The War on Bedsharing Continues

If you haven’t heard or seen yet, you probably will soon: news media reports that bedsharing comes with a five times greater risk of SIDS, even if the mother is a breastfeeding non-smoker.

Don’t believe it folks.

And I’m not just saying that because I’m sympathetic to breastfeeding and bedsharing. There is a organized, and quite bitter, campaign against bedsharing going on in the Western world. I don’t quite understand it. I think it might partly be well-intentioned, because bedsharing does definitely increase the risk of sudden infant death, but only in certain circumstances – particularly if the mother smokes (probably the father too, but they haven’t collected much data about parternal smoking) and particularly in the context of parental alcohol or drug use ( and most likely not just a glass of wine, if you know what I mean). I think that the anti-bed-sharing lobby thinks it’s too complicated to explain these things to parents, plus they think bedsharing is weird and unneccessary. (You know, these researchers slept alone in their cots as babies and they’re all fine… sort of thing. Yeah, exception for their scientific tunnel vision.) So, they think it’s best to simply tell all parents to never bedshare, completely ignoring the biological and social absurdity of telling mothers to breastfed and then warning them to never sleep with their babies. Breastfeeding causes besharing, pure and simple. Not always perhaps. but very often. It’s biologically inevitable.

Back to the study. Discombobulated, perhaps, by recent evidence that has clarified that the risks of bedsharing are limited , and that breastfeeding protects against SIDS (a finding which some SIDS researchers have never wanted to accept) several authors teamed up to to rehash and respin some of their old data, much of which uses poor, outdated definitions of things like co-sleeping and breastfeeding. How do I know? I’ve seen the peer reviews. Journal articles have to be reviewed by academic peers to ensure high standards of scholarship. I actually have personal experience of this with regard to the one journal article I co-authored. I was unimpressed. The biases of the two reviewers were blatantly obvious. That is not to demean all peer reviewers. I do have some faith in the process, and I will acknowledge that the peer reviewers’ questioning of our findings – which they really just didn’t think could possibly be true (specifically, that many mothers of nightwaking babies idon’t think their baby has a “sleep problem”) – led to improvements in our article.  But just keep in mind that peer reviewed is as imperfect and, at times, flawed as most human endeavours can be, even though it is often implied to be foolproof.

With respect to this article that supposedly found that bedsharing increased the risk of SIDS fivefold even if the mother didn’t smoke and did breastfeed,  3 of 4 reviewers did say it was excellent and made fairly cursory comments. One admitted to not being a statistical expert. But the dissenting, and more detailed review  was from Peter Blair, who, IMO, is by far the best SIDS epidemiologist in the world. I’ve interviewed him several times, and he’s pretty much the only SIDS epidemiologist I would trust for the truth about risk factors. He thoroughly trashes the study. Here’s a link to the peer reviews (Blair’s is the second, and by far the most painstakingly detailed). The authors’ response is there too. See how scientific publishing works!  http://m.bmjopen.bmj.com/content/3/5/e002299.reviewer-comments.pdf

By the way, notice that the article, didn’t make it into the main British Medical Journal, only BMJ open, an online journal that authors actually have to pay a fee to get into.

Gee, I wonder why.

Oh and here is another rebuttal by some academics (who, obviously were not invited to be peer reviewers) whose work I trust http://bit.ly/11Tc76g

But don’t believe the news headlines you’re going to see and hear over the next few days.

Part 2: Real Self-soothing.(It’s not what sleep experts say it is)

This is the second of a two-part post. If you haven’t seen Part one I suggest you read it first.

When I left off I was talking about self-regulation in children and how its early development begins with parents “regulating” babies externally.

Another great piece of concrete scientific evidence on how this works comes from Dr. James McKenna’s co-sleeping studies, which some of you may be familiar with. Among other things, his work showed that sleeping next to a parent (mothers in his studies) helps to regulate a baby’s heartbeat, breathing, body temperature, sleep state and arousal level. The famous kangaroo care studies (by other researchers) have shown similar sorts of things. Near-constant physical contact with an adult body helps premature babies regulate their body temperature and breathing, and simply helps them to thrive.

So, as a parent, your body has a physiological, regulating impact on your baby.  You probably already knew that. I sensed it as a new parent but had trouble putting it into words. I touched on that in a previous post.

