A Review of the Sleep Experts

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If successfully teaching your child to fall asleep and stay asleep sounds like a dream, here are some schools of thought to help you unlock the mysteries of good sleep habits.

“Sleeping, like eating, is not a state you can force a baby into,” write the renowned healthcare couple Dr. William and nurse Martha Sears. Most pediatricians agree that many sleep problems in both older children and adults stem from growing up with unhealthy sleep attitudes and habits. If you can teach your baby a restful attitude toward sleep in his infancy, your child will sleep much better when he is a toddler—and ultimately throughout the course of his life.

So, how do you unlock the mystery of good childhood sleep habits and teach your youngster how to fall asleep and stay asleep? There are several schools of thought. Here is a summary of three methodologies offered by today’s major pediatric sleep experts.

Attachment Parenting

The Sears couple has practiced pediatrics for more than 30 years—in addition to raising eight of their own children. Many parents are attracted to the “attachment parenting” style the Searses offer. This affectionate, intuitive style focuses on learning how to read your baby’s cues—an important aspect in deciphering any young child’s sleep problems.

“The approach we have learned, by trial and error, that usually works for most families,” writes Dr. Sears, “is the attachment style of nighttime parenting.” This style of parenting uses two elements: organizing and mellowing your baby’s temperament during the day, through feeding on cue and baby wearing; and sleeping close to your baby at night.

The preliminary sleep lesson taught in the Sears’ The Baby Book, is “Babies need to be parented to sleep, not just put to sleep.” Infants enter sleep through a very light initial stage that lasts up to 20 minutes. If parents try to rush a child to sleep during this early stage, he will usually wake up. The Searses encourage parents to closely watch their infants and observe their sleep stages (when an infant’s limbs are limp when lifted, he has entered deep sleep).

To condition your baby to sleep, the Searses recommend first incorporating a relaxing practice into the bedtime ritual—such as infant massage or a warm bath. After your baby shows signs of getting sleepy, the Searses then suggest nursing, snuggling in a parent’s arms, rocking, or climbing into bed with your baby to help parent him to sleep.

Advocates of co-sleeping—whether it be in a family bed, a co-sleeper, or even a bassinet placed very close to the parental bed—the Searses say that this practice can be one of the most powerful ways to help your child learn healthy sleep habits. The smell of the mother, the feeling of parents close by, and the ease with which a nursing mother can tend to an infant are all reasons given by the Searses for why so many parents find success with this method.

“It is not your job to make your child nighttime independent,” the Searses say, “but rather to create a secure nighttime environment and feelings of rightness to allow your child’s independence to develop naturally … When the time comes, your baby will wean from your bed just like all the other weanings.”

The Five S’s

Author of The Happiest Baby on the Block (and the more recent Happiest Toddler on the Block) books and DVDs, Dr. Harvey Karp is endorsed by the Surgeon General as well as La Leche League, Lamaze, and the American Academy of Pediatrics. Dr. Karp has been teaching his specialized calming techniques for more than 25 years. The Five S’s—swaddling, side, stomach positioning, shushing, swinging, and sucking—are simple and easy to employ, and each S triggers natural calming reflexes to soothe your baby.

Swaddling is an excellent way to prepare younger children and newborns for a good night’s sleep. Dr. Karp cites a 2002 study done at the Washington University in St. Louis School of Medicine, in Missouri, involving 37 infants (aged 19 days to six months). The study found that the younger babies went to sleep more quickly after being swaddled. The study also showed that babies who are swaddled, or wrapped tightly in cloth before being put down to sleep, were more likely to sleep on their backs—a position that is now suggested by most pediatricians for prevention of SIDS. “You get the benefit of tummy sleep with the safety of back sleeping,” says Dr. Karp. “It extends an hour to two hours a night the sleep of babies, I like to tell my parents.”

Side and stomach positioning mimic your baby’s posture in the uterus—it also switches off your baby’s Moro (falling) reflex. Dr. Karp suggests placing a swaddled infant on a parent’s lap while seated; put the child on his right side with his head on your knees and his feet on your hip. Then slide your left hand between your knee and his cheek so you support his head in your palm and fingers. Finally, roll him onto your left forearm so his stomach rests on your arm; bring him in close to your body, lightly pressing his back against your chest.

