Amazing Baby Sleep Secrets

8/10/2019 Amazing Baby Sleep Secrets

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You are strongly encouraged to print this book out immediatelyand then read it.Most of us just dont have the patience to read through something on the

screen, and its much easier to pick it back up later if youve already printed it.

The Baby Sandmans

Amazing Baby Sleep Secrets:

The Ultimate Guide to getting your infant or toddlertogo to sleep and stay asleep every night

By Michael F. Quarles, Sr.,The Baby Sandman

2001 Franklin Miami Publishing, LLC


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Introductory

Materials


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Amazing Baby Sleep Secrets Page 3Available athttp://www.fmpllc.com/babysandman.html

Copyright Notice

2001 Franklin Miami Publishing, LLC

All rights reserved.

Any unauthorized use, sharing, reproduction or distribution of these materials by any means, electronic,mechanical or otherwise is strictly prohibited. No portion of these materials may be reproduced in anymanner whatsoever without the express, written consent of the publisher.

Published under the Copyright Laws of the Library of Congress of the United States of America, by:

Franklin Miami Publishing, LLC7548 Preston Road, Suite 141-222Frisco, TX 75034

Phone (972) 335-6677Fax (214) [email protected]: www.fmpllc.com/babysandman/

Office phones are answered live only Wednesday morning from 8:00 a.m. to 12:00 p.m. Texas time.All other times, calls are routed to voice mail. You can FAX anytime to (214) 853-5648. Routinecustomer service calls, faxes and emails are usually handled within 72 hours. When we respond to you byFAX, we try connecting three times, then resort to mail, so if you dont have a dedicated FAX line or youturn your machine off, you probably will not get a response by FAX.

Legal NoticeWhile all attempts have been made to verify information provided in this publication, neither the authornor the publisher assumes any responsibility for errors, omissions or contradictory interpretation of thesubject matter herein.

This publication is not intended to be used in place of proper medical advice. Often, pediatric sleepdisorders are caused by medical problems, and appropriate medical advice from a licensed doctor should

be sought for any medical problem or perceived medical problem.

The purchaser or reader of this publication assumes responsibility for the use of these materials andinformation.

While this publication does provide analysis and opinion regarding the sleep methods of other sleepexperts, this analysis is designed to be informational only. Any perceived negative remarks about anyindividuals or organizations are unintentional.


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Additional Information

Amazing Baby Sleep Secrets:The Ultimate Guide to Baby SleepLatest Update - March 1st, 2001 - Version ABBS103

Thank you for ordering Amazing Baby Sleep Secrets. If you paid for thisbook by credit card, your statement will show a charge fromFRANKLIN

MIAMI PUBLISHING, LLCplease make a note of this.

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Contents

INTRODUCTORY MATERIALS

Copyright Notice ...............................................................................................................3 Legal Notice .......................................................................................................................3 Additional Information ....................................................................................................4 Contents...............................................................................................................................5

SECTION I: AN INTRODUCTION TO INFANT ANDTODDLER SLEEP PATTERNS AND ISSUES

Chapter One: Infant and Toddler Sleep An IntroductionHe/She Issues......................................................................................................................9How to Use This Book........................................................................................................9Whats Normal? ..............................................................................................................10The Non-Controversial Sleep Suggestions .........................................................................12

SECTION II: THE EXPERTS ANALYZED

Chapter Two: Dr. Richard FerberBackground on Dr. Ferber ..................................................................................................16Introduction to Dr. Ferbers Ideas.......................................................................................17Bedtime Routines and Going to Sleep................................................................................17Sleep Patterns and Staying Asleep......................................................................................19Cosleeping...........................................................................................................................20Feeding as a Cause of Sleep Problems ...............................................................................21Daytime Routines................................................................................................................21Medical Issues.....................................................................................................................22Summary/Diagnosing Sleep Problems ...............................................................................23

Chapter Three: Dr. William Sears

Background on Dr. Sears ....................................................................................................25Introduction to Dr. Searss Ideas ........................................................................................26Facts About Infant Sleep.....................................................................................................26Step-by-Step Approach to Nighttime Parenting .................................................................27Cosleeping (aka sharing sleep)........................................................................................29Summary of Dr. Searss Sleep Program.............................................................................30


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Chapter Four: Dr. T. Berry BrazeltonBackground on Dr. Brazelton .............................................................................................31Introduction to Dr. Brazeltons Ideas..................................................................................32Statistics and Independence Issues .....................................................................................32Three Personality Types Who Dont Sleep Well................................................................33

Miscellaneous Extras ..........................................................................................................34Chapter Five: The American Academy of Pediatrics and Dr. George J. Cohen

Background on Dr. Cohen and the AAP.............................................................................35Introduction to the AAPs Ideas .........................................................................................36A Little More Sleep Science...............................................................................................36Newborns Through Three Months......................................................................................37Three to Six Months............................................................................................................38After Six Months.................................................................................................................38How to Deal With Nighttime Crying in Infants and Toddlers............................................39Other Sleep Issues and Suggestions....................................................................................40

Chapter Six: Joanne Cuthbertson & Susie Schevill

Background on the Authors ................................................................................................43Introduction to the Authors Ideas ......................................................................................43Book Introduction ...............................................................................................................44Getting Your Child to Go Back to Sleep on Her Own .......................................................45How to Get Your Baby to Fall Asleep on Her Own...........................................................47Situations and Developmental Factors That Can Disrupt Sleep.........................................48Other Age-Specific Advice.................................................................................................49

Chapter Seven: Gary EzzoBackground on Mr. Ezzo ....................................................................................................50Introduction to Mr. Ezzos Ideas ........................................................................................51Parent-Directed Feeding (PDF) ..........................................................................................52

Babies and Sleep.................................................................................................................53Scheduling and How to Drop a Feeding.............................................................................54

Chapter Eight: Dr. Paul M. FleissBackground on Dr. Fleiss ...................................................................................................55Introduction to Dr. Fleisss Ideas........................................................................................56The Problem is One of Expectations ..................................................................................56A Few Miscellaneous Points of Interest .............................................................................57

Chapter Nine: Dr. Jeffrey HullBackground on Dr. Hull......................................................................................................59Introduction to Dr. Hulls Ideas..........................................................................................59Whats This Disappearing Chair Thing All About?........................................................60A Few Other Thoughts........................................................................................................61

Chapter Ten: Jodi A. MindellBackground on Dr. Mindell ................................................................................................62Introduction to Dr. Mindells Ideas ....................................................................................63The Basic Method ...........................................................................................................63Miscellaneous Advice from Dr. Mindell ............................................................................64


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Chapter Eleven: Dr. Benjamin SpockBackground on Dr. Spock...................................................................................................66Points From Dr. Spocks Book ...........................................................................................67

Chapter Twelve: Dr. Marc WeissbluthBackground on Dr. Weissbluth...........................................................................................68

Introduction to Dr. Weissbluths Ideas ...............................................................................69How Much Day and Night Sleep........................................................................................70The Newborn Up to Four Months.......................................................................................72Months Four and Beyond....................................................................................................72Other Thoughts from Dr. Weissbluth .................................................................................73

SECTION III: PUTTING IT ALL TOGETHER

Chapter Thirteen: The Baby Sandman

The Short Version (I Need Help Now) ...........................................................................75What You Can Learn from Each of the Authors ................................................................76Putting It All Together........................................................................................................78Checklist for the Basics ......................................................................................................84


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Section I:

An Introduction to

Infant and ToddlerSleep Patternsand Issues


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Chapter One:

Infant and Toddler Sleep An Introduction

He/She Issues

Every author nowadays faces the questionof what to call people. Is it his, hers, his orhers, or should I struggle to work in ageneric form? In this book, I haveuniversally adopted the feminine version. Ifind the flipping back and forth that manyauthors have adopted lately to be contrived

and awkward. Traditionally (until the lastcouple of decades), books have used themasculine as the inclusive version.

Therefore, to even it out a bit, I have simplychosen the feminine version.

There are only one or two places wheregender even comes up in this book, andwhat I mean should be readily apparent inthose sections. Everywhere else, she meanshe and hers means his and so on if you have

a baby boy.