Back to the specific link between infant feeding and self-regulation, which I explained in my last post. Here’s a really cool thing you might not know.  Dr. Stephen Porges’ research (see Part one) has shown that along with providing nutrition and comfort, infant suckling also helps develop the facial muscles and other neural pathways that are essential for smiling and other aspects of social interaction. Some of these mechanisms start to become more functional at around the age of six months, when he says infants become able to engage in self-soothing.

Yikes! Doesn’t this sound like Dr. Porges is saying the same thing as the sleep pundits whose mantra is that infants become capable of self-soothing around sleep at age six months?

Not at all. Which leads me to the even cooler part.

The self-soothing that Porges is talking about is not a solitary pursuit. Rather it’s the enhanced developmental ability to seek out the social interaction that is an infant’s primary source of comfort. Babies have ways of getting us to interact with them before age six months – crying, smiling, waving their arms and legs, looking cute and vulnerable etc. But at around six months they become more aware and consciously active participants in the process, plus they are more capable of being comforted by things other than feeding and physical contact (although those remain important), such eye contact or your soothing voice. Here’s how Porges puts it in one of his articles:

“For humans, maturation does not lead to a total independence from others, but leads to an ability to function independently of other people for short periods. Moreover, humans, as they become more independent of their caregivers, search for appropriate others (e.g. friends, partners, etc.) with whom they may form dyads capable of symbiotic regulation.”

In other words, self-soothing is not about a little baby lying there crying for comfort and then somehow having this eureka moment where he thinks, “You know, I don’t really need Mom or Dad to get back to sleep anymore…. Zzzzzzzzzz.”

It’s more like, “Hey, I’m starting to figure this thing out about how to get Mom or Dad or big brother or Grandma to interact me. And, come to think of it, I’ve noticed that sometimes I can get by just knowing that Mom or Dad is there and paying attention to me.”

Six-month-olds don’t really think like that, of course, but you get the drift. If there is such a thing as “self-soothing” between 6 and 12 months of age, it is the beginning of an enhanced ability to manage the way you seek out social sources of comfort and support. Improved internal biological calming mechanisms, which the baby does not consciously manage, play an important role. They help the baby stay in the calm and alert state which enables her to focus on and participate in back-an- forth social interaction.  This “social engagement system,” as Dr. Porges calls it, is a crucial mechanism for recovering from stress and, more generally, managing physiological, emotional, cognitive and social self-regulation (see previous post) throughout life.

Does this relate at all to the self-soothing sleep professionals talk about? Mostly no, but the confound here is that some babies do wake up and go back to sleep on their own. I’d guess that many are physiologically calm when they do so and that their internal calming mechanisms help them go back to sleep.  I can’t tell you why some babies are like that and others aren’t – although I’ll bet variations in vagal tone have something to do with it some of the time.  Dr. Porges’ research has shown that babies who cry excessively tend to have poorer regulation of the vagal brake. That could explain why some babies are less upset than others when they wake at night and why sleep training goes so much harder with some babies than others.

Bottom line, it’s safe to say that babies who go back to sleep on their own do not do so because they are employing self-calming techniques they learned while being Ferberized.

In fact research by Wendy Middlemiss, of the University of North Texas, suggests that in some cases at least, it’s the opposite. She monitored cortisol levels (cortisol is a hormone that helps mobilize our physiological resources to deal with a challenge or threat) in babies at a New Zealand clinic where they practice a sleep training technique that really does warrant the term “cry it out.” In this clinic, after mothers and babies went through their normal bedtime routine the babies were left in a room to, well, cry themselves to sleep, and the mothers were not allow to go back in (nurses went in to check on the babies but they didn’t offer comfort). Middlesmiss (who does not espouse controlled crying sleep training methods, by the way) and her team measured the babies’ levels of cortisol on the first and third nights of treatment. On the first nights, when the babies were wailing away, they had elevated levels of cortisol (and so did the mothers).  On the third night, most of the babies were going to sleep with little or no crying. But their cortisol levels were still elevated.

That’s a pretty clear sign that these babies were not physiologically calm when they fell asleep, even though they weren’t crying. Actually, their stress response systems were active.

Now, this does not prove that the methods used in that New Zealand sleep clinic, or any other of the variations in sleep training methods, damages babies. Human beings are resilient and can recover from setbacks – the stress of sleep training is far from the biggest bump in the road a child can encounter. But if someone wants to use sleep training and self-soothing in the same sentence, the most scientifically accurate thing to say would be that ignoring a baby’s cry is a disruption of the social process by which babies learn to self-soothe. Dr. Porges refers to it as “a violation of the child’s biological expectation of safety from an external source.”

