We have one rule when it comes to sleep in our house. Everyone needs to sleep and everyone deserves to be comfortable when they are sleeping. Where people sleep or how often that changes, isn’t really relevant as long as everyone is able to sleep comfortably. Sounds idyllic, you might say. But how do you make that happen? Let me tell you the story of how we got there.

Before we had kids, I had a colleague that I’ll call Mike. Mike often came into the office in the morning complaining about a sore neck or a sore back. Ask him why and you’d get an earful. His daughter wet the bed, so they got her changed and brought her into their bed so they didn’t have to change the bed in the middle of the night. Then, his toddler son would wake up and want to come to their bed, but there wasn’t enough space, so he would go over there and sleep with him. The problem? His son had a toddler bed. This scenario, or some version of it, played out frequently enough that I knew when we had a baby that we were never going to buy a toddler bed. The rest of our sleep arrangements worked themselves out over the years, but buying a toddler bed was not something we ever considered.

Who sleeps where and in what type of bed has changed

many, many times since our first child was born seven years ago. But it seems like the most challenging time for a lot of parents is during the toddler years, especially if they are adding a newborn sibling at the same time. So I thought I would talk about what our sleeping arrangements were like when our children were that age.

• When Julian was around one year old, we took down the large-sized laundry hamper in his room (also known as a crib) and replaced it with a double futon (which used to be our guest bed) equipped with a bed rail (which you can see pictured in my co-sleeping safety post). Once we did that, most nights we would put him to bed in his room, and then sneak out once he was asleep. Initially, it was almost always me putting him to bed because he nursed to sleep, but he would go down for my partner with a combination of a bottle of breastmilk followed up by a pacifier  if I was out for the evening (as well as for daytime naps because I worked and he was a stay at home dad).

• We bought a king-sized bed for our room and then moved our queen sized bed to the guest room to replace the futon (my mom came to visit and help out almost every week, so we needed another sleep space). Before Emma was born, when Julian woke up at night, I would either go and join him in h is bed (which was not a toddler bed!) or I would bring him to our bed.

• When I was pregnant with Emma, we gradually stopped bringing Julian to our bed at night and my partner also started more frequently being the one who would go and sleep with him at night if he needed someone. We didn’t want it to be a sudden switch from mommy to daddy once the baby arrived, so we made the switch gradually.

• Once Emma arrived, she slept with us in our bed (following safe bed sharing guidelines) and Julian kept sleeping in his bed, with Daddy going to him as needed at night.

• But once Emma was a little bit bigger and the suffocation risk wasn’t a big issue, things became more flexible. If one parent was sick, that person could sleep alone (to get more rest and not keep others awake with coughing) while the other parent slept with the kids. If one of us snored, we could kick that person out or sneak away to the other bed. If one bed got wet due to a leaky diaper, we didn’t have to change the bed in the middle of the night.

As long as everyone was sleeping, the “where” didn’t matter so much. Here’s the three of us lying in Julian’s bed cuddling.

This approach was based on the size of our house and the space that we had available. Not everyone has the same space available, but similar arrangements could be worked out (temporarily or permanently) with a mattress on the floor or a pull-out couch (not for the newborn, but okay for older kids or a parent alone). Creating options, so that no one keeps the rest of the family awake at night, helps everyone to get a bit more rest.

I think the musical beds approach has also made our kids more comfortable with sleeping in new and different places. As long as we are there, they are not attached to a particular bed, nightlight, or star stickers on the ceiling. Whether it is a hotel, a tent, or a relative’s house, they are pretty easy going.

Now that our kids are older, we still have very fluid bed space. We still have the king-sized bed, Emma (4 years) now has the double bed, and Julian (7 years) has a bunk bed. But as I sit here and type, Daddy and the two kids are cuddled upstairs in the king-sized bed.  As they grow, finding a balance between independent sleep and keeping the closeness of the family bed is important to us and the musical beds approach continues to work for that.

Need more sleep tips and resources? Check out my Gentle Baby and Toddler Sleep Tips and Read How We Transitioned from Nursing to Sleep to Other Forms of Comfort.

Toddler Carnival Sponsor

The City of Milwaukee Health Department wants to tell you that co-sleeping is like letting your baby sleep with a sharp knife . They are sharing this news via two new posters (one with a black baby one with a white baby) that tell parents that babies can die when sleeping in adult beds and that warn parents to always put their baby to sleep on its back in a crib. They also give a phone number for people to call if they cannot afford a crib.

I’ve been over this before. Statistically, co-sleeping is as dangerous as traveling by car (really, read the stats). But the health authorities ignore that.  When I wrote about this previously, I said:

Cars are convenient. People like cars. Peoples lives would be changed significantly and we would have to drastically change our habits to give up cars.

Bed sharing is convenient. Parents and babies like co-sleeping. Parents would be more tired, breastfeeding rates would be reduced, and parents would be less responsive to their infants at night if they had to give up bed sharing.

Bed sharing is a reality. Parents do it. Banning it or discouraging it is as ridiculous as trying to ban or discourage car travel.

