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Friday, 25 May 2012

Trust Yourself: An open letter to parents considering 'The Gift of Sleep'



I've just finished reading The Gift of Sleep by Elizabeth Sloane. Now, I knew I would probably disagree with the majority of her words, but what I wasn't expecting was this reaction: I actually feel sick. My stomach is in a knot and I feel kind of trembly. And not in a good way.

You see, as a baby, I was left to cry myself to sleep until I 'learned' to. So I actually found the advocation of this advice quite triggering and stressful. I'm writing this post mostly as catharsis, as I don't want to carry this with me anymore.

Although the author takes great pains to stress that the book does not advocate "crying it out", I believe there is really no way of getting around the fact that that is exactly what the program is. This is just my opinion – you can make up your own mind.

I'll show you what led me to this conclusion.

Just to be clear: I believe The Gift of Sleep is nothing other than an innocuously-painted version of cry-it-out/controlled crying.

Obviously, due to copyright issues I cannot quote directly from the book without the author's permission. So please bear with me whilst I paraphrase. I will however directly quote some single words.

Ok, are you ready? Deep breath. You might need it. (You might like to know that a similar sentence is written before the program instructions in the book.)


The theme of the book is based on a 3-night regime that promises to get a currently wakeful baby sleeping independently. The authors assert that most "sleep problems" are based on using aids or props to encourage a baby to sleep, i.e. rocking, breastfeeding/bottle-feeding, dummies (pacifiers), etc. The aim of the program therefore, is to remove the infant's reliance on these "props". Although the author claims that the program won't guarantee the child sleeps continuously through the night, she does claim that her program will "teach" the child to self-settle if they do wake – namely, to fall asleep independently, without any parental involvement when they are first put to bed in the evening, and whenever they wake subsequently throughout the night.

The book is aimed at parents of babies 6 months or older.

While she says that she can often "crack it" in 3 nights, sometimes "stronger" babies may take a little longer.


So what exactly does this program entail? Well, to sum up, it's essentially putting the baby into their cot (or bed) – awake – tucking them in in a specific manner, saying goodnight, and then walking out.

Parents are then given arbitrary but somewhat confusing instructions on how to approach the subsequent crying, or "protesting." They are told to wait X amount of minutes outside the door, and if the baby is still crying, to knock on the door or make a loud "shhh" noise.



She explains that this is so that the baby (somehow) knows the parent is there. Although goodness knows how, considering that object permanence (the ability to know that something exists even if you can't see it) isn't fully developed in a child until they are closer to 2 years of age.

Would you feel comforted by a knock on the door and a loud "shhhhh" if you were upset? I wouldn't.

It goes on. If, after these X minutes the baby is doing a certain level of cry (parents are to rate the baby's cry based on how it sounds), parents are allowed to go in to the child and "re-settle." I think it's important to note something here - the re-settle isn't advocated if the child is still crying at all - it's only advocated if they are doing what the parent rates to be a cry based on the author's description of how a cry sounds. It goes without saying - how on earth can written text convey how a unique human baby's cry should sound? 

Okay, phew, I hear you say. They can now attend to their crying baby.

Nope, think again. The "re-settle" involves not talking to, picking up or giving eye-contact to the baby. Instead, parents are to pop the sheets back around the baby, making the "shhhh" noise a few times, and then leave again. Then the whole listening-outside-the-door-and-knocking/shhhhing timings are listed.


That's it. Eventually, she says, the crying gets less, and the baby will put themselves to sleep. Or in some cases, through "exhaustion".


I found the entire tone of the writing condescending, authoritative and bordering on patronising. There's lots of DO NOT (yes, in caps), and several warnings against "cave ins" or "cracks". There's lots of words like "distressing", "guilt", and "hard work".

Does this sound like the fostering of a positive self-esteem and feelings of worth in a developing human being? It doesn't to me.

I need to say that the author does make a point of insisting, early on in the book, that the program won't appeal to or suit every family. She recommends that if a baby is waking up during the night and that doesn't bother the parents, then there is no problem. Her program is recommended if the parents feel it is right for them. The author also stresses that the baby should be well, and the program is not recommended around the time of immunisations or other distractions such as a holiday, etc.