How to Use This Book

This book is designed to be thorough, yetconcise. At the same time, you may have aneed to start making changes immediately.Maybe you just cant wait until youve read

this all the way through.Therefore, I have designedthis book so that you canuse it any of three ways.

No matter which of theways you choose, Istrongly suggest you printthis entire book out, ratherthan trying to read it on acomputer screen. As much

as I would like toencourage conservation, Iknow that none of us hasthe same attention span forreading on a computermonitor as we do for reading in print.

The three ways you can use the book are INeed Help Now, a complete reading takingmy suggestions, or using it as a review ofwhats out there so you know where to go

next.

If you are in I Need Help Nowmode, I suggest you readChapter One, then ChapterThirteen. As you find the time,you should then come back andread the rest of the bookbeginning at Chapter Two.

If you think you might want to

take my suggestions (which ofcourse I think are valuable, butyou have to read them to findout), and youre not in criticalemergency mode, I suggestreading, or at least skimming,

straight through from Chapter One throughThirteen. I have tried to make the text

If you are in I Need

Help Now mode, I

suggest you read

Chapter One, then

The Short Version in

Chapter Thirteen. You

can come back to the

rest later.


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succinct and readable, and an average readershould be able to get through the wholebook in about two to four hours.

The last method, which is for those who

think Im probably full of hot air, is to usethis as a resource for further research. Evenif you decide my method, which combineswhat I consider to be the best of the otherauthors ideas, is wrong for you, this book iswell worth your time and money. Afterreading this, especially Chapter Twothrough Chapter Twelve, you will havegained enough knowledge about what else isout there to decide whose program you wantto adopt.

If its not mine, I have provided links to thematerials from each author so that you canpurchase the one or two that make the mostsense. By using this as a book review of thebaby sleep literature, you can save the

hundreds of dollars it would have cost tobuy all the authors materials and reviewthem on your own. If you choose thisapproach, note that I have actively attemptedto prevent repetition of information in the

middle eleven chapters. Therefore, youshould not assume that a failure on my partto mention an authors coverage of a topicmeans that they skipped it. If theirinformation was especially enlightening, Ihave highlighted it, but if its pretty genericand covered elsewhere, I have not.

If you skim the table of contents, you willsee that the chapters that review the variousauthors methods start with Ferber and

Sears, and then proceed alphabetically withthe others. Ferber and Sears represent thetwo most commonly discussed schools ofthought (progressive waiting andattachment parenting), so I put them first.

Whats Normal?

Although the question of how to handlesleep problems results in dramatically

different responses, there is generalagreement on many of the standards fornormal. Everyone agrees that what youshould be doing depends on your childsage.

For the first six weeks or so of a newbornslife, sleep is just plain disorganized. There isa sort of a cycle that has three elements:waking, sleeping and feeding. As someparents have said, at this age babies dont do

much other than sleep, feed and eliminate.The cycle typically lasts around three or fourhours around the clock, and night is notmuch different than daytime.

Sometime around the four to six weekperiod, your infants system will beginrecognizing day and night. Biological

rhythms will start forming, and theserhythms will, as your baby ages, control the

release of various hormones, including thosethat govern the sleep cycle. By the time yourbaby is around four to six months old, herneurological system will be pretty fullydeveloped in its ability to regulate theserhythms.

While science still has not really discoveredexactly why we need to sleep, many studieshave shown that it is important. Similarly,we dont know exactly how much sleep we

need, but we can obtain some guidance bylooking at typical sleep patterns. Thefollowing table, which I built by combiningthe numbers from several sources, shows theapproximate amount of sleep required bychildren at various ages.


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The ranges are for the middle eighty percent,so if your child falls outside of the range,she is at the extreme ten percent on one endor the other. Although your child may beinto one extreme or the other, she may still

be getting just the right amount of sleep forher. If she is in one of the extremes,however, it is probably worth pointing out toyour pediatrician. Similarly, the fact that

your child is in the range, or even dead onaverage, does not necessarily mean she isgetting the right amount of sleep for her.Watch for signs of overtiredness, especiallylate in the day. As sleep deficits have

somewhat of a cumulative effect, it may takedays, weeks or even months before the signsappear, so always listen to your babyssignals.

Typical Sleep at Various AgesNight Sleep:

Mid 80% Range and MidpointTypical Number of Naps

In Early Postpartum PeriodTotal (including naps):

13-20 hours (avg. 16)

6-8 Sleep Periods

At Three MonthsNight Only (here and below):

11-16 hours (avg. 14)3 (2-3 hours each)

At Six Months 9-12 hours (avg. 10) 3 (1-2 hours each)

At One Year 10-13 hours (avg. 11) 2 (1-1 hours each)

At Two Years 9-12 hours (avg. 11) 1 (1-2 hours)

At Three Years 9 - 12 hours (avg. 11) 0

You will notice that, at certain ages,particularly when children drop naps,sometimes their requirements for nighttimesleep go up for a while.

The sleep cycle for children is also differentthan that for adults. While all humans cyclethrough different sleep states during thenight, infants have a cycle that involvesshorter and more frequent cycles, with alarger percentage of their time spent in lightsleep states. For this reason, slight wakingsduring the night are not only acceptable, butalso perfectly normal and unavoidable.

Therefore, the question is not how to preventthese wakings, as you cant, but rather how

to help your child go back to sleep when sheexperiences these wakings. How toaccomplish this objective is where theauthors disagree.

A newborn will take about twenty minutesafter first falling asleep to enter a deeperstate of sleep, and this time comes down toaround ten minutes by three months of age.For this reason, if your child has fallenasleep and you want to move her, you areless likely to wake her if you wait until shehas entered this deeper sleep state.

Beyond what Ive gone over above, wesimply dont know a lot about what worksbest or the long-term impact of various sleep


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methodologies, and there is not muchgeneral agreement. Although our knowledgeis scanty, it is growing. Much of the advice

is based on anecdotal experience, rather thancareful research.

The Non-Controversial Sleep Suggestions

I have purposely avoided controversialsubjects in this opening chapter. This sectionreviews suggestions that are agreed upon byalmost all those giving infant and toddlersleep advice. The controversial issues areaddressed both in the individual chaptersand in the final chapter.

Circadian Rhythms. As mentioned in the

previous chapter, biological rhythms calledcircadian rhythms govern the sleep-wakecycle in humans. These rhythms control therelease of hormones including humangrowth hormone, melatonin and serotonin.The single biggest factor influencingcircadian rhythms is light, but eating times,routines we associate with bedtime, andeven clocks themselves can make adifference.

In studies where all external time clues wereremoved, sleep researchers have determinedthat the natural human clock, on average, iscloser to twenty-five than twenty-four hours.For this reason, it is often easier to adjustyour babys schedule, or your own schedule,in the direction of later times, rather thanearlier times.

Additionally, it is helpful in regulating yourchilds biological rhythms to make sure that

she is exposed to light in the morning and todim the lights as sleep time approaches.According to one study cited by Dr. Fleiss(Chapter Eight), a 100-watt light bulb tenfeet away shed sufficient light to disruptsleep patterns in some people.

Maintaining a relatively stable, although notnecessarily rigid, daily schedule for eating,playtime, naptime, and other majoractivities, should also help to regulate yourchilds biological rhythms. Many authorsencourage a reasonably stable routine,especially for toddlers, as an aid to sleep. Abedtime routine is an important element ofthis stable routine, and the pieces that make

up the bedtime routine may be lessimportant than keeping it consistent.

Consistent Sleeping Environment. Likeadults, children sleep better when they are inthe same environment each night. If yourbaby sees the same things each time shewakes in the night, she will not have to tryto figure out what a particular piece of herenvironment means. The more consistentyou can make the sights, sounds and smells

she experiences upon waking, the morelikely it is that she will easily go back tosleep.

Consistent Sleep Practices. While there is alot of disagreement over which method isthe best for encouraging your child to sleep,virtually all of the authors suggest that youadopt a consistent approach. Going to sleepand going back to sleep after night wakingsare largely habitual, and consistency on your

part will help your child learn these skillsmore rapidly. You should make sure thatyou, your spouse, and any others who putyour child to bed are all using the samebasic routines and methods.