Keep in mind that all babies will experience these violations from time to time – not just in the context of sleep training, but for all the myriad reasons that parents can’t necessarily attend to babies immediately: having other children to care for, other responsibilities to attend to, being exhausted or frustrated or ill.  (Children will also experience similar violations many times in interactions with peers and other people as they grow up.) Babies are designed to withstand some of these violations, provided that for the most part parents do respond, not just to a baby’s distress, but also to their other bids for social interaction.

So with respect to sleep training, for me, it’s not a question of absolute right and wrong, it’s about a risk/benefit question for each family. If parents feel that their functioning is greatly compromised, or they are highly stressed by lack of sleep because of an older baby’s night waking (or that their baby is adversely affected by night waking) it’s not our place to second guess them if they want to try sleep training. Highly stressed, unhappy parents aren’t the best thing for babies either. So if a family tries sleep training and it works relatively quickly, and they don’t have to keep doing it over and over again, and the parents understand that the non-responsiveness required in sleep training is an exception to the rule, and if less interrupted nights help the parent(s) be happier and more responsive and sensitive to their babies, then sleep training could be helpful for a family.

But at the same time, if parents want to soothe their babies at night, because they think that’s what their child needs, or they find it easier, or because they’ve tried sleep training and it didn’t work (which happens frequently), sleep training proponents have no right  to tell them that they are failing to teach their babies to self-soothe. Science suggests otherwise.

Real Self-Soothing (It’s not what sleep experts say it is)

Sorry for the long absence.

Noticing the great interest in my self-soothing post, I thought I’d go further into the subject. It took me awhile to make sure I had it right.

So, if there is a real thing that we could rightly call self-soothing,  here’s how I would talk about it.

Regardless of your position on sleep training, I think we can all agree that self-soothing, meaning the ability calm yourself, is a very important life skill.

The questions are: How does that ability begin to develop early in life and how do we, as parents, help babies develop that ability? And, OK, is there any conceivable way that sleep training/controlled crying could help babies develop this ability?

I don’t think my elevator speech answer will surprise many people. Babies and little kids learn to calm themselves from the experience of being calmed by others – mainly their parents. I was aware of this on some level from my earliest days as a parent, although I couldn’t have put it into words. All I knew was that here was this little guy who was often upset, agitated and, at times, totally discombobulated. And he needed us – our physical contact, being fed, carried, sung to etc. to recover from that. I’m sure you’ve all felt like that.

But as time goes on I continue to find new and deeper ways to understand and think about how people develop the capacity to managing their inner feelings. And I keep stumbling on more research that tells us how the process works. I want to share some of that.

But first, I have to say that I dislike the term self-soothing and I don’t normally use it – except when I’m tearing a strip off conservative sleep pundits who try to co-opt self-soothing to put a happy face on their methods.

I prefer to talk about self-regulation. Because the ability to settle down is part of what many scientists, psychologists and some educators call self-regulation. (I have to credit my colleague and new boss, Stuart Shanker for some of the ideas I’m presenting here.)

Self-regulation, as I think about it, is the ability to adapt your physical, mental, emotional and social abilities and energies to the situation, task or challenge at hand.  So, if you’re crossing the street and a Hummer is bearing down on you, you need to be able to summon up the energy and will to get of the way, real fast. And your body helps you do that by, among other things, increasing your heartbeat and giving you a shot of adrenalin. If you’re a child in school, you need to be able to stay calmly focused and attentive so you can learn. And if you’re tired, you need to be able to wind down so you can sleep.  Your brain and body need to help you do those things too. That’s self-regulation at work.

Self-regulation happens on various levels – physiological, emotional, cognitive (thinking) and social.  But physiological self-regulation is at the root of it all. If the physiological mechanisms of self-regulation aren’t working right, you’re going to have trouble controlling your emotions & impulses, getting along with people, recovering from stress and thinking clearly under pressure. That’s because your brain must put your resources toward coping with how unsettled or agitated you feel on a visceral level, instead of helping you to do what you want or need to do at a given moment.

Physiological regulation is even more important with babies because of their neurological immaturity. I’m sure many of you have heard or read that human beings are born neurologically immature compared to other mammals. Dr. James McKenna, an anthropologist and pioneering co-sleeping researcher at the University of Notre Dame, was the first person who pointed this out to me, but lots of people are talking about it these days.