However, what I feel is important to note, is that any concerns that a parent would rightfully have about leaving the child to cry, are several times through the book soothed with reference only to a single study completed by Murdoch Children's Reasearch Institute that found:
"...techniques including 'controlled crying' - which helps babies learn to put themselves to sleep by letting them cry for set periods of time - and positive bedtime routines, had no adverse affects on the emotional and behavioural development of children or their relationship with parents when compared to children who as babies had sleep problems but received no sleep intervention."
This particular study was part of a longitudinal study of 225 6-year-old children who had received some form of "behavioural intervention" on their sleep as infants. 

Personally, I have a couple of problems with this study:
1) It's my understanding that the original paper has not been published – just presented at a conference.
2) It's also my understanding that the study was undertaken on a questionnaire basis: i.e. parents were asked to complete a questionnaire based on their child's behaviour. 
3) One study alone, of questionable validity when the original research is unavailable, does not make sufficient evidence given the contrasting knowledge that is now available about how the human brain develops.

This is the only research the author uses to backup her claims of the safety of her program. 

However, the research that speaks against leaving an infant to cry alone for any period of time, or that encourages maternal/paternal responsiveness is insurmountably more convincing. A non-exhaustive list follows, if you're interested:
  • Bell SM & Ainsworth MD (1972). Infant crying and maternal responsiveness. Child Development 43, 1171-1190.
  • Bowlby J (1973). Attachment and loss: 2. Separation. Harmondswroth, Middlesex: Penguin.
  • Dolby R (1996). Overview of Attachment Theory and Consequences for Emotional Development. In: Seminar 15. Attachment: Children's Emotional Development and the Link with Care and Protection Issues. Sydney: Child Protection Council.
  • Hope MJ (1986). Selected Paper No. 43: Understanding Crying in Infancy. Kensington, NSW: Foundation for Child & Youth Studies.
  • Keller H et al. (1996). Psychobiological aspects of infant crying. Early Development and Parenting 5, 1-13.
  • Lamport Commons M. & Miller PM. Emotional learning in infants: Across-cultural examination.
  • Leach P (1994). Children First: What we must do, and are not doing - for our children today. London: Penguin.
  • McKenna J & Gartner L (2000). Sleep Location and Suffocation: How Good Is The Evidence? Pediatrics 105, 917-919.
  • McKenna J (2000). Cultural Influences on Infant Sleep (abbreviatedchapter) Zero To Three 20, 9-18.
  • Mitchell EA & Thompson JMD (1995). Co-sleeping increases therisk of SIDS, but sleeping in the parental bedroom lowers it. In: Rogum TO (Ed). Sudden infant death syndrome: new trends in thenineties. Oslo: Scandinavian University Press.
  • Odent M (1986). Primal health: A blue print for our survival. London: Century Hutchinson.
  • Perry BD. Memories of Fear: How the Brain Stores and Retrieves Physiologic States, Feelings, Behaviors and Thoughts from Traumatic Events.
  • Perry BD & Pollard R (1998). Homeostasis, stress, trauma, and adaptation: a neurodevelopmental view of childhood trauma. Childand Adolescent Psychiatric Clinics of North America 7, 33-51.
  • Trevathan W & McKenna J (1994). Evolutionary environments of human birth and infancy: Insights to apply to contemporary life. Children's Environments 11, 88-104.
You see, a baby is born with 100 billion brain nerve cells (neurons) in place. However, these neurons are relatively 'unconnected' - the pathways that govern action, thought, emotions etc. are not yet formed. This is why newborns are so developmentally immature. Over the first 2 years of a child's life, a staggeringly large amount of neural connections are made. The more a pathway is used (for example, lifting their hand to their mouth is a connection that gets used frequently), the stronger that pathway becomes. (1)