Sleeping with a Bottl e. You may find thatyounger babies fall asleep more easily while


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nursing or taking a bottle. This is verycommon and normal, and all of the authorsrecognize that it happens. Some feel that youshould try to discourage falling asleep whilefeeding, and others do not, but all agree you

should not let your baby sleep with a bottle.If the bottle has something other than water,it can promote tooth decay, and even watermay promote ear infections. So, if your babydoes fall asleep with a bottle, dont leave itwith her through the night.

Feeding and Attention in the Early

Morning. Children learn very quickly aboutgetting what they want. If you are givingthem a bottle, or a chance to nurse, or,

especially for an older infant or toddler,attention, in the early morning, you may beencouraging an early waking time. Theauthors disagree about whether you shoulduse an earlier bedtime, a later bedtime, orsome other method to discourage your childfrom waking too early in themorning. They all agree,however, that giving themsomething they enjoy whenthey first wake can encouragethem to wake up a little earliereach day in anticipation ofreceiving that pleasure.

Swaddling. Swaddling newborns cancomfort them, but as they age, your childrenare more likely to be hampered than helpedby tight swaddling. It is thought thatswaddling may emulate the tight conditionsof the womb. As children start to moveabout more, however, they feel confined byswaddling. By three months of age, andoften much earlier, your baby will probablyprefer a less confining blanket or sleeper.

Transiti onal Object. This is the generic termfor a favorite blanket, stuffed animal, orother comforting object. Transitional objectsare commonly adopted after six months of

age, and they may help comfort your childwhile she goes to sleep or in the middle ofthe night. Even Dr. Sears, who does notencourage what he calls parental substitutes,says that a familiar warm fuzzy object

may help your child sleep once shes in herown bed.

Temperature. Your baby is probably bestoff sleeping in a room that is about 65 to 70degrees Fahrenheit. At this temperature, shewill probably need some covers, a warmsleeper or a sleep sack to keep warm.

Dir ty Diapers. Although you will not wantto let them go too long, most babies do not

really care about dirty diapers. The mostimportant reason to keep your baby cleanwill be the prevention of diaper rash, nothelping her sleep.

Permanence and Developmental

M il estones. Even the best ofsleepers will go throughtimes when they do not sleepwell. For instance, your sixmonth-old baby may besleeping perfectly, only tostart experiencing sleepproblems at nine months.This is perfectly normal, and

these new sleep problems often coincidewith developmental milestones such aslearning to crawl, learning to walk, orunderstanding separation and return(separation anxiety).

Problems Do Not Disappear on Their Own.If your child is experiencing sleep problemson a regular basis, it is very unlikely thatthese problems will get better if you justkeep doing whatever youve been doing.You will have to take a more active role inhelping your child develop the skills sheneeds to sleep well.

It is thought that

waddling may emulate

the tight conditions of

the womb.


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SIDS: Back to Sleep. Newborns shouldsleep on their backs to minimize the risk ofSIDS. Once she can roll over on her own,your baby can sleep however she chooses.The highest risk of SIDS is the time before

she has learned to roll over.

Need to F eed. Exactly how long your childcan sleep without a feeding before sixmonths of age is a matter of somecontention. By six months, however, she nolonger has a nutritional need for middle ofthe night feedings. Continuing them beyondthis age is usually for comforting, not out ofneed.

Premature Babies. For developing sleephabits and evaluating recommendations forvarious ages, use your babys adjustedage, which begins on her original due date.

Sleep Di ary. By keeping track of what youhave done and how your baby has slept, youmay spot patterns that are easy to miss ifyou dont keep track. If you decide to seekhelp from your pediatrician or others, thisdiary will also provide them with someuseful background information.

Soli ds to Help Your Baby Sleep Thr ough

the Night. With the exception of Dr. Hull,all of the authors that I have read, includingall of those reviewed in this book, agree thatfeeding solids before bedtime (or including

cereal in her bottle) does not help your babysleep longer into the morning. By the timeshe is old enough for solids, she has passedthe time when she needs to feed during thenight.

Teething. While my anecdotal experienceseems to argue against this point, the authorsare pretty universal in agreeing that teethingshould not cause night wakings. They implythat teething causes more discomfort than

sharp pain, and that the discomfort is notsubstantial enough to cause wakings.

Medical I ssues. The different authors eachhad their own list of medical issues andremedies. They all agree that you should nottry to change sleep habits while your child issuffering from a medical problem. You willhave more success if you wait until she ishealed first. I have not designed this book tobe an authoritative medical reference, as youare better off consulting with yourpediatrician on medical issues.


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Section II:

TheExperts Analyzed


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Chapter Two:

Dr. Richard Ferber, M.D.

Background on Dr. Ferber

Dr. Richard Ferber is perhaps the bestknown of the baby sleep doctors. Accordingto the biographical information in his bookSolve Your Childs Sleep Problems, Dr.Ferber is widely recognized as the nation'sleading authority in the field of children'ssleep problems. Director of the Sleep Lab

and the Center for Pediatric Sleep Disordersat Children's Hospital in Boston (Harvard'spediatric teaching hospital), Dr. Ferber alsoteaches at Harvard Medical School and is apediatrician.

To my knowledge, Dr. Ferber has publishedtwo books on baby sleep issues. The mostwell known, Solve Your Childs Sleep

Problems, at about $13, is targeted towardsthe needs of parents who are trying to handletheir own childrens sleep issues. Thesecond book, Principles and Practices ofSleep Medicine in the Child, is a much moreexpensive ($60) and technical resourcedesigned primarily for use by pediatricians,neurologists, and psychiatrists.

If you are interested in finding out moreabout either book or in purchasing them,click on the appropriate link below (if youare logged in) or cut and paste or type it intoyour browser manually (if you are notlogged in).

Solve Your Chi ld s Sleep Problemsis available at:http://www.amazon.com/exec/obidos/ASIN/0671620991/franklinmiamipub

Pri nciples and Practice of Sleep Medicine in the Chil dis available at:http://www.amazon.com/exec/obidos/ASIN/0721647618/franklinmiamipub

To the best of my knowledge, Dr. Ferber

does not have a personal presence on theweb. The closest I could find was a link to

the Center for Pediatric Sleep Disorders at

Childrens Hospital in Boston, which is at

http://www.childrenshospital.org/neurology/sleep.html.

If you find any other links to Dr. Ferber, or if you find contact information that he would like tomake publicly available, please drop me an email [email protected].


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Introduction to Dr. Ferbers Ideas

The first comment that I feel I need to makeabout Dr. Ferbers book is that it has beenoversimplified. As others have pointed out,it makes a quick and easy magazine article,newspaper article, or television story to justexplain the progressive waiting aspect ofDr. Ferbers work, but there is much more toit than just that aspect.

In the beginning of his book, Ferber givessome interesting background, including achart of typical sleep requirements forchildren of various ages (see my table inChapter One, which is a compilation ofFerber and others numbers).

Dr. Ferber points out that, although it is

normal for babies to wake briefly at night

as it is for adults most babies should beable to sleep through the night by the timethey are three of four months old. He alsostates that, past around five or six months of

age, a total inability to fall asleep and stayasleep is NOT normal. He believes parentswith children older than this age should be

more proactive, not just waiting for the stageto pass.

Ever the researcher, Dr. Ferber includes a lotof interesting information about sleeppatterns in adults and children. Whileinteresting, I have not included a summaryof this information here, as I do not believemost of it will directly help you with gettingyour infant or toddler to sleep. If you areinterested in this subject, I would encourage

you to buy Ferbers books.

Lastly, in terms of introduction, at severalpoints in the book he offers a strong ray ofhope. According to Ferber, most sleepproblems can be corrected in a few days to,at the most, two weeks.

Bedtime Routines and Going to Sleep

As many of you may know, humans have anatural body clock that has, on average,around twenty-five hours in a day. Sleepresearchers have determined this by puttingpeople in controlled environments wherethere were no external signals regardingtime.

So how do we know when to fall asleep?

Our bodys sleep is controlled largely byhormones, and those hormones are triggeredby a variety of environmental factors. Lightsources, eating times, and routines weassociate with sleep can all help triggerthese hormones. It is very important tocontrol these factors when getting your baby

to sleep, as sleep time will otherwise tend todrift later and later each day.