So we’re born with this under developed brain and neurological system that, literally, develops outside the womb after birth. For one thing, the basic internal neurobiological mechanisms that our body uses to help us calm down are not fully functional. And, as various scientific findings show, those mechanisms become functional in the context of the caregiving relationship. The caregiver basically regulates the baby externally through interaction, holding, feeding, basic caregiving, talking, eye-contact, singing or making little soothing sounds that help the baby feel OK. Those experiences also help build the brain pathways needed for the emotion cognitive and social self-regulation.

Here’s just one example of how this works on a visceral level. We have a nerve – a network of nerves, really – called the vagus nerve. It connects part of our brain to the workings of our internal organs and also the muscles of the face and the middle ear.

One of the things the vagus nerve does is regulate our heartbeat, keeping it from beating too fast. However, when our brain detects a threat, the “vagal brake” as it’s called, comes off so our heart can beat faster to help us mobilize our physiological, wherewithal to deal with the threat. When the threat is over, the brake goes back on and our heartbeat returns to normal, which enables us to calm down. (BTW, the ideas I am presenting in this section come from the work of a brilliant psychologist by the name of Stephen Porges.)

We don’t do that consciously. It just happens – part of the workings of the autonomic nervous system.  However, in some people (and some babies), that brake doesn’t work as well as it should. This is called “low vagal tone.” It can be assessed by measuring a normal variability in heart rate relating to breathing.  When people have low vagal tone the brake doesn’t go back on properly when the threat, crisis or stress is over, and the person remains more agitated and reactive, and has trouble calming down. Nor surprisingly, people with low vagal tone are at greater risk for all sorts of mental disorders and behavior problems. There is some evidence that good parenting can sometimes correct low vagal tone. I’ll get into that in another blog. But for now I want to help you understand the role that the vagus nerve plays in self-soothing.

What fascinates me is that the vagus is centrally involved in infant feeding. It turns out that suckling places a lot of demands on a newborn’s resources, so the vagal brake comes off when the infant feeds and goes back on when nursing is over (except with preemies – one example of their neurological immaturity).

Thus, infant feeding is not just about nutrition and satisfying a baby’s hunger. It’s inherently regulating. By that I mean it also helps the infant feel “OK” on a visceral, physiological level.  I’m sure that makes sense to anybody who has breastfed a baby or watched one nurse.

In other words breastfeeding is one of elemental mechanisms in the development of self-regulation. In fact, in one of Dr. Porges’ presentations, which I found on line, when he first presents the term self-regulation, his slide shows a photo of a baby breastfeeding. That doesn’t mean a bottle-fed baby can’t develop self-regulation. Other kinds of sucking and, obviously, other aspects of parental care  – including things like physical contact between babies and fathers (like me!)- are involved in the early development of self-regulation.

But the take home points are that a)babies are not created equal in terms of physiological self-regulation (some require more external regulation than others and, b)two key ingredients in the early development of the higher levels of self-regulation that people have more conscious control over are physical contact and interaction with a caregiver. (This is what English psychoanalyst Donald Winnicott was talking about when he wrote the now famous line: “There is no such thing as a baby. There is a baby and someone” or whatever it is he actually said.)  We often think of that dynamic as primarily emotional and social in nature. And, of course, it is. But the roots are physiological – a parent “regulating” a baby externally.

There’s  more to say on this, and it’s pretty interesting. But this is already pretty long for a blog post. The next one will come in a couple of days. Promise.
(Part two has now been posted. You can read it here.

Here’s the link to the Steven Porges presentation I mentioned earlier.

The new, or more to the point, real normal of baby sleep

I’m working on another post, the next, and, who knows, possibly final chapter in my self-soothing saga. I hope to have that up in a day or two.

In  the meantime I wanted to alert you to a series of blogs that you may find interesting and helpful. Shortly after the first of two recent studies came out claiming to show conclusively that sleep training methods were not harmful (I blogged about it last September), I connected with an interesting group of researchers and parent educators who came together to work on some responses to this shoddy research and the mindless, gullible media coverage it got. One of our actions has been to work collectively on some articles and blogs that offer parents a different, and we think, more supportive way of thinking about infant sleep and night waking.  Some of those blogs have been posted on Darcia Narvaez’s Moral Landscapes blog on the Psychology Today website.  The latest one is on what  normal  infant sleep really looks like. Others cover baby calming and mistakes that researchers make. Have a look http://bit.ly/VDtvZi

Eek! Even more thoughts on sleep training and night waking.