These neural pathways, in the first few years, operate on a 'use it or loose it' basis. Those neural connections that don't get used, get 'pruned'. Parental behaviour is the most important  influence on how an infant's brain pathways develop: which connections will be strengthened, and which will wither away. In this sense, the brain is literally moulded and shaped by how a caregiver reacts and responds to the baby: the smiles, cuddles, and loving touch. (2) The brain pathways that get used the most are the ones that become the strongest. Just like a path worn through the bush - used once, it has little impact. But used every single day, the path becomes well defined.  A baby is too immature to handle and manage their own emotions; they rely on their parents to help them learn how to do this. If a parent consistently, lovingly, shows them comfort and reassurance when they are upset, then these loving, emotionally stable neural pathways will form to help them deal calmly with stress and upset throughout their life. (3)

And this is why I believe that so many of us are so prone to depression and anxiety. Myself included. Because it is so common to leave babies alone, repeatedly, with their grief - for however many minutes that may be. What is happening is this: baby's brains are getting the message: upset = grief  = abandonment. I'm not worth it. I'm not always loved.

Sad, huh?

I want to acknowledge that sleep deprivation can be so, so tough to deal with. It can make life incredibly difficult for a family, a partnership. It can be a real catalyst for depression. However, I am incredibly concerned that the answer to these issues is so often advocated to be simply ignoring the infant. After all, they are the least mature being in the entire house. If the adults are suffering, I believe it is our problem to address - not the infant's!

But my concern doesn't only extend to sleep. I believe that encouraging and enabling parents to ignore their infant during times of inconvenience sets up a mindset that disconnect is okay, and takes the power to parent away from the parents. Parents must continue to pay for advice. In essence, parents lose confidence that they actually know what to do with their baby.


If sleep deprivation is negatively affecting our life, what can we do about it? What can we simplify for a few months until it passes? What help or support can we reach out for from others around us? What reassurances about normal infant behaviour can we find? 
And, if the situation is really dire, what other gentle methods could we try instead, that don't "break" the infant into shutdown and learned helplessness?

Finally, I want to address another pivotal point: how does The Gift of Sleep feel about criticism?

Defensive much?
While I was grabbing some screen shots from The Gift of Sleep's Facebook page, I came across the above. Obviously, as the book's publicity grows, it is inevitable that so too will it's criticism. While I can imagine that internet trolling is quite frustrating, the comments that I did see (before they were deleted), certainly weren't "bullying" or "arrogant" - they were simply asking for clarification of concerns based on emerging neuroscience and the importance of secure attachment. After all, if the program is so innocuous - why so defensive?

And I have read the book, and no matter how the author's paint it: the method – in my opinion – is the same thing as crying it out – because it offers exceptionally little reassurance to a crying infant.

I can't speak for the "attachment parenting fanatics," but I would assume that other adults who are concerned about this sleep training advice, are concerned because they are compassionate human beings who care about the emotional wellbeing of others - both babies and their parents. 

Yes, Elizabeth Sloane has a business to run. I understand that criticism is frustrating. But I believe she also has an ethical and moral responsibility, as she is charging people for this advice – to ensure transparency and honesty with parents. And, based on what I have read: I don't believe she is. 

After all, we're talking about the emotional development of our children

This particular book isn't the first to spout this kind of advice; but I can only hope that as science sheds more light on healthy emotional development, this kind of advice will become an embarrassing memory – like the days when doctors used to endorse brands of cigarettes.

So, for parents considering The Gift of Sleep I offer this: read everything, read both sides of the spectrum. Ask yourself - does this feel right? Can I do this feeling confident and 100% happy that I am making the right decision? If not, I encourage you to follow your instincts, trust your gut, and hold your baby.

Because I'll continue to say over and over: a world with more unconditional love expressed in it, has got to be a better world.

Peace and love to you. xo

References:
(1, 2, 3) Gethin, A. & Macgregor, B. 2007. Helping Your Baby To Sleep. Finch Publishing, Sydney.

16 comments:

  1. Yep! You've nailed it again Kim! A recipe for lifelong predisposition to depression and upregulated stress reaction

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  2. Goodness, Lost for words - it's so sad that something like this can be allowed to be sold. Why are there no rules or legalities to prevent it from happening? Poor babies :-(

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    1. I agree babycalm, I don't understand how it can be OK to be selling such scary advice. :(

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  3. Love this... all very well put, if only Elizabeth Sloane would read this

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  4. I feel sick too. We humans are a foul bunch, aren't we :(

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  5. With all that crying and knocking going on it really makes me wonder if we are going to end up with a lot of very anxious adults who either loose it or fall asleep every time someone knocks at the door. Only time will tell unfortunately :'(

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  6. What a great blog post! I'm so glad I never went down the CIO route though there were nights that were tough and I seriously considered it becaue I didn't feel like I was coping.

