Yesterday I was thrilled to discover that Dr. Thomas Anders himself, whose e-mail I quoted in my original blog post about the myth of self-soothing (as one of the inventors of the term), made a comment on one of my blogs. I salute him for his willingness to engage in dialogue with parents. And I really appreciated his thoughtful comments, so much so that I wanted to share them with my readers. Dr. Anders us a rare window into what a researcher thinks about what his research really means in terms of our insight into how infants sleep and our understanding of parenting. I have always found that what researchers say in conversations is far more interesting and useful that what the rules and language of scholarly discourse allow them to say in journal articles.
Thank you Dr. Anders!
Here are his comments.
Dear uncommonjohn, Let me begin by stating that I am a newcomer to your blog. A former student/research assistant of mine recently delivered her first baby and has been following you closely. She recommended that I read your post on self- soothing which I did. In fact I read the several posts on self-soothing, self- regulation, sleep training and the review of Steve Porges’ vagal brake research several times. I even agreed with your quote of me stating that there was very little, if any, research on quantifying actual behaviors that self soothe an infant who awakens in the night and does not cry.
I believe that we may be in agreement that infants often awaken briefly and return to sleep without crying. It was this observation made from time-lapse video recordings of infant sleep in the 1970s that led me to the conclusion that hardly any infants, if any, actually “sleep through the night” as had been described in pediatric text books of the time. The construct of sleeping through the night after six months of age had been embedded in pediatric lore since the writings of Drs. Gesell and Spock, but our videos demonstrated that infants at 6 months rarely slept more that 5-6 hours uninterruptedly without an awakening; that brief unobserved awakenings and arousals were common at all ages including in adult sleep; and that expectations of young infants’ sleeping from 8:00 pm to 6:00 am, through the night were unrealistic.
As the original observers of this phenomenon (because of our video cameras), we were at a loss to describe these “silent” awakenings. Everybody was aware of the awakenings associated with crying, but the non-crying awakenings, in our review of the extant literature, had not been previously described. As you suggest, it may have been better to call them crying vs. non-crying awakenings. Since we did see some awakenings that were accompanied by fingers/thumbs in the mouth at 6 months of age, and some that were accompanied by the use of a fuzzy blanket or toy at a slightly older age, we chose the terms “signaled” awakenings vs. “self-soothing” awakenings. The latter term was meant to imply a developmental trajectory on the road to self-regulation, although this term was not widespread in the 1970s.
In subsequent longitudinal studies we made three further observations. In repeated video recordings from 1 month to 12 months of age, we noted that 1) there did seem to be a developmental trend to these two kinds of awakenings. Crying awakenings decreased as the children matured but the non-crying awakenings did not. Yet, in some children, the crying awakenings did not decrease, or if they decreased between 3-5 months to 9 months, they recurred after 9 months. We also noted 2) that when we tried to introduce a self-soothing prop (a soft t-shirt impregnated with the mothers’ pheromones) only a very few (not statistically significant) number of infants seemed to reduce their crying awakenings. In short, we concluded that a self-soothing prop was ineffective. However, we did note 3) that infants who fell asleep on their own (when put into their cribs awake) in contrast to infants who were placed into their cribs already asleep were more likely to have fewer crying awakenings later in the night. Similarly, we noted that infants who used a pacifier or fuzzy prop as they were falling asleep at the beginning of the night were more likely to re-use these “sleep aids” in association with a non-crying awakening and return to sleep. In other words, infants who routinely fell asleep on their own with or without a sleep aid at the beginning of the night tended to repeat their falling asleep behaviors after a middle of the night awakening.
These were our observations of the development of sleep patterns in infants over the first year of life. I believe that other investigators around the world have replicated many of these core observations. But, as you suggest, it is the interpretation of these observations and, perhaps the inadvertent use of misleading terminology that may have led to unintended consequences.
Our research always emphasized the transactional nature of the sleep process. The transactional model of sleep-wake state development (with Prof. Avi Sadeh) defined both proximal factors such as the infant’s and parents’ state of health and well being, and more distal factors such as family support, external stresses and cultural influences etc. that impacted on the dyadic interactions that occurred between parent and infant around bedtime and during the night. This transactional model was developed to inform sleep clinicians that “one size does not fit all.” Careful and comprehensive evaluations (assessing all of the domains in the model) were necessary before prescribing an intervention. Our group has always focused on individual differences and individual family friendly recommendations rather than on boiler-plate interventions. It is also important to note that in all of our publications we have stressed that our observations were made on solitary sleeping infants and that we had no knowledge about the developmental trajectory of sleep in co-sleeping or bed-sharing infants. We also noted that the developmental trajectory for nursing vs. bottle fed infants differed.
Some final thoughts—The term self-soothing may have led to some unintended consequences, but as a definition of an observed behavior it is not unlike “vagal brake.” Vagal inhibition no more resembles the braking mechanism of an automobile than self-soothing resembles mechanisms of self-regulation. Moreover, as the vagal brake learns from contextual, consistent and comforting/discomforting experiences, so too self-soothing behaviors learn from the same contextual, consistent and comforting/discomforting experiences. In summary, I hope you might look more kindly on the term “self-soothing” It distresses me that you are so distressed by the term. Best regards and keep up the good work.
Thomas F. Anders, M.D.