White noise can also be a benefit for many babies and toddlers. Reminiscent of the womb, white noise is especially helpful for soothing newborns. You can add this to your routine simply by softly “shhh”-ing to your infant as you help her to sleep; or you can play a white noise recording (see Karp’s website for several examples). The sound works to mask other sounds in your home that may wake up light-sleeping children.

Since ancient times, parents have employed “swinging” to soothe a crying baby. Gentle motion mimics life in the womb for your baby—much like “shhh”-ing—and, as Dr. Karp writes, “[it] turns on ‘motion sensors’ in [your baby’s] ears, which then activate the calming reflex.” Dr. Karp’s swing motion is achieved by beginning in the same lap position as in the side/stomach posture (baby swaddled, and stomach-down in your arms). Just add a gentle rocking back and forth by swaying your legs from left to right, and add a little jiggle by bouncing your knees up and down. Or, you can try an infant swing as well.

Sucking is another age-old soothing technique. In a modern-day twist, Dr. Karp suggests the use of a pacifier for children who haven’t found a favorite finger or thumb to suck. He prescribes bottle and breast feeding whenever your infant appears hungry (a sure sign is when he turns his head and opens his mouth when you touch his cheek), or employing the use of a pacifier when your infant is merely looking for comfort. But when using a pacifier, Dr. Karp says it’s important to know when to stop. “At three months, phase out pacis and wake them up a bit just before you put them to sleep so they can learn how to self-sleep.”

“Ferberization”

Dr. Richard Ferber is director of the Center for Pediatric Sleep Disorders at Children’s Hospital in Boston, Massachusetts. Since the release of his book, Solve Your Child’s Sleep Problems, Dr. Ferber has become a world-famous pediatric sleep expert; however, some see his views as rather controversial.

The Ferber technique is centered on putting your child to bed awake so he can learn how to fall asleep on his own. Often misunderstood as a cold and insensitive parenting style, many completely miss Ferber’s “progressive” approach to helping a child fall asleep and stay asleep. Dr. Ferber strongly recommends developing a loving and predictable bedtime routine for you and your child to help ensure that the transition to falling asleep solo is comfortable for your little one.

“If feeding is offered, babies may learn to expect it at night,” Dr. Ferber says, advising parents to keep interaction to a minimum if a baby wakes at night. Instead, Dr. Ferber teaches parents to use their voices as a salve to soothe—but doesn’t encourage picking up the child, feeding, or rocking. Under this method, parents should increase the period of time between each bedcheck. These waiting times are charted out in Dr. Ferber’s book and are based on how comfortable the parents are with the technique, how many days it’s been in use, and how many times you’ve already gone to check on your baby throughout the night. And after a week or two, babies learn to fall asleep without parental help.

Routine is fundamental to the Ferber method, so developing a bedtime routine is essential. Dr. Ferber argues that if children grow to recognize the steps in a bedtime routine, they will soon feel safe and comfortable enough to drift off into dreamland on their own. Rather than the intuitive approach that the Searses endorse, Dr. Ferber prefers establishing a set routine that to help babies develop a sense of schedule—his approach tries to establish an environment where nighttime parenting is unnecessary (no need to “parent” a child to sleep). However, Dr. Ferber understands that there will be times these bedtime rules will need to be flexible, such as when your child is sick. If your baby is older than one year, Ferber also suggests using a transitional object, such as a stuffed toy or blanket, as a comfort when you aren’t there.

Before using this method, Dr. Ferber says you should be sure that the daytime necessities and living environment (feeding, stress, playtime, parental attention) are all operating well, as these can all contribute to a baby’s problems falling asleep. Also, keep in mind that Dr. Ferber only recommends using his method if your baby is six months or older. As most sleep experts agree, by this age most infants no longer need a nighttime feeding.

Teaching children to sleep is far from an exact science. But with some help from the experts, you can pick a plan that will work best. No matter which sleep method you try, be consistent but flexible; trial and error will eventually help you find something that works for you and your family. Most parents find that if they establish a pattern—whether it be one that involves nighttime parenting or one that focuses more on the child falling asleep independently—and stick to it as closely as they can, babies begin to learn how to sleep. “After three to four months, babies develop sleep associations or dependencies,” points out Dr. Karp. “When you do it right for the first days of life, it soon becomes automatic.”

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