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Friday, 18 May 2012

The Silence of the Babies: When Sleep Training 'Works' – Who Wins?

When the lambs went quiet for Clarice, it wasn't because they'd contentedly learned to 'self-settle'

Ahh, sleep deprivation. The baby is born, and she doesn't know night from day. You feed, and walk, and feed some more. She cries – sometimes, a lot. Time wears on and you realise you don't even know what day it is anymore. For crying out loud, what you wouldn't do for some SLEEP!

Enter sleep training. It sounds promising, and you're told it's what you need to do. For you, and for your baby. 

You believe them. Why wouldn’t you? Despite the increasing warnings against the practice, the conflicting advice just does your head in. Especially when you can barely keep your eyes open, and the prospect of a full nights sleep appeals like an icy-cold drink in the Sahara. And besides, this particular program promises not to use 'controlled crying'. It says so, right there on the professional-looking, pretty coloured website


Talking about the potential risks of sleep training can often be fraught with emotion. It's such a common practice, that most parents (in western culture at least) have either done it or attempted it at some point. Denial, guilt, anger, resentment - they're confronting emotions to deal with. And those confronting feelings can make it difficult for parents to hear those risks  and not take it personally.

But I see it this way. It's a bit like a drug dealer and the junkie. While they both have a responsibility - who is really to blame? And who is really just the victim? 

So what exactly is sleep training, who's dealing it, and why?

With the pressures of our modern lives, and our nuclear families living in isolation from one another, the biologically normal needs of a human infant can make exhaustion very difficult to cope with. Many of us are inexperienced in the care of infants until we have our own. Thusly, normal newborn behaviour can be incredibly confronting. A baby's intense primate need to he held continually, and fed frequently, topped off with interrupted sleep and recovery from often traumatic childbirth, can all compound and threaten to overwhelm a new parent entirely. It's easy to feel pushed to the brink, and fear that life will forever be this utterly exhausting and relentless. 

We feel powerless. We feel useless. We have no idea of what is considered normal on the spectrum of normal newborn and infant behaviour. So, when a glossy book or website promises answers, promises "sleep" and "contentment" and "happiness" - oh my, where do I sign up?

As emerging science sheds more and more light on the vast importance of secure attachment in infancy, modern sleep training has attempted to skirt it's growing alarm by taking on a few pseudonyms. 

Known most commonly as controlled crying, cry-it-out or Ferberisation; advocates are instead now using terms like controlled comforting, and spaced soothing. But despite what advocates of these ‘methods’ will tell you – these are all pretty much one and the same thing. 
"I'm not a fan of controlled crying, and for most people that term conjures up horrible upsetting images of screaming babies being left in their room for hours. I call my program 'controlled comforting' ... I think the longest I ever ask parents to stay outside the nursery is maybe 10 minutes." – Elizabeth Sloane
Sleep training goes a little something like this:
  1. Place baby where the parent believes they are supposed to sleep
  2. Ignore their resultant cries until they stop happening.
That's pretty much it. Of course, the baby sleep whisperers/experts/trainers will tell you it’s far more complex.

Knock on the door? Scratch on the carpet? For 1 minute or for 5 minutes? Are you confused? I am.
Usually advocated as an integral part of the sleep training 'method', is a daily routine or schedule. As well as controlling their level of received comfort overnight, a parent must control when the baby eats, sleeps, and plays during the day. 

Put bluntly, the parent must take over control over the timing of all of the baby's physiological needs. Period.

So now, the day progresses at parental convenience and control, and predictability can ensue. Naturally, for a stressed, harried parent, this can feel intensely reassuring. The previous feelings of chaos become manageable, and the parent is told that by following the 'routine' the baby's cries - perhaps previously confusing and upsetting - now become 'recognisable'. 
"When following a baby routine, you will start to recognise your baby's hungry, tired or bored cries. When your baby starts to cry, you will be able to look at the baby routine and see what is due next. If your baby is due a feed, you will start to recognise that cry as a hungry cry. If your baby is due to have a sleep, you will learn that cry as a tired cry."Tizzie Hall
Will the parent actually learn to interpret their babies cries? Or will they just relabel that cry according to what the book says to do next?
"Routines teach you to recognise the difference between hunger and tiredness and how to listen to what your baby is really saying.  They are all about providing your baby with security and comfort, giving him what he wants before he needs to cry and demand it, and the result is a contented little baby who is likely to sleep the longest spell at night at around six to ten weeks." – Gina Ford 
Repeatedly forcing a baby to eat and sleep at prescribed times doesn't provide the child with "security and comfort" - it produces a kind of submissive compliance, a child who has given up bothering to communicate because it is pointless.

You see, the baby doesn’t suddenly think: “oh, I get it. I’m supposed to sleep now. I guess I have been crying too much just to be a pain in the arse. Nighty night. Gosh, I’m so loved.”

Here’s what actually happens:
“He cries and cries; his lungs, new to air, are strained with the desperation in his heart. No one comes. Trusting in the rightness of life, he does the only act he can, which is to cry on. Eventually, he falls asleep exhausted. He awakes in a mindless terror of silence, the motionless. 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 stops, able to suffer, unable to think, unable to hope. He listens. Then he falls asleep again.” (1) Jean Liedloff, The Continuum Concept. 
Almost hurts just to read, doesn’t it?

