Toddler

"If I've had a couple of good nights I feel I can take it on, but if I've had a week of him waking up three times each night, I'm trashed. I just have to get through the night."

Sibylle Tinsel is talking about her repeated efforts to teach nine-month-old Erik to sleep through the night. The first time we spoke, the Vancouver mother of two was in the midst of an attempt. But, as she explains, she's caught in a double bind. In order for this already tired mom to adopt the method that, according to some experts, will eventually bring more peaceful nights, she has to go through a period when she gets less sleep. So she needs to start off well rested. That's a tall order when you have a baby who wakes up three times a night, plus a toddler.

And it's going to be stressful. The technique, which comes from a book calledHelping Your Child Sleep through the Night, involves leaving Erik to cry for short but gradually increasing periods while he learns to go back to sleep without help. That conflicts with Tinsel's instincts and her belief that a baby's cries should be attended to. She could hack all of that if she were sure that at the end, Erik would be sleeping through the night. But she's not. "At first it seems to work, but then something always comes up. He starts teething, he gets a cold, we go on a trip, and we're back into the old pattern."

Night waking is a big deal. "Is she sleeping through the night yet?" is often the first question you are asked as a new parent. If your baby doesn't, count on being asked again and again. Helping parents and kids reach this "milestone" has become a mini-industry, with expert advice bombarding us through countless articles, books and television shows.

Yet parents are still struggling. Why?

Perhaps the steep experts' advice isn't good enough. Perhaps some parents don't want it or, more to the point, can't use it.

According to prevailing North American wisdom, kids, even babies, should sleep independently - that is, go to sleep on their own at bedtime and go back to sleep on their own when they wake in the night. Boston-based paediatrician Richard Ferber, whose 1985 best-seller,Solve Your Child' s Sleep Problems, largely shaped conventional thinking about children and sleep, writes, "You may not recognize that your child even has a problem, or... that the problem he does have should be considered a disorder that can and should be treated." Many members of the medical community agree with Ferber. They consider night waking a behaviour problem. But is it?

"Absolutely not," says Penelope Leach, a British child psychologist and renowned parenting expert. "It's nonsense to say that babies who wake a lot and need parents have a disorder. I think it does a great disservice to parents."

That's not to say night waking is easy for parents. In fact, they' re the ones who are strung out and short of sleep.

Although Catharine Tozer's nights are relatively peaceful these days, for the Port Hope, Ontario mother of four, nocturnal waking is a vivid memory. "I never slept through the night, not even once, for eight years." The hard part wasn't just getting up in the night, but dealing with the advice of the sleep experts. "I still have trouble thinking about it without getting angry," says Tozer. "When [firstborn] Sean was a baby, I read everything I could get my hands on, but what I read didn't seem to describe him."

Eventually Tozer stopped reading because it all made her feel like there was something wrong with either her or her kids. "It was like being kicked when I was down. I wanted someone to understand, but the experts just threw it all back in my lap. I felt my kids were clearly telling me they needed me when they cried at night, but the experts said I was doing something wrong."

Researchers use videotapes to prove that virtually all babies wake in the night but, they say, the "self-soothers" go back to sleep, while the "signalers" begin to cry. Tozer guesses Sean was one humdinger of a signaler. "He'd be crying before his eyes were open," she says. "I saw him do this many times. How is a child who wakes up so agitated supposed to learn to be a self-soother?"

Those who advocate independent sleep for babies tend to gloss over these individual differences. Why do some seem to be born self-soothers, while others wake up miserable? Ferber admits that his techniques won't work for "a few" children, but you won't find "temperament" in the index of Solve Your Child's Sleep Problems. The babies you read about in these books are not like Tozer's Sean, or my Riley, or Tinsel's Erik - babies who wake up crying hard. The logic of sleep experts seems to suggest that this must be a learned behaviour.

Leach scoffs. "Look, you cannot purposely do anything that you do when you are asleep. The idea that babies wake up and say to themselves, 'I can cope, I don't need Mommy' - it's simply rubbish."

