Rude Awakenings

For many adults, the first big test of parenting comes about four months after having a baby. Call it the first semester exam.

That’s when most pediatricians and textbooks suggest that baby should be sleeping “through the night,” that being an ill-defined concept of six to eight hours of uninterrupted sleep sometime between 10 p.m. and 6 a.m.

If baby is cooperating, good for you; you lucked out this time, perhaps without even having to study.

If baby is still waking--and you feel that is a problem--it may be time to hit the parenting textbooks.

Many parents do just that. Sleep deprivation is the pop quiz of parenting. Parents wonder whether the dark circles under their eyes will ever fade. Arguments over whose turn it is to get up with the baby replace earlier forms of marital communication. A full night’s sleep is akin to acing the SATs.

“For many parents, it’s the biggest problem,” says Dr. William Sears, a Capistrano Beach pediatrician and author of several parenting books. “Parents need to think about what their goal is regarding sleep. To me, the main goal is to create a healthy sleep attitude so children grow up learning that sleep is a pleasant state to enter. This is a long-term investment.”

A good sleeping pattern is not just for the parents’ benefit. Hormones related to growth are released at night. And, like adults, children simply learn better during the day after having adequate sleep.

But this is where the consensus about babies and sleep habits ends. There is no right or wrong way to get a baby to go to bed passively and sleep through the night. For a minority of parents, how much and when the baby sleeps isn’t even an issue.

The majority of parents, however, usually need to come to grips with baby’s sleep patterns. And that requires some research on various philosophies and, perhaps, some experimentation to find what works best for you and your baby.

“I think, a lot of times, that we approach babies with the intent of trying to make things as easy as possible for the parents instead of trying to help the child grow into their individual strengths,” notes Dr. Rachelle Tyler, a professor of pediatrics at UCLA.

The American Academy of Pediatrics is a good place to look for guidance because the organization takes something of a middle road on the matter, while some other popular methods are more dogmatic.

According to the academy’s literature--which many pediatricians adhere to--there is a wide range of “normal” sleep behavior in babies under 1 year old. And, the academy notes, babies’ patterns change. Sometimes an infant will sleep well for a few months, then will start waking.

Working Toward the All-Nighter

In general, however, newborns will sleep off and on around the clock because they do not yet differentiate between night and day and because they need to be fed every two to four hours. This is called an ultradian sleep cycle, meaning it is less than 24 hours.

But, around 3 to 4 months, according to the academy, babies should naturally settle into a circadian rhythm, which means their sleep-wake pattern will follow a 24-hour pattern. At this age, they can usually skip a feeding, such as the 2 a.m. one.

At 4 months of age, studies show, about one-third of babies will sleep through the night on their own.

By 4 to 7 months, baby should be able to go eight hours without feeding, and during this period, parents can play a role in promoting uninterrupted sleep, experts say. For example, the pediatric academy does not follow any particular method, but suggests such things as not bothering to screen out light and noise during baby’s daytime naps and not letting baby nap for long periods.

At night, the academy suggests, minimize play and interaction. Keep lights low when feeding. Don’t talk or turn on the TV. And put baby in her crib when she’s sleepy but is still awake so that she can learn to put herself to sleep.

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It sounds pretty simple. Too often, however, such mild advice doesn’t cut it, and parents turn to more strategic methods.

For instance, the 1985 bestseller “Solve Your Child’s Sleep Problems” (Simon & Schuster), by Dr. Richard Ferber, is still recommended for parents whose babies have developed troublesome sleep habits.

Like Dr. Benjamin Spock before him, Ferber says that by 5 to 6 months, babies who cry at bedtime or when awakening in the middle of the night should be allowed to cry, giving them a chance to learn to put themselves back to sleep.

After five minutes of crying, a parent can go in for a couple of minutes to reassure him, pat him, talk to him but not pick him up.

This process is repeated each night lengthening the interval that the baby cries to 10 and then 15 minutes. Parents are advised to return to the baby’s room every 15 minutes for reassurance until he falls asleep. After a few nights of this, Ferber says, baby will adapt to the routine without crying.

“It’s almost foolproof,” noted Dr. Joseph Hagan, an American Academy of Pediatrics spokesman and Vermont pediatrician, last year in an issue of the academy’s magazine Healthy Kids. “But parents have to be sure they’re ready to try this, because if they chicken out and pick up the baby after an hour and a half, they’ve conditioned the baby to think that, eventually, they will always pick him up.”

Some parents find they cannot bear the emotional anguish that is part of “Ferberizing” a baby. Debi Lasky-Fingerhut was pleased when her son began sleeping through the night at five months. But when the Tustin woman returned to work and the baby entered day care, at 6 months, things changed. The baby, John Dominic, was frequently ill with respiratory infections. Lasky-Fingerhut, whose husband is a ship captain who often spends months out at sea, found her nights becoming nightmares. John Dominic woke up whether he was sick or not.

“‘I made all the [nighttime] boo-boos,” she says. “I held him and pulled him into bed with me. Then he got used to sleeping with Mommy. It was never good sleep for me or the baby.”

When her husband, Frank, was home, he advocated letting the baby cry when put down in his crib for a nap or bedtime. But Lasky-Fingerhut couldn’t stand it.