In addition to helping stimulate sleephormones, as Ferber points out, a goodbedtime routine will help a childs emotionalstate at bedtime. If she enjoys the routine,shell look forward to getting it started, andshell ease into sleep. If she dreads it, the

whole process can be a daily battle.

Dr. Ferber also points to the importance ofkeeping the environment before your babygoes to sleep consistent with what she willsee when she wakes up. For instance, if atotally different set of lights is on when shewakes in the middle of the night, she may


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become disoriented and are more likely tocry out. The next section discusses this issuemore fully.

According to Dr. Ferber, associations with

falling asleep are formed early, so youshould start to lay the groundwork as soonas possible. He points out that you mustchoose the associations very carefully aswell. If you choose associations that requireyou to be there, then your child will havedifficulty going back to sleep when shewakes up in the middle of the night withoutyou there. Ferber has found that difficultysettling to sleep alone because of problemswith associations is a common problem up

to four years of age.

If youre having difficultyappreciating the importanceof associations, think of yourown sleep patterns. Asexplained in the book,having all your normalassociations in place fellsright, and if they are notthere, it feels wrong. Forexample, imagine Ferbersillustration using yourpillow. If it was missing, andyou had to sleep without it, itwould be harder to go tosleep.

Even worse, if you woke up in the middle ofthe night, and it was missing, you might bevery disoriented. If it had just fallen to thefloor, you could adjust quickly and go backto sleep (although your baby might not havethis luxury). But if someone had taken it,you might not be able to go back to sleep. Ifyou were a baby, you might cry out infrustration.

To take the example even farther, imagine ifsomeone started stealing your pillow every

night, your sleep would be extremelydisrupted. If you fell asleep each night withit there, but it wasnt there when you awokein the middle of the night, your sleep wouldprobably suffer mightily. If you are letting

your child fall asleep in your arms in theliving room, but she wakes up alone in hercrib in the night, its like someone stealingher pillow.

When you are building your childs sleepassociations, Dr. Ferber states that atransitional object can be very helpful. Forinstance, if your child has a stuffed animalthat can be in view as she falls asleep andthere when she awakes, it can help her settle.

He recommends that you letyour child pick this item byshowing what she likes. Ofcourse, he also emphasizes theimportance of this object beingsomething other than you, orelse your child will need yourpresence to go back to sleepwhen waking at night.

It is for this reason that Ferbersays that your child must learn tofall asleep on her own.

And it is this fact that leads tothe Ferberizing, or

progressive waiting, approach to gettingyour baby to sleep. As the name progressivewaiting implies, the basic concept is togradually increase the time that you waitbefore responding to your babys cries.

For instance, you might start out by lettingyour baby cry for five minutes before goingin to comfort her. Then you go in, soothyour child a bit, and leave again for fiveminutes or until she falls asleep. Yournumber the next day might be six minutes.

As the name

progressive waiting

implies, the basic

concept is to

gradually increase

the time that you wait

before responding to

your babys cries.


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Dr. Ferber describes this as a five-step approach:

1. When its time for her to go to sleep, put your child in her crib.2. Leave the room while she is awake.

3. Stay out of the room for your number of minutes (five in the aboveparagraph).4. If your child is still crying at the end of the time, return briefly to assure her

that she is not abandoned, but leave while she is still awake.5. Gradually increase the time each day until your child is sleeping on her own.

The specific time is really designed more tohelp the parent than the child, since it is veryhard on most parents to not respond to theircrying baby.

Dr. Ferber recommends the same basicapproach for getting your child back to sleepwhen she wakes in the middle of the nightand is crying out (see the next section).

Returning to the pillow example above,Ferber puts it on the parents level again.For instance, if you had to give up yourpillow for orthopedic reasons, you would

probably have some difficulty the first nightor two. But, as you become used to sleepingwithout your pillow, you would return toyour normal sleep patterns.

Dr. Ferber also points out that certainchanges, like moving a child from a crib to abed, involve substantial changes inenvironment, you may have to go throughthe process again when these occur. Keepingyour babys environment and bedtimeroutine as stable as possible will minimizethese factors.

Sleep Patterns and Staying Asleep

Although I dont advocate spending a lot ofyour time learning everything there is toknow about sleep research, I do believe itsimportant to understand a few basics. Mostimportantly, you need to know that there aredifferent levels (called stages) of sleep,including one you have probably heardbefore called REM (for Rapid Eye

Movement) sleep.

As a parent, there are really two things youneed to know. If you are interested in more,I would again encourage you to consult Dr.Ferbers shorter book, or even the technicalone if youre really interested.

The first relates to getting your baby to go tosleep. When you or your baby is going tosleep, you descend through various levels ofsleep until you reach Stage IV, at whichtime you are deeply asleep and very hard towake. According to Ferber, by about threemonths of age your baby will take about tenminutes to enter Stage IV from when she is

first asleep.

This is important whenever your baby fallsasleep somewhere other than her crib, asmoving her before this time is likely to wakeher. In the next chapter we discuss this issuefurther and apply it to newborns (under threemonths) with Dr. Sears advice.


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The second part of sleep that you shouldunderstand relates to the way sleep cycleswork. As Dr. Ferber explains, during thenight, adults and children are cycling

through various stages of sleep, some ofwhich are deeper and some of which arenear waking. In an infant, or even in atoddler, these cycles are shorter, and a babymay go through ten to twelve cycles in anight.

At the light sleep end of thecycle, a baby is most likely toawaken. In fact, despite yourbest efforts, Ferber explains

that your child is almostcertain to awaken several timesa night. He explains that this isperfectly normal, but that yourreactions to it (going in tocomfort your child) can resultin abnormal behaviorinvolving difficulty going backto sleep.

If you quickly pick your child up and rockher in the middle of the night whenever shecries out, Ferber states that you will bothmess up her sleep rhythm and prevent herfrom learning to go back to sleep on herown.

One situation in which Ferber does say youmay want to respond is if you know that youknow that your baby is having difficultyfinding her associations or transitionalobject. In this case, you may want to helpher find it quickly and then leave.

If your child is having problems withwaking and crying out in the middle of thenight, Ferber recommends the sameprogressive waiting approach described

above to condition her to falling back asleepon her own. He further emphasizes that thetwo work best together, as youreconsistently reinforcing associations that donot require your presence. In other words,both are helping your baby learn to sleep on

her own.

This method will not stopthe normal nighttimewakings. In progressive

waiting, Dr. Ferber saysthat, rather than stoppingthe wakings, the cryingwill become whimpering,and the whimpering willbecome silence duringthose wakings.

In explaining theimportance of sticking with a consistentplan, Ferber points out a common mistakeand easy trap for new parents. Many parentswill let a child cry for a period of time, butthen go in to rock her to sleep (followingonly steps 1-3 and part of 4, but not the restof 4 and 5). In this case, he says you havejust caused her needless trauma, as she hasnot learned anything about falling asleep onher own.

In other words, you and your baby will bebetter off sticking to one method thanbouncing around.

Cosleeping

Dr. Ferbers advice on cosleeping is assuccinct as Dr. Searss advice (next chapter)on crying it out.

Simply put, he says that it is a fact thatpeople sleep better in their own beds.

If you quickly pick your

child up and rock her in

the middle of the night

whenever she cries out,

you will prevent her from

learning to go back to

leep on her own.


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Others movements, sounds, or wakingsunnaturally wake others in their bed. Thishappens to both the parents and the children.

Dr. Ferber encourages having children sleep

in their own bed as a way to help them learn

to be separate from their parents withoutanxiety.

As he makes clear when addressing thisissue, Ferber believes that parents often

choose cosleeping for their own needs, notfor their childs needs.

Feeding as a Cause of Sleep Problems

Dr. Ferber points to three potentialproblems related to feeding that can causedifficulty with sleeping.

One of these problems is experienced by

parents who let their baby fall asleep whilenursing or taking a bottle at night. As mostparents know, this is a very easy thing to do.Most babies are very relaxed while feeding.This state seems to help them fall asleep.

The problem is that children who fall asleepfeeding will develop associations betweenfeeding and falling asleep, with all theproblems discussed above as a result.

