How to Help (the Parents of) a Baby Who Won’t Sleep – The Science of Baby Sleep Problems
I am writing this in the wake of yet another piece of research advising parents to leave their babies to cry. The recent study by Marsha Weinraub, published in Developmental Psychology advises anxious, sleep deprived parents to let their babies cry themselves to sleep (read HERE for a poorly written summary full of Weinraub’s own assumptions and bias).
In part I admit I am heartend by the Weinraub report, as it highlights quite clearly how normal it is for babies to wake regularly at night. The Weinraub findings show that by 6 months of age, the majority (66%) of children were still waking at night once or twice per week. Around one third of 1200 infants studied (34%) woke 7 times per week at 6 months, twice per week at 15 months and once per week by the time they were two years old. I have already blogged about the normality (and indeed necessity) of infant night waking HERE.
Back to the Weinraub study, those who woke more frequently were more likely to have been assessed as having a ‘difficult temperament’ (I would far rather see this termed ‘babies who needed more parental input to feel calm and secure for whatever reason”, labelling it as ‘difficult temperament’ is a surefire way to guarantee parents will feel negative and unhappy with their baby’s perfectly normal needs), be breastfed at 6 and 15 months old, and have more depressed mothers at 6 months old.
I’m sure you can see where this is going now, we have a neat little sum that the mainstream media and the ‘baby sleep experts’ can use to tell parents to leave their babies to cry in order for everyone to get a good night’s sleep and be psychologically healthy. Indeed these articles from the UK’s Daily Mail and The Daily Telegraph do just that very thing. The sum in question being:
Breastfeeding + frequent night waking = depressed mothers.
The solution? Train the babies to sleep through the night = mothers will be less depressed and the babies will learn the all important skill of self soothing, a win-win surely?
Only this is a naive solution at best and a damaging one at worse. Firstly it is factually incorrect, as highlighted by the work of Dr Kathleen Kendall Tackett, Psychologist and IBCLC, HERE whose research in this area leads her to say:
“Breastfeeding mothers are less tired and get more sleep than their formula – or mixed feeding – counterparts. And this lowers their risk of depression”.
Further commenting on the ethics and framing of the Weinraub research results Professor of Psychology at the University of Notre Dame, Darcia Narvaez has a similar opinion:
“The framing of the research is misleading, dangerous and unethical. The research focusses on babies 6 months and older, yet (the report of the research HERE) begins the piece by talking about newborns, thereby implying that parents of newborns should use the cry it out techniques. There is no evidence to support this and much evidence to show that leaving young babies to cry does much long term damage to their physiological and psychological development.”
Weinraub, her fellow baby training advocates and all of the media who pick up on their work are perpetuating harmful myths about the normality of baby sleep. The more research of this kind that is published and the ensuing media reporting, the more we will lose our understanding of normal infant sleeping patterns and that is a dangerous myth to believe, for it causes parents to disregard their instinct and follow advice which can cause much harm (see THIS BLOG for more my thoughts here).
Agreeing with the problems in the definition of infant sleep problems, Professor of Psychology at the University of North Texas, Wendy Middlemiss suggests:
“Waking is what babies do… sometimes, babies need assistance to return to sleep… those assisted return to sleep more readily and achieve a better quality sleep. Babies who are breastfed have a greater probability of some extremely positive outcomes. Breastfed babies wake more but mothers maintain close proximity and thus wakings are less disruptive. Parental fatigue is not generally reported with one nightwaking; early wakings seem to sort themselves out by the second year of life; So… Why does research continue to focus on waking… It isn’t the Waking. It’s the Regulation of Responses… and the best regulation comes from attention, touch, proximity, responsiveness”.
Then there is the potential damage to the breastfeeding relationship caused by the sleep training suggested in research such as that by Weinraub and Price. The World Health Organisation recommends that: “Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond” however much of this still occurs during the nighttime hours, a time that is therefore crucial to the continuation of the nursing relationship (see HERE for a good explanation of milk production). What effect then does the artificially induced cessation of night feeds have upon the viability of exclusive breastfeeding until 6months and continuation to 2 years and beyond? This point is one that is sorely missed in the current craze of sleep training advocacy research.
John Hoffman, Canada’s leading parenting writer and ex columnist of Todays Parent comments further on this issue:
“I have the impression that the breastfeeding/nightwaking connection is an uncomfortable topic for many people. Study after study that I’ve seen shows that breastfed babies wake up more often than bottle fed babies (ergo, night waking is arguably normal in breastfed babies). Some breastfeeding advocates don’t seem to like to talk about this because, perhaps, they are afraid mothers will be discourage from breastfeeding. Sleep experts don’t like to talk about it at length (although, like Weinraub, they do mention it) because they can’t be seen to be anti-breastfeeding, but their focus/obsession is that babies simply have to sleep through the night.”
John has already written of his concern that many seem to feel that parenting only happens during waking hours (you can read more on John’s blog HERE) and like many of us (I use ‘us’ as a term referencing those scientists, authors and birth and parenting workers who advocate gentle parenting based on a sound evidence base) he is an advocate of parental informed choice. Currently though the influx of biased and misinformed pro sleep training research is not affording parents that opportunity. If a parent chooses to sleep train their child that is absolutely their perogative, all I hope is that their decision to train has been fully informed and is based not on feelings of guilt and desperation but on research and understanding of the wider implications. Or as John says:
“In an ideal world, I think the core message parents need is (coming from the assumption that breastfeeding is not best, but rather, the normal way to feed a baby – the kind of feeding that babies and mothers were designed to experience) to understand that night waking ( to varying degrees) is normal in breastfed babies, so if your baby is waking, you may not like it, but understand that it doesn’t mean that anything is wrong, and that there is nothing wrong with you if you choose to live with it rather than fix it.”