If people stopped traveling by car except when it was really necessary, there would probably be more accidents and more deaths because the roads would be full of inexperienced drivers. And when parents are generally discouraged from sleeping with their babies and then bring them into bed when really desperate, there are more accidents, more deaths.

The Ontario coroner should stop telling people not to bed share and instead tell them how to make bed sharing safer. Public health agencies don’t tell people not to travel by car, instead they tell them to use seatbealts, use car seats, drive the speed limit, don’t use cell phones while driving, etc. Address the conditions that make bed sharing unsafe. But don’t tell people not to do it. Because they will. And they will do it unsafely.

But since the City of Milwaukee likes its analogies in visual format, I thought I would help them out by creating an equivalent poster with the message that taking your baby in the car is just like giving your baby a loaded gun to play with.

The idea that crib sleeping is always a perfectly acceptable alternative to co-sleeping is laden with as much societal and cultural baggage as the assumption that walking is always a perfectly acceptable alternative to travel by car. Sometimes it might be, but often it simply isn’t. Health authorities need to stop scaring and shaming parents and instead teach them about the pros and cons of different sleep options and about the things that they can do to make their chosen sleep environment as safe as possible.

More info: Co-Sleeping Safety

Three years ago today, I wrote what has become the most viewed and the most popular post on this blog. I wrote the post, Cry it Out (CIO): 10 Reasons Why it is Not for Us, after years as a message board moderator where we would post lists and lists of links over and over again, each time someone asked what was so bad about cry it out or every time someone needed information to help convince their partner, parents, in-laws, friends, nosy neighbours or whoever else was sticking their nose into their business. I wrote the post as a support for parents who didn’t want to let their babies cry it out and as information for parents who were exploring their options. I didn’t write the post to make parents who chose cry it out feel guilty, but I also realized, of course, that it would. My feelings on this topic are perhaps stronger than my feelings on any other parenting topic and there really isn’t a way to write about it without that shining through.

As I think back, with my children now 4 years old and almost 7 years old, I am considering how my views on cry it out have changed. Ultimately, they haven’t. I don’t think it is right. I think it is disrespectful and I think it has the potential to be harmful. That said, I have changed. I have realized that  we all have limits as parents and that we will all do things, at some point in time, that have the potential to be damaging to our kids or to our relationship with our kids. I was able, despite having one horrible sleeper and one clingy sleeper, to persevere and never use cry it out. There were tough bedtimes and rough nights, but we never left a crying baby or child alone to fall asleep while they sobbed. However, I’ve done other things, as a parent, that I am not proud of. For example, I tend to yell when I lose my patience. Perhaps there are other parents out there who opted to use cry it out, but who have never-ending patience during the day, never raise their voice to their child, and feel as strongly about that as I do about cry it out.

None of us are perfect. All of us have things we feel strongly about and things we feel less strongly about. If we could enter into conversations about these things with that understanding, they would be a lot less controversial. If someone comes into the discussion with the perspective that they are a perfect parent and that cry it out is the best thing ever, there will be hurt feelings and heated disagreements for sure. Just as I would be hurt reading an article about the problems with screaming at children, if I actually thought it was an effective and positive discipline technique.

Three years later, the post still averages more than 2000 page views per month, from search engines, message boards where it gets posted, and facebook shares. It is among the top five posts on my blog pretty much every day. It upsets some people for sure, but I hope at the same time it reassures others that they have made the right choice for their family and their child.

Now, if only I could get my post on Gentle Baby and Toddler Sleep Tips to be just as popular as the anti-CIO post.

Photo credit: .Dianna on flickr

We’ve all heard people say that babies need to be taught to sleep through the night and that it is necessary to let them cry it out to achieve this. However, the Western child rearing practices of having babies sleep in separate beds (often in separate rooms) and ignoring their cries at night has not been around forever. When did our culture move from gentle approaches to promoting healthy sleep to ignoring the cries of infants in an attempt to teach them to self-soothe?

Everyone is familiar with authors like Ferber and Weissbluth (or if you aren’t, it’s okay…you don’t want to be), but the idea of leaving babies to cry it out did not start with him. The only history of the cry it out method in English-speaking countries that I have seen is a brief discussion in Aletha Solter’s article Crying for Comfort. She writes:

After the industrial revolution in the 18th century, the notion of “spoiling” became widespread in industrialized countries, and mothers were warned not to hold or respond to their infants too much for fear of creating demanding monsters. If the home was big enough, parents moved cradles and cribs to a separate room. With the infants sleeping alone in another room, it was easy for parents to follow the cry-it-out advice, even if it went against their gut instincts.

The decline in breastfeeding further contributed to the separation of mothers and infants. With bottle-feeding from birth on, the last remaining link to the mother’s body was removed, resulting in the deplorable, detached methods of child-rearing that predominated in Western civilizations during the 20th century.