The next problem Ferber identifies isfeeding too much too late in the day. Heprimarily focuses on the problem of excessfluid and very wet, uncomfortable diapersthat result from too much fluid closer tobedtime. His answer? Progressive changes(have we seen this theme before?). In this

case, he is talking about progressivelylessening the fluid in late feedings andprogressively making feedings earlier.

He points out that day feedings may need to

increase to make up for less at night, but thatthis should not prove too difficult, as mostchildren will naturally want more thenanyway.

The last problem that Ferber mentions thatcan cause sleep problems is nighttimefeedings. While younger infants require acertain number of regular feedings, hebelieves that many parents deliver anexcessive number of feedings during the

night and fail to scale back on them as earlyas they should.

In many cases, the desire to feed at night ismore a result of habit or hunger brought onby a regular pattern of night feedings thanby a genuine need.

Daytime Routines

In order to maintain the proper, regularnighttime schedule, Dr. Ferber stresses theimportance of a proper, regular daytimeschedule.

The components of a daytime schedule thatmay influence the bodys natural rhythms

include meal times, timing of naps, timingfor the start and end of night sleep, activetimes, exposure to light and dark, andbedtime routines.

With meals, naps and active times, Ferberrecommends not having them too late in theday.


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The start and end of night sleep are the bestindication of the current schedule. Regulartimes that do not fit a proper scheduleindicate a need for progressive change.

As bedtime approaches, a gradual dimmingof the lights and entering into the bedtimeroutine will trigger the sleep hormones,making the onset of sleep easier.

Regular daytime schedules must bemaintained in order to keep biologicalrhythms in order and stabilized. If theschedule is too irregular in the daytime, thebodys rhythms are disturbed. In this case,

your child may be simply unable to fall backasleep at times.

She may act as if she has just woken upfrom a nap, although its the middle of thenight. When the body is out of rhythm, andit is producing the wrong hormones at the

wrong times, it may be impossible for yourchild to go back to sleep.

Some children will have difficulty acceptingwhatever it is (nap, food, active time) at the

appropriate times. In this case, Ferbersuggests offering the item only at thescheduled time, and then taking it away ifshe doesnt accept it. Do not reoffer the itemat other times.

For naps, he recommends using the sameprogressive waiting approach as you woulduse at night. As mentioned earlier, Ferberfeels that a child who has learned to fallasleep on her own at any one time will more

easily learn to do so at other times.Similarly, you should not let your child useyou to fall asleep at certain times, whiletrying to get her to do it on her own at othertimes. In this case, she may receive mixedmessages and have difficulty fully changingover to a self-sleeper.

Medical Issues

Although neither Dr. Ferbers book nor thisone is designed to be a medical reference,both of us feel it is helpful to at least touchon a few medical problems that mayinterfere with your babyssleep.

Most importantly, perhaps, isFerbers discussion aboutcolic. According to Ferber,in the early months this is

probably the most commoncause of significant sleep problems.

As Ferber points out, the actual causes ofcolic are not really known, but many peoplethink it is related in some way to intestinaldistress. The difficulty in looking tosymptoms such as gassiness is that it can be

as much a result of the intense crying as asymptom of some other problem.

Dr. Ferber discusses one possible reason forcolic. This analysis is largelybased on the fact that episodestend to occur later in the day.Ferber thinks that it maysimply be a problem ofoverload. That is, an infantmay accumulate experiences

and sensations over the dayuntil his or her system has hadabout as much as it can handle. This mayresult in a need to cry.

Ferber points out that, if this is the cause,soothing the child may not be helping herout. If she needs to let it out for a while, then

The good news is that

most symptoms of colic

disappear by about

three months of age.


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perhaps you should let her do so. Notsurprisingly, he suggests a progressiveapproach to doing this. This progressiveapproach might be used when other methodsare not quieting the outbursts.

As support for this claim, Dr. Ferber pointsto the fact that babies often quickly becomequieter when hospitalized. He feels this isprobably a result of nurses letting the infantcry it out when comforting doesnt work.

Lastly, Ferber mentions that most symptomsof colic disappear by about three months ofage. He cautions parents to try to developgood sleep habits in their babies as soon as

they are ready, and not to blame it on colicfor too long.

In addition to colic, Ferbers chapter alsodiscusses chronic illness, middle ear disease,

medications and brain damage as possiblemedical causes of poor sleep. His advice onthese issues can be summarized as saying ifits one of these, you probably know it.

Of course, Ferber is realistic enough to notethat medical causes may prevent good sleeppatterns no matter how good the methodsimplemented. He does, however, take apretty aggressive stance on returning to hisbasic five-step method as soon as your child

might be ready.

Summary/Diagnosing Sleep Problems

Dr. Ferber offers a list of general points to keep in mind when determining the causes of yourchilds sleep problems. Here are some highlights from his analysis:

If your child cries out at night but quickly quiets when you return and provide the sameassociations that were there when she went to sleep, she has learned sleep associationsthat require your presence. To resolve this, make sure your baby is falling asleep on her

own, not with you there all the time. If you are using things like rocking to put your baby to sleep, and she is not waking up in

the middle of the night, then its okay to continue. Probably your child has learneddifferent associations for returning to sleep than she had for going to sleep.

If your child cries so hard that she throws up, respond immediately. Clean it up, but thenleave so as not to encourage this as purposeful behavior.

Even once your child has learned proper associations, there will be disruptions. These canspan the spectrum including travel, visitors, teething, medical problems or something likemoving from crib to bed. In these cases, you may need to work a bit to reestablish thepatterns

If your child is falling asleep at nap time on her own but needs you at night, the processwill probably go more quickly, as she already knows how to fall asleep on her own.

It is very important that you follow through consistently with your program if you wantconsistent results.

If your child is sleeping normally, but at the wrong times, it may be necessary to modifydaytime routines (see section below on this) and to gradually shift her over to the righttime. If the times are close, remember the twenty-five hour natural schedule and adjustthe schedule by shifting your babys sleep time later until it reaches the desired time.


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Early waking can be caused by too early of a nap in the daytime. It may also be caused bya habit of feeding immediately upon waking. Sometimes, it is just a problem with gettingback to sleep for that one last cycle, in which case you need to pay careful attention toenvironmental conditions (light and noise in particular).

If your child is sleepy long before bedtime, she is probably overtired. She may not be

getting enough or long enough naps, or she may need more sleep at night. Herecommends starting by consulting his table of sleep requirements for some guidelines.

As you can see, Ferber has a lot more to offer than just the progressive waiting approach, butthis is a key element of his discussion. He has many followers, and I believe has some valuablelessons, but read the next chapter for the other side of the story.


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Chapter Three:

Dr. William Sears, M.D.

Background on Dr. Sears

William Sears, M.D., and Martha Sears,R.N., are the pediatrics experts to whomAmerican parents are increasingly turningfor advice and information on all aspects ofpregnancy, birth, childcare, and familynutrition. Dr. Sears was trained at HarvardMedical School's Children's Hospital and

Toronto's Hospital for Sick Children, thelargest children's hospital in the world. Hehas practiced pediatrics for nearly thirtyyears. Martha Sears is a registered nurse,certified childbirth educator, andbreastfeeding consultant (from the backcover of The Baby Book).

Dr. Sears has published a number of booksrelated to the full spectrum of parentingfrom pregnancy on through discipline and

other child development issues. As far as Iknow, only two of these books haveextensive sections relating to infant andtoddler sleep.

These two are The Baby Book, which isdesigned to be a pretty thorough guide toissues for children under two years of age,

and Nighttime Parenting: How to Get YourBaby and Child to Sleep.

If you are interested in finding out moreabout either book or in purchasing them,click on the appropriate link below (if youare logged in) or cut and paste or type it intoyour browser manually (if you are notlogged in).

The Baby Bookis available at:http://www.amazon.com/exec/obidos/ASIN/0316779059/franklinmiamipub

Nighttime Parenting: How to Get Your Baby and Chil d to Sleepis available at:

http://www.amazon.com/exec/obidos/ASIN/0452264073/franklinmiamipub

Dr. Sears has an extensive set of web pages at http://www.askdrsears.com. If you would like totake a quick jump to his resources related to sleep problems in infants and children, go here:http://www.askdrsears.com/html/7/T070100.asp.