Previous generations of parents who were advised to let babies cry at night were given more or less the same rules for daytime if you pick up your baby every time he cries, you'll spoil him. Not us. We' re told that you can't spoil a baby and that we should respond to his cries quickly. To most of us that feels like the right thing to do. But then, when our kids reach the age of six months the age when sleep experts say babies should be able to sleep through the night on their own - they want us to be more sparing with after-dark comfort. But why would you expect your child to be independent in the night when you don't expect it during the day?

Here's how paediatrician T. Berry Brazelton, another popular parenting author, makes the independent sleep argument in his 1992 book, Touchpoints. "I am convinced that while a child's independence may not be easy for parents to accept, it is an exciting and rewarding goal for the child. Being able to manage alone at night helps a child develop a positive self-image and gives her a real feeling of strength."

Helping Your Child Sleep through the Night puts it like this: "A child who depends on her parent's presence to sleep through the night cannot be as secure as the child who has learned to feel comfortable with herself."

"I beg to differ!" says James McKenna, an anthropologist at Indiana' s University of Notre Dame. McKenna says that human beings are biologically designed to be dependent. "Human babies are the slowest to develop of all the primates and, at birth, they are neurologically the least mature and therefore, the most dependent on the external regulation from the parent.' McKenna says the Euro-American view that normal, healthy sleep for babies equals solitary sleep is based on culture and belief, not science.

"Solitary sleeping arrangements - a child in a crib in her own room, who goes to sleep by herself and self-soothes - are believed to foster more independent infants and children," he notes. "But this is unproven. They haven't even defined exactly what is meant by independence, or how it can be measured, or if it can be measured, or, assuming that it can be achieved at a young age which is debatable - whether this quality can be linked to childhood satisfaction, competence or happiness.

McKenna researches co-sleeping, his term for various arrangements in which parents sleep in close proximity (usually within arm's length) to young children. He has observed that mothers and infants who routinely sleep together seem to "tune in" to each other's sleep - for example, they spend more time in the same stages of sleep than they do when they're apart. He thinks proximity to mom helps a baby regulate his physiological system. "Early in life, babies are supposed to wake up. It's good for their cardiopulmonary system, for example. I suspect that this may be more important for some babies than others right through the first year of life and that's why they wake up." So the mystery might not be why some babies wake up and cry, but why some don't.

Sibylle Tinsel has wondered. She's had one of each. Her first baby, Johanna, slept through the night from five weeks on, even though Tinsel nursed her to sleep - one of the very behaviours frowned upon by Ferber and company. At around five months, Tinsel did a bit of training around bedtime. She would place Johanna in her crib and leave. Johanna would "complain" and sort of fuss herself to sleep. "The first night it took 45 minutes, the second 25 minutes, the third, only five, and after that she'd turn her head and go to sleep," Tinsel recalls.

Things are different with Erik, though. He cries hard almost whenever he wakes up - at night, in the morning, even from naps. "The last time I tried [to train him] I had three nights that went really well. He complained but he didn't cry hard. Then we had three wonderful nights." Then came three "horrible nights" when Erik woke up screaming. Tinsel would settle him down and then put him back in the crib. But he didn't respond as he had on the other nights. One night he cried for two hours. "We're finished," she says flatly. "I'll never do that again."

Why do prescribed techniques work for some parents and not others? The way babies respond is one factor. Not all babies subscribe to the sleep pundits' implication that all babies will respond more or less equally to these techniques. "Even an infant or toddler who has never slept through the night can begin doing so within a few days with the right assistance from parents," writes Ferber. It's true that any baby will go back to sleep on his own eventually, but sometimes it's a very unsettled sleep. On one memorable, desperate night, my wife and I finally decided to give the cry-it-out technique a try. At that time a toddler, Riley fell asleep after two hours of crying, with us going in periodically to "reassure" (i.e. enrage) him. We lay listening to our son's sob-ridden, spasmodic breathing for 15 minutes. Then he woke up, and that was it. We were too wrung out to continue. My wife went in and picked Riley up. He threw himself out of her arms and ran blindly into a wall. I guess we hadn't been giving him quite the right "assistance."