“I’m a big wimp, and I would give in,” she says. “It didn’t feel right to me. My husband would try to restrain me from going into the baby’s room. I would be sobbing. I felt he was crying out to us and that he trusted us to be there for him.”

Now 13 months, John Dominic is sleeping through the night after about five minutes of rocking.

“He’s a much happier child when I give in to why he cries,” Lasky-Fingerhut says. “I do what works for me. I’m a firm believer that you have to do what works for you.”

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What appears to work for a growing number of new parents, however, is a more rigid approach in which a very young baby is trained to sleep when the rest of the family does.

One such “sleep training” approach has been popularized with the 1995 book “On Becoming Babywise” (Multnomah Books) by Gary Ezzo, a nondenominational Christian minister and parenting educator, and Louisville pediatrician Robert Bucknam. The book has sold 234,000 copies while Ezzo’s Growing Families International parenting programs, headquartered in Simi Valley, have become popular in many churches throughout the country.

While Ferber’s method focuses on fixing sleep problems that have developed, Ezzo advocates training babies to put themselves to sleep beginning at about 8 weeks.

“There are certain things you can do to establish healthy nighttime sleep,” Ezzo says. “The key to nighttime is, No. 1, you have to synchronize the child’s circadian clock.”

To do that, he says, the baby should be kept on a fairly strict schedule for feedings, wake time and nap time. This repetition will lead an infant into a natural circadian rhythm at night.

“It’s a no-brainer,” says Ezzo, who says his own surveys show that the method works in 98% of infants.

If the baby starts waking up in the middle of the night, he encourages parents to investigate why the baby is waking.

“That’s the beauty of having a routine,” he says. “When something out of the routine takes place, you know there is a problem. Go in and find out what the problem is. It’s not uncommon for a baby to begin to wake up at 2 a.m. Ninety percent of the time they need more food during the day. Whenever comfort is needed, parents must give comfort.”

Enduring the Pain of Hearing the Wails

Jennifer Kerr used the “Babywise” approach to encourage her son, Alan, to sleep through the night at about 8 weeks. But when he started to teethe a few months later, he began waking at night.

“We did really well until he started teething. So we’d go in and pick him up. Initially he just woke up when teething. But after a while he was waking up all the time and we thought, ‘Wait a minute; that’s not the same cry as he had when he was in pain.’ He was working us. So we let him cry. And, sure enough, he was back out within five minutes.”

But she still has her doubts.

“If he starts to teethe again and is uncomfortable, I wonder, will I hear the difference in his cry?” she says.

She admits she has to psyche herself up to let him cry and feels a “physical pain” when he wails.

“It’s very hard for me to do by myself,” she says. “When my husband, Steve, is there it’s easier because Alan will sometimes cry 15 to 20 minutes. But I think of it as being good for him. When he gets his sleep, he’s happier.”

Ezzo’s approach, however, has been criticized as being insensitive to a baby’s needs. Harsh criticism over putting baby--especially a breast-fed baby--on a strict eating schedule even led Ezzo to soften his instructions in a recently revised edition of “Babywise.”

“This [approach] could only be written by a man,” says pediatrician Sears, who advocates “parenting” a baby to sleep by nursing or rocking and always picking up a crying baby. “It desensitizes a parent to the cues of their infant. A mother is biologically wired to respond to an infant’s cry. But that doesn’t mean that you don’t teach your child that nighttime is for sleeping.”

Sears is well-known for his advice that parents put the baby in bed with them or move the crib within arm’s reach of the mother. He calls this “co-sleeping” and says it satisfies the baby’s need to be physically close to the mother. Few pediatricians are enthusiastic about co-sleeping, however.

So, with “experts” at odds with one another’s approaches, what is a parent to do?

It all goes back to doing what is best for the individual family, most of these experts also acknowledge.

“You can’t follow the same set of rules for every baby,” says UCLA’s Tyler. “In parenting, you have to be very fluid. You may do one thing with one child, and the second one comes along with a different attitude. You can’t try to fit that second child in with the first child.”

Tyler recalls a colleague who counseled a family with a newborn who cried incessantly.

“This was the couple’s 13th child,” she says. “But none of the others had ever had colic, and the parents didn’t know what to do.”

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Pointers for a Restful Night

Here are some tips from the American Academy of Pediatrics on helping your baby learn to sleep through the night

* Don’t let your infant sleep for long stretches during the day (no more than 3 1/2 hours during naps).

* Make sure there is a quiet period before your infant goes to bed. A pleasant routine, such as singing or bathing, may help the baby prepare for sleep.

* Put your baby to bed at the first sign of drowsiness. Let the baby learn to relax into sleep.

* If you hold or rock a baby to sleep, he or she may become dependent on you to help fall asleep.

* Give your child a security item at nighttime, such as a soft toy or blanket.

* Avoid putting the baby to bed with a pacifier. If the child loses it at night, he or she might wake up and cry.

* Begin to delay your reaction to the infant’s fussing or crying around the age of 4 months to 6 months. Wait five minutes before going into the baby’s room to see if the child will settle. When you do check on the baby, be sure the baby isn’t hungry, soiled or sick.

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