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Introduction to Dr. Sears Ideas

You can tell a lot about Dr. Searsperspective right up front. For instance, he isnot an advocate of goals like how to get

your baby to sleep. Instead, he prefers toencourage a concept he calls nighttimeparenting.

By nighttime parenting, Sears meansdeveloping a good sleep attitude so that youand your baby all sleep better as a result. Hepoints out that you cannot force a baby tosleep, and that you are better off working ina caring, supportive environment.

Not surprisingly, Dr. Sears is no fan of Dr.Ferbers approach. While never mentioninghim by name, Dr. Sears often makesreferences to advocates of the cry it outapproach. The references are never positiveones. Sears has been quoted as saying thatthe cry it out system is a method thattrains babies with less sensitivity than wetrain pets. The Baby Book,p. 293.

His whole philosophy is based on the

principle that the goal is not just to getbaby to fall asleep and stay asleep, we want[him] to regard sleep as a pleasant state to

enter and a fearless state to stay in. TheBaby Book,p. 293.

In reading Dr. Sears book, it is clear that itis as much a book about attitudes towardssleep (especially parental attitudes) as it isabout how-to advice. The implication is thatthe how-to piece will evolve naturally if theright beliefs are instilled first.

Lastly, please note that, as discussed in the

first chapter of this book, I have purposelyavoided repeating the same material overand over again if an author repeatsinformation covered earlier in this book,unless I believe the author being coveredoffers substantially different insights into anissue. Therefore, you should not assume thatmy lack of coverage of a particular issue inone of the chapters analyzing the expertsnecessarily means that they did not discussthe topic.

Facts About Infant Sleep

As was touched upon in the analysis of Dr.Ferbers work, Dr. Sears emphasizes thatsleep is not a single, continual state. Rather,sleep represents various stages from verydeep sleep to a light, near-waking state, andthese stages progress cyclically through the

night.

If sleep is a cycling through various stagesof awareness, there will be times when asleeper, adult or child, is nearly awake. Thenatural lesson that evolves from this fact isthat, during the lighter sleep times, yourbaby is easier to awaken.

In fact, Dr. Sears points out that childrenssleep is more sensitive than that of adults fortwo reasons. One is that they have shortersleep cycles than adults, and therefore havea higher number of times during which theyare vulnerable to outside influences that

might awaken them. The other is that, on thewhole, babies have more light sleep and lessdeep sleep than adults.

Sears points to the combination of these twofactors as the reason that most parentalcomplaints about their childrens sleep


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habits relate to wakings during the night, notto problems getting them to go to sleep.

Dr. Sears also mentions a point made by

Ferber infants have a light sleep period

that lasts for many minutes before they arefully (deeply) asleep. As you read in theprevious chapter, this is why Dr. Ferberstates that waiting at least ten minutes fromthe time a child goes to sleep before doinganything that might disturb her is moreeffective.

In addition to the analysis offered by Ferber,however, Sears points out that this number is

even longer for newborns. In fact, he saysthe light sleep period can be as long asaround twenty minutes in a newborn,quickly decreasing to around ten minutes fora three month-old baby.

If you are interested in reading more aboutthe reasons Sears cites for the different sleeppatterns of infants, his books offer someinteresting information. I did not include thisinformation here in order to keep our focuson how to get things done, given that thingsare the way they are, rather than spendingtime wondering why they are the way theyare.

Step-by-Step Approach to Nighttime Parenting

The heart of Dr. Sears nighttime parentingmethod is a three-step approach to handling

sleep issues. The steps, outlined in moredetail below, are:

One. Give your baby the best sleep startTwo. Condition your baby to sleep, andThree. Lessen conditions that cause night waking.

These steps are discussed in detail below.

STEP ONE: Give Your Baby the Best Sleep Start

The first step is where Dr. Sears lays thegroundwork for his sleep method. First ofall, Sears encourages that parents developthe right mindset. By this, he means youshould not just be on a mission to get yourbaby to sleep, but that you should work tounderstand your babys needs as well.

Dr. Sears also offers encouragement andgood advice about developing your personalstyle of parenting. He advises parents not tobe too swayed by experts, but rather toremain open-minded and form your ownopinions. Obviously, he is most of allencouraging you not to put too much weightin the opinions of experts advocating the

cry it out approach (i.e. Ferber).

The last element of Step One is toimplement what Sears calls attachmentstyle parenting. Attachment style parentingrequires close attention to your babys cuesso that you can best address her needs.

During the daytime, elements of attachmentstyle parenting include feeding on cue (noton schedule) and wearing your baby in ababy sling or carrying her for much of theday. Sears offers more details on theseaspects of parenting, as well as othersuggestions for putting yourself more intouch with your babys needs, in The Baby


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Book. Sears believes that a parent who isphysically close to his or her baby for muchof the day will be much more aware of andattuned to the needs of that child.

Dr. Sears also recommends physicalcloseness at night. That is, he encouragessleeping in the same bed or next to yourbabys bed. The reasons for this arediscussed further in the Cosleeping

section below.

STEP TWO: Condition Your Baby to Sleep

As Dr. Sears points out, you cant force yourbaby to sleep; you can only set up the rightconditions that will make it easier for her tosleep.

In providing the right environment for yourbaby to fall asleep, Dr. Sears provides a listof suggestions. All of these

are pretty self-explanatory orhave been discussedelsewhere in this book,although Sears does providemore details in his book.These suggestions include:daytime mellowing,consistent bedtimes, calmingdown, wearing down,nursing down, fatheringdown, nestling down, rocking down, using

the car and gadgets.

Dr. Sears prefers more natural approachesand encourages the use of the car andgadgets only very sparingly. Similarly, hedoes not believe in using substitutes for aparent (such as the transitional objectFerber recommends).

Sears also offers a list of suggestions forproviding a nurturing environment that willhelp your baby stay asleep or return to sleepquickly if she wakes up in the middle of thenight. This list includes swaddling (fornewborns), beds that move or rock (like acradle), putting your baby in her best sleep

position (which you can

determine byexperimentation), using afamiliar warm fuzzy object(if shes on her own),touching and caressing,leaving something belongingto a parent with the baby ifshe is sleeping on her own, arelatively quiet environment,reacting quickly when she

starts to fuss, and a full but not too full

tummy.

Obviously, Sears has a very differentopinion about how to react to your babyscrying. Ferber believes in conditioning forindependence through a disciplinedapproach, while Sears encourages quicklyreacting in a nurturing manner.

STEP THREE: Lessen Conditions that Cause Night Waking

As discussed before, it is inevitable thatyour baby will have times during the nightwhen she is less deeply asleep. If you wantyour child to stay sleeping, it is, therefore,very important to provide the best conditionsfor remaining asleep during these times thatyou reasonably can.

Dr. Sears analysis of these issues is largely

based on physical/environmental factorscombined with an awareness of medicalissues.

In discussing the environmental factors,Sears offers self-apparent advice on many ofthe issues (like consider giving her somepain killers if she is teething). His list is

You cant force your

baby to sleep; you can

only set up the right

conditions that will make

it easier for her to sleep.


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worth checking through, however, to see ifany of these factors might be contributing tonight wakings.

Specifically, it is worth checking for wet or

soiled diapers, skin irritations fromsleepwear or detergents, hunger, temperature(room and sheets/mattress), and unfamiliarsounds. His advice on each of these is prettymuch common sense; he mostly focuses onthe importance of parents awareness oftheir babys needs.

In addition to the physical/environmentalcauses, Dr. Sears addresses some medicalissues. Unlike Ferber, whose advice was

pretty much if your child has one of theseyou know it, Sears offers some morespecific advice on how to tell if certainmedical issues are causing sleep problems.The Baby Book, and to some degreeNighttime Parenting, also offer remediesand symptom relief suggestions for manymedical causes.

A couple of the more useful suggestions fortwo very common problems include:

Using vaporizers (better thanhumidifiers) for thinning coldsecretions and loosening coughs.

Sears has detailed information onwhen and how to use vaporizers, andwhy they are superior to humidifiers.

Using a combination of painrelievers, positioning your baby withthe infected ear up, and a warmmixture of vegetable oil and water inthe ear for ear infections.

