Wise” message without regard to the messenger. This is as it should be. Here’s what I took away from it:

Baby Wise

The lesson I took away was the commonsense observation that a baby who has just finished a good feeding is probably not hungry. If one hour later, the baby starts fussing and crying, many experienced parents understand that what is bothering the baby cannot be hunger. Because the baby just ate! “Baby Wise” suggests that parents first seek to find what’s bothering the baby before reflexively feeding her.

This is what happens in the real world. What mother has not looked into the bassinet at her crying baby (whom she finished nursing 30 minutes ago) and thought, “You can’t be hungry, I just fed you!” Mom then proceeds to see if the baby had gas, or needed a diaper change.

Another Fact of Life

“Baby Wise” recognizes a fact of life about babies: they are not born knowing how to get along in this world. They are equipped with certain biological set-points, but becoming a person requires nurture as well as nature. Most parents understand this implicitly.

Need a SLEEP CONSULTANT?

Ezzo suggests that babies need to be nudged, gently, in the direction of sleeping when it’s time to sleep and eating when it’s time to eat. This may involve staying with the baby for a few minutes to stroke her back, to sing to her, or to give her a fingertip to suck on. I believe that even parents dedicated to attachment methods recognize this truth. I believe “attachment parents” do a fair bit of nudging themselves, though they might not care to acknowledge it!

Baby Wise Claims the High Middle Ground

It has become fashionable in the Baby Sleep World to claim that one’s own method is “centrist” or a “combination method“, and that all the others are either “baby-led” or “parent-led” extremists. Everyone clamors for the exalted, er, middle ground. Ezzo is no exception.

[Parent-directed feeding] is the center point between hyper-scheduling and the re-attachment theories. It has enough structure to bring security and order to a baby’s world, yet enough flexibility to give Mom the freedom to respond to any need at any time. It is a proactive style of parenting that helps foster healthy growth and optimal development. For example, a baby cannot maximize learning without experiencing optimal alertness, and he can only experience optimal alertness with optimal sleep. Optimal sleep is tied to good naps and established nighttime sleep. These advanced levels of sleep are the end result of consistent feedings. Consistent feedings come from establishing a healthy routine.

baby wise
Who’s the director?

Ezzo then goes on to mis-characterize the so-called “baby-led schedule” and “attachment theories” and exhumes the body of Luther Emmett Holt’s clock-feeding schedule.

I wish Ezzo and others were lumpers instead of splitters. We are all “combination schedulers” now. This is where the “debate” has led us.

Off the Rails

Where Ezzo over-promises and under-delivers comes with his discussion of sleeping through the night.

In fact, healthy, full-term babies are born with the capacity to achieve 7-8 hours of continuous nighttime sleep between seven and ten weeks of age and 10 to 12 hours of sleep by twelve weeks of age. But these achievements require parental guidance and a basic understanding of how a baby’s routine impacts healthy outcomes.

I’m not sure where Ezzo gets these optimistic numbers from, but they do not square with observed data, as in this study:

Continuous night-time sleep for at least 6 hours was noted in 35% of the infants under 3 months old and the proportion increased to 72% by the age of 9–12 months. The youngest infants were fed on average 6–7 times per day at 2- to 3-hour intervals in the daytime and at 4- to 6-hour intervals at night.

Ezzo also nods with his misunderstanding of circadian rhythm. “Babies do not have the ability to organize their own days and nights into predictable rhythms, but they have the biological need to do so.” In fact, babies do have the ability to organize day and night, if they are permitted allow synchronize their sleep-wake cycle with the cycle of day and night. This requires no effort on the parents’ part at all. Just allow daytime to be light and nighttime to be dark. You don’t need to train the sun.

I’m not sure what Ezzo means by a “biological need” to organize day and night. There’s a need to sleep, and it’s probably the case that we do better when we sleep long periods at night. Is this what Ezzo means? Perhaps.

baby wise
Oops. Ran out of track

Back on Track

The remainder of the book gives solid common-sense advice about the hazards of overstimulation and bad sleep associations (though Ezzo refers to the latter as “props”, confusing cause and effect). The chapters on crying, feeding, baby care and troubleshooting are all pretty standard fare.

