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| Family First Feature |

Sweet Slumber: Sleep Training for Little People

“People who say they sleep like a baby usually don’t have one,” a wit once observed. Few challenges leave mothers more frazzled than a little one who simply will not slumber.

There are few things more peaceful than watching the cherubic face of a sleeping baby.

There are few things less peaceful than stumbling out of bed five, six, seven, eight times a night to settle that sleeping baby.

There’s good reason why sleep deprivation is used as a form of torture in some countries: deprived of sleep, our frustration waxes and our patience wanes. We feel stressed and depressed, overwhelmed and underappreciated. Brain fog descends and the strongest espresso is unable to lift it. Generally, adults need around eight hours sleep a night.

Babies need much more. At the newborn stage, babies might spend eighteen out of twenty-four hours sleeping. At twelve months old, between thirteen and fifteen hours of sleep a day is still the norm. Sleep rejuvenates our bodies and our minds, physically and emotionally.

Sleep scientists divide sleep into two basic categories: rapid eye movement (REM) or dreaming sleep, and NREM (non–rapid eye movement) which is usually deeper. Throughout the night, we cycle between these two types of sleep. Even in utero, from the sixth month of pregnancy, babies show clear sleep-wake patterns. During the last two months, sleep cycles develop, with periods of wake, periods of quiet sleep (NREM), and periods of active sleep (REM). Each night, infants have eight to ten cycles of sleep. The cycles get longer until adulthood, when they drop to five or six cycles a night.

Sleep scientists can only hypothesize about why babies need so much sleep. But among their theories is that dream sleep stimulates brain growth and development, and is important for learning and memory formation. The eight hours a day spent in non-dream sleep is important for body growth.

Why Cry?

While some babies naturally slip into a bedtime routine and teach themselves to sleep through the night, most don’t. Pediatrician Dov Rosen points out the gap in parent education that leads to so many sleep issues. The most common sleep issue is an irregular sleep-wake pattern in infancy, he says. This is the usual pattern of newborn sleep, but after six months, and certainly in childhood, this is considered a sleep disorder.

We all have an inbuilt clock, a circadian rhythm that signals our bodies when and how to sleep. Almost like a clock synchronized via GPS signals, our circadian rhythm relies on zeitgebers to keep us on track. Zeitgebers (a contraction of two German words: zeit, meaning time, and geber, meaning giver) are the external cues that keep the body on a twenty-four-hour schedule, telling it when to wake and when to sleep. Exposure to sunlight or dark, meal times, social activities, noise level and temperature are all examples of zeitgebers; regulated carefully, they can be a key to getting children to sleep deeply and sleep long at the right time.

When a baby refuses to go to bed on time and wakes constantly through the night, it’s a sign that his circadian rhythm is out of sync. In such a situation, Dr. Rosen works with parents to develop individuated strategies to get baby back on track.

“Sometimes, two weary parents accompany their child to the doctor for a standard childhood illness. Then, the father says, ‘Doctor, please tell my wife that the baby doesn’t have to be picked up every time he cries.’ A beautiful partnership called parenting has become stressful and discordant, all because of a treatable sleep disorder.”

But what happens when achieving those fifteen to eighteen hours sleep that a baby needs is an impossible task? What is a mother to do when a good night’s sleep becomes a distant dream? The answer, in two words, is sleep training.

Ready, Set … Cry

Shulamit, a mother of three, relates: “Of course I didn’t want to Ferberize my baby. No one wants their baby to cry. But quite frankly, the Ferber method works, and because it works, I use it. The consequences of not using it are too great.”

Half a year after she returned to work following her first baby, Shulamit was politely let go.

“Although I was devastated, I understood why. I was exhausted. I could hardly talk clearly, let alone think in a rational or methodical way. I’d fall asleep in front of the computer. My baby’s bed time was around 2 a.m., and even after that, she’d be up three or four times before waking at six. For my next babies I couldn’t allow that to happen.”

The “Ferber method” that Shulamit used was devised by pediatrician Richard Ferber, MD, director of the Center for Pediatric Sleep Disorders at Children’s Hospital Boston. It involves putting your baby in his crib while he’s drowsy but still awake, saying good night, and leaving the room. If your baby cries when you leave, allow him to do so for a predetermined period of time (say, three minutes). When this time has elapsed, return to the bedroom to reassure him — without picking him up. Leave again, returning after a slightly longer period (say, five minutes) to reassure him, and then leave while he’s still awake. Build up the time you spend out of the room to a maximum of around fifteen minutes. (Dr. Ferber doesn’t recommend leaving a crying baby for longer than this without returning to reassure him you’re present.)

