What I learned in Graduate School About Sleep
Sleep is a natural state most mammals, especially babies, seek as a restorative state needed for the body to repair all the horrible things that came at it while it was awake. There are two main schools of thought about sleeping. Parents who fallow the Attachment Parenting philosophy advocate for a family bed until each child decides they want to sleep on their own. I do not personally ascribe to this approach, but to each his or her own. I can’t imagine getting a good night sleep myself with a foot or four in my mouth and, let’s face it, being married and a parent is hard enough without several marital bi-products in the bed! (I’m joking of course, I love and adore my children and they are not mere bi-products!) If you are practicing Attachment Parenting, you probably want to skip what I have to say about sleep.
The opposite point of view, in theory, can seem pretty ridged. A baby should sleep in his or her crib from the first night home until forever. Never, ever, let your children sleep with you because 1) our culture values independence and if you sleep with children you will make them horribly dependent or 2) you might roll over on them and smush the little things! Children need to practice calming themselves down to sleep without the use of mothers, fathers, pacifiers, security objects, music, white noise, etcetera because if they get used to having something help them go to sleep they will not be able to do it on their own. Additionally, if parents forget the child’s blankie etcetera while away, their child will scream bloody murder the whole night, which is not good.
There are some books out there that attempt to teach parents to get in tune with their babies so that they can teach them to sleep without the all or nothing approach. I don’t see any harm in these approaches, but, practically, I could not have kept all the charts and taken all the steps the authors give as solutions. My mother guilt immediately kicks in after that last statement as my brain says, “I thought you would do anything for your kids?” It’s just not in my nature. I am somewhat disorganized in an organized sort of way and sticking to a strict set of rules with a new baby is not very practical to me.
What I have Learned About Sleep in my Practice
I have seen many kids in my practice that start out in their own bed, but become co-sleepers along the way, many times because of anxiety. Usually the anxiety starts with the child about storms or something that scared them in a movie or TV show. Both parents, especially moms, and children can then develop anticipatory anxiety about going to sleep. Parent and child sometimes worry, long before bedtime, whether the child will be able to get to sleep that night. Parents may also worry about having another terrible night of “bad” behavior surrounding sleep and bedtime.
Another common time parents sleep with their children is after a divorce or while single parenting. Single parenting is one of the most difficult jobs, EVER! I have never been able to look at a single parent and say “stop sleeping with your kid!” As soon as my husband went out of town, sleeping with one or both of my kids was the first thing I wanted to do! I always fought the urge (see what I was taught in graduate school section above) because I thought I would damage them. I’m pretty sure their dad did not feel the same way!
Most people probably land somewhere in the middle of the two view points. When one of our kids was sick or scared they usually were let in, albeit by their father because I am a three headed monster who would also think about what I learned in graduate school when woken in the middle of the night. What I know as a clinician is that it is true the older a child gets, the harder it is to get them to sleep in their own bed at night. So, choosing one approach and sticking with it most of the time is probably best.
There are a couple of things about sleep that I know now that I didn’t before I had my own children and my own clinical practice. One is that there seems to be prime developmental periods that children often experience disrupted sleep. Infancy, because temperamently they just don’t all seem to know how. I believe temperament plays a large role in whether a baby is a “good” or “bad” sleeper. In my clinic, I ask the parents of even teenage kids how they slept as babies. A lot of babies who had trouble sleeping have been shall we say, “high maintenance,” all or most of their lives. High maintenance does not mean bad, actually, it often means smart!
Other common times seem to be during developmental shifts in how kids think. Without giving an entire lecture on development, it’s the times when instinctually parents can tell something new needs to happen. For example, when you just get a feeling a child should move from crib to “big bed.” Change and transition are very difficult for some kids, even good transitions and change. Kids that have the most trouble are kids that are particularly sensory based. Meaning, certain children tend to be very intuitive and have a heightened awareness and are over responsive to clothes, food, light, noise, and /or socio-emotional information. They often times “feel deeply” and, therefore, changes in their developmental status send them into a bit of a tailspin until they get used to being a little more grown up.
In particular, some children between the ages of nine and twelve have problems getting to sleep. It may seen like they change overnight. They go from no problems to significant problems going to bed and falling asleep. Children between the ages of nine and twelve are what we have come to know as Tweens. I see many 6-9-year-old children who suddenly will not spend the night at a friend’s house and can’t explain why.