"I have received many letters from parents who tried these techniques and felt as though they'd failed when the techniques didn't work," says Leach. "Others were shocked when it worked at first, but then the baby began to wake up again after a few nights or a few weeks. Almost anything will work for some people some of the time. The lie is that anything works for everybody, or in the case of sleep training techniques, that they work permanently."

Paediatrician Judith Owens agrees, but with a proviso. "The Ferber technique certainly doesn't work for everybody. However, in some cases, part of the reason it doesn't work is that parents did not fully follow through with the technique. For example, the second or third night is really bad so they give in, which just serves to reinforce the baby's behaviour. That's not to suggest they failed. Sometimes they haven't been adequately educated about what to expect or how difficult the process might be, and if they try again with the proper support and information, it works.

I'm concerned, however, about giving parents the message 'Just live with this,' because there is a subgroup for whom night waking will persist for a really long time," Owens says. Those are the families she sees in the Pediatric Sleep Disorder Clinic at Hasbro Children' s Hospital in Providence, Rhode Island, families in which older preschoolers and school-aged children are still having sleep problems that affect the whole family. "Those are the hardest to treat. The problem for doctors is that we have no way of telling which families will be the ones to have the difficulties later on."

She concedes that paediatricians may have latched on to Ferber as the one way to deal with these problems. "The challenge is that, in a typical visit, physicians have just a few minutes," she says. "The parent says the child isn't sleeping. The doctor says, 'Read Ferber.' It's easy to read and well laid-out. But that advice won't work for all families and it also excludes some other possibilities."

Indeed, a very important part of living with night waking is how you think of it. For many of us, the problem is not just disturbed nights, but the conflict we feel about it. So we get up to comfort our baby, but we think we aren't supposed to. Or, in desperation, we let him cry, but that doesn't feel right either.

Somewhere along the way, my wife and I made peace with night waking. We stopped kicking ourselves over our inability to control the way our children slept and we stopped worrying that something was wrong. The physical problem of getting enough rest remained, but that was a solvable, practical issue instead of an emotional minefield.

For our kids, the move to independent sleep was very gradual. Tozer also found that night waking didn't stop so much as peter out. "It was a little easier when we could talk to them," says Tozer. "Over time our children gave up wailing and simply got out of bed and shuffled to our room. They had learned that we still existed, even in the dark, and that they could be with us."

McKenna, who would like to see co-sleeping regarded as a more legitimate choice, cites new research showing that it may have long-term benefits. "A study of middle-class English children showed that children who never slept in their parents' bed tended to be harder to control, less happy and had more tantrums.

Other studies have found that co-sleeping (as children) was correlated with positive outcomes for adults. We can't say that co-sleeping is the sole cause of these outcomes, but it certainly suggests that our cultural bias against it is unjustified."

The desire to keep children close and to comfort them in the night may be, as McKenna suggests, biologically based, but for North American families, it isn't culturally accepted. "Their paediatrician will probably disapprove, as will the grandparents and many other people they know."

Many Canadian parents are somewhere between the family bed and Ferber. They rock their babies or try to get them to take soothers. They rub backs, walk the floor or even sit in front of fuzzy TV screens if that's what works. Eventually, many take little ones into bed with them so they can get a little sleep themselves. Some feel OK about it and stick with it. Others go back and forth.

The issue is not just about sleep habits. If you're lying there listening to your baby fuss and, though it's disquieting, you believe, deep down, that this is what's best, that's one thing. But if you're lying there and you feel like the cure is worse than the disease, that's something else. Because this is part of a bigger picture that involves your relationship with your baby and your image of yourself as a parent.

The solutions offered by sleep experts have helped many families, but by taking what is essentially a practical problem and turning it into a moral or a mental-health issue, they have also served parents poorly. Leach puts it like this. "Every parent and child is different - that's what these sleep programs disregard. Sleep isn't about programs. It's about children and parents living together the best way they can. The people who know the best way are the parents because they are the ones, the only ones, who are tuned into their child at this moment."

August 1999