Now I’m going to tell you why a 58-year-old guy, whose kids are all over 20, is still wading into debates about night waking and sleep training. I’m not so much concerned about what individual parents decide they need to do to navigate sleep issues. If a family feels they need to try a Ferber-like technique, for whatever reasons they have – it’s not any of my business. Similarly, whether or not someone chooses to co-sleep, go into a different room to settle their baby back to sleep twice a night for three years, or flop on mattress beside the crib, is none of my business either.

My business is what parents are told they should do.

And my concern here is the promotion of sleep training as the only legitimate way to manage night waking and nighttime needs of babies. I don’t mind people promoting it as one way to handle night waking. But there are a few things I wish the promoters of sleep training would start admitting.

Admit it! Sleep training doesn’t always work.

Some of the studies by the very researchers who promote sleep training actually show that sleep training is not always successful. They know this but they prefer to look on the bright side because, in fairly controlled settings where parents have a lot of support and guidance, sleep training often does work, though by no means always. The thing is that most parents who try sleep training methods do it in the messy world of real life. And it doesn’t work for a lot of them. In a study that I helped design (led by Dr. Lynn Loutzenhiser of the University of Regina) 53% of the 900-odd mothers of babies 6 – 24 months old who answered our internet survey said they had tried a “controlled crying” technique at some point. Only one in six of them said it eliminated night waking completely. Another 26% said it reduced the number of awakenings significantly. That means more than half the families who tried it got little or no improvement. One third said it made no difference at all!  That’s a pretty shoddy track record for a technique that is billed as “effective.” Parents seem to have figured this out, if some experts haven’t. We asked parents to agree or disagree with the statement. Controlled crying seems to work for some children but not others: 86% agreed.

Admit it! Even when it works, the results aren’t necessarily permanent.

We asked the mothers of night wakers – 43% of our sample by the way – if there was ever a time when their child slept through the night and 41% said yes. That may explain why 43% of the parents in our study (about 20% overall) said they had initiated a round of controlled crying on four or more occasions and fits with what I’ve heard anecdotally. There are all sorts of reasons why kids “forget” how to go to sleep on their own. Sometimes a little cold or teething is all it takes. I was actually able to get a Canadian sleep training proponent/ researcher to acknowledge this in a Today’s Parent article a couple of years ago. I admire that and I wish more sleep training proponents were as honest as her.

Admit it! Sleep training is stressful for babies.

Some experts like to gloss over this by reassuring parents that sleep training causes no long-term harm (and I have seen no convincing evidence that it does). Well, don’t try to tell me it ain’t stressful for the babies. Moms know it is. We asked mothers if they thought controlled crying was stressful for babies.  63% said it was. (73% said it was stressful for mothers.) Wendy Middlemiss, of the University of North Texas, did some really interesting research at a facility in New Zealand where they do an approach to sleep training that really does warrant the label cry-it-out. Basically, moms, with the help of nurses, go through their normal bedtime routine, then they put the baby in a crib and leave the room. The nurses go in occasionally to make sure the babies are OK, but the moms, who are in another room where they can hear their baby crying, can’t go in. Researchers measured the moms’ and babies’ cortisol levels on the first and third night. Cortisol is a hormone that is elevated when we are stressed. Both moms and babies had elevated cortisol on the first night. By the third night the baby’s were going to sleep with little or no crying. The moms’ cortisol levels went down. But the babies’ cortisol levels stayed up. So these kids were going to sleep but they were still displaying physiological signs of stress.

Now, that doesn’t prove in any way that these kids were “damaged.” Babies can endure some stress from time to time. Geez, they’d better be able to; stress is part of life. And one thing that is totally clear from research is that even when babies experience pretty significant stressors, they can be OK if they also get sensitive, supportive, responsive caregiving.

Back to the Middlemiss study. What I’d like to know what those babies’ cortisol levels were like on, say, day 8 or day 14, and I’d also like to know if they kept going to sleep on their own, without crying, after they went home. But this study wasn’t designed to record that info. So what does it prove? Mostly that sleep training is stressful for the baby, which we already knew. But I think this finding is another nail in coffin of so-called “self-soothing.” These babies went back to sleep in spite of stress, not because they had summoned up their little resources to calm themselves. Pretty hard to call that self-soothing.