I believe a disruption in sleep during this time is due to the rumblings of the ability to reason abstractly which is actively beginning to develop during the teen years. A seven-year-old child is very concrete. When a parent tells them the noise at grandma’s was just the furnace turning on to keep them warm, a seven-year-old is more likely to believe and accept the explanation. An eleven-year-old child who starts reasoning at a higher level will interpret a noise at grandma’s house as “what if it’s a ghost?” Many of the kids that suddenly won’t sleep at this age, suddenly will again once they become adolescents because the brain changes again! By the way, it usually is not a life skill to be able to spend the night between the ages of 6 and 9. Politely make excuses like I did for my son such as, “he’s just not a big spend the nighter,” or “he is just a home body!” Believe me, he had no trouble as soon as he got to high school, when I really would have preferred that he not spend the night.
Practical Sleep Parenting or Stuff they didn’t Teach Me in Graduated School
Sleep in Babies
I always thought sleep was an instinct. That is, until I met my son, Nash. I had been in homes with colicky babies while doing research. He was not colicky. He just didn’t seem to need or know how to sleep! The first night home, I thought we had the best sleeper ever. The three of us slept in our finished basement because I had gotten the pregnancy-brained idea that the same number of steps down would be better than up after my C-section.
He had been placed in the basinet next to the horribly uncomfortable fold out couch (again, we had a perfectly fine, warm, and cozy bed upstairs!) I awoke in the middle of the night and realized he had not waken to eat like the nurses told me he would and should. When I reached in to see if he was still breathing, I realized he was frigid! Not cold, frigid. The good news was he was breathing. I snatched him up and put him in bed between us. I had not made it one night following my own advice.
Six to nine weeks later, when his pediatrician said that he was developing normally, meaning: gaining weight, growing within normal limits, and hitting his first milestones. I began to make him practice getting back to sleep without eating. Sleep practice. Also known in the professional literature as stretching. I will tell you what I did as a parent but it is not clinical advice. It does not mean it will work for you and your baby. You should ALWAYS ask your child’s pediatrician if this approach is feasible for your baby.
I was nursing when I started this process. I would make sure and feed on demand but not more than every two hours during the day. Then, I gave what is called a “focal feeding” between 10 and 11:00 p.m.. Between 11:00 p.m. and 5:00 a.m. was stretching time. Stretching refers to stretching the amount of time between feedings ONLY in the middle of the night. Anytime after 5:00 a.m. he went back on his on-demand but not more than every two hour schedule again.
When he would wake, I would immediately go to him and pick him up out of the crib. I left the room as dark as practical and did not talk to him. I was neutral. Never angry but not my happy, smiley, this lady is awesome, self. I would change his diaper in silence and then pick him up and held him with his head away from me. I didn’t want to torture the kid by holding him in a feeding position! Then, we would walk. We would walk around his room in silence. The goal is for the infant to know you are responsive, but that eating is not part of waking between 11:00 p.m. and 5:00 a.m..
For the first three or four days we walked for 10 minutes. Then I fed him and put him back into his bed, ideally drowsy but awake, but I found it very hard to keep him awake. Then, the next three or four days we walked for 15 minutes before I feed him. Slowly the time is lengthened so that the association is broken, only during the night, between waking and eating. His weight and height were monitored throughout the process until he did not wake between the hours of 11:00 p.m. and 5:00 a.m.. It has been shown that babies make up for what they do not eat during those night hours during regular feedings during the day. My son did not have any developmental or physical effects from stretching his feedings and was monitored by his pediatrician, Dr. Flint!
He cried the most while we were waiting out the 10 or more minutes, which of course made me feel a lot of mother guilt. It did work well and we were all sleeping between 11:00 p.m. and 5:00 a.m. by about eight or nine weeks after he was born. When Dr. Flint told me it was okay to give him cereal, he slept even longer.
The Modified Ferber Method and The Ferber Method
It all changed about the time he started one of those developmental changes I described above. Around a year or sometimes later, children naturally develop stranger anxiety. The biological purpose is so that they won’t just go with someone who isn’t their parent who may not take care of them and it keeps most kids from running away from parents which keeps them safe. Although clearly tired at 7:30 or so in the evening, he would not lye down and go to sleep. He had given up the pacifier at about three months on his own and his security blanket did nothing to ease the separation of bedtime.
The modified Ferber Method is basically the same as the stretching method I described above accept with an older child, usually still in the crib and not in ANY danger of falling or climbing out. Again, if you are not sure, ask your pediatrician. Instead of going in right away, waiting 10 minutes, and then feeding, the strongest willed parent waits first 5 minutes and then goes in and rubs their child’s back but doesn’t talk, turn on the light, or act fun/nice in anyway. Just neutral, never angry.