Dr. Luther Emmett Holt, an American pediatrician and child-rearing expert, was the first person to make the cry-it-out approach explicit and popular in the US. Over 100 years ago, his best-selling book, The Care and Feeding of Children, was the child-rearing bible of the time. The book is structured as a series of questions and answers. One question is, “How is an infant to be managed that cries from temper, habit, or to be indulged?” The very wording of this question reveals Holt’s bias. His answer: “It should simply be allowed to ‘cry it out.’ This often requires an hour, and, in some cases, two or three hours. A second struggle will seldom last more than ten or fifteen minutes, and a third will rarely be necessary.”2 Several generations were raised according to this advice.

Dr. Benjamin Spock, the medical and parenting guru of the second half of the 20th century, recommended a similar cry-it-out approach in his best-selling book, Baby and Childcare. Modified versions of the cry-it-out approach can be found in many current, popular parenting books.

While Solter’s brief summary is interesting, it does not tell us a lot about why or how Dr. Emmett Holt’s advice became acceptable and popular. In addition to understanding what he advised, more historical context would be useful to understanding the conditions under which his recommendations were made.

After reading some of my posts, one of my German readers, Karin Bergstermann, sent me a copy of an article she published on the shift in infant sleep advice from the early 19th century to today. Her article, “Seit wann müssen Kinder schlafen lernen?” (Since when do children need to learn to sleep?) first appeared in the German Midwives Journal (Deutschen Hebammen Zeitschrift) in August 2010 and has since been republished online with her permission on a German anti-sleep training website (you can use Google Translate to get a rough translation of it, but it doesn’t make for particularly smooth reading). I found the article to be fascinating and with Bergstermann’s permission, am providing an English summary of the article for my readers.

Since when do children need to learn to sleep? (“Seit wann müssen Kinder schlafen lernen?”)

Bergstermann begins her article with a description of the current cultural context  — one where mothers are pressured to ignore their own instincts and implement sleep training methods that will teach their children to sleep through the night. If the child does not sleep through or sleeps in the parents bed, this is seen as a parenting failure. Our society expects children to sleep when and where the parents want them to. Bergstermann asks where this expectation comes from.

To answer this question, Bergstermann analyzes parenting advice in Germany going back to the 1830s. The literature of the 1830s, includes books by doctors and medical professors (e.g. Christoph Wilhelm Hufeland, Adoph Menke) who wrote about infant sleep. They note that, for example, by about six months of age babies could get used to sleeping at specific times of the day and that an appropriate sleep environment should be created to facilitate this (e.g. turning off lights at night, avoiding noise). They do mention that mothers could attempt to night wean their babies (e.g. by using methods other than nursing to settle the child) and that they should not rush to comfort the baby immediately, but should instead see if it resettles on its own. However, they also note the importance of caring for babies day and night and indicate that if the baby does not resettle on its own and if gentle rocking does not help that no other tricks should be used to get the child to sleep.

Bergstermann then looks at the work of other authors in the late 1870s and 1880s. These authors (including Hermann Klencke, Ernst Kormann, and William Thierry Preyer), wrote about introducing regular sleep schedules early in the baby’s life and also talked about expectations with regards to “normal sleep” (e.g. newborns don’t sleep for more than 2 hours at a time, children won’t sleep through regularly until about 17 months). However, they also emphasized that no child should suffer from thirst at night and that parents should not be ruthless in the introduction of sleep schedules.

Marie Susanne Kübler (who wrote books for housewives in the 1890s) and Dr. Otto Köhler (who wrote a book about the care of infants in 1921), both agreed that around eight hours of sleep was an absolute necessity for mothers (otherwise they would have problems with milk supply). They both recommended mother-led feeding schedules (e.g. mothers feeding based on feeling in their breasts or feeding at specific time intervals instead of feeding on cue). However, Köhler also noted that not all babies would easily sleep through for eight hours and that it was better to give them a nighttime feeding than to have them disturb everyone with hours of crying at night. Overall, however, this time period seemed to mark the beginning of sleep being characterized as a problem and the child being considered the source of that problem. (Interestingly, Kübler’s book, “Das Buch der Mütter”, came out in 1891, which is about 3 years prior to Emmett Holt’s book that I mentioned in the introduction).

In 1933, pediatrician Dr. Philipp Niemes wrote that sleep is incredibly important for mothers and babies and that nighttime rest needed to be strictly enforced. He wrote that it was especially important not to pick up the child at night, even if it screams. He said that tending to the baby at night could lead to overfeeding, which would lead to more illness. Around the same time, in 1930, Dr. Walter Birk and Dr. A. Mayer wrote that newborns call out in the night, but that nighttime feedings were unnecessary to the child and disruptive to the mother. They also suggested a variety of tricks that could be used to get the child to sleep better. Ultimately, if none of those tricks worked, the mother must absolutely enforce nighttime rest. The most “heroic method” for a young mother, in their opinion, was to let the baby cry it out.  In their work, the infant’s behaviour is suddenly characterized not only unhealthy, but also bad and in need of correction. Sleep had become a battleground and the child was the enemy. Bergstermann notes that the influence of Nazi ideology here is unmistakable and that the need to portray the child as a problem in need of correction was definitely politically motivated.