Admit it! Some kids are going to be very, very hard to sleep train. One question we asked in our study – a question I’m pretty sure has never been asked before in any sleep study – was this:  What is your child’s state upon awakening in the night? More than half of the parents – 60% – said their child was either calm or not very upset when they first woke. This is the state that some sleep experts would have you believe virtually all babies are in upon waking, But almost a third of our sample described their child as very upset, very quickly when they woke up. 14% said their child was very upset shortly after waking. And 17% said their babies appeared to be crying hard before they were even awake. How is a child in that sort of physiological state supposed to settle down with no help?

Admit it! Some parents are just not going to be willing or able to implement sleep training successfully. In our study various beliefs that mothers held predicted their success or lack of success with sleep training. Moms who agreed with the statement: “My baby will feel abandoned if I don’t respond immediately to his/her cries at night” were much less likely to report success with controlled crying. Those who agreed with “It is all right to allow my child cry at night” were more likely to succeed. No surprise. Those statements, by the way, come from something called the “Limit Setting Scale” on the Maternal Cognitions about Infant Sleep Questionnaire. It’s a recognized research tool developed by a British researcher and now used in other studies. Do you get the implication of the phrase Limit Setting? That’s right, the implication is that parents who feel they can’t let their babies cry at night don’t set “limits”, which as we know, has a negative connotation. Good parents set limits, weak parents don’t. That’s just another example of the ways in which researchers and conservative sleep experts use rhetoric to promote their views. I actually read one paper that referred to a “sleep disorder” (I’ve forgotten the name) which was defined by the presence of a parent at when the child falls asleep (which BTW, is the norm in many cultures all over the world). Where do these people get off? Honestly!

Here’s what I will admit.

Sleep training (in varying forms) has worked and been helpful for quite a few families.

I have seen no evidence that kids are damaged in the process.

I know kids who have been sleep trained, and they’re fine. And their parents are nice, warm, caring and loving.

Sleep is important, for both parents and babies.

When it comes down to it, parents have to make these tough decisions about how to deal with things like night waking, whether or not they and their children are getting enough sleep, and what to do about it. And I’d like them to be able to do make those hard decisions in an atmosphere of support, respect and non-judgment, based on their understanding of their child and his or her needs, not what some researcher believes is best for most children (and, in case you hadn’t noticed, researchers don’t all agree anyway.)  Parental judgment – call it intuition, if you will, but I think it’s more than that – is an imperfect mechanism. But it’s the best one we’ve got.

Wakeful baby? Chin up, it may mean you’re a good mom

One thing that fascinates me about the world of academic studies is the findings that don’t get reported, or at least, are not emphasized by researchers and thus, are not reported in media stories.  This happened with the Temple University study on night waking which I blogged about last week. I want to tell you about a couple of really interesting findings that you may not have heard about.

And, just for some cheeky fun, I decided to do it in the form of a mock news story: the one I might have written if I parked my scientific objectivity and let my biases run rampant. Here goes.

Study shows that babies who wake in the night have better moms!

A new study by Marsha Weinraub, a psychologist at Temple University, suggests that night waking in babies may be a sign of good mothering.

Dr. Weinraub and her colleagues tracked 1200 infants for three years, measuring nighttime sleep awakenings when the babies were 6, 15, 24 and 36 months old. They also gathered data on other family characteristics, including breastfeeding and the mothers’ sensitivity.

Mothers were asked if they were still breastfeeding when babies were 6 and 15 months old. Breastfeeding is known to be beneficial for babies’ health and development. Health authorities advise mothers to breastfeed their babies for at least six months and encourage them to continue nursing for up to two years and even beyond.

The researchers also videotaped mother-child interaction in play sessions at each age and mothers were rated for their sensitivity. Maternal sensitivity has been shown to be a key factor in healthy child development.

Thus, breastfeeding and maternal sensitivity could be regarded as indicators of good mothering.

The study found that the single biggest factor associated with continued night waking was whether or not the mother had been breastfeeding when the baby was 6 months old. Since it is well known that breastfeeding is the biologically appropriate way to feed babies, this suggests that it may be normal for breastfed babies to wake in the night after the age of six months. This challenges the view, expressed by some pediatric sleep experts, that xis-month-old babies are developmentally capable of “self-soothing,” that is, going back to sleep on their own with out parental assistance, in the middle of the night.

Another key finding was that wakeful babies tended to have sensitive mothers. As Dr. Weinraub and her colleagues noted in their article, ”Infants whose mothers display sensitivity during play and structured interactions are more likely to continue to awaken more frequently than infants whose mothers are less responsive.”

Thus, it appears that night waking may not be a sign of a sleep disorder, but rather an indicator of good parenting.