Gradually lengthen the time before going in. Always start with a short time and add minutes. Never the other way or you will teach a child to cry for 45 minutes before the parent comes in and then they will never get to the point where they get the feeling that things are just getting worse instead of better and they will give up.
I used the Ferber Method which is basically, the going cold turkey method, or not going in know matter how long the child cries. We had a baby monitor so we could sort of hear what was going on. Now there are camera monitors, which would have been awesome! The first night was the longest 45 minutes of my life! Even with all of my fancy training, I kept asking my husband, “Do you think he is okay?” He continuously pointed out that I was the one who was telling him what we needed to do! My son just kept saying Mamamama over and over. The next night it was 20 minutes and the next night it was 10. The fourth he did not cry.
What I encourage parents to do is what they know they can follow through with without caving. I knew that if I did not cave, it would not last more than 3 days. If it does last more than three days, check in with your pediatrician. If you can make it without caving, it is one of the first times your child will get the message that you are not a caver. No caving is a perfect set up for future discipline!
When a child has a sudden change in sleep habits, ask yourself a few questions. The first, “Is my child full of poop?” Sounds crazy, but constipation can cause night waking and behavior problems during the day! I will include a whole section on this website about poop and constipation in children so I won’t elaborate here. If you suspect your child might be constipated, check with your pediatrician. If they do not go a healthy amount for their age and the consistency is harder than peanut butter, especially if they are not having at least one bowel movement a day, you should check with your child’s pediatrician.
Another question to ask yourself is, “Is my child sensitive in general, and is this a time of some type of change or transition?” It could be a television program, company staying, a new daycare or preschool, kindergarten, and new pet or sibling, moving, a new bed, loss of a security object like a blankie, even happy events like holidays or birthdays can set a child into a new sleep habit. If significant disruptions like death or divorce are happening, sleep disruption would be the norm.
If a child suddenly starts having nightmares it is often in reaction to any or more of the above. Humans cycle through 5 different types of sleep every 90 minutes. Sleep quickly develops both positive and negative habits.
A quick and easy technique to try before calling a mental health professional or your pediatrician is a planned rousing. If your child has been having nightmares at about the same time each night, say 4:00 a.m., set an alarm for 3:30 a.m. and go in and rouse them enough to get a “what, huh, jfourlsjfljs” and let them go back to sleep. If the time they are having nightmares varies, rouse them around 10:30 or 11:00. Sometimes, rousing can disrupt the sleep habit or cycle just enough to reset the habit and the nightmares will stop. If they don’t, call your pediatrician.
Sleep is one of the things parents can’t make a child do. It is often a time of conflict because it is one of the few areas where children are in control. These two facts makes it a prime area of difficulty for parents. Times like these are cause for firm but loving parenting. No caving and positive reinforcement are the best way to make it through sleep problems. If your kids smell the fresh meat of doubt, it will stir them into an even bigger reaction!
There is a delicate balance between being firm and not caving and assessing if your child really needs you. One of my biggest regretful moments as a parent happened when my son was about three-years-old. My kids and I were at my mom’s house. My daughter, who arrived on this earth on sleep autopilot no matter what, was asleep in the same room in which my son was supposed to be asleep. He began crying out for me and became very upset. I went to him right away because we where not at home, and nicely told him to go to sleep, helped him back into bed, and made sure he had his Blankie. I left the room and he ran out after me, something he had never done away or at home. I did the same thing no less than 10 times, sometimes not so nicely, but never out of control, until I was almost in tears and didn’t know what to do.
What I wished I had done was go in, lay down with him, and stayed there until he was asleep. My rules and control issues got in the way. It turned out he had the start of an ear infection and I think he was also genuinely scared of the unfamiliar room and shadows of trees etc. moving outside. It was one night with a lot of change and transition and he was always so sensitive and intuitive. I botched it and still feel bad about it 14 years later! One night does not make a life of bad habits. I would have told myself what my son has told me a million times as a teenager, “Relax!”
Punishment means to force. Punishment for not sleeping or staying in bed never helps. If punishment appears to be helping, it’s because your children are scared of you and your actions. Punishment creates distrust between parents and children (see discipline). Staying calm and acting like you know what your doing will get you farther than you think toward catching some ZZZZs yourself!