By Dr Jay Gordon
I can only
imagine a mom and dad who are as tired as anyone can be, eager to see this
article on sleep, and finding that we had made it unavailable for a little
while!
We had to do
that because I didn't write the article clearly enough and need to clarify some
very important facts.
It would be
hard to find as strong a proponent of the family bed as I am. Yet, I have
received email commenting that there were sections of this "plan"
which were easy to misinterpret as being just another angle on "sleep
training" for young babies. It is not meant to be that. Not even close to
an endorsement of the benefits of getting your baby to "soothe herself to
sleep" during the first year.
Here's what I
really want to do: I want to offer an alternative to Ferber and Weisbluth and
the Whisperer. I never want to see my ideas applied to a four month old or even
a seven month old baby. As a matter of fact, I am not too excited about pushing
any baby around at night but I know that sometimes it will be done and I'd like
to offer a gentle, supported plan for after the first year.
Before I go
any further, let me express my overriding concern. Babies do better when we
answer all their questions as best we can and meet their needs as best we can.
Most of the
families I have taken care of in my pediatric practice sleep in a family bed.
Their babies
tend to breastfeed for more than one year and they don't sleep through the
night any better than most of us would if we napped and cuddled within inches
of the best restaurant in town and knew it was open 24 hours a day.
This
arrangement is not just adequate and tolerable, but actually feels easier to
moms who can just roll over, nurse a while and fall back to sleep with their
babies rather having to get out of bed to nurse or, alternatively, refuse to
nurse and get their babies back to sleep some other way.
Lots of
parents continue this pattern through the first year and well into the second
and beyond, but some get tired of it -- or just plain tired -- after a while
and are looking for a way to change things. Saddest of all, some moms and dads
think that total weaning from breastfeeding is the best way to get more sleep.
They choose not to look into nighttime weaning as a good option instead.
There are
dozens of confusing books and magazine articles implying that there can be some
quick and easy way to get your baby to sleep or to not nurse through the night.
I have yet to read one which told parents the complete truth: It's not easy,
it's rarely quick and it's usually a little loud and heartbreaking for a few
nights . . . or more. I have seen too many families needing help and getting
offered choices they didn't like at all.
I have a
better alternative to completely weaning or to letting the baby cry it out.
Babies wake up for the optimal interaction with their moms, breastfeeding back
to sleep. If we offer them a little less than that for a few nights and then a
little less and still less in the ensuing nights, gentle behavior modification
will lead them to realize that it might not be "worth it" to knock on
the door of a closed restaurant, so to speak.
I don't recommend
any forced sleep changes during the first year of life. Probably the only
exception to this would be an emergency involving a nursing mom's health. There
are many suggestions in books and magazines for pushing "sleeping through
the night" during a baby's early months or during the first year. I don't
think this is the best thing to do and I am quite sure that the earlier a baby
gets "non-response" from parents, the more likely he is to close down
at least a little.
Don't get me
wrong. I love the family bed, child-led weaning and cuddling all through the
first, second, third year or more if it's working well and if the family
is doing well. Don't let anyone convince you that this is a harmful
choice or that there will be "no way" to get him out of your bed if
you don't do it now. Don't believe anyone who says that babies who cuddle and
nurse all night long "never" learn to self soothe or become
independent. This is simply not true but it sells books and the myths
stay in our culture.
Some moms just
don't want to do this after some months or years and there should be a third
choice to the dichotomy of crying it out or giving in to all-night nursing.
Again, I support the family bed and frequent night nursing for a long time and
even attempt to pull some parents along "just a little farther," but
I often have to switch tacks and support and help families with difficult
choices.
Here's what I
recommend for older babies:
Choose the
most valuable seven hours of sleep for yourselves. I personally prefer 11p.m. through 6 a.m. but you might have a slightly different
idea.