Parenting author, International Board Certified Lactation Consultant (IBCLC) and mother of five Pinky McKay describes the process of how sleep training 'works' on an infant:
"When controlled crying 'succeeds' in teaching a baby to fall asleep alone, it is due to a process that neurobiologist Bruce Perry calls the 'defeat response'... When infant cries are ignored, this trauma elicits a 'freeze' or 'defeat' response. Babies eventually abandon their crying as the nervous system shuts down the emotional pain and the striving to reach out. ...the baby who is left to cry in order to teach him to sleep will learn a much crueler lesson – that he cannot make a difference, so what is the point of reaching out. This is learned helplessness." – Pinky McKay
When faced repeatedly with a distressing situation over which they have no control, animals will often cease to protest. This is a psychological defence mechanism known as learned helplessness. Rather than legitimately embracing sleep, and drifting off peacefully, the suggestion is that infants 'shut down' in order to conserve energy to survive.

It's not because they've learned a handy skill - it's because they've given up.

Just as humans have a basic need for food, water and oxygen, humans also have a basic need for positive regard. An infant needs unconditional positive regard from a caregiver as significantly as food and water. A caregiver's timely, loving response communicates to the infant that they are worthy of protecting from predators. 

However, sleep training encourages parents to ignore a child's 'protests' for certain amounts of time. Warning of the risks of attending to the child too soon, parents are reminded that although it's hard to listen to their child's cries, they need to "win" and the child will "soon be asleep". (2) Does this send a message to the child that they are always worthy of their parents love and comfort? No. What this does is foster in the child what psychologists call 'conditions of worth' (3) - whereby the child learns that they are only worthy of love if they act or behave or feel in certain ways.

When a human is stressed, the stress hormone cortisol is released. Evidence suggests that excess cortisol levels can be damaging to a developing infant's brain, leaving the child at a higher lifelong risk for emotional disorders such as depression and anxiety. (4)

So why is sleep training, in one form or another, so very common in western culture?

With our fast-paced lives, emphasis on early independence, fear-based campaigns surrounding bed-sharing, and the social importance of a ‘marital’ bed, the biological needs of a baby suddenly become almost impossible.

Sleep becomes a fixation. We need sleep to survive. And that is the reason that so many self-proclaimed ‘baby sleep experts/whisperers/trainers’ are cashing in the big bucks – by trying to scare the pants off of us.
"They won’t sleep better if they are weaned or start to crawl, they won’t grow out of it!! They have the wrong sleep associations, they have bad sleep habits and unless you teach them how to fall asleep without these props then they will never learn." Jo Tantum  
 Yikes. Run – don't walk – to the nearest sleep trainer! So by this logic, does holding a child's hand while they learn to walk mean they will never walk alone? Or dressing them mean they will never dress themselves? Or putting them in nappies, cutting up their food, tying their shoelaces...? Not only is this just logically ridiculous, it's a downright lie. Myself included, anecdotally, I know of thousands of children who have been rocked or cuddled or fed to sleep, and have naturally outgrown it when they were ready. Not to mention what pretty much the rest of the world does, and has done, since humans have walked the earth.

Parents are told that the problem lies with their baby, or with their parenting style, and therefore, if they don't sort it out lickety-split, they're in for a lifetime of sleeplessness – them and their child.
"Usually a baby of six months will show the first signs of a self-settling problem by waking at about 5:00am. Then she will begin to wake at 11:00pm, and by the time your baby is one year old she will be waking at 9:00pm, 11:00pm, 1:00am, 3:00am and 5:00am! The sooner you solve the waking problem the better."Tizzie Hall
But I don't think the problem lies with the baby. The problem lies with a culture that is unwilling or unable to meet the biological needs of a newborn.

It seems that the mark of a ‘good’ parent, and a 'good' baby, is a baby who sleeps ‘well.’

No parent wants to believe that their baby is anything other that healthy and normal. So, a baby who doesn’t miraculously sleep around the clock can cause a huge amount of anxiety. What am I doing wrong? What is wrong with my baby? Parents want to be able to say “my baby is a good sleeper,” because for some reason, it validates their success as a parent – and validates the worth of their baby in the eyes of society.

And so, the baby sleep whisperers/experts/trainers with all their lofty promises and fancy marketing empires suddenly gain great appeal – and parents pay through the nose for it.
"Her three-night program is suitable for babies older than six months because she forbids night feeds, dummies, cuddles, toys in  the cot, music and eye contact, but the child is allowed one "sleep friend" for comfort.And you need to be prepared for tears -- your baby's and, most likely, your own.Among Sydney's eastern suburbs set, she's simply called "Elizabeth", charging families $3600 for three nights to teach babies how to self-settle. – Elizabeth Sloane
Parents have a right to raise their own children however they believe is best. Exhaustion and excessive crying (for both the parents and the baby) can be so hard to get though – it takes a huge toll on emotional, mental and physical health, work and relationships – I know, I've been there! But parents also have a right to the correct information, as well as a right to – and an obligation to – protect their child from harm. And in the case of baby sleep whisperers/experts/trainers, I don't believe this is happening. 

