Sunday, September 30th, 2012
In response to the publication of the recent study on sleep training methods in Pediatrics, many of the headlines focused on the conclusion that the cry-it-out method does not harm kids. In reality, the implications of this are more nuanced than those headlines would lead you to believe. Here are 5 things you should know:
1) This paper was important because there are few studies that have evaluated sleep training methods using scientific designs. This one is especially interesting because the research team followed 225 7-month-olds – reported by their parents to have sleep issues – for 5 years. This longitudinal design permitted the researchers to examine short- and long-term effects of sleep training.
2) The study examined 2 types of sleep-training methods – controlled comforting and camping out. Controlled comforting is a variation on what you might think of as cry-it-out (or pure extinction). In contrast to pure extinction (which is let baby cry until they fall asleep – however long that is), controlled comforting involves settling a baby in to sleep, leaving the room, and establishing short intervals of tolerated crying (say, 2 minutes) before going in to soothe the baby. These intervals can be increased slowly with the idea being that baby will stop crying and fall back asleep. Camping out involves starting off in the room with baby – typically next to or near baby – and waiting until baby falls asleep before leaving. After a period of success, the parent then changes the routine by sitting in the room, but not right next to baby, and again staying until baby is asleep. And here the idea is that parent can get to the point of leaving the room before baby falls asleep. In the study, 3 conditions were used. Some parents could choose to be trained (by a nurse) in either controlled comforting or camping out (conditions 1 and 2) – and some parents were offered just general advice but received no sleep training.
3) The results were that either sleep training method was successful in improving the babies sleep and reducing levels of maternal depression – both conditions produced better results than no sleep training. So in the short term sleep training worked.
4) The positive effects on sleep did not extend out for 5 years. This is not surprising, as each developmental period raises new sleep challenges. In terms of kids’ outcomes – behavioral and emotional – there were also no differences across all 3 groups. Sleep training (either method) had no positive or negative effects. The headlines here were that “cry-it-out” didn’t harm kids. Well, not exactly. Controlled comforting did not have negative consequences 5 years later – and neither did camping out. The camping out part of this was typically left out of many news stories.
5) The key takeaway is that when parents are trained in reputable methods, they work to reduce sleep problems and indirectly help parents sleep better and feel better. Parents can feel comfortable choosing either controlled comforting or camping out, based on the results of this study. What didn’t work so well was not receiving instruction in sleep training – in the short term, these families continued to experience all the negative stuff that happens when baby won’t sleep at night. Keep in mind the point made above – the sleep training will certainly take for awhile, but sleep problems could happen again during different developmental periods (e.g., age 2, age 5). The inference to be made, however, is that sleep training will work again, but it will of course be somewhat different and tailored to the age of the child.
This study is a welcome addition to the scientific literature and also to the endless debates about sleep training that we all have. Modern sleep training methods work – especially if parents are trained to use them properly and stick with them. And you can feel comfortable picking a method that suits your style. Just remember to talk to your pediatrician (or other experts) when you are ready to start – and also remember that these kinds of sleep training methods are typically recommended for infants at least 6 months of age.
Image of adults sleeping – via Shutterstock – as a reminder that when baby sleeps, parents sleep too!
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Thursday, February 16th, 2012
I’m used to seeing parents having spirited debates about sleep methods. But now sleep experts are having their own debate about sleep guidelines.
A recent paper suggests that the sleep recommendations for kids are, in essence, not supported by research. The implication is that kids may not really need as much sleep as we are told. An expert’s reaction to this paper was that, in general, the guidelines are backed up by enough research to make them useful.
So what do you, the parent, make of all this? Here are two things to consider.
First, keep in mind that the sleep recommendations – such as those provided by the National Sleep Foundation – have a lot of fuzziness built into them. How fuzzy? Check these out and notice the numbers that I have italicized and bolded:
Infants (3-11 months): typically sleep 9-12 hours during the night
Toddlers (1-3 years): typically need 12-14 hours of sleep daily
Preschoolers (3-5 years): typically sleep 11-13 hours each night
Second, consider why these guidelines are so broad. Yes, you already know the answer. Simply put, not all kids are the same – some kids need more sleep, others need less. And that’s where we should focus our attention in this debate. These figures do come from both research and clinical practice. As broad guidelines, they are reasonable. What I suggest is that the expert debate move on to address the real need for parents: to stop talking about how much sleep kids need on average and start developing better, empirically-supported, guideposts that help parents understand how to figure out how much sleep their own child needs. If a toddler sleeps 13 hours a night, is that enough? (It’s within the guidelines). If a toddler sleeps 11 hours a night, is that problematic? (It’s outside the guidelines). The problem is that these guidelines don’t give you the answer to these questions. It’s possible the toddler getting 13 hours of sleep needs more – and the toddler getting 11 hours of sleep does not.
So where does that leave you, the parent, right now? I suggest you become familiar with a few indicators that can tell you how well your child’s sleep routine is working beyond the obvious goal of having them sleep through the night (click here to read about this in more detail). You can start looking for these during the toddler years and beyond (once sleep patterns become established):
- Does your child get to sleep around the same time most nights? (They should)
- Does your child get to sleep within 15-30 minutes once they are settled in and it’s clearly time to sleep? (They should)
- Does your child wake up pretty easily in the morning – and after a nap – without lots of prompting? (They should)
- Does it feel like it takes a long time for your child to seem alert after waking up? (It shouldn’t)
- Does your child seem tired a lot during the day (e.g., yawning, eye rubbing, etc) – excluding nap time? (They shouldn’t)
- Does your child fall asleep frequently when you drive – excluding nap time or if you are driving near bedtime? (They shouldn’t)
- Does your child sometimes fall asleep (crash) much earlier than the usual bedtime? (They shouldn’t)
If you go through this list and find that your child is showing signs that their sleep routine needs adjusting, then it does. Continual sleep deprivation can have severe effects on kids, including interference with learning and compromised health. So getting a handle on this as soon as possible is important. In addition to doing your own research and trying out different methods, it’s often helpful to consult with your pediatrician. And if that doesn’t work, see if you can visit a pediatric sleep clinic – you can learn lots of little tricks that can help you set up a routine (click here to see my post from last month that discusses tips I learned) that can be calibrated to get your kid the amount of sleep that’s right for them.
Restful Sleep image via Shutterstock.com
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