In short, the similarities between Baby Wise and other baby sleep books are greater than the differences. The latter are cosmetic, the exceptions having been noted.

Summary

  • Ezzo may be a religious man, but “Baby Wise” is not a religious book
  • Apart from some unrealistic expectation management regarding uninterrupted sleep at night, the advice is solid.

Hail Spock! Leader of the Baby-led Schedule Revolution

Spock, Benjamin M., “The Commonsense Book of Baby and Child Care (9th ed)”. New York: Skyhorse Publishing, 2012

Maier, T., “Dr. Spock, An American Life”. New York: Harcourt Brace & Co, 1998

You Say You Want a Revolution?

Vladimir Putin and Czar Nicholas II walk into a bar and order a bottle of vodka.  After the third or fourth shot, Nicholas begins to reminisce:

“My Okhrana (secret police) would do anything I asked. They were totally loyal to me.”

“Your Excellency,” Putin replies  “my KGB is just as loyal as your beloved Okhrana.”

“Ah, but I could send my enemies to katorga (prison camp) with a wave of my hand!” Nicholas protested.

Putin is unfazed. “Your Excellency, I have just as many enemies in my gulags.”

Czar ruminates over his vodka. “Well, at least I had the best 70 proof vodka in the world…”

Putin springs to his feet. “Your Excellency, today Russian vodka is 75 proof!!!”

“For this,” the Czar smirks, “you had a revolution?”

Ben Spock, Revolutionary

Spock
Spock. True Revolutionary

The point of the story is that political revolutions don’t change things all that much. Cultural revolutions are more uncommon than political revolutions, and they are rarely led by individuals. Spock’s was such a revolution. Spock’s “Baby and Child Care” upended the entire enterprise of raising children. Spock raised up the infant and child from the status of mute object of parenting to the subject of parenting, actors to be listened to and respected. Put that in your gulag and persecute it, Vlady!

The Cultural Context

Spock came along in at a very particular time, and in a particular cultural context that was essential for making his revolution possible. Fifty years earlier, in 1900, an Austrian neurologist named Sigmund Freud published Die Traumdeutung (On the Interpretation of Dreams), launching a thought revolution that to this day influences the way we think about ourselves.

Spock underwent Freudian psychoanalysis after medical school at Columbia. Through analysis, Spock learned that his own insecurities and anxieties were the result of his rigid upbringing in New Haven, Connecticut. Spock’s mother forced her children to sleep on a porch, even in winter. Spock and his siblings were subjected to strict rules and schedules. Though Baby and Child Care never says so explicitly, Spock’s philosophy is heavily influenced by Freudianism.

Need a SLEEP CONSULTANT?

At mid-century, the cultural ground was prepared for suggestions that leaders could be challenged and their authority questioned. The reasons for this are complicated and require a book-length discussion. It’s possible that the experience of two world wars and a post-war baby boom spawned a libertarian uprising in which ordinary people cast off traditional authority and began to assert self-rule and self-ownership.

spock
Mere poser

Spock Steps Up

So when Spock entered the stage advising mothers “Trust yourself. You know more than you think you do,” he was delivering a message mothers were ready to hear. Drawing on his experience in psychoanalysis, Spock suggested that mothers trust their own instincts, and not to bow to so-called experts, including himself. However, especially in early editions of the book, Spock never lets go of the authoritarian impulse to tell mothers how to raise their children. He insists throughout that mothers should listen to the pediatrician. I credit my mother for pointing out that Spock begins his book by telling mothers they know more than they think they do; then he describes in exquisite detail all the things mothers don’t know, like how to fold a diaper.

Trust yourself. You know more than you think you do.

In the 1950’s and 60’s Spock began to draw the ire of his colleagues for publishing articles in Ladies Home Journal. It was thought that a physician should not lower himself to publishing in the lay press. If he should write at all, a physician should publish in scholarly journals only. Imagine what Spock’s stodgy colleagues would think of physician bloggers!