Ultimately, Bergstermann notes that the desire for a good night’s sleep has always existed, but the way that sleep disruptions (especially from children) are dealt with has changed over time. This has created a great deal of pressure on parents and has resulted in them resorting to techniques that they can hardly bear (like cry it out) rather than tending lovingly to their babies at night.

My thoughts

Overall, as I read Berstermann’s review of the literature, I noticed two major shifts. The first was when the advice turned from information of a medical nature (developmental information on normal sleep from doctors and medical professors) to “housewife” advice (tips and tricks that would benefit the mother, but that don’t necessarily consider the best interests of the child). The second shift was when the advice became politicized, turning it from something mothers may want to consider to something they were expected to do, creating the “good mother” and pitting her against the “bad mother” who spoils and coddles her child.

Over the past few days, several people notified me about a Globe and Mail article called Coddle or let the kid cry? New research awakens the sleep-training debate with a header that read: “While many moms and dads reluctantly allow their infant to ‘cry it out,’ some experts now say the practice can cause real damage.”

As someone who believes, based on my instincts and research on excessive crying in general, that the cry it out method can be damaging, but that has also been told over and over again by commenters that none of the research about the damage of excessive crying can definitively point the finger at the cry it out method, I was intrigued.

Then I was disappointed.

I was disappointed because the study, Maternal Emotional Availability at Bedtime Predicts Infant Sleep Quality by Douglas M. Teti et al and published in the Journal of Family Psychology, doesn’t actually demonstrate that the cry it out method can cause real damage.  Unless you define “real damage” as “poorer sleep quality”. Personally, when I read “real damage” I was thinking more along the lines of long-term psychological damage or significant damage to parent-child attachment. Instead, what the study concluded was that:

…parents’ emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality. Results support the theoretical premise that parents’ emotional availability to children in sleep contexts promotes feelings of safety and security and, as a result, better-regulated child sleep.

If that is true, then it certainly makes a good case for trying to be patient, calm, and responsive when dealing with sleep difficulties. It also seems to go against the stereotypes of the sleep deprived parent that responds consistently to their infant’s cries versus the well rested sleep trainers.  But perhaps those two groups are just the most vocal and not really representative of the sleep experiences of the average family.

Let’s explore…

Methodology used

The study involved 45 families with infants 24 months and under (however, due to technical difficulties data was only available for 39 families). The families were divided into cohorts based on the age of the infants (1, 3, 6, 12, and 24 months). There was a mix of male and female babies and a mix of firstborns and later borns. There was some variety in socioeconomic factors, but not enough (this is noted as a limitation of the study).

For each family, a variety of methods were used to record information on the infant’s sleep pattern, on parenting practices and on parental emotional availability at bedtime. This included:

• Sleep Practices Questionnaire (SPQ): This questionnaire, which was adapted from a questionnaire previously used by other researchers, was used to get information on the sleep methods and parental satisfaction with their infants’ sleep arrangements.

• Infant sleep diary: Over the course of a week, parents kept a sleep diary indicating the number of times the parent had to return to the infant during bedtime (note: this number also counted incidences of re-settling an infant if the parent remained in the room during bedtime), the number and duration of night wakings and of infant naps during the previous day, and infant sleep location.

• Infant Sleep Questionnaire (ISQ): Another questionnaire, this time on the parent’s perception of the frequency with which infants signaled to parents during bedtime and now often infants awakened at night, as well as the parent’s assessment of whether the infant has sleeping difficulties.

• Parent-infant video recording: Using three different cameras, bedtime practices and night wakings were recorded on video. The video was coded independently by two researchers who were trained by Dr. Teti. The coding involved recording data on the presence or absence of parenting behaviours (in 30-second intervals), the bedtime length, and parental emotional availability at bedtime (using Biringen, Robinson and Emde’s Emotional Availability Scales (1998)) on four different scales, namely:
  • Sensitivity: “parent’s ability to read accurately and respond contingently to child signals with warmth and emotional connectedness”
  • Structuring: “parent’s capacity for appropriate scaffolding of child activities and setting appropriate limits”
  • Nonintrusiveness: “reverse-scored, refelcting parent’s capacity to respect the child’s autonomy and personal space”
  • Nonhostility: “reverse-scored, assessing parent’s ability to interact with the child without signs of covert or overt irritability/anger”

Interestingly (or perhaps shockingly), of the 39 families for which data was recorded, the emotional availability of the parent at bedtime could not be coded for four families because there was little or no parent-infant interaction at bedtime (less than 1 minute). The complete absence of a bedtime routine (i.e. expecting an infant to go from 100% on to 100% off without an aided transition period) is incomprehensible to me and for that to have been the case in 10% of the families studied is shocking.

Emotional availability and cry it out

In the study “only three families reported that they were currently using a sleep training method.” This doesn’t mean that some of the families hadn’t used sleep training methods in the past, but they weren’t being actively used at the time of the study except in a small handful of families. That meant that no meaningful comparisons could be drawn between families engaged in sleep training and families not engaged in sleep training.