“This study is a clear indication that some pediatric sleep experts may need to completely re-examine their thinking about what constitutes normal in terms of the sleep and night-waking patterns of older babies,” said Biasus Maximus, a sleep researcher who was not involved in the study. “We may even need to give advice to mothers whose babies sleep through the night about how to be more sensitive and responsive to their babies.”

————————————————————————–

Please, don’t take that last comment seriously. It would be judgmental, cruel, and downright wrong to suggest that mothers whose babies sleep through the night are insensitive.  But that speculative comment is no more absurd, and in some ways, more justified by the data, than the statement made in news stories all over the world that the study shows that babies should be left to cry themselves to sleep. I just wanted to show how silly it can get when academics and media types try to turn their often hard-to-interpret data into instant rules for living, and how biases and assumptions can have a big influence on the way study results are spun.

And, in fact, even though the associations I chose to highlight between breastfeeding, sensitive mothering and night waking really were found in the study, concluding that night waking is a marker for good parenting is not justified. As my blogging colleague Tracy Cassels so adroitly explained in her Evolutionary Parenting blog on this study, the effect sizes in this study were very small, so small as to be virtually meaningless, even though, technically, the researchers can say there was a difference. (I also admire the way Tracy methodically picks apart the uber-shaky connection Weinraub and colleagues, and others before them, tried to make between infant night waking and poor outcomes later in childhood.)

But Dr. Weinraub did report (that quote I used is word-for-word from the journal article) that mothers of nightwakers, as a group, on average, tended to be a little more sensitively responsive in videotaped play interactions with their babies.  I happen to find that interesting, but I can’t say what it means. But I think closer study of this association (and the association with breastfeeding) might shed some light on what I see as one of the big problems in advice for parents about night waking: the massive disconnect between what mothers are told about the importance of exclusive breastfeeding for six months, plus the importance of responding promptly and sensitively to babies’ distress in general, versus the way (some) sleep pundits tell them they need not worry about withholding or substantially delaying comfort to their babies’ cries at night in the context of sleep training.

I hasten to say that I am not aware of many sleep experts – certainly not reputable ones – who actually advise parents to let their babies cry themselves to sleep without ever going back in to provide at least temporary reassurance and comfort.

I’m starting to get some push back on my last blog. Good. Night waking/sleep training is a multi-layered issue that warrants a lot of discussion. I would like to see more of it aimed at identifying areas of agreement and cooperation between the “two sides” (for lack of a better term) as a opposed to a struggle for supremacy.

I’ve got more to say on these issues in future blogs. But please understand one thing. I do not have The Answer to sleep issues.  And I can’t tell you what is the right way for you to handle it.

What I’ve been trying to do is expose some of the untruths so that we can get on with the important task of making sleep advice for parents more flexible, non-judgmental, realistic and helpful.

 

Self-soothing. Possibly the biggest lie ever foisted on parents

I haven’t blogged in over a month — busy with many things — Christmas, Christmas concerts and my new part-time job as research associate with the Milton and Ethel Harris Research Initiative at York University.

It figures it would be the latest propaganda about baby sleep that would wake me from my blogging slumber. This time it was news reports of a study by Dr. Marsha Weinraub, a psychologist at Temple University. In an article recently published in Developmental Psychology, she reports on data (collected 20 years ago, oddly enough) from a study which tracked patterns of nighttime sleeping and wakening in babies aged 6 to 36 months. Sleep patterns were recorded at four points in time – 6 months, 15 months, 2 years and 3 years. They found that 30% of the babies were sleeping through every night at age 6 months, while another 29% were waking one or two nights a week. The researchers decided for some reason that 30% and 29% add up to 66%, and that this means that that most babies sleep through the night at six months.

I don’t agree with the math or the interpretation, but what really got me is the egregiously inaccurate way these findings were spun in the news piece put out by Temple University’s communications department and subsequently parroted in web and news stories around the world. The University news story  is framed with the entirely unjustified and arguably dangerous headline  “Let crying babies lie: Study supports notion of leaving infants to cry themselves back to sleep.”

The study does nothing of the sort.

I have to wonder if that headline made Dr. Weinraub, who is an attachment researcher among other things, cringe. But, upon reading the journal article it’s very clear that she does support the mainstream idea that it’s important for babies to learn how to “self-soothe” and that mothers who attend too often or too quickly somehow interfere with this “ability.”

This is an opinion, not fact. Nothing in her data supports this idea.

