Infant Sleep and the Experts, Part I

Many parents have told me they found sleep deprivation to be the hardest part of new parenting. And indeed, being tired and, potentially, grouchy (and having a tired and grouchy spouse … not that I would know anything about that…but my husband might) makes every other aspect of life more challenging. The proliferation of books and articles promising to help babies sleep better is thus no surprise. We, too, have fought the sleep battle with our now six-month-old, and I have had a chance to review a few of the popular publications on the subject.

I should note that I began my research with a bias. Seven or eight years ago a friend who had just given birth for the second time told me she and her husband give a copy of Gary Ezzo’s Babywise to all their newly pregnant friends because of the dramatic results in their own family. Their son slept through the night from infancy and they never had problems getting him to go to bed. Not long afterward, however, another friend studying to be a counselor said one of her professors told the students that children brought up with Babywise would be their future clients. Then, in the fall of 2000, I ran across an article in Christianity Today highlighting the not only philosophical but ethical concerns with Babywise and its author. (Click here for an intro to the article, available in full in CT archives: CT on Babywise.) In brief, some of the principal objections to Ezzo are that he has claimed degrees and professional qualifications he does not have, his rigid feeding and sleep schedules do not reflect a sound knowledge of pediatrics and child development, and his claims for the scriptural authority of his approach, which he calls “Growing Kids God’s Way,” are tenuous.

With this background, I read with some skepticism when a friend with a one-year-old introduced me to the scheduled sleep program outlined in Marc Weissbluth’s Healthy Sleep Habits, Happy Child. Weissbluth is an MD and author who specializes in sleep issues among children. His book had been my friend’s salvation. She read it when her sleepless son was four or five months old and she and her husband were desperate for relief.

Weissbluth’s schedules and his reassurances that allowing babies to cry themselves to sleep is harmless called to mind Babywise techniques. However, Weissbluth does not recommend allowing children under four months of age to cry unattended, nor does he say that healthy sleep habits require parents to let their babies cry after they reach four months. But he says parents should adhere consistently to whatever method they choose for putting their children to bed, and since for many it is impractical to rock a child to sleep every night and naptime, most parents find it more effective to let their children cry it out for a few nights and learn to put themselves to sleep. He writes that if parents take this approach, they should let their children cry for no more than an hour at naptime, and he places no restriction on how long babies should be allowed to cry when going down for the night (159).

Personally, I could never listen to my daughter cry for an hour. Weissbluth attempts to assuage guilt by assuring parents they are doing the best thing for their children by helping them get the sleep they need. He alleges that attachment theory–or at least what he calls the popular distortion of it–is a “myth” (155). He cites one 1997 article to support this claim, but many of his other references for the chapter in which this statement appears are from the ’50s through the ’70s. A great deal of research has been done on attachment and attachment disorders since this Healthy Sleep Habits was originally published in 1985 (this edition does claim to be “completely revised and expanded”), and I suspect there are at least an equal number of theorists on both sides of this issue. (More on attachment in the next post.)

I did glean a great deal of useful information from Weissbluth regarding the science of sleep and infant sleep needs. Weissbluth’s basic message is that babies and children need more sleep than most parents realize. An important message in itself. But his method for enabling children to get this sleep is so prescriptive that I found it formidable and frustrating to embrace. My efforts to adhere to the regimen he prescribes for naps and nighttime increased the stress I was already feeling from dealing with a child who didn’t want to sleep. When asked, my pediatrician told me she also considers Weissbluth’s approach excessively rigid and said she has found that a more flexible sleep pattern works fine for most families.

Secrets of the Baby Whisperer, by Tracy Hogg, is not exclusively about infant sleep, but sleep is an important element of Hogg’s E.A.S.Y. (Eat, Activity, Sleep, Your time) program. Hogg is a midwife, RN, and consultant for families who can’t get their babies to sleep. She, too, has some valuable wisdom to offer. I appreciated that she emphasizes respect for babies, although I didn’t always agree with the form this takes. (For example, she considers it disrespectful to allow babies to sleep in the living room or other “high-traffic” area. Why, if the presence of other people does not disturb them?) She also does not advocate allowing babies to cry alone. Instead, she recommends picking the child up every time he cries, soothing him, and then laying him back down until he cries again. Tedious, but apparently effective. And, some would say, less tedious than rocking to sleep every night and naptime.

However, I disagree with Hogg on other points. She strongly discourages allowing babies to sleep in their parents’ bed (Weissbluth is neutral on this point), arguing that babies need to learn independence. When questioned as to why she would start encouraging independence at birth, she asks, “Well, when would you start?” (173). A phrase she repeats often is that parents need to “start as you mean to go on” (172). Such a statement, however, seems to ignore the fact that babies have different needs at different developmental stages. Couldn’t you rock a baby to sleep in the beginning and adopt a different method later on? (Weissbluth suggests that you can [124-126].) Thus, she advises always putting baby to bed before he has fallen asleep so that he learns to put himself to sleep. That’s why “Eating” and “Sleep” are separated in her acronym by “Activity.”

Hogg tells parents to trust their intuition (17), but she insists that babies should only be held and cuddled–apparently at any time, not just bedtime–when they are crying. Otherwise, they will get used to being held and become unhappy when left on their own (260). Surely, though, such a policy goes against every maternal (and paternal, for that matter) instinct to hold and cuddle one’s baby. Pity the content baby who rarely cries and rarely gets held! Perhaps Hogg would say, Bravo! She’ll develop early independence. But surely this will happen soon enough, in toddlerhood.^1,2

In a discussion of the recent “fads,” Hogg explains the rationale for her “sensible sleep” philosophy. She writes that if you are either sleeping with your baby or have established a sleep schedule by letting him cry it out and your chosen method is working for you, by all means stick with it. She says, however, that most of the parents who contact her for help have begun with a method at one end of the spectrum and, upon finding it doesn’t work for them, made a radical swing in the opposite direction, confusing the baby, traumatizing themselves and ending in sleeplessness for the whole family (171-72). Thus her advice to “start as you mean to go on.” Understandable, but it does seem that more gradual change is possible if the ideal you envisioned before birth does not pan out.

Come back for Part II of this discussion in the next post, which will focus on publications by William and Martha Sears.

Notes:
1. In The New Baby Planner, William Sears discusses studies that indicate that prolonged holding of infants does not result in overindulgence or excessive dependence (31-32).
2. It is not directly a sleep issue, but it also concerns me that Hogg seems to give equal weight to the arguments for and against breastfeeding (92-98). Certainly women who can’t breastfeed should not be made to feel guilty. But all new mothers should also be aware of the risks of not breastfeeding–so significant that the US Health Department of Health and Human Services has launched a Breastfeeding Awareness Campaign. (Click here for more: National breastfeeding campaign)

References:

Hogg, Tracy, with Melinda Blau. Secrets of the Baby Whisperer. New York: Ballantine Books, 2001.

Sears, William, and Martha Sears. The New Baby Planner. Nashville: Thomas Nelson, 1994.

Thile, Kathy. “Timeline of Ezzo Controversy” on ezzo.info, owner Steve Rein. www.ezzo.info/Timeline/timeline1.htm. Accessed 3 Aug 2007.

US Department of Health and Human Services, womenshealth.gov. “Breastfeeding–Best for Baby, Best for Mom.” www.4women.gov/breastfeeding. Accessed 1 Aug 2007.

Weissbluth, Marc. Healthy Sleep Habits, Happy Child, revised ed. New York: Fawcett Books (The Ballantine Publishing Group), 1999.

*Note: Author of ezzo.info site added August 3, 2007.