Don’t Lose Sleep for Crying Out Loud : Child-Care Experts Help Parents Deal With Night Wakings
Nighttime feedings and interrupted sleep come with the joys of a newborn. But what happens when those initial months of nocturnal waking stretch into a year or more?
Night waking in infants and toddlers is one of the most prominent developmental issues, according to Helen Reed, coordinator of Cedars-Sinai Medical Center’s Warm Line, which provides free telephone counseling and guidance to parents. Of the 6,000 or more phone calls the Warm Line receives annually, at least 60% concern night waking, she said.
Coping with a child who wakes during the night can be exhausting and strain family relations. Often parents are told by relatives or friends not to rush to a crying child’s side, that the infant should be left to “cry it out.” Such advice was standard, beginning with child-care books of the late 1800s, and remained unchanged through the 1960s.
Today, however, advice to parents has changed markedly. Few child-care books and experts now recommend allowing children to cry themselves to sleep, advising some parental intervention when a child wakes frequently and regularly at night. It is the nature and duration of that intervention, however, that divides the experts.
Professional advice ranges from sitting beside a crying child to making periodic visits to the child--but prolonging the intervals between visits--to taking the child into the parents’ bed.
Central to modern-day theory and advice is the “separation anxiety” infants begin to have around their ninth month of life, said Josie Alexander, a psychotherapist and senior staff member of the Warm Line. During the second year of life, separation anxiety begins to abate, although it remains an important factor, she said.
The Warm Line’s advice to parents of night wakers is oriented toward allaying the fear of separation, Alexander said. “We take a very individualized approach. The separation anxiety experienced by a 2-year-old, for example, may often relate to issues surrounding discipline and the anger the child feels about it. A 2-year-old may wish that Mommy would go away when she tells him not to do something. When he wakes at night and Mommy isn’t there, he may think his angry feelings made her go away.”
Offering Reassurance
When an infant wakes at night wanting to be held, Alexander recommends leaving the child in the crib but staying close by to reassure the baby he or she is not alone.
For a baby of 8 months, she said, counselors might recommend the introduction of a blanket or cuddly toy as a “transitional comfort object” to remind a child of the absent parent.
Warm Line counselors also stress the importance of a nighttime ritual announcing to a child that the day is over and it is time for sleep. In dealing with chronic wakefulness, Alexander also emphasized that messages to the child must be clear and firm and delivered without anger.
Another view in the treatment of night wakers comes from Dr. Richard Ferber, director of the Center for Pediatric Sleep Disorders at Children’s Hospital in Boston.
While Ferber endorses notions of clear and firm messages, nighttime rituals and transitional objects, he believes poor sleeping habits cause the majority of sleep disturbances in young children.
He takes issue with the idea that separation anxiety is at the root of most nighttime waking. “You have to look at a child’s behavior throughout the day,” he said. “If separation is handled well during the day, night waking is usually more a problem of bad sleeping habits. I’m not convinced that a deep-seated separation anxiety can resolve itself so quickly.”
He likens a child’s inability to fall asleep without parental intervention--such as rocking, back rubbing or walking--to an adult who needs a favorite pillow to get a comfortable night’s rest. After a few nights of sleeping without a pillow, one learns new associations and can sleep soundly. Ferber offers a variety of approaches to a number of sleep-waking patterns in his book, “Solve Your Child’s Sleep Problems.”
Waking Briefly
Sleep researchers point out that most people wake up briefly several times a night. “The child who cannot go back to sleep without a parent there to help needs to learn how to do that for him- or herself,” Ferber said.
If a child is a chronic night waker, Ferber instructs parents to put the child to bed after the nighttime ritual. When the child starts to cry, parents are told to wait five minutes before going to the bedside, stay with the child briefly to offer comfort and then leave. If the crying continues, they are instructed to wait another 10 minutes before going to the child.
Measuring the Time
On the first night, he advises waiting 15 minutes between visits. Each night thereafter, parents add five-minute increments to the time between visits. The five-minute figure is arbitrary, he said, but parents can wait a minute to begin with if they cannot tolerate their baby crying. “The key to the approach is gradually lengthening the time between visits. Any schedule will work as long as the times increase progressively,” Ferber said.
At odds with Ferber on the issue of allowing a child to cry even briefly at bedtime is Dr. William Sears, a San Clemente pediatrician and professor of pediatrics at USC who advocates “shared sleeping,” a practice generally discouraged by Ferber and other child-rearing authorities. Sears also has written a book, “Nighttime Parenting--How to Get Your Baby and Child to Sleep,” which is published by La Leche League International, on whose professional advisory board he sits.
He advocates what he terms nighttime harmony for the family and thinks that Ferber’s approach is simply a newer version of the old “let-them-cry-it-out” school. “I believe sleep-training regimens offer a short-term gain for a long-term loss because allowing a child to cry desensitizes parents to their child’s needs,” Sears said.
Sears, the father of six, says children should be nursed or “parented off” to sleep rather than put in a bed to fall asleep alone as Ferber recommends. Human interaction is crucial to the healthy emotional development of a child, Sears says.
Around the age of 2, he says, a child needs to be made aware of his parents’ need for privacy.
How long does the family bed last? For Michael Muller and his wife, Adrienne Hoskins, who run an advertising agency in Los Angeles, the question was answered by the needs of their children. Their son, Casey, 6, sleeps on a futon in the family bedroom with his sister, but also will sleep alone or with a friend in his upstairs bedroom. His younger sister, Laila, 2, still requires occasional nighttime parenting and will join her parents in their bed at the other end of the room.
Security, Self-Esteem
But her parents say their experience with Casey has convinced them that they’re doing the right thing for their children in terms of building security and self-esteem. Either parent reads with Casey for a minimum of a half-hour before his bedtime and Laila is still nursed to sleep. The children go to bed together and the parents join them later. “It’s an investment of time and closeness that we feel is the whole purpose of being a parent,” Hoskins said.
