One of my most important jobs is giving families permission to sleep train their children because parents often feel very guilty and selfish about this. The fact is, sleep training your child is not selfish, and sleep training doesn’t hurt your child.
Why sleep training isn’t selfish
Several years ago, I got a taste of what the parents of many of patients have experienced on a nightly basis for months or years– a perfect storm of bad sleep
Let me preface this by saying that I’m pretty lucky in the sleep department in my home. I have two little boys, C and T, who are 8 yo and 5 yo respectively who are great sleepers. Sure, we’ve had to fine tune things occasionally (for example, when T got up at 4:30 AM for a month). I don’t think I can take much credit, as I think that this is just the way that they are. We had a much easier time than many of our friends getting a good night of sleep. My experiences has led me to believe that every kid is good in some area and struggles in others. (My older son is a great sleeper, but we struggle with his diet, for example). Parents usually bring their child into Sleep Clinic for sleep problems around certain milestones. The imminent birth of another child, or after about two years, which is as much as most people can stand. There is inevitably a lot of guilt, and at least one prior failed attempt at sleep training.
So back to our night. It was going smoothly until around 3 AM when C came into our room announcing that he had wet the bed. (Fortunately a very unusual event). We cleaned him up, changed the sheets, and put him back to bed. About 30 minutes later, the little one started to cry. I went into his room, replaced his binky, and then back to sleep for all of us. Then I hear C shout, “Dad!” I go into his room and he is perched on his pillow. He had gotten out of bed, rearranged his blankets, and turned on his nightlight. He was concerned about monsters in the room. I laid down with him for a few minutes, went back to bed, then T was up again for about 30 minutes. By now it was around 5:30 AM. My wife got him up, and he had soaked through his diaper. Apparently I had given him a diaper wedgie the night before. My credentials as the resident sleep expert in our home, already tenuous, were further in jeopardy.
The next day, I was a slug at work. The application of caffeine helped me limp through my day. My wife fared about the same. I mention this because we felt lousy after one bad night. I see parents in clinic who have had nights like this for years. The consequences of chronic sleep deprivation is significant for children — and parents.
Bad sleep is bad for parents
During my experience with ONE bad night of sleep, I didn’t feel like I was the best parent I could be. The fact is, ensuring that YOU get a good night sleep is critical for your child. Why is this? The potential consequences to parents of chronic sleep deprivation include:
- Depression and low mood: Alice Callahan wrote a great series of posts at Science of Mom about sleep in infants (and her book is amazing (affiliate link)). Poor sleep in infancy is associated with maternal depression. Alice points out, “Postpartum depression is hard on moms, but it is also hard on babies. A mother suffering from depression may not be able to be emotionally available, sensitive, and responsive to her baby, day in and day out.” Read more about infant sleep and maternal depression here.
- Difficulty being attuned to your children. As Kathleen Berchelmann writes, “Sleep deprivation steals your patience towards your children. Without patience, apathy and anger easily replace love and gentleness. “
- Poor driving: A researcher named Daniel P. Chapman has studied the effects of children on parental sleep. Children seem to be a risk factor for insufficient sleep in adults (not that you need research to prove that). I worry about the effects of chronic sleep deprivation on the parents I see in clinic in terms of car accidents and their own health. Parents need to be well rested to be vigilant behind the wheel so they can keep their children safe. Drowsy driving is like driving drunk. You owe it to your kids to come home safe, and to be safe when you drive them around town.
Bad sleep is bad for kids as well.
Twenty to 30% of infants and children will have difficulty with falling asleep and/or night-wakings. Without treatment, these issues may persist in 60% of those children. However, there is a cost to continued sleep disruption in terms of mood, learning, attention, behavior, and even weight.
Sleep training helps parents and kids sleep better
Behavioral sleep training is very effective in treating sleep problems in children (The American Academy of Sleep Medicine published a Practice parameter on sleep training which reviews much of this evidence.) There are many methods of effective and safe sleep training. Here’s a link to my post providing a comprehensive overview of sleep training techniques.