Change the
rules during those hours and be comfortable that a "well-built"
family bed baby's personality can withstand this rule changing and the mild
inconsistency of getting everything he wants all the time . . .oops, almost all
the time. That's the word we want to show this baby. The word
"almost." If only we could explain to him that "tired moms and
dads take their children to the park a little less and that children of well-rested
parents get to go the zoo and for hikes a lot more than children of exhausted
parents." If that explanation only made sense to kids somewhere before the
third birthday (and it doesn't!) they would simply roll over, say, "See
you in the morning," and let us get the sleep we want.
I try to do
this in three- and four-night intervals.
I'm assuming
that you have a wonderfully healthy 12-, 15-, 20- or
30-month old baby who still loves to wake up every 2 to 4 hours to
cuddle, eat or . . . whatever. I'm assuming that you have thought this through,
decided you want to make changes and alerted the neighbors that it might be a
little noisy for a week or so.
I'm assuming
that both parents agree -- or almost agree -- that this is the best thing to
do. And, most important assumption of all, you are willing to go "in a
straight line" to the goal of seven straight hours of sleep.
The reason for
that last statement: If your baby learns that crying, squirming and fussing
(euphemisms, let's just say "crying" . . . sorry) for an hour will
get him fed you will set yourself back quite a bit. This is the best program I
have seen but it's far from easy. And now, to say it again, I really like what
you've been doing. Cuddling, nursing, hugging through the night. Don't change
this with my program or any other if you're happy doing what you're doing. But
. . .
The First
Three Nights
At any time
before 11 p.m. (including 10:58) nurse to sleep, cuddle and
nurse when he wakes up and nurse him back to sleep, but stop offering nursing
to sleep as the solution to waking after 11
p.m.. Instead…..
When your baby
awakens at midnight or any
other time after 11 p.m.,
hug him, nurse him for a short time but make sure he does not fall
asleep on the breast and put him down awake. Rub and pat and cuddle a
little until he falls asleep but don't put him back on the breast (or give him
a bottle if that's what you've been doing). He must fall asleep with your
comfort beside him, but not having to nurse to feel comforted enough to drift
off.
Now, he will
tell you that he is angry and intensely dislikes this new routine. I believe
him. He will also try to tell you that he's scared. I believe he's angry, but a
baby who's had hundreds of nights in a row of cuddling is not scared of
falling asleep with your hand on his back and your voice in his ear. Angry,
yes. Scared, no, not really.
During these
first three nights, repeat this pattern only after he has
slept. He might sleep for fifteen minutes or he might sleep for four hours, but
he has to go to sleep and reawaken to get cuddled and fed again.
These will be
hard nights.
You may have
decided you're really not ready to do this. That's OK. Stop and start over
again in a few months if you like. Choosing the right time is crucial and many
people choose a time suggested or pushed by friends, doctors or in-laws. This
doesn't work as well.
Is it better
to do this in the family bed, a crib in the same room or using a crib in
another room? I prefer to continue the family bed even though it might seem
harder at first, but it has always seemed harder to me to be putting a baby in
and out of a crib. However, a crib or toddler bed in your room may be what
works best for you. Another option is to expand your bed's limits by placing
another mattress against your mattress. A bit more space for each family member
may help to solve some of the sleep issues. My least favorite choice is a crib
or bed in a separate bedroom.
Again, during
these first three nights, between 11 p.m. and 6 a.m., cuddle and feed
short, put him down awake, rub, pat, talk until he falls asleep and repeat this
cycle only after he's slept and reawakened. At 6:01 a.m., do whatever you have been doing as a
morning routine ignoring the previous seven hours' patterns. Many babies will
roll over, nurse and cuddle back to sleep and give you an extra hour or so.
Some won't.
For me, one of
the most reassuring parts of this "sleep plan" is seeing that babies
wake up fine, happy and grudge-free about the change in the rules. You'll see
what I mean, even if the first few minutes of the morning are not exactly as
they've always been.
The Second
Three Nights
Again, the
nursing to sleep stops at 11 p.m.
