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About this blog: I am a clinical psychologist, mother, and wife committed to using my life to help the lives of those around me. In addition to seeing clients in my private practice, I contribute to various training and research initiatives in cli...  (More)

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The Sleep Training Controversy

Uploaded: May 23, 2015
Few topics are as controversial or polarizing amongst new parents as sleep training. It has become one of those issues, like bottle feeding, or childcare, that seems to draw a line in the sand of parenting separating those who do from those who don't.

I was actually blissfully unaware of the sleep training controversy until I had my daughter. As some of my readers may know, I have multiple sclerosis (MS). Like many with MS, I have found sleep to be a critical ally in my efforts to stave off the exacerbation of symptoms and the disease's progression. In other words, prolonged periods of sleep deprivation or sleep disruption could spell disaster for me.

The first 16 weeks after my daughter was born, we were blessed with a sleep fairy (aka: my mother in-law). She took the night-duty and slept in my daughter's room so that she could feed and attend to her as needed.

But really, how sustainable was that? As comforting as it was to know that my daughter had round the clock coverage, I hated putting my mother in-law through those grueling night shifts. The guilt was killing me; we needed another approach.

I spoke to some colleagues of mine who specialize in child psychology, and they were unanimous: sleep training.

By "sleep training," they meant the "Ferber Method" (named after the researcher who popularized it) - a way of helping children 6 months or older sleep through the night. This method entails some degree of "crying it out," (allowing the child to cry for an interval of time before providing soothing). The Ferber Method has parents check-in on their child at scheduled intervals throughout the night. Other sleep training approaches have derived from this method and use a similar schedule of spacing out the intervals at which you comfort your child until they sleep through the night.

Although I trusted the recommendations of my colleagues, I wanted to research sleep training myself. It wasn't long before I was overwhelmed by the controversy. Consider the following headlines, both published in the Huffington Post: "Baby Sleep Training Method Safe for Infants," published in 2015, and "Cry it Out: The Method That Kills Baby Brain Cells," published in 2012.

Unfortunately, I found that many of my friends and family members were as polarized as the headlines on the issue of sleep training. Some suggested that the approach would jeopardize my daughter's ability to trust and depend on me; others thought a lack of sleep training set her up for a lifetime of sleep problems and an inability to self-soothe.

Despite the controversy, I did not find compelling data to suggest that sleep training is detrimental to children. I did find a decent amount of research to suggest that sleep training is safe and effective (in recent years researchers have even gone so far as to advocate for an increase in parent education regarding the benefits of sleep training). Following the results of a 5 year randomized control trial in 2012 the American Academy of Pediatrics concluded that, "behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression."

So yes, we ultimately decided to sleep train our daughter.

Because she was still feeding throughout the night, we used the Sleepeasy Solution to help wean her off these night feedings (after of course clearing this with her pediatrician). The method involved feeding her an hour before she would normally cry out for food so that if and when she awoke in the night, we knew she was well fed. We would then provide comforting every 5, 10, or 15 minutes for 30 seconds without removing her from her crib.

To be honest, I think our daughter did exceptionally well with this method and I don't know if her response was typical of other children, though I've heard other parents report similar outcomes. The first couple nights were tough, but she was sleeping through the night (11 hours) by the fifth night. She was 6 months old and hasn't had any problems with sleep since.

Now, at 16 months, she never cries before going down for the night or for a nap. She'll sometimes play with her dolly in her crib for about 10 minutes before falling asleep (we spy on her with a camera), but she isn't upset or distressed (though she does jibber jabber to herself from time to time).

So what are my thoughts about sleep training? For this parent, it was invaluable. I have never been a good sleeper and take tremendous solace in knowing that my daughter has developed healthy sleep habits.

That said, I am certain that this approach is not for everyone. Specifically, you should discuss sleep training with your pediatrician before undertaking it to ensure that your child is of sufficient height and weight to abandon night feedings. I also would not use this approach with children who have been exposed to trauma, or are extremely anxious. And if your gut tells you this is not the right approach for you or your family, I would trust your instincts.

If you have decided to use this approach and cleared it with their pediatrician, I highly recommend doing it exactly according to protocol. This is not a method that lends itself to improvisation. I also have several friends who gave up on it several days in and, again, I'd really encourage you to stick it out for at least one week once you've committed to trying it.

For those who practice co-sleeping, I'm honestly not sure how the sleep training methods described above are adapted for this arrangement, so if you have experiences or thoughts on this matter, do share. I encourage folks to contribute their thoughts and experiences with sleep training generally as well.

If you find that you are really polarized on this issue, I HIGHLY recommend this Youtube clip for some comic relief.
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Comments

 +  Like this comment
Posted by Harvey Karp, a resident of another community,
on May 24, 2015 at 8:41 am

Hi Carolyn,

I am just curious if you used white noise and swaddling?
As described in "The Happiest Baby Guide to Great Sleep" rumbly low pitch sound (to mimic womb sound) and swaddling (4-5 months) can be highly effective to promote sleep from the first days fo life...thus avoiding sleep training. And when the correct sound is continued for the first year it can often prevent night waking from teething, etc.
Best,
Dr. Karp


 +  Like this comment
Posted by Caroline Fleck, a Mountain View Online blogger,
on May 24, 2015 at 11:30 am

Caroline Fleck is a registered user.