For more information on Dr. Searssuggestions for treating medical problems, I

would suggest purchasing The Baby Book,which devotes over fifty pages to self-helpmedical care. If you have a real need for amore thorough analysis of medical issuesand treatments for babies, I am considering aseparate publication on these issues. I wouldwelcome your thoughts [email protected].

Cosleeping (aka Sharing Sleep)

Dr. Sears answer to whether or not youshould share your sleeping area with yourbaby is perhaps what he is best known fordiscussing. Sears clearly advocates parentsconsider what is often called cosleeping,although he prefers the term sharing sleep.

Sears offers several compelling reasons forsharing sleep, but even he agrees it is not

right for everyone. His list of reasons foradvocating sharing sleep:

1. Its easier to get your baby to go tosleep because she trusts that you willbe there when she wakes up.

2. Your baby can more easily stayasleep, knowing youre there during

those vulnerable times. AlthoughSears doesnt mention thisspecifically, Im sure if asked hewould point out how much cryingcan be saved here for an eight totwelve month old, as this is the agewhen they are most likely toexperience separation anxiety.

3. You will be in nighttime harmony

with your baby, and you willtherefore also sleep better.4. Breastfeeding is easier.5. This fits with the busy lifestyle most

of us have today. If you dont haveenough time to be with your babyduring the day, at least you can bewith her more at night.


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6. Sharing sleep allows a parent to bondwith their baby. This additionalnighttime bonding may be especiallyimportant to parents whose childrencould not be with them as much

during the time just after birthbecause of medical reasons,including a premature birth.

7. Babies thrive in this environment.

Sears does point out that sleep sharing maynot work if it is started later in a babys life,rather than being a habit from the beginning.He also states that, if one or the other parentdoesnt really buy in to the concept, it is farless likely to work out.

Dr. Sears also discusses some arrangementswhere space needs can cause problems.Everyone has a certain amount of criticaldistance where they are more comfortable. Ifyour baby is too close to you all the time, herecommends putting some sort of softbarrier or bolster between you and the baby.If your bed is just too small, he suggestsconsidering a sidecar arrangement, wherethe babys bed is pushed up against theparents bed. If a crib is used for this, youcan probably remove the side of the cribwhere it meets the bed, as long as there is nocrevice between the babys mattress andyours.

If you are interested in the sidecararrangement, http://www.armsreach.comoffers several product choices.

In both of his books, Sears offers a lot of

encouragement for parents who areconsidering a shared sleep arrangement. Hisadvice demonstrates that he appreciates that,at least in the United States, this is not acommon arrangement. At the same time, heoffers common sense advice about how tohandle criticisms and worries about thearrangement.

Dr. Sears does say that, at some point,babies must learn to sleep on their own. He

emphasizes that this should only occur,however, after an appropriate period of timeduring which she has been parented to sleep.Unfortunately, his advice is noticeablyvague about when your child will be readyto make this transition.

Basically, the final word from Dr. Sears oncosleeping/shared sleep is about trust andsensitivity. He believes that crying it outbuilds mistrust and makes you insensitive toyour babys needs, and therefore less likelyto see certain causes of sleep problems. Hefeels that shared sleep arrangements, on theother hand, will build an environment oflove and awareness that will make you abetter parent.

Summary of Dr. Sears Sleep Program

As you can see, Dr. Sears sleep method isessentially one of responsiveness. Like most

practitioners, he first encourages the rightenvironment. In looking at daytimeschedules and routines, however, hepromotes responsiveness to your baby ratherthan the strict adherence that Dr. Ferberadvocates.

Similarly, his nighttime philosophy is much

more laid back. Rather than battling withyour baby, he believes in giving her a

certain amount of what she is looking for.He does not view this as excessivepermissiveness, but rather as nurturing.

The philosophies are clearly at odds. BeforeI give my thoughts on combining the two,lets see what some other authors cancontribute to the solution.


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Chapter Four:

Dr. T. Berry Brazelton, M.D.

Background on Dr. Brazelton

T. Berry Brazelton, M.D., "the beloveddean of American pediatricians, is aninternationally known expert on childdevelopment. At Children's Hospital inBoston and at Harvard Medical School,which has recently named a chair inpediatrics in his honor, he has taught, trained

pediatricians, and carried out his influentialresearch. His books have been translatedinto eighteen languages." (from back coverof touchpoints).

Dr. Brazeltons philosophy is based on agood deal of guidance from his trainedpractitioners. If you are looking for someoneto tell you what to do at each stage, thisapproach may make sense for you. If youare more of a self-learner, it probably doesnot.

Like Dr. Sears, Dr. Brazelton has publishedand been involved with a number of booksrelated to the full spectrum of parenting. Asfar as I know, only two of these books havemuch relating to infant and toddler sleep.

These two are touchpoints: The EssentialReference, which is designed to be a pretty

thorough guide to issues for children underthree years of age (there is anothertouchpoints book for three to six year-oldsas well), and, writing the foreword, The Self-Calmed Baby.

If you are interested in finding out moreabout either book or in purchasing them,click on the appropriate link below (if youare logged in) or cut and paste or type it intoyour browser manually (if you are not

logged in).

Touchpoints: The Essential Referenceis available at:http://www.amazon.com/exec/obidos/ASIN/020162690X/franklinmiamipub

The Self -Calmed Babyis available at:http://www.amazon.com/exec/obidos/ASIN/0312924682/franklinmiamipub

Dr. Brazelton has an organization called theBrazelton Touchpoints Center, which isavailable on the web athttp://www.touchpoints.org. He describesthis center as a training organization at the

Child Development Unit of ChildrensHospital in Boston. In reviewing the site, Ifound that it is targeted primarily towardschildcare professionals, not towards theneeds of individual parents.


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If you are looking for professionals whofollow the Brazelton philosophy, you couldtry contacting the center [email protected].

In addition, you can find out more about theBrazelton Institute, which is a site gearedtowards healthcare professionals, at

http://www.brazelton-institute.com/. This isa unit at Childrens Hospital in Boston.

If you didnt notice, yes, this is the samehospital that employs Dr. Ferber. I cant

help but think that Dr. Ferber has been amajor influence on Dr. Brazelton, especiallyin recent years.

Introduction to Dr. Brazeltons Ideas

Before beginning the introduction to Dr.Brazeltons ideas, I think it is worth notingthat the following is derived almost entirely

from touchpoints, and not from The Self-Calmed Baby. There are two reasons forthis. First, although Dr. Brazelton seems tohave had some input into The Self-CalmedBaby, his contribution was mostly limited towriting the foreword. Secondly, The Self-Calmed Baby is really a book aboutunderstanding your babys language andsignals, not about getting her to sleep.

If you are looking for a reference about

understanding your babys own way ofcommunicating, The Self-Calmed Babyis anexcellent reference. It is far more detailedthan Tracy Hoggs book Secrets of The BabyWhisperer, and falls short perhaps only in

Dr. Sammons failure to adopt as catchy aname as The Baby Whisperer (or The

Baby Sandman, for that matter !). In

reality, Dr. Sammons may be the original,but unaccredited, baby whisperer.

Also, it is worth noting that sleep problemsonly make up one chapter, or ten pages, ofthe touchpoints book, although there aretidbits, and even some more substantivematerial, about sleeping, scatteredthroughout the book, especially in the age-specific chapters that make up the first of thethree main sections of touchpoints. So why

did I include Dr. Brazelton at all? Well, likeDr. Spock, he is so universally recognized asa general childcare expert that a lot ofpeople want to know what hes got to say.

Statistics and Independence Issues

The research that Dr. Brazelton refers to

(probably from Dr. Ferbers sleep center,although Brazelton does not provide acitation) states that 70% of children aresleeping through the night (for eight hours)by three months of age, that 83% are by sixmonths of age, and that 90% are by one yearof age.

He points out a fact that is often not statedclearly, but that is abundantly clear when

deciding which side of the Ferber-Searsbattle you want to take. Sleep issues largelycome down to a question of how parents feelabout the issues of autonomy andindependence.

As decisions about how parents feel aboutautonomy and independence at various ages


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is so vital to the decisions they will makeabout not just sleep problems, but allchildcare issues, Dr. Brazelton urges parentsto start by analyzing their feelings aboutindependence. He emphasizes that, in many

cases, it is better forparents to be unified inan imperfect set ofbeliefs than for them tobe divided, even if one ofthe parents beliefs aremore helpful in gettingbaby to sleep. As hestates it, A goodrelationship between herparents is probably more

critical to a childsdevelopment than hersleeping arrangements. touchpoints, p. 387.

