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Friday
Mar272015

Sleep Training at 8 Weeks? Absolutely Not! Why This Recommendation is Wrong and Other Myths About Infant Sleep

When human infants are born, in essence they are still gestating.  Their nervous systems are immature, their brains minimally developed, and they are completely dependent on their parents for survival.  Their neurological development continues at an almost exponential rate, yet it takes until 3 months before these infants are truly “born to the world.”  At last parents see those smiles, as their little ones begin to respond to their environment and to their parents who have survived a world of sleep deprivation caring for them during all that time!

This reality came to mind as I read a New York Times blog post today about the recommendation by Tribeca Pediatrics to sleep train 8 week old infants by leaving them at 7 p.m., only returning to them at 7 a.m. the following morning.  As a family sleep consultant, I was stunned when I first heard about this advice from clients who receive their pediatric care from Tribeca.  Stunned because it implies that infants do not need care and soothing from their parents during the night. 

Leaving an infant alone for that length of time runs counter to everything experts in human development know about the critical connection between infants and their parents.  An infant’s developing brain is significantly influenced by the back and forth interaction between her and her parents or caregivers, and parental response to her cries is the earliest such interaction.1  From birth to 3 months, infants must grow to feel loved, cared for, and secure in their world.  Without this bond, healthy development does not occur. 2 

Recommending sleep training at such an early age also implies the mistaken belief that an infant’s cries are intentional.  Research makes a clear distinction between cries in the first three months of life and cries after the major developmental changes that occur between 3 and 4 months of age.3, 4

Moreover, this recommendation propagates another myth: that a young infant can regularly sleep for 12 hours a night.  “Is your baby sleeping through the night?” generally is the first question asked of new parents in the United States.  It is a cruel question, given the lack of sleep these parents are experiencing and their newborns’ total lack of mature circadian rhythms.  Without an internal biological clock, infants’ brains do not distinguish between day and night and they cannot be expected to sleep a prolonged period of time at night.

Prior to 3 months of age, a baby’s sleep patterns are primarily influenced by biological factors and are not under her or her parents’ control.  In other words, parents must take their cues from and follow their baby’s schedule.5, 6 But not for long, because once a baby is 3 months old, parents can begin to introduce strategies that will “nudge” their little one toward becoming more independent with sleep.

An important piece of sleep knowledge is that both going to sleep and staying asleep are learned behaviors.  Most babies and children will need their parents to help them learn this skill.  And by 4 months of age, parents can embark on some gentle sleep coaching methods. 

Parents are generally averse to leaving an 8 week old baby (and very often even older babies) to cry unattended for hours at a time.  What feels so wrong to many parents is in fact wrong.  Yet eventually, it is important to help a baby learn to sustain sleep.  Parents cannot go on for much longer than three or four months without good sleep.  Babies will be able to sleep better with sustained sleep.  Families and relationships will all benefit from everyone getting better sleep.  And there are ways to help a baby learn to sustain sleep without leaving her alone to cry. 

Unfortunately, recommendations such as those given out by Tribeca Pediatrics ignore the clear evidence from the literature and are often based on the pediatrician’s own cultural beliefs and values.7, 8 I am deeply sympathetic to parents who have to navigate the many contradictory points of view found in the media and often in their own pediatric practices!

Citations:

1 “The cultural study of infant development and parenting might be beneficially understood in a framework of necessary versus desirable demands. A necessary demand is that infants and parents communicate with one another. Normal interaction and children’s healthy mental and socioemotional development depend on it.” Bornstein, M. H. (2002). Parenting infants. In M. H. Bornstein (Ed.), Handbook of parenting (2nd ed., pp. 3–43). Mahwah, NJ: Erlbaum

2“Babies' brains expect that they will experience nearly constant physical touch, rocking and cuddling: without it, they just don't grow.”  www.zerotothree.org

3“…excessive crying is primarily an honest signal of need, namely, to elicit additional parental resources and attention to modulate the behavioral state.”   Oskar Jenni. 2004.

4“Sleep-wake processes play a key role in early infant crying,” Behavioral and Brain Sciences, 27, 464-465.

5“From 0 to 3 months of age, it is difficult to separate sleep and excessive cry/fuss problems because the architecture of sleep at this age is less established and the two behaviors are so closely linked.”  Jordana Bayer et al. 2007. “Sleep problems in young infants and maternal mental and physical health,” Journal of Paediatrics and Child Health, 43, 66-73.

6“The decrease in crying with increasing age is due to the development of controlling mechanisms in the nervous system that permit inhibition of excessive arousal as well as… sustained sleep…  Responding to the babies’ crying with soothing efforts during this period seems to be helpful to both parents and their babies…and does not seem to cause more crying, unless it is intrusive, but, in fact, may result in less crying in subsequent months.”  Remarks by Arthur Parmelee, M.D. on receiving the 1975 C. Anderson Aldrich Child Development Award from the American Academy of Pediatrics

7“Differences in sleep patterns as a function of development add to the complexity of understanding sleep biology in children.”  Oskar Jenni and Bonnie O’Connor. 2005. “Children’s Sleep: An Interplay Between Culture and Biology,” Pediatrics, S115, 204-216

8“Many pediatricians…lack sound training in developmental and behavioral pediatrics, and thus their advice is largely based on their own cultural values and beliefs (many of which may be operating out of their own direct awareness) in interaction with their personal and clinical experience.”  Oskar Jenni and Bonnie O’Connor. 2005. “Children’s Sleep: An Interplay Between Culture and Biology,” Pediatrics, S115, 204-216

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