Someone told me that sleep training will hurt my child.
It’s unclear when people started making accusations about sleep training being dangerous, but I suspect that it goes back to the publication of The Baby Book by Dr. William Sears and Martha Sears in 1993. This kickstarted a movement called “attachment parenting”. They espoused “the family bed”, wearing your child everywhere, even at work, and nursing on demand and indefinitely. Cosleeping was a cornerstone of this1.
The Sears’ books and world view has been very influential. At this point a whole generation of families has subscribed to the attachment parenting philosophy. One of the most significant consequences of this has been the politicization of sleep in children. In his book, Dr. Sears makes the claim that allowing your child to cry can cause brain damage. (You can also read about his views on this on his website). However, this has been extrapolated from research looking at children who were the victims of severe abuse or neglect, not children who cried on occasion for 30 minutes of less. Many of the researchers referenced actually refuted Sears’ interpretation of their work. For a detailed account of this, I recommend this article from Time which talks about how the risks of crying were greatly overstated.
The term “attachment parenting” was coined by two psychologists working in the mid 20th century named Mary Ainsworth and John Bowlby. When they started their work, the conventional wisdom was that showing too much attention or sympathy a child would make them weak. Through a large body of work, Ainsworth and Bowlby showed that emotionally available parents produced confident and successful children. Their work has been hugely influential. However, these two founders of “attachment theory” were curiously mum when it came to topics such as nursing, sleep patterns, or wearing children. They emphasized that there was little advantage for one parenting technique over another:
Questions like whether to breastfeed or bottle-feed, or at what age to introduce solid foods, though still important, no longer carry the same urgency. Attachment theory suggests that babies thrive emotionally because of the overall quality of the care they’ve experienced, not because of specific techniques. A bottle-fed baby whose mother is sensitively attuned will do better than a breastfed baby whose mother is mechanical and distant [emphasis mine]. (Quoted in The Atlantic, “What Everyone’s Missing in the Attachment Parenting Debate” 5/31/12).
My concern is that exhausted parents can’t be as attuned to their children. Healthy, well rested parents are better parents. Do I have a problem with people who make their own choice to practice attachment parenting? No. Do I have a problem with people who tell others that sleep training will brain damage their child? Absolutely.
I also worry that cosleeping actually leads to worse sleep in parents, and, long term, in children. Scan through the comment threads on this website to find many examples of this.
What’s the evidence that sleep training is safe?
I am not aware of any research which demonstrates harm. The best study to date looked at five year old children who had and had not sleep trained. There was no difference in their behavior, no evidence of psychological problems in the sleep training group, and, importantly, no change in their secretion of cortisol, a stress hormone. This is important as much of the discussion about the danger of sleep training centers on experimental data showing increases in cortisol associated with crying. Long term persistent elevation in cortisol can be dangerous to development, but this is not going to occur with intermittent crying in otherwise healthy children who are well cared for. For more on this study, you can read this article here.
I will say that some pediatricians have been espousing sleep training as young as two months of age; I don’t think this is a good idea as a) all of the studies of sleep training safety have looked at older kids b) two month olds are quite immature from a neurological standpoint.
The take home
The fact is, if your child is sleeping poorly, you owe it to yourself and her to help her sleep better at night. There are many safe and well studied ways for your to do so. Don’t feel bad about making changes that will benefit your whole family long term even if they are associated with a little bit of distress for a few days.
I’d love it if people would share their experiences with sleep deprivation. How did it affect your life? How did you cope? Any advice you would offer to other parents?
1. To be clear, the terms bedsharing and cosleeping are frequently used interchangeably. Bedsharing means having your child sleeping in your bed. Cosleeping may include bedsharing, room sharing, or having your child sleep immediately adjacent to your bed in a sort of crib called a cosleeper. For the purposes of clarity, I use cosleeping to mean bedsharing in this book as this is the way that it is most commonly used. ↩