A packet of cigarettes now comes with a health warning. Alcohol products, gambling venues, all come with health warnings. Heck, even formula companies slap the obligatory 'breast is best' message on their tins. But do baby trainers adequately convey their risks? I haven't seen it yet. In fact, what I have seen is political spin and skirting of facts to rival the best politicians.

But shouldn't we just butt out and let parents be? To each their own? While I respect a parent's right to parent as they see fit, I think it's important to remember – these infants grow into children. Into adolescents. Into adults. They interact with their peers, they engage in society - they shape the future. Psychologists have presented compelling evidence that insecure attachment can contribute to a range of disruptive and anti-social behaviours in children, and a host of emotional problems (addiction, mood disorder, relationship problems) in adulthood. (5) 

But what do we do instead? I hear you shriek. I cannot take another night like this! There are plenty of gentle ideas, (sharing sleepparenting to sleep,) evidence-based reassurances, that don't compromise a child's secure attachment, nor strip the parent of their power or instincts. On the contrary - uncovering and embracing our biological, instinctive nurturing abilities can feel incredibly liberating and powerful.

Parents deserve to hold, hear and worship their babies. Babies deserve to be held, heard and worshipped. After all, there's no such thing as too much love, right?

References
(1) Liedloff, Jean. The Continuum Concept. 1977. Perseus
(2) Hall, Tizzie. Save Our Sleep. (p. 186) 2011. Macmillan Australia.
(3) Cervone, D. & Pervin, L. A. Personality: Theory and Research. 2010. John Wiley & Sons. 
(4, 5) Grille, Robin. Parenting For A Peaceful World. 2005. Longueville Media.

7 comments:

  1. So SOO true. I entered one of these programs and from the moment I walked in the door my gutt said this is WRONG. At one point my daughter had tears running down her cheek with her little arm stretch through the cot calling out 'maaa', she has NEVER done this in her entire 7 months of life - this was a first. Once she had 'self soothed' i checked on her to find her squashed up in the corner of the cot with her head jammed against 2 metal bars that was the cot bed. Please don't try and tell me that that is the position that my daughter decided was the most comfortable to go to sleep in because thats the position she had put herself in once she had 'self-settled', no thats the position she FELL in once she collapsed and passed out of pure exhaustion. I completed the program by sneaking feeds and cuddles to my daughter and was told how good she was going in the program. Little did they know that during the night I would slip her into my bed for a snack at 6am to take her through to the 7:30. I got home from 'school' and went about my normal routine to have my daughter head back into our normal routine of feeding to sleep to have her fall straight asleep and not murmur.
    I am her mother, it is my job to calm her, soothe her, HELP her - I am her mother.

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  2. I could not agree with you more. Why do people not understand the defeat response and that this is a very bad thing? I have never been able to put myself or my children through that despite chronic sleep deprivation, depression, relationship breakdown. It's just feels completely wrong to me.
    Extremely well written post. My first visit here and I LOVE what I see, especially your tag line.

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  3. This has got to be the best compilation of common sense and research around this subject. I will share this with others mercilessly.

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  4. When my youngest was a baby I nursed on demand, coslept, & nursed to sleep. When she was about 3 or 4 months old we let a friend watch our kids (2 older kids from my husbands previous relationship & our little girl) while we went out for a movie & dinner. When I came home I heard my little girl screaming in our room & I ran to her. Our sitter had thought that we did cry it out. My baby was in her crib screaming in the dark with the doors closed. After holding her while she was still sniffling & whimpering she crashed out on me, my son who was 9yrs old was very upset because the sitter didn't listen to him telling her that we don't let her cry. She had never cried like that before, we never let her get to that point before we took care of her. The next couple weeks she would start crying when we turned out the light for bed, even with her with us so we started leaving a small light on.

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    1. How upsetting for you all! Yes, it seems that the 'default' style of caring for babies is leaving them to cry - rather than holding or cuddling crying babies, the general assumption is that they must just be ignored through it. Thank you for sharing your story, and illustrating the power of a mama's loving arms xoxoxo

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  5. Interesting read - I'd like to know where the middle ground is on this. I've bfed my baby on demand for 11 months, and night times got increasingly drawn out. She was nursing for 60-90 minutes on and off before drifting off to sleep (and at nap times she often wouldn't even fall asleep, just nurse for an hour then be all awake again). The result was very sore nipples (according to a dermatologist I have developed eczema on them from over-nursing!)
    I've started "training" her to fall asleep alone - after she's done nursing and moves into play-nursing I take her off and don't let her back on the boob - I did cuddle her, sing to her, stroke her, speak to her, hush her etc etc but she still cried. It took a day and she now falls asleep and stays asleep without boob. She sleeps much longer too.
    I don't think this falls into either category, and I don't really know anyone else who's done it this way but it would be nice to hear about other middle ways, rather than just how bad sleep trainging is and how good it is to let babies fall asleep at the breast.

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