Wednesday, November 28, 2012

The Sleep Debate

We received the following comment from a Help Me Grow mom on Facebook:

"Help! My daughter is 4 months old and her pediatrician says now is the time to teach her to "self soothe" by letting her cry during the night. It's kind of now or never since she'll be rolling around and crawling soon and she might need help during the night. He said she'd cry for 40-60 minutes the first night, then less and less each night after and she'll be sleeping through the night in a week. Is it worth it to abandon her for a week to teach her to sleep? She's so happy, giggly, and snugly now. I'm afraid if I let her "cry it out" she won't trust me anymore and won't be so happy. I'd rather get up with her during the night if it means she'll be happy and psychologically healthy, but if it won't hurt her, I'm doing it. Her Dr. said it won't scar her, but I'd like your input too."

In response to this comment, we thought it would be a great idea for us to compile information about different sleep methods or tips!

The most important thing to remember is that there is no one right solution for every family or every baby

One of the most heard-of sleep training methods is the Ferber Method, sometimes referred to as the "cry-it-out" method. While Richard Ferber never actually uses the phrase "cry-it-out" it has become almost synonyms with his method because of its popularity. "Cry-it-out" actually refers to any method that says that some crying is often a side-effect of developing a normal, healthy sleep routine. The goal of these methods is to teach children to self-soothe so that they can use these techniques when they wake in the middle of the night or during nap times.

Here is a quick run-down of the Ferber Method:
  • Create a warm, loving bedtime routine that ends in putting baby to sleep awake and leaving them for longer periods of time, gradually, even if they cry. Ferber believes that putting your child to sleep awake teaches how to go to sleep on their own.
  • At the predetermined intervals, go in and check on baby. These intervals can be set by you and depend on how comfortable you are with leaving the child; ideally though, these should increase as the process continues. Patting or comforting baby is acceptable during these periods, but do not pick up or feed baby. This process is referred to as "progressive waiting." 
    • In his book Ferber suggests the following intervals:
      • 1st night--leave for three minutes the first time, five the second time, and ten the third and all subsequent times.
      • 2nd night--leave for five minutes the first time, then ten, then 12 for all subsequent times.
      • 3rd night and beyond--make intervals progressively longer
  • Ferber says that after about a week, baby should learn to fall asleep on their own.
  • The Ferber method does not propagate leaving baby to cry alone in their crib until they fall asleep. The progressive waiting approach encourages mom or dad to check in on baby but parents are encouraged to gradually limit the amount of time spent in the room.
"Simply leaving a child in a crib to cry for long periods alone until he falls asleep, no matter how long it takes, is not an approach I approve of. On the contrary, many of the approaches I recommend are designed specifically to avoid unnecessary crying."
 - Richard Ferber
But for those who don't feel like this is a good fit for them (and it's not for everyone), there are other sleep options. Pediatrician William Sears, parent educator Elizabeth Pantley, and registered nurse Tracy Hogg are three opponents of the Ferber method. 

Dr. Sears, an advocate of attachment parent, suggest "co-sleeping, rocking and nursing your baby to sleep, and other forms of physical closeness to create positive sleep associations now and healthy sleep habits down the road" (quote from here). His website offers 31 Ways to Get Your Baby to Sleep and Stay Asleep

Photo credit
While Sears provides many great suggestions, it's important to remember the American Academy of Pediatrics' (AAP) stance on bed-sharing (sometimes broadly referred to as co-sleeping). The AAP does not recommend bed-sharing, as it increases the risks of SIDS. There are, however, safe alternatives (like the one pictured to the right) that provide many of the same benefits as bed-sharing, without the risks.
Tracy Hoggs, author of Secrets of the Baby Whisperer, offers a middle ground between Ferber and Sears. She propagates positive sleep associations, but unlike Sears, disagrees with the use of props (such as breastfeeding, rocking to sleep, etc.). Rather, she suggests responding to baby every time they cry by picking them up and putting them back down. According to Hoggs, this can be done as many times as is necessary and it will help continue the relationship of trust.

Elizabeth Pantley, author of The No-Cry Sleep Solution, offers a similar solution to Sears. She emphasizes a "gentle and gradual approach to all aspects of sleep, customized to your baby's needs" and recommends "rocking and feeding your baby to the point of drowsiness before putting him down--and responding immediately if he cries" (quote from here). Her website offers many tips and pamphlets with baby-focused sleep suggests that encourage closeness and security in the sleep-training process. 

The thing about all these "sleep solutions" is that not even the experts can agree! Parents should choose the option that works best for them, or combine aspects of each that they like. If you try one way and it's not working, try another! 

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