Thanks for your comment Dr. Karp! It's funny you mentioned the white noise machine, as we really wrestled with this decision! Around the time our daughter was born, some research was published suggesting that white noise machines might be dangerous to kids, but after reviewing the data, we did not believe this to be the case (at least, we felt confident that the research did not provide evidence to suggest that low or moderate volume settings on a white noise machine would be problematic). Long story short, we used a white noise machine and use it to this day. Our daughter literally will point to the machine if we forget to turn it on at night:)

We also swaddled for the first few months. Our daughter wasn't as soothed by it as I think some children are, but I do think it helped her feel secure in the beginning.

Btw Dr. Karp, yours was one of the books that got us through that first year. Very accessible, well-informed, and applicable; I highly recommend it!


 +  Like this comment
Posted by Harvey KARP , a resident of another community,
on May 24, 2015 at 12:31 pm

Hi Caroline
I'm so glad that the book was helpful for youâ?¦ In fact most people find the DVD is most helpful. The five esses are a visual technique (like tying your shoe laces) so most people find it easier to learn by watching.
You're right about the white noiseâ?¦ That was a very misleading study. In fact the sound inside the womb is louder than a vacuum cleanerâ?¦ So moderate level sound is best for all night long (about the intensity of a shower). If the sound is too quiet it has no effect whatsoever.
I actually made a special CD of white noise to engineer it to make it the most like the sound in the roomâ?¦ Because for sleep the sun should be rumbly in low pitchedâ?¦ High-pitched sounds can actually interfere with sleep.
Some children even need motion to be able to sleep wellâ?¦ The sound in the swaddling her just not enough for them. All of this is disrupting my sleep.

I hope you have an opportunity to take a look at my book about toddlers (the happiest toddler). It teaches very simple techniques for children eight months to five years of age boost emotional health, patience, cooperation and to reduce temper tantrum is by 50 to 90%.

All best

Harvey


 +  Like this comment
Posted by Caroline Fleck, a Mountain View Online blogger,
on May 27, 2015 at 11:57 am

Caroline Fleck is a registered user.

Yes, I should have mentioned that we watched the DVD as well and found it very helpful. I don't think we would have been able to master the swaddle without it!

I just ordered The Happiest Toddler and look forward to reading and reviewing it. Thanks again for your contributions to the field Dr. Karp - your approach was incredibly valuable to us!


 +   4 people like this
Posted by Karen, a resident of Blossom Valley,
on May 28, 2015 at 3:53 pm

I agree that crying it out is definitely not for everyone. There is some scientific truth and proof about how crying for an extended period of time (as used in the crying it out method) does increase anxiety, stress, reduces oxygen to the brain, and reduces a baby's IQ if done several times. It may have worked wonders for your child now, but you have no idea yet as to what the long-term impact will be. Maybe your child will have learning problems. Maybe your child will have self-confidence issues. This is Silicon Valley, learning math and science is very valuable, as a parent, it is important not to create limitations early on for our children, and it is important to put all chances on their side.
I have also read Harvey Karp's book, and have held my baby a lot, and still do. She is in the 99 percentile for height, weight, head circumference and is very easy to sooth. She very seldom cries for more than a minute. I believe in the opposite of sleep training: attachment parenting. My baby sleeps in my bed, and I still carry her around often at 27 pounds. She feeds before she goes to bed, then when I go to bed, and when we get up at 6:30-7a.m. so I get a decent night sleep. She'll feed an extra time at night when she is sick, because a cold gets her dehydrated, and staying hydrated is important for the baby's recovery, so I would not skip that feeding. And it doesn't bother me much since she sleeps in my bed.
I found that kids - especially girls - who have a good relationship with their mother in their teenage years are very close to their mom, and I find that difficult to achieve if you start off her life by letting cry for extended periods of time. It's important to be there for our babies.
I understand your health situation forces you to be more careful with your own health, but if your mother-in-law (or someone else) was OK helping out, I don't think your guilt should have taken precedence over the health of your child.
I completely disagree that letting children cry themselves to sleep helps them develop healthier sleeping habits as adults. It is entirely normal that babies be dependent on their parents at a young age. They are dependent for feeding, changing their diaper, moving (they cannot walk), communicate (they cannot talk), etc so why would it be expected that they be independent when it comes to sleeping? Needing their mother or caregiver to fall asleep is developmental, and just like they will learn to eat, walk, talk, tie their shoes, etc, they will learn to sleep as well. Being there for your child gives her a sense of self worth, that she is important enough to have someone come and care for her. Many of my friends who have children who are pre-teens and older told me to forget about sleep training, that if my baby needed 15 minutes of my time to fall asleep, then just do it, she will grow out of it and become a much more confident and balanced human being, and smarter too. I think that these benefits are well worth the short-term sacrifice.
Let's be honest, the benefits of sleep training are for the caregivers, not the baby. Parents and caregiver have to stop kidding themselves and justify neglecting their child just because it makes it easier for the parents and caregivers. There are other ways to reduce the impact of the time needed to care for a baby who needs help falling asleep. I've changed my schedule around that. I put her to sleep, take a power nap, then get up and do my chores and log back in to work. I have her sleep in my bed in case she needs a night feeding, she doesn't have to cry for help if she does. And when she was a newborn, that's the only way she would stay calm (stay close to mommy), it worked wonders, she cried very little and slept well (one night feeding between 11:30 pm and 6:30 am starting at 3 weeks old, and none - unless she's has a cold - starting at 6 and a half months).
I have nothing to complain about, I have a very happy baby, I want the very best for her and am willing to make the sacrifices it takes to help her be a happy, smart, well-balanced, self-confident human being.


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