Despite this, the researchers do use their definitions of emotional availability (as outlined above) to draw certain conclusions about parents that use the cry it out method. Dr. Teti is quoted in the Globe and Mail as saying:

An emotionally available parent would probably not let their baby cry it out. Quite frankly, there aren’t too many researchers that advocate that any more. I don’t want to diss sleep-training programs per se, but the way we construed emotional availability is that an emotionally available parent is not a parent who is going to abandon a child at night and let the child cry it out.

It is this quote that initially intrigued me and made me want to learn more about the study. On this point, I certainly have come across people who believe emphatically that cry it out is the best and only method to teach an infant to sleep. To be perfectly frank, I think that a certain emotional distance is required in order to believe something like that. However, I have also come across parents who want to be emotionally available and who are trying hard to be there for their children, but who find that sleepless nights are making them irritable and depressed. These parents have come to a point where they believe that in order to be emotionally available to their infant during the day, that they need to let them cry it out at night, even though they find it extremely painful to do so. I am not going to argue that cry it out is the right approach under those circumstances (because I don’t think it is), but am also not ready to label everyone who does resort to cry it out in desperation as emotionally unavailable (but I will concede that at that point, where they are not responding, that they are being emotionally unavailable). I do see a big difference between someone who sees cry it out as the optimal solution and someone who sees it as a last resort in a downward spiral. I make similar distinctions when discussing spanking, i.e. I would distinguish between someone who thinks spanking is the correct way to discipline a child (which I think is wrong) and someone who thinks spanking is wrong, but who ends up spanking once or twice while at the end of their rope and feels horribly about it.

Chicken or egg? Emotional availability or good sleeper?

As indicated in the introduction, the study concluded that “parents’ emotional availability at bedtimes may be as important, if not more important, than bedtime practices in predicting infant sleep quality.”  Specifically, it found that parents who were less emotionally available also had to return more often to their infants at bedtime, experienced more frequent infant night wakings, and were more likely to say that their infant had sleep difficulties. However, the study did not find any linkages between specific bedtime practices (e.g. nursing to sleep) and infant sleep disruption.

In order to have a detailed discussion of emotional availability, I think some examples are important. In addition to listing the criteria used to assess emotional availability, the study also included the following descriptions, which I think are useful:

Differences between mothers in EA become evident in the following descriptions, taken directly from our videorecordings. One mother, rated high on EA, directed quiet and gentle vocalizations to her 6-month-old infant while breastfeeding. She continuously gazed at the infant’s face and, whenever the infant vocalized, she responded promptly (e.g., “It’s OK.”). When necessary, the mother adjusted the infant’s position for easier access to the breast, and hugged and patted the infant’s back to burp the infant following nursing before putting the infant down to sleep. Another mother highly rated on EA responded to her 24-month-old’s questions during book reading with explanation and reassurance. When the book was finished, the mother said a brief prayer, caressed her child’s head, kissed and hugged her, then spoke softly to her, and sung to her. She then handed a soft toy to the child, tucked the child into bed, and left the room. Low EA, by contrast, is exemplified by another mother, who used stern directives with her 24-
month-old during book reading whenever the child got up out of bed, and at one point physically pulled the child back to her. This mother continually attempted to engage the child in the book despite clear signs that the child was losing interest (e.g., child was fidgety and continually turned his attention elsewhere). The child continued to squirm in bed after the book reading was finished and was having trouble settling down to sleep. The mother repeatedly directed the child to lie down and close his eyes, threatening to take his toys away if he does not settle down. At the same time, she asked for hugs and kisses from him, to which he did not comply. The child got up and left the room four times before
he eventually fell asleep.

As I read these examples, I had flashbacks to various stages of sleep with our two children in our home. While none of them corresponded exactly to our bedtime practices, I could see some of our family in all of these (despite the fact that we have never left our children to cry it out and that we always remained present and in close physical contact as long as they needed us at bedtime).

Seeing some of us in these descriptions, and realizing that there were scenarios where we were more emotionally available and scenarios where we were less emotionally available led me to send the following question to Dr. Teti:

As a mother of two children reflecting on my own experience, I can remember being more emotionally available when my children fell asleep easily and didn’t wake too frequently at night. I also remember being less emotionally available at times when they fought bedtime and fought sleep. I wonder (and know my readers will wonder too), whether the infant’s sleep quality could be a predictor of the mother’s emotional availability rather than the opposite being true.

The response I received from Dr. Teti was as follows:

I think that is certainly possible, and in order to address directions of influence, these phenomena need to be examined longitudinally.  We are doing so in an NIH-funded study (SIESTA II), which is ongoing and hopefully will be contributing more to this topic in the not-so-distant future.  The preliminary findings we are getting, however, appear to support a causal link between earlier parenting and sleep quality in infants at later points (e.g., by 6 months of age).