Trouble

Spock got himself into even more trouble with his colleagues by his vocal opposition to the Vietnam War. He was blamed (incorrectly, in my view) with creating a generation of unpatriotic children raised in permissive homes. Of course, even a cursory reading of Spock reveals no advocacy of permissiveness. Nevertheless, in later editions, Spock felt compelled by his critics to emphasize that parents set limits and enforce them. It’s clear to me that Spock never thought otherwise about the importance of parental limit-setting. He would edit subsequent editions as well to placate feminists who criticized the book for suggesting that mothers stay at home with their children. Spock’s compulsion to please his critics is a failure on his part, in my view. He had authored a book that was more popular than the works of Shakespeare, and sold more copies than any volume other than the Bible. He didn’t need to bow to anyone.

Spock
Nope.

Spock Wins

If  there were only one contribution that “Baby and Child Care” made to the modern world of parenting (and their were actually several), it would be the introduction of “on-demand” infant feeding. Spock made what in retrospect is an uncontroversial suggestion: babies eat when they are hungry. Babies grow best when parents obey hunger signals and feed the baby when she appears hungry. On demand feeding was in fact controversial at the time because the “official recommendation” of scientific pediatrics was strict schedule feeding. Eventually, on demand feeding won the endorsement of the American Academy of Pediatrics.

But schedules and routines never went away entirely and are with us until today. In fact, most experts (present company included) recommend routine and consistency as pillars of health and well-being for infants and children. Perhaps it is this uneasy balance between on-demand and strict scheduling that gives rise to our contemporary division between “baby-led” and “parent-led” camps.

Because I’m a lumper and not a splitter, I don’t see much of a distinction between the two groups. I agree, based on my training and experience, that routine and consistency are most conducive to health and well-being of children. I also acknowledge that you cannot force a baby to sleep who is not sleepy. That’s just a fact of life. I consider it cruel and unusual to force a tired baby to stay awake. I would go further and say that so-called “baby-led schedule” advocates agree that routine is important, and so-called “parent-led schedule” advocates acknowledge that babies are not digital timers. “Combination schedule” advocates only offer recommendations that differ in style, but not in substance.

In future posts I hope to delve a bit deeper into the various schools of thought about schedules.

mao-1028505__180

Sleep Schedules: Who Makes Them?

New parents who buy baby books and browse the internet may come to believe, reasonably, that there are two basic “philosophies” of sleep schedules for babies: parent-led and baby-led. It’s true that there are different philosophies out there (including combination philosophies), but no philosophy ever made a baby schedule.

“Schedule” is a funny word. In English the word schedule implies a scheduler, someone who makes the schedule. I explain to my clients that sleep schedules are a lot less scheduled than parents care to admit.

The philosophy I share with my clients is based on my belief that sleep schedules are a type of spontaneous order: The baby sleeps and eats at (roughly) the same time every day. It looks like a schedule! In fact, it is a schedule. But there was no scheduler.

Need a SLEEP CONSULTANT?

I’ll get to my account of where I believe the two philosophies came from. But first, a word about the tendency to divide the world into groups.

Lumpers and Splitters

baby schedules
Thiago Splitter

There world is divided into two parts: People who divide the world into two parts and people who don’t. That’s a joke, of course. But like many jokes, it reveals a truth about human nature. Some people are “splitters” and some are “lumpers”.

Splitters tend to see the world as divided up into categories. The task of the splitter is to find the appropriate category for everything. A splitter asks “how is this thing different from that thing?”

The world is divided into two parts: People who divide the world into two parts, and people who don’t.

sleep schedules
He is a lumper. Look it up

Lumpers tend to see the world as a series of connections among things. The task of the lumper is to find ways to lump everything into as few categories as possible. A lumper asks “how is this thing like that thing?”

 

I am a lumper by nature. I don’t know how or why I got this way. For me, lumping is the most intellectually-satisfying way to make sense of the world.  It informs the way I look at sleep schedules. Having said that, I don’t “lump together” the various sleep schedule philosophies into one group. Rather, I believe that the various philosophies arrive at the same end-point: the child (and parents) settle into a pattern that appears to be a schedule. Babies contribute to the development of a schedule, and parents play a role as well, but there is an important third party that plays a crucial role as well. I’ll get to that at the end of this post.