If your baby wakes in the middle of the night, follow the same routine — reassuring, but not picking him up. After three or four nights, your baby should have mastered the art of falling asleep alone. He will have learned how to self-soothe, and crying will become a thing of the past. (Dr. Ferber recommends sleep training for babies between the ages of four to six months, depending on the individual. Babies younger than this should be tended to immediately.)

The Price to Pay

But what about the following description of a baby’s waking up in the middle of the night:

“He awakes in a mindless terror of the silence, the motionlessness. He screams. He is afire from head to foot with want, with desire, with intolerable impatience. He gasps for breath and screams until his head is filled and throbbing with the sound. He screams until his chest aches, until his throat is sore. He can bear the pain no more and his sobs weaken and subside. He listens. He opens and closes his fists. He rolls his head from side to side. Nothing helps. It is unbearable. He begins to cry again, but it is too much for his strained throat; he soon stops. He waves his hands and kicks his feet. He stops, able to suffer, unable to think, unable to hope. Then he falls asleep again.” (Jean Liedloff, The Continuum Concept: In Search of Happiness Lost, Perseus Books, 1977)

Before you dismiss this as melodrama, consider the words of Dr. Michael Commons of the Harvard University Department of Psychiatry: “Parents should recognize that having their babies cry unnecessarily harms the baby permanently. It changes the nervous system so they’re sensitive to future trauma.”

Ironically, although Ferber’s name has become closely associated with the method of training babies to sleep by leaving them to cry, in his bestselling Solve Your Child’s Sleep Problems (Fireside Books, 1986), Ferber maintains, “Crying does not help at all. Better sleep comes only when the child learns how to fall asleep, and return to sleep, alone” (pp. 67). Ferber fans claim that by reentering the room, the baby understands that his parents are present and care for him.

But there’s no question that crying is an inevitable byproduct of the Ferber method. And that’s why, although the Ferber method has attracted countless followers, considerable criticism has been leveled at his approach, which can leave babies crying for prolonged periods. And even if it works once, what happens during winter colds, teething, and even times of family upheaval—travelling for a chasunah or Yom Tov? Each time the baby must be “retrained”—and the nights spent in tears add up. Effective or no, is the price Ferberizers pay too high?

For Henny, who tried the Ferber method on ten-month-old Shloimy, it was.

“I’d temporarily moved Shloimy back into my bedroom in an attempt to stop him waking the other kids, but they all woke up anyway. For the duration — and it lasted almost two hours — I sat on the hallway floor crying my eyes out.”

The Mechanchim Speak

Upheaval and sacrifice, according to some mechanchim, are only the initial costs of crying-it-out methods. In their opinion, which echoes that of Dr. Commons, the damage goes much deeper. This is particularly true when the baby in question is younger than ten months, and so has not yet developed a sense of permanency, a sense that he has not been abandoned.

Rabbi Leib Kelemen is perhaps the most forthright of a number of mechanchim who discourage crying-it-out. In To Kindle A Soul (Targum Press, 2001), he writes, “Ignoring a child’s nighttime cries might eventually produce quiet, but it does not cultivate security” (p. 107).

As an alternative, Rabbi Kelemen recommends what he calls Attentive Parenting, which distinguishes between five types of cries. Occasional whimpers are a normal part of sleep and can be ignored, as can tantrums, which can be distinguished by their cries of anger rather than distress. A child who cries loudly because he is afraid or lonely can be patted, massaged, or rocked to sleep. (Note that most times, the baby can be comforted without having to be picked up.) If a child cries hysterically, he needs to be picked up and calmed down, before patting, massaging, or nursing back to sleep. If a baby wakes up hungry, he should be nursed or fed. If he is wet, he should have a fresh diaper and then be patted, nursed, or massaged back to sleep.

Rabbi Kelemen admits that attentive nighttime care will result in a tired parent, so he recommends that parents nap during the day — going so far as to comment that parents might have to adjust their professional schedule to accommodate this nap. “Admittedly, an attentive approach requires more parental energy than modern reincarnations of the kibbutz system, but it also promises a psychologically healthy child” (ibid., p.108).