In the end, Brazelton comes out on theFerber side of the argument, but he

demonstrates an understanding andsympathy for the Sears side as well. Part ofthis, he admits, is driven by the fact that wemost of us (i.e. most of the people whowould be reading his book) live in a society

that fosters the idea thatself-reliance is necessary toself-esteem.

Lastly, he, at least in part,addresses one question thatDr. Sears does not seem tofully answer. If you aregoing to choose acosleeping arrangement, atwhat age should you

transition your child to herown room and bed?According to Dr. Brazelton, in cultures thatencourage cosleeping, such as India andMexico, this typically occurs when the childis two or three years old.

Three Personality Types Who Dont Sleep Well

Dr. Brazelton identifies three differenttypes of temperaments that children whodont sleep well tend to exhibit: the drivenchild, the low motor expender, and thesensitive child.

For the driven, or extremely active child,Brazelton suggests that the very intensitywith which she pursues new skills disruptssleep. Not content to merely work onimproving a new physical skill during thedaytime, this child will wake at night to

practice some more. For this type of child,periods of nighttime waking will oftencoincide with developmental milestonessuch as standing or walking. Dr. Brazeltonsuggests that parents of the driven child beespecially cautious about nighttime visits, astheir already stimulated child will only

become more awake with her parents added

presence.

The low motor expender is a quiet, alert,and watchful child during the day. She tendstowards the cerebral, rather than thephysical, world. As she is not as active inthe day, she will not be as worn out whennighttime comes around. For this child,encouraging somewhat more independenceand activity during the day may help withsleep problems.

Lastly, the sensitive child is likely to beeasily upset and rather clingy. Her sleepingproblems will probably revolve around newsituations, whether they be developmentalmilestones, new social situations or newenvironmental conditions. Because of hersensitivity, her parents may tend to be

A good relationship between

her parents is probably more

critical to a childs

development than her

sleeping arrangements.

-Dr. T. Berr Brazelton M.D.


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somewhat overprotective. The best way tohelp this child is to encourage independence

during the daytime in measured steps so thatshe does not become overwhelmed.

Miscellaneous Extras

Beyond that mentioned above, and the twoideas below, Brazeltons sleep advicelargely mirrors that already discussed inother authors chapters.

One unique suggestion he offers isespecially useful for parents who haveworries wondering if their baby is okay. Ifyou wake your child before you go to sleep,and repeat some or all of the bedtime

routine, you may be able to more easily goto sleep yourself. You will have alleviatedmost of your concerns about her, such as

whether or not she needs to be changed, tobe fed, and so on. I havent tried this onemyself, as around my house were all asleepby nine oclock or earlier most nights.

Another interesting suggestion applies tocomforting your child. If you find your childis too stimulated by your going into herroom, you can try just calling to her fromoutside of the room. Dr. Brazelton states that

he has been amazed by how willing a childcan begin to accept a parents voice for theiractual presence.


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Chapter Five:

Dr. George J. Cohen, M.D., F.A.A.P.,

as Editor-in-Chieffor the American Academy of Pediatrics

Background on Dr. Cohen and the AAP

George J. Cohen, M.D., F.A.A.P., asEditor-in-Chief for the American Academyof Pediatrics. George Cohen is attendingpediatrician at Children's National MedicalCenter and a professor of pediatrics inWashington, D.C. The American Academyof Pediatrics is an organization of more than55,000 primary-care pediatricians, pediatricmedical subspecialists, and pediatricsurgical specialists dedicated to the health,safety, and well being of infants, children,adolescents, and young adults (from backcover of the American Academy ofPediatrics Guide to Your Child's Sleep).

Although I could make a strong argumentagainst putting too much weight in medicalscience in this area, I also cannot think ofany more objective source than theprofessional medical community. This book

is the result of input from a committee ofmany doctors, with both the inherentproblems and inherent benefits of input frommany different places.

The one concern I always have withanything authored by the medicalcommunity is that it tends to be dominatedby doctors in the over fifty crowd. Sincedoctors, unlike lawyers, accountants, andmost other professions, do not have anyongoing education requirements, these olderdoctors are often relying on very outdatedinformation.

If you are interested in finding out more

about the AAP book or in purchasing it,click on the link below (if you are logged in)or cut and paste or type the address into yourbrowser manually when you log in (if youare not logged in now).

The Amer ican Academy of Pediatr ics

Guide to Your Chi ld' s Sleep: Bi rth Th rough Adolescenceis available at:

http://www.amazon.com/exec/obidos/ASIN/0679769811/franklinmiamipub

The American Academy of Pediatrics has aweb presence at www.aap.org. They offerseveral additional publications on topics

such as nutrition, allergies and medicalsymptoms.


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If you are interested in really learning whatthe doctors are hearing, they also offerextensive information through the

professional education section athttp://www.aap.org/profed/.

Lastly, they also offer a link over to theNational Library of Medicine, where youcan perform free research on Medline, the

most comprehensive medical research sitethat I know about. The Medline free linksare at:

http://www.nlm.nih.gov/databases/freemedl.html.

Introduction to the AAPs Ideas

You can pretty well guess what the AAPadvice is by considering how the book wasput together. It is written and reviewed bypediatricians. It is the result ofa whole bunch of differentreviewers and writers fromvarious parts of the AAPcombining their results.Therefore, it is, notsurprisingly, pretty middle-of-the-road.

It does not offer extremistadvice in any direction; insteadit is kind of a consensus book.The tone of the book is, morethan any others I have read,one of objective analysis andadvice, not one of partiality and advocacy.

The basic philosophy is as follows: Youcant force your child to sleep; what you can

do is help her learn that nighttime is for

sleeping and daytime is for play, and todevelop regular sleep habits. Guide toYour Childs Sleep, p.76.

In terms of timing, thebasic idea is that,sometime in the threeto six month oldperiod, you should beable to get your baby to

sleep at least five to sixhours straight throughduring the night. Theydo not recommendallowing a child to cryunattended for longer

than ten minutes, but they recognize acertain amount of crying as normal.

A Little More Sleep Science

Although Im not going to review it in toomuch detail here, as much of it would berepetitive this book probably has the bestsection on sleep science of those I havereviewed. If youre really interested in this

subject, I would suggest reading this bookfirst.

According to the AAP, the circadianrhythms that govern sleep/wake cycles donot even begin to develop until around six

Even today, very little

teaching regarding sleep

(only about five hours) takes

place during the three-year

pediatric residency

program.

-Dr. Marc Weissbluth, M.D.


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weeks of age. This is one of the reasons whyyoung babies have such irregular sleep/wakecycles. The ability to maintain a regularcycle is pretty much fully developed by thetime a baby is four to six months old.

This guide also emphasizes the importanceof getting enough sleep. Children who areregularly short on sleep do not learn as wellas those who get enough, and they are alsomore likely to have behavioral problems as

they get older.Newborns Through Three Months

During to the first few weeks, the AAPsuggests you pretty much demand feedevery two to four hours. By four weeks, theysay sleep will begin to show more of a dayand night pattern, as the biological rhythms(circadian rhythms) are starting to show up.

From the beginning, there are some things

you can do under the AAP guidelines. Forinstance, you should make sure your houseis more well lit in the day (even duringnaptimes) and becomes darker at night, sothat your babys clock will start to recognizethe natural cues from light and dark. Tofurther strengthen the concept of daytime asawake time and night as sleep time, you canencourage play and activity a bit more in thedaytime, even if it keeps your baby awakefor longer periods.

The AAP also recommends that you exposeyour baby to normal levels of noise, ratherthan teaching her to sleep only in absolutequiet. A constant state of absolute quietduring sleep can make her very sensitive tonoise, which may cause problems later.

By around two or three months, the AAP iscomfortable with babies sleeping up toaround five or six hours in a night. In fact,

by around six weeks you should beginteaching your baby to go to sleep on herown in her crib. You can encourage this atnaptime by putting her into the crib whileshe is tired but still awake.

At this same time, around six to eight weeks,you should also start to

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