Baby Sleep Schedules: Parent-led vs. Baby-led

Prior to the 19th century, nobody thought much about baby sleep schedules, either parent-led, or baby-led. The concepts simply didn’t exist. All a mother had to guide her was the advice and counsel of experienced mothers in her community, first and foremost her own mother. Therefore, if one could say that there were such a thing as child-rearing philosophies, these were traditional philosophies. That is to say they were based on tradition: familial and cultural.

In mid-19th century, coincident with the creation of pediatrics as a medical specialty, there emerged what could be called the “era of scientific parenting”. Pediatrics came into being to solve two problems: infant mortality and malnutrition. By the middle of the 20th century, both problems had been largely solved in the developed world, leaving pediatrics, temporarily, with no reason for being.

The Origins of the Parent-led Schedule

sleep schedules
Luther Emmett Holt, MD

One of the giants of the early days scientific parenting was Luther Emmett Holt, who in 1894 published “The Care and Feeding of Children“. Originally intended as a teaching manual for nurses in New York City, Holt’s book quickly spread in popularity to the reading public. It takes the form of an extended FAQ, with questions and short answers.

The section on sleep in Holt’s book is remarkably brief. Holt’s advice is clearly prescriptive, particularly with respect to feeding and sleeping:

How can a baby be taught to be regular in its habits of feeding and sleeping?

By always feeding at regular intervals and putting to sleep at exactly the same time every day and evening.

When should regular training be begun?

During the first week of life. (p 109)

Holt may not have invented parent-led schedules, but the publication of his book gave the imprimatur of the medical establishment to the method.

The Baby-led Revolution

sleep schedules
Spock

Holt’s prescriptions lasted about 60 years, until the publication in 1946 of a book called “The Commonsense Book of Baby and Child Care” by a Connecticut pediatrician named Benjamin Spock.

“Trust Yourself. You know more than you think you do.” With this famous opening line, Spock fired the first shot at medical establishment prescriptions about feeding and sleeping. Spock counseled parents to trust their own instincts and to pay attention to the baby and her signals. It’s difficult to imagine just how controversial this idea was in the mid-20th century. These ideas were so dangerous to his own standing in the medical establishment that Spock couches his recommendations in extremely cautious language. In his chapter called “Schedules”, Spock begins by saying

“Your doctor will prescribe the baby’s schedule on the basis of his needs, and you should consult him about any changes. The following sections are mainly a general discussion of what schedules are all about…”

But Spock then goes on to argue, persuasively in my view, that baby-led feeding and sleeping habits pre-date “scientific pediatrics” and have been in fact the way babies have fed and slept from the beginning of time until Holt. Spock advocates an essentially baby-led feeding and sleeping schedule, and he endured a barrage of criticism because of it. He nevertheless prevailed, and until the modern resurgence of the parent-led schedule movement, Spock reigned.

The Sun

It’s human nature to see a pattern and to conclude that someone created the pattern. Such is the case with sleep schedules. By a few months of age, most babies tend to sleep and eat at about the same times every day. Some people believe that parents were essential to creation of the schedule. Not coincidentally, these tend to be people who favor parent-led methods of child rearing. Others, who favor baby-led methods, believe that the baby made the schedule.

sleep schedules
The rhythm

Both camps ignore the crucial role played by light. From a very early age, babies start to sleep longer at night, and to stay awake longer throughout the day. How do they do this? The light that strikes their eyes causes them to synchronize their sleep-wake cycles to night and day. We get sleepy at night and alert during the day.  All the baby needs to do to synchronize this “circadian rhythm” to day and night is to see light during the day, and to see darkness at night.

So parents and babies rely on the crucial participation of a third partner: the sun. Little babies wake up when they are hungry and then fall back asleep, but with time, they develop a circadian rhythm that is tuned to the day-night cycle. They sleep longer during the night and less during the day. The sun helps push them into a schedule, as much or more than they schedule themselves, and more than parents schedule them.

The system isn’t perfect. No system is. The schedule gets thrown off. Babies have busy days, they get overstimulated. They get sick and need more comfort. But the basic schedule remains unchanged and so do the influences that created the schedule.

How do you create a good sleep/feed schedule? The best advice I can give is to stop trying to make a schedule and allow the schedule to make itself.