    Now at 17 months my daughter magically just got it. I thought I would just try popping her in the cot one night after nursing when she still wasn't that sleepy, and she waved and me and said "night night" lay herself down and started humming twinkle twinkle as I left the room. I was amazed, relieved and a bit sad all at once - my baby was growing up :)

    It just proves that kids really will get it in their own time - previously the only way she would fall asleep was via nursing, rocking or driving.

    Now just waiting for her to decide she doesn't need some cuddles 2-3 times in the middle of the night still :)

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    1. What a lovely story of a child growing up in their own time! Beautiful. Thank you for sharing :)

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  7. So sad. As a mother of 5, who all waitied till they were around 4 years old to sleep through the night, I know what sleep deprivation means. I also know that when a child is tired and confused, they need love and reassurance even more. So-called experts who push theories and practices that go against a mother's natural instincts, who make good parents feel guilty for loving and comforting their babies, are downright dangerous.

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  8. I love everything you write and have been sharing. Do you actually remember being left to cry as a child? It is amazing that with all the sleep problems adults have today that many don't see that there could be a plausible connection between them and our baby sleep training methods.

    Susan

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    1. Thank you Susan. I don't consciously remember being left to cry as a baby, but it was somewhat of a family joke growing up – I was the baby who "didn't sleep" therefore was left alone at 7pm, crying, night after night, until I finally stopped. Although I don't consciously remember it, my brain is certainly hardwired for grief leading to despair. Don't get me wrong - my parents weren't horrible, they just did what they thought was right. Just like the parents who follow this kind of advice. The thing is, I now deal with my terror of abandonment by tending to keep people at a distance, and those that I 'let' in close, I often deal with quite ambivalently. I'm working on it!

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  9. ps have you read or heard of this book? http://www.amazon.com/Why-Love-Matters-Affection-Shapes/dp/1583918175/ref=lh_ni_t Looks good/interesting...

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  10. Thank you so much for writing this. My heart breaks for those poor little babies. And for the parents who have decided to take the advice of a stranger, rather than trust their own instincts. I fed/rocked/cuddled my first daughter to sleep for about 16 months until she finally just "got it" (in her own time). And I'm currently doing exactly the same thing with my youngest. I'm quite sure that all of the current "sleep training" advice is going to lead to a whole generation of adults with abandonment and anxiety issues

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  11. I believe there should be a happy medium between allowing your baby to have a grizzle/protest cry and comforting them. Parents should not be bullied either way. There are plenty of things that people don't agree on when it comes to parenting and raising children but we have to do what works for us.

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    1. I agree, Anonymous, that as parents we have to do what works. But there's a difference between parenting with your heart, or doing "whatever works" as you say, and being given a set of arbitrary 'rules' by someone who is raking in cash to ignore your baby, uncomforted, all night.

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  12. Thanks for a great piece! When I was a little girl I had a friend who always wanted to play her "Mommy/Baby" game, in which I would be the baby and she would be the mommy. She would put me to bed, tuck me in, leave the room, and when I cried "Waa Waa" (as I was instructed to do), she would rush back in, hit me upside the head and shout: "Shut Up!" Even as a child I knew someone must be doing that to her...

    The study that convinced me of the importance of responding to a baby's cry was this one: Wendy Middlemiss, et al., “Asynchrony of Mother-Infant Hypothalamic-Pituitary-Adrenal Axis Activity Following Extinction of Infant Crying Responses Induced During the Transition to Sleep, Early Human Development 88 (2012): 227-232, http://www.ncbi.nlm.nih.gov/pubmed/21945361.

    She discovered that when a baby is left to cry and finally quiets down, the levels of the stress hormone cortisol come down in the mother, but remain high in the baby!

    I write about this issue in my book, The Secret Life of Sleep.

    Thanks again for speaking up for the ones who don't yet have words.

    Kat Duff

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