Further, Weintraub’s opinion is based one the biggest lies that parents have ever been told: the doctrine of self-soothing.

I gotta tell ya. My blood pressure rises every time I hear or see the words self-soothe. Because it’s such a crock. There is no research proof whatsoever that babies who sleep through the night do so because they have learned to “self-soothe.”

Oh, search the literature and you’ll find all sorts of references to self-soothing, some of which Dr. Weinraub quotes. I know those studies because I read them. I traced my way back through the all the references on self-soothing, trying to locate the study that actually proved that babies soothe themselves back to sleep. I couldn’t find it  – just a bunch of people saying (claiming) that babies learn to self-soothe around six months. But actually, all that’s really been proven, as Dr. Weinraub’s data confirms, is that some babies are sleeping through the night by age six months. But whether or not they do this because they’ve learned to self-soothe, is an interpretation, not science-based fact.

How do I know? I e-mailed Dr. Thomas Anders, the guy who invented the term self-soothing way back in the in 1970s. Here’s what he said when I asked him if any studies had documented that infants who go back sleep without crying engage in some sort of soothing behaviour to help themselves get back to sleep.

“I know of no studies that address either of your questions. Self soothing is a label we coined to contrast it with signaling (crying) upon awakening. I would bet that most non-signaling awakenings occur without active self soothing.”

That’s a direct quote. I still have the e-mail.

So this self-soothing that experts talk about is nothing more than a made-up research term. But here’s what sometimes happens to research terms. Somebody coins a research term in a study and then all the researchers doing similar research start to adopt it because it’s “in the literature.”  But after awhile people start to forget that it’s just a research term. And since self-soothing appears to mean a certain thing – a baby actively soothing herself back to sleep – people started believing that it meant much more than it was ever intended to mean. This is the same sort of thing that happens in propaganda and advertising. Repeat something over and over and people start to assume it’s true.

But,  no Virginia, there is no such thing as self-soothing, at least not the self-soothing that conventional sleep pundits talk about.

I’m not saying that babies don’t wake up and go back to sleep on their own without crying. Some do. And I’m not saying babies never do things that could be thought of as self-soothing. Obviously some suck their fingers and thumbs and seem to be calmed  by that. I’ve seen it happen. But what isn’t proven – even though lots and lots of experts will tell you it has – is that babies learn the “skill” of self-soothing and that this “skill” is a developmentally normal and appropriate milestone for all six-month old babies.

So, anybody who says things like,  “Learning how to self-soothe is a vital skill in learning how to develop good sleeping patterns during infancy,”  (as one news story posited) is either a liar or very careless with facts.

And anyone who claims that it’s normal for all babies to sleep through the night at six months is ignoring mountains of research evidence. In fact, the pro-sleep training pundits’ own studies all show that night-waking is so common that it can only be thought of as one kind of normal. To be fair, Weinraub doesn’t exactly state that anything is wrong with babies who wake at night beyond six months. Mind you she does suggest that some babies may have had their “self-soothing” skills interfered with by parents who are too quick to comfort them. Imagine! Parents wanting to calm an upset baby. Shocking!

Grrrr.

Night waking is a tough issue for a lot of families. I know I’ve been there. (None of our three boys slept through the night until they were three – consistent, by the way, with one of the patterns noted in the Weinraub paper). Tons of professionals, of varying opinions and philosophies, possibly including Marsha Weinraub, are sincere in their intent to help parents.

I don’t believe there is any one solution that will work for all families.

But a couple of things are certain. It doesn’t help to keep repeating something (the doctrine of self-soothing) that isn’t true. Nor do I think it helps to tell parents that something that is within the range of normal is a disorder, or a sign of weak parental limit-setting, a sign of a disordered baby, or that night waking in baby and toddlerhood causes sleep and behaviour problems (I defy anyone to show me a single study that proves this).

Some other time I’ll get into the elephant in the room which is the colossal disconnect between mainstream infant sleep ideology and the social and biological realities of breastfeeding (something that all mothers are encouraged – pressured, some say – to do these days). The biggest single predictor of night waking in this study was breastfeeding at six months, something health authorities want all mothers to be doing.

There’s actually a lot of pretty interesting data in this study that was not reported in media stories. In fact, I think the study could have been spun in a totally different way. I’ll tell you about that in my next blog – very soon, I promise.

(This post has generated an amount of interest that really surprised me. If you want to read my take on what self-soothing really is, click here.)