I’ll be interested to read more of the findings from the further research that they are doing. I would certainly characterize our earlier parenting as being high on the emotional availability scale, except perhaps by about the 10th night waking during a particularly bad sleep stage, at which point irritability may have set and could have been apparent in my behaviour while responding to my child. However, it is more so with toddlers who refuse to stay in bed and keep trying to get back out of bed, that I get the flashbacks of us perhaps being less emotionally available at times (whoever said “whatever you do, ensure you follow the same bedtime routine each night and do not interrupt the routine” forgot to inform parents what they are supposed to do when the bedtime routine is done and the child decides to get out of bed).

All that to say, I found it easier to be fully emotionally available to an infant than I did to a toddler, but certainly tried my best with both. However, I didn’t suffer from postpartum depression (PPD) and I can see how things might be different for a mom who is suffering from PPD and is less able to be emotionally available until she is diagnosed and treated.

Gender roles and mother blame

You may have noticed that the name of the study contains the word “maternal” but that I have been using the term “parental” or “parents” throughout my post (except in direct quotes). That is because I wanted to save the discussion of gender for the end of the post.

In other studies that I have read, I have been disappointed to learn that they didn’t even consider the father. When I read the first sentence of the abstract of this study, I thought that might be the case here too:

In the present study, linkages were examined between parental behaviors (maternal practices) at bedtime, emotional availability of mothering at bedtime, and infant sleep quality in a cross-sectional sample of families with infants between 1 and 24 months of age.

I cringed, but I read on. When I got to the section on the methodology, I discovered that fathers were recruited into the study but that too few of them interacted with their infants long enough (at least 2 to 3 minutes) during bedtime to be able to capture and code the data. As a result, the study had to rely exclusively on information from maternal bedtime behaviour.

The unfortunate result of the over-focus on the mother is that the conclusions sound an awful lot like mother blame (poor sleep can be blamed on the mother’s lacking emotional availability). I’m not a fan of cry it out and I’m not shy about that. But I also think that the responsibility of caring for an infant is a shared responsibility. That doesn’t mean that both parents have to get up every time the baby wakes up (in fact I think that is a good way to ensure that no one has any emotional availability left), but I do think that it means both partners need to support each other in order to ensure that whoever is caring for the infant has all the support necessary to be as emotionally available as possible. Sometimes that means trading off. Sometimes that means having the other partner take over other chores so that duties are more evenly distributed. Sometimes it means having one partner do most of the bedtime routine (e.g. bath, PJs, book, massage) and the other one just do the final stage (e.g. nursing to sleep).

The study does reference an earlier study by Countermine and Teti that found that spousal criticism of the mother about her handling of infant sleep behaviour makes it more difficult for the mother to adapt to infant sleep. This, plus the lack of fathers in this study, shows a need to emphasize and perhaps study further the role that the other parent plays (directly or indirectly) in emotional availability and sleep quality.

Something to sleep on?

My reading of this study does not support the statement from the Globe and Mail that cry it out can cause real damage. I do believe that cry it out can be damaging. I just don’t think this study demonstrates that. That said, I do think that it contributes to a body of research that shows that being responsive at bedtime is a good idea and I look forward to further exploration of the themes in the research.

I also wish there had been some follow-up to the large scale survey that Thomas Hale conducted back in 2008. I blogged about the survey at the time, encouraging my readers to complete it, but have not seen him publish any results. If they are ever published, I think they also have the potential to contribute a lot in this field.

In any case, infant sleep research is important and I’m glad I read the whole story rather than just waving around the headline from the Globe and Mail.

Image credit: istockphoto

This video from Fox News that my friend Allie at No Time for Flash Cards sent me a link to is a must watch (never thought I’d say that!):

There is so much I want to say about this video, yet I don’t know where to begin. So I’ll let you all start.

Discuss…

When people talk about baby-led weaning, they are usually referring to the method of introducing solid food that involves introducing finger foods and allowing the baby to decide what and how much to eat, rather than the parents spoon feeding baby food. Over time, feedings at the breast are gradually replaced with self-feeding of the same types of solid foods eaten by the rest of the family.

But breastfeeding is about more than just food. So in families that have chosen child-led weaning, meaning that the child (not the mother) decides when to stop nursing, the gradual process of weaning involves not only introducing other forms of food, but also other forms of comfort.

In our family, our babies were always nursed to sleep. That meant that I, as the nursing mom, lay down with them at bedtime and nursed them until the gulps turned to flutters and they drifted off to sleep. I could then sneak out and go about the rest of my evening. If I wasn’t there, Daddy would do, but their preference was always to nurse to sleep.  We never pushed or forced independent sleep, knowing that like eating, walking, talking, reading and so many other things, they would one day be able to do it on their own. It might require some guidance and some reassurance, but certainly not force.

As it happens, both of our children were ready to give up nursing to sleep before they were ready to give up having a parent present at bedtime. Nursing is a powerful sleep tool and our kids needed something to replace it. Something that would help them go off smiling and secure into the Land of Nod. They didn’t stop nursing at bedtime all at once. It happened gradually. With both of them, they went from nursing to sleep to nursing at bedtime but not falling asleep while nursing.

So then what do you do with a still awake child that has finished nursing?