When he wakes up, hug him and cuddle him for a few minutes, but do not
feed him, put him down awake. Putting him down awake is a
crucial part of this whole endeavor because it really does teach him to fall
asleep with a little less contact and then a little less. Not feeding is
the big change during these three nights. One-year-old
babies can easily go for those seven hours (or more) with no
calories. They like to get fed a little through the night, but
physiologically and nutritionally, this is not a long time to go without food.
If I could
wake my wife a few times each night, ask her to squeeze me a little fresh
orange juice (my favorite drink) and rub my back while I drank it, I wouldn't
choose to voluntarily give up this routine. My wife might have some different
ideas and get tired of the pattern quickly. Babies rarely give up their
favorite patterns and things -- day or night-- without balking and crying.
I really don't
like listening to babies cry. I actually hate listening to babies cry.
Unlike them, though, we adults can truly understand the implications of lack of
sleep for a family of three, four or more people. Sleep patterns sometimes have
to be changed. The incredible safety and reassurance the family bed has
provided, and continues to provide, supplies the best context and location for
these changes.
During these second
three nights, some babies will cry and protest for ten minutes at a time
and some will go for an hour or more. Your toddler is aware that you are right
beside him, offering comfort and soothing. It just isn't the mode of comfort he
wants at the moment. It is hard to listen to him fuss, but it will work. I
believe that a well-loved baby, after a year or more
in the family bed, will be the ultimate beneficiary of his parents
getting more sleep. Not coincidentally, the parents benefit "big
time," too.
"Yes, for
the past many months we have enjoyed voting "1 to 2" -- non-democratically
-- in favor of . . . the baby. 'Anyone want to get up all night, feed and walk
the baby and be really tired all day and the next day too?' Well, the vote is 1
to 2 in favor of the baby."
Now, what
we're saying is, we will sometimes be voting two to one in favor of the
baby's family. This "baby's family" concept may be abhorrent to he
who considers himself the King of England, or Emperor of the Whole World, but
our knowing he has that feeling of power allows us to confidently demote the
dictator to a majority-respecting member of the family. His family.
By the end of
the sixth night, your baby is going back to sleep without being nursed or fed.
He's going back to sleep after a nice hug, a cuddle and with your hand on his
back and your words in his ear.
If, at any point this is feeling "wrong" to you, stop, wait
some months and start over. Don't go against your "gut instincts"
which tell you that this is the wrong time to get longer sleep intervals from
your baby. Your instincts are better than any sleep-modification program ever
written.
The Next Four
Nights
Nights seven,
eight, nine and ten. Don't pick him up, don't hug him. When he awakens
after 11 p.m., talk to him,
touch him, talk some more, but don't pick him up. Rub and pat only. No feeding
either, obviously. He will fall back to sleep. Repeat the rubbing and talking
when he reawakens. By the end of the ninth night, he will be falling back to
sleep, albeit reluctantly for some babies and toddlers, with only a rub and a
soothing voice.
After
After these
first ten nights, continue to cuddle and feed to sleep if you like and he wants
to, but do nothing when he wakes up except to touch a little and talk to him
briefly. This may continue for another three or four nights but occasionally
keeps going for another week or more. Then . . . it stops. He has learned that
he is just as well-loved, gets virtually everything he needs and wants all day,
but must give seven hours per night back to his parents and family.
What happens
if you travel, he gets sick or some other circumstance demands a return to more
nighttime interaction? Nothing. You do what you need to do (cuddle, nurse,
walk, in the middle of the night, as many times as you need to) and then spend
a night or two or three getting back to the new pattern the family has
established.
By the way,
pay the baby. Make sure that he really does get a lot of the benefit of
your getting a good night's sleep. Go to the park more often. Do all those
things with him you said you'd do if he ever let you sleep longer.
Explain it to him as you're doing it. He'll understand in an ever increasing
way and will be OK with all this.