Close and Cozy

For some mothers, Attentive Parenting is a minimum standard. Shaindy, mother of nine, has developed her own method of coping with newborn nights.

“Whenever I’m toting a newborn, the same question is always asked: ‘Is he a good baby?’ My answer: ‘Of course — he has a pure neshamah, he must be ‘good.’ ‘Easy?’ That’s another question!

“Each time I come back from the hospital with a newborn, I make sure I’m in bed by ten. From just a few days old, my babies learn that night is dark and it’s sleeping time. They’re snuggled up beside me, sensing my heartbeat and feeling my warmth and the comfort of my presence. There are always glitches, like when you’ve got a wide-eyed infant at three in the morning, but usually it works great.”

Co-sleeping is not considered the ideal sleeping arrangement and it must be done with care.

“At first the idea made me nervous,” Shaindy admits. “But then I realized that falling asleep with a baby in my arms while I’m on a rocking chair is much more dangerous, and I stopped feeling so bad. Besides, it feels right.”

Knowingly or not, Shaindy is practicing Attachment Parenting, an approach devised by Dr. William Sears that promotes safe co-sleeping, carrying baby in a sling, and immediate response to a baby’s cries. Kate Allison Granju and Betsy Kennedy, in Attachment Parenting: Instinctive Care for Your Baby and Young Child (Pocket Books, 1999), write: “Babies are people, extremely helpless, vulnerable, and dependent people. Your baby counts on you to lovingly care for her. When she cries, she is signaling — in the only way she knows how — that she needs you to be with her … You know what it feels like to cry in fear or distress. It feels terrible. And it’s no different for your baby.”

Shaindy, and mothers like her, sense this instinctively. But co-sleeping is not for everyone. Are there any other solutions?

Tailor Made

No matter what method you choose, all sleep experts agree that prevention is better — and far easier for baby and mother — than cure. That’s why baby sleep therapist Blimi Schloss has devised an innovative class for expectant mothers. Blimi’s holistic approach also emphasizes the “why of the cry,” her background in psychology and nutrition, as well as her vast research into sleep issues.

An initial consultation lasts for around an hour and a half, and before coaching parents on how to teach a baby to fall asleep by himself without being reliant on external props, Blimi addresses any underlying problems. Is the baby suffering from colic? Is he failing to gain weight, in which case he’s waking up because he’s hungry? Is sleep apnea a problem? Are parents showing consistency through the process?

“The Ferber method does work for many babies,” Blimi maintains, “but it involves a heartrending sacrifice that’s just not necessary.”

In her work, Blimi addresses not just nights, but a twenty-four-hour day as a whole.

“Some mothers think that if they deprive their baby of his naps he’ll be so tired he’ll sleep through the night. That’s one example of how mothers can unwittingly sabotage their baby’s sleep.”

Most of us can testify to the fitful sleep we experience when we’re jetlagged. When babies are tired, they behave the same way. Good daytime naps are the first step toward a good night’s sleep.

Sleep Solutions

Sears or Ferber? Co-sleep or cry? Two extremes on the childcare continuum. It’s easy to get caught up in the argument without ever addressing the why of your wakeful nights. Is there a reason for a baby’s wakefulness? If yes, what it is? And how can we help?

Dr. Shelly K. Weiss, a pediatric neurologist at the Hospital for Sick Children (SickKids), Toronto, offers a baby-friendly technique to help treat what she calls sleep-onset association disorder; a common condition in which babies are reliant on something external — nursing, a pacifier, rocking, music, a parent’s presence, etc — to fall asleep. In her book Better Sleep for your Baby and Child (Robert Rose, Inc., 2006), she recommends the following:

  1. Eliminate nighttime feedings. Do this gradually, by decreasing the time you spend nursing by a few minutes every few days. Alternatively, decrease the amount of formula you offer in each nighttime bottle. Stop feeding before he is entirely full and put him in his cot drowsy, but slightly awake. As you wean him off nighttime feedings, increase other comforting measures, such as rocking, singing, and cuddling.
  2. Start at naptime. Once your baby is no longer waking for nighttime feeds, you can begin to teach him to fall asleep alone. To lessen the stress on parents, begin with naptime. Select one of your baby’s sleep associations, for example, falling asleep to soothing music, and remove it. Follow this schedule:

Days 1-3: Dim the lights and make sure the house is quiet, and then follow your usual procedure to get your baby to sleep — e.g., rocking, etc.