In our case, in child-led fashion, each of our kids decided for themselves what comfort they needed that would help them doze off. With Julian, it was an involved process. He wanted his back rubbed while being sang to. The Thomas the Tank Engine theme song, the Elmo Song, the Wheels on the Bus, over and over and over again. He wasn’t always quick to fall asleep and I would find myself drifting away mid-song as I tried to get him to sleep. With Emma, who is now just shy of three years old and only nurses at bedtime about every third night or so, the request is clear and simple: “Mommy, cuddle my bum.”

So I cuddle. Because she wants me to, because it comforts her, and because one day she won’t want me to anymore.

Photo credit: ibu menyusui on flickr

Dear Editor,

I was dismayed but unfortunately not shocked by Sarah Schmidt’s article Co-sleeping fears prevented call for parents to abandon defective cribs. Governments across North America, including the federal and some provincial governments in Canada,  have been waging an ongoing war against co-sleeping. Unfortunately, this is not based on sound science.

It is important to note that both bed sharing and cribs have safety risks. Both co-sleeping and cribs can be made very safe if certain safety precautions are taken (but neither one is completely safe all of the time – there is no such thing as a 100% safe sleep environment). However, when a baby dies in a crib, the Ontario coroner will determine whether it was an unsafe sleep environment (e.g. full of stuffed animals and blankets) or if it was SIDS (meaning they don’t know why the baby died). When a baby dies in bed with its parents, the Ontario coroner simply calls it an unsafe sleep environment. This is unfair to parents who do make the effort to create a safe sleep environment and also unfair to parents who are scared out of co-sleeping by the dire warnings of the government.

Even if co-sleeping were more dangerous than sleeping in a crib (which I do not accept), parents are going to co-sleep with their babies. Some do it for cultural reasons. Some do it because of the benefits of co-sleeping, such as ease of breastfeeding and promoting bonding. Some do it to because their baby simply will not sleep in a crib. By telling parents that co-sleeping is dangerous, rather than providing them with guidelines on how to make shared sleep as safe as possible, the government is playing a role in the deaths of co-sleeping babies. Tell parents not to drink or smoke and co-sleep. Tell parents to do something to prevent falls, to avoid crevices where the baby could get stuck, to avoid thick bedding that can cause suffocation, to not co-sleep on a couch, and so on. Some governments, like Quebec and Nova Scotia, do provide such guidelines for co-sleeping parents. Ontario should do the same. Most co-sleeping deaths (like most crib sleeping deaths) are preventable.

Telling parents to use a crib instead of bring their baby into bed with them is like telling parents to take the bus instead of taking their baby in the car. It isn’t convenient or even possible all of the time. In the case of cars, the government advises parents on the use of car seats, tells them not to drink and drive, not to use their cell phones while driving, to obey the speed limits, etc. If they can and do expect parents to follow those rules while driving a car, why not do the same with regards to bed sharing?

Calling co-sleeping dangerous is calling parents stupid. Give them some credit. Give them some responsibility. Give them some safety guidelines. Stop making parents feel guilty for getting some sleep and bonding with their baby.

Annie

In light of the massive crib recall, there were a lot of concerned parents on twitter today wondering where their baby should sleep while they wait who knows how long for the repair kit to make their crib safe again.

As a non-crib user, I threw out a few suggestions to people (not intended as prescriptive, but more as “thinking outside the crib”):

• I said that if they are considering co-sleeping, they should read up about co-sleeping safety first to ensure that they are creating the safest sleep environment possible.
• I also suggested that for babies over 12 months, parents may want to consider transitioning them to a big kid bed.

On the second point, I had a number of people respond that they need their baby contained or that their baby would just get up out of bed if they did that.  As someone who parents my children to sleep stays with my children while they fall asleep, this was foreign to me.

But it got me wondering:

• How do parents transition their kids from the confined space of a crib to a big kid bed?
• Is it a difficult transition?
• When and how does this happen?

Everyone tells people who parent to sleep start out staying with their kids while they fall asleep that their kids will never learn to go to sleep on their own. I won’t pretend that it is easy. But to me, it seems like it would be easier to go from being parented to sleep to not being parented to sleep having a parent in the room to not having a parent in the room than it would to go from being confined to sleep to not being confined to sleep.

Educate me.

Image credit: teresia on flickr

I received an e-mail from a reader who is feeling alone and criticized due to her parenting choices. Unfortunately, she is not alone in feeling that way. A lot of people do. Here is her story:

I am a 23 year old mom, with a 2 1/2 year old son. I really don’t know many young women my age with children, so I don’t have any friends who are in the same situation. I have a lot to learn from others, this is very new to me, and sometimes I’m not sure whether my gut instinct is enough.

I’ve had a few issues that I really don’t  know how to respond to…

My toddler sleeps in our bed with my husband and I, and unfortunately, family members seem to be enraged that I don’t have him sleeping on his own yet. I love having him in bed with us, and it tears me to pieces to force him to sleep on his own.