Psychologist Oliver James is known for his belief of “Do the least harm”, for some parents deprived so much of sleep and lacking support that their physical and mental health are affected sleep training may well be the least harm. The key here is not dictating to parents what they should or shouldn’t do with their children. The key is providing them with the support and information they need in order for them to make their own decisions, confidently.
John Hoffman agrees here saying:
“If parents want to try a controlled crying method they should understand the risks which are:
A)it will be hard for them
B) It will be stressful for their baby
C) It may not work or it may work only temporarily
Parents should also get guidelines on when to give up when controlled crying isn’t working and outside limits in terms of how long to let babies cry.”
So what are the risks of controlled crying? I have already covered this topic HERE. Darcia Narvaez, Associate Professor of Psychology at Notre Dame University, also covers this topic excellently HERE commenting:
“One strangely popular notion still around today is to let babies ‘cry it out’ when they are left alone, isolated in cribs or other devices. This comes from a misunderstanding of child and brain development.”
Perhaps some of the most compelling evidence to date concerning the potential side effects of controlled crying is research conducted by Wendy Middlemiss, Associate Professor of Psychology at the University of North Texas. This simple, elegant study showed the dissonance between the term ‘contented babies’ and what was really happening on a biological level (by measuring cortisol – stress hormone – levels). In short Middlemiss’ research clearly proved that whilst babies may not cry out for their mother after a few nights of training, they are anything but soothed, with their spiked cortisol levels indicating the stress trauma they were experiencing internally. The Daily Telegraph covered the Middlemiss research quite well HERE if you would like to read more. As Australian parenting author Pinky McKay says frequently “No evidence of harm is not the same as evidence of no harm”. Currently the work of Weinraub and Price, study limitations aside (I have discussed some of the Price study limitations HERE) do not provide adequate evidence of no harm, yet the work of Middlemiss most definitely indicates evidence of harm. Why then is it the former that is more widely reported and latched onto by worldwide health services and workers?
With reference to the commonly banded ‘”self soothing’ terminology used by so many sleep trainers Wendy elaborates on how mothers can truly help their baby learn how to soothe:
“Soothing is part of the self-regulatory behavior that will develop as infants mature and as their physiological responses mature. This maturity is best achieved, according to extensive research, through attention to signaling. The adult is the first source of emotional and physiological regulation for infants. Through their guided regulation, infants develop physiological and emotional regulation. There is an extensive body of research that without this responsiveness, physiological and neurological development is impaired…not support. Thus, it is parents’ early presence and guidance in regulating emotional responses for infants that is likely to contribute to infants’ developing capacity to soothe themselves.”
What does that mean to us as parents? In short it means our responses to our baby’s (totally normal) awakenings determine whether our young truly have the ability to self soothe to sleep later in life, by not leaving them to ‘self soothe’ at a time when they are psychologically/biologically unable to we are more likely to create a ‘contented’ (ref Gina Ford), independent child.
So what can we do to help parents who are despairing of their offspring’s (lack of) sleep? I have a few ideas:
1. We can educate them about normal infant sleep, the effect on parents upon hearing that their baby’s sleep is entirely normal never ceases to amaze me. Once we know something is normal and only a problem if it is a problem for us personally it suddenly lessens hugely in intensity. I feel it is vitally important that each new parent understands the biological norm of our species.
2. We can provide unbiased factual information, not only on the normality of infant sleep, but on the pros and cons of different forms of sleep training and modification. Allowing parents to make a truly informed choice. Part of this may involve challenging the voices of those ‘experts’ who choose to ignore the scientific evidence surrounding infant sleep and related behavioural modifications.
3. We can help parents to know they are not alone, we can support them, we can listen to them – unconditionally, nurturing them in their parenting journey so that they may nurture their babies in the way that they see fit.
4. We can provide more practical help, better maternity and paternity leave here would be a huge help and a good start.
5. We can help health and childcare professionals around the world to stay up to date with research, not just that from researchers with the loudest voice and biggest column inches.
6. We can provide suggestions and help parents to form their own toolkit to help them through their early parenting journey (I have blogged a little about this HERE).
Make no mistake, there are many passionate, talented individuals who are working towards these goals, some you may have heard of, some perhaps you might not have – yet, but they are there, they are working hard and soon it will be impossible to not hear what they have to say.
As Psychologist Robin Grille says HERE “ the time of being ignored is over; and the mainstream media has begun to ridicule, judge and smear. I know of no better evidence that the new parenting movement has grown enough to reach – and pass! – a critical tipping point. It is now a big enough minority to cause a stir. Time to fasten seatbelts, there is turbulence ahead!”
Me? I’m all buckled up and ready to go, I just hope the road isn’t *too* bumpy!
Sarah (Mum to Four, Parenting Author and Founder of BabyCalm Ltd)
You can read more of Sarah’s articles HERE.