Days 4-6: Teach your baby to fall asleep in his crib rather than in your arms. Put him in his crib, drowsy but awake, and sit beside him with physical contact, rubbing or patting him. This step helps him learn to associate sleep with his cot, but you are beside him for comfort. Nevertheless, you are no longer holding him or rocking him to sleep.

Days 7-10: Now teach your baby to fall asleep with you beside him, but without physical contact between you. Sit beside him in his crib, occasionally touching him to soothe him, but making sure not to sing or shush him, or do anything that might encourage him to stay awake rather than go to sleep.

Day 11: Now you put your baby into his cot and, after your usual kiss and “sleep well,” you leave the room. An older baby might protest at this point, so keep entering and leaving the room, reassuring him that you’re still around and reassuring yourself that your baby is fine. If you hear your baby begin to settle, consider not entering the room—he might just be settling himself to sleep.

Even if your baby wakes up ten minutes later, congratulate yourself on having taught him to go to sleep by himself. You can do anything you like (rock, cuddle, sing, etc — but not nurse or feed) to get him back to sleep for the rest of his nap.

  1. Once you have succeeded at naptime, transfer the technique to bedtime. It’s not a three-day wonder, but if the choice is between time and tears, it’s a valuable, relatively stress-free technique.

Another relatively stress-free technique has been developed by Tracy Hogg, neonatal nurse and author of Secrets of the Baby Whisperer (Ballantine Books, 2001). Hogg cautions against letting your baby depend on props such as nursing, patting, and rocking to sleep. She recommends putting your baby to sleep when he’s drowsy, but awake. If he cries, pick him up and soothe him, putting him down again when he’s calm and drowsy — but not yet sleeping. Do this repeatedly, until your baby realizes that he must fall asleep by himself.

One mother relates, “On the first night I tried this, I picked up my baby 136 times. The second night we were down to 47. On subsequent nights, I lost count. But after a week or two, he got the message and went to sleep by himself.”

There are a whole range of methods out there to try and get your baby (and you!) a good night’s sleep. In fact, a 2006 study in the journal Sleep showed that most sleep training methods parents used were equally effective. What really matters is consistency.

Dr. Rosen sums it up: “There’s been so much negative reaction to the Ferber method that parents are reluctant to intervene at all. In an attempt not to Ferberize their child, parents have lost sight of the ultimate goal — that the infant and parents should have a good night’s sleep in their own, separate rooms.”

Watchers of the Moon

Miriam, one of the shining women in our history, is referred to in the Torah as Puah, because she was “Puah umedaberes vehogah lavlad, she cooed, murmured, and whispered comfortingly to the newborn infant.” Miriam occupied the spiritual stratosphere of prophecy, and so was a woman on the highest intellectual and spiritual level. And yet, it is the simple comfort that she provided to newborn babies that is her accolade, her greatness, and what women of all ages are charged to follow.

Seek solutions? For sure! But whether we’re awake rocking them to sleep when they’re infants, or awake waiting for our babies to return from a shidduch date, from time immemorial, Jewish women have been watchers of the moon: wholeheartedly dedicated to a role that fills our days, nights, and hearts. And that’s something to celebrate.

Top Tips To ensure a good night’s sleep for baby — and mommy

  • Encourage your baby to get plenty to eat during the day. He’ll learn that daytime is for eating and nights are for sleeping, and is less likely to wake up to fulfill his calorific needs.
  • Establish a regular nap schedule, putting your baby to sleep around the same time each day.
  • Don’t fall into the trap of keeping your baby awake so he’ll be more tired. An overtired baby has a harder time falling asleep.
  • Make changes slowly. Don’t move bedtime from 10 to 6:30 in one shot.
  • Stick to a soothing bedtime routine: supper, bath, Kriyas Shema, and bed — at roughly the same time each night.
  • Create a comfortable sleep environment: quiet, dark, comfortably warm.
  • Don’t respond to your baby’s every whimper. You can wait to see whether it was the prelude to a real cry or simply another sleep sound.

 

(Originally featured in Family First, Issue 216)

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