The fact that I am still breast feeding has everyone up in arms as well. Unfortunately, I feel like I’m always being criticized. I feel an enormous amount of pressure to quit, and while I am ready (I would love to be able to own my boobs again lol) he is still quite attached.  I have no issue breast feeding until he is ready to wean himself off,  (I really thought by 2 years of age he would be done…) but the pressure from others is making me feel like I’m doing something wrong.

I’m even slightly embarrassed to admit to family members that I still am. I live in the U.S, and somehow it seems like its taboo to breastfeed past the age of 1. I hate this pressure that I’m feeling, but I really have a hard time ignoring it. Have you had negative responses to extended breast feeding? If so, How do you cope with negative responses to extended breastfeeding? Do you recommend an age that would be an appropriate to quit?

She raised a number of different issues in this e-mail that I think are quite common for women that are co-sleeping or breastfeeding their toddlers.

Dealing with criticism

Sometimes it seems like everyone thinks they are entitled to an opinion about how you should raise your kids. There are a few things that I have found useful to combat this type of thing:

• Be confident: If you nurse your toddler confidently, with a big smile on your face and your back straight and don’t look nervous about doing it, people will be less likely to feel like they have the right to say something about it. But if you look nervous or if you mention any negatives about it, then they will take the opportunity to jump in with all sorts of advice about what you should be doing.  I have found that making it very clear to people that I am happy with my choices and that they work for us usually keeps people from opening their mouths. I call it flaunting my crunch.

• Know your stuff: If people suggest that you should be weaning already, then you could mention that the World Health Organization recommends nursing for at least 2 years and then for as long as the mom and child want after that. You could mention that the average natural age of weaning is between 2.5 years and 7 years. With regards to co-sleeping, there are many benefits to co-sleeping and despite what people often assume, children that co-sleep are generally more independent and have higher self-esteem at preschool age than those that don’t.

• Pass the bean dip: If none of that works or if you don’t even want to discuss it (because it really is no one’s business but yours), then you can make it clear that you don’t want to talk about it using a technique called pass the bean dip.

That is what works for me, but there are other things that you can do too. There are some more ideas in this article on handling criticism about breastfeeding.

An age for weaning

You asked if there is an age that I would recommend for weaning. I think it is a very personal decision, so I wouldn’t recommend a specific age.

As I mentioned above, the natural age of weaning is generally between 2.5 years and 7 years and the WHO recommends a minimum of 2 years. The approach I have chosen is to do everything I can to ensure my children nurse until 2 years and then after that it is up to them to decide when we will stop. But after 2 years I will also take what could be considered risks to our breastfeeding relationship (if I feel my child is ready), like for example going away for a few nights.

If you choose child-led weaning, then you would continue to nurse for as long as he continues to have that need. It doesn’t mean that you can never say no, you certainly can if it is not a convenient time. The approach that I have taken is that I try to offer as often as my daughter asks. For me it is a relationship, one we are both invested in, and I don’t want her to feel that she always has to be the one to initiate it. Also, I try to watch to see when she really needs to nurse versus maybe just doing it out of boredom. If she is really upset or sick and really needs me, then I try not to say no, but if she is just bored and I’m trying to get something done then I might tell her to wait a little bit. If you want to read another story about child-led weaning, you can read Sam’s story on the babyREADY blog.

If you feel ready to stop breastfeeding and do not want to go down the path of child-led weaning, you can choose a gentle weaning technique that will respect your child’s needs while at the same time slowly decreasing the frequency of breastfeeding until it stops. One method is called “don’t offer, don’t refuse“. That means that you will nurse as often as possible when he asks, but you will not offer. That is considered a gentle weaning technique, but depending on how committed the child is to weaning it could go quite quickly or it could take a very long time.

If you want to stop more quickly than that, some things you can do include:

• Avoid sitting in the places that he usually likes to sit to nurse.
• If he does tend to have a specific nursing schedule, try cutting out one session at a time very slowly (e.g. one session every few weeks). Try to replace it with something else that is enticing – e.g. if you always nurse right after nap, then replace the nursing with a visit to the park, a favourite game, favourite snack or something else that he loves.
• Create a few rules about when and where breastfeeding can happen. Start off not too restrictive, but you could become more restrictive with time. Although we generally do child-led weaning, I did have a rule with my son of no nursing between dinnertime and bedtime, because otherwise he would nurse all evening and then I couldn’t entice him to go to bed. Saving nursing for bedtime was a way to get him to go to bed.
• Try shortening nursing sessions, e.g. tell him that he can nurse, but just until you count to 10. You can then count very slowly to 10 and when you reach 10 let him know that he is done. You can count more quickly or more slowly depending on what you think his need is. This technique is used a lot by moms that are pregnant and finding nursing uncomfortable during their pregnancy. It is a good way to meet their child’s need to nurse while still restricting it and keeping some control over their own body.

For more information on weaning, I would recommend this article on how weaning happens.

My final word of advice to you would be to dig deep into your own mind and decide what you want to do.  Whatever choice you make, be confident in your decision and make it clear with your body language and, if needed, your spoken words, that the opinions and advice or others are neither needed nor welcome.

What do you think? What additional advice can you offer on dealing with criticism from others or about deciding when the right time is to wean?