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