When to start ferberizing baby
Sleep Training for Parents and Infants
when my wife Ami's water broke minutes
after I went to bed back in January of
2002 I remember driving her to the
hospital and anguishing over one thought
I am never going to be well-rested again
if there's one thing all new parents
wish it's for a good night's sleep
unfortunately infants sometimes make
that impossible they wake up repeatedly
needing to be fed changed and comforted
eventually they reach an age when they
should sleep through the night
some don't though what to do with them
continues to be a topic of heated debate
in parenting circles that's the topic of
this week's healthcare triage
one camp believes the baby should be
left to cry it out they should be placed
in their cribs at a certain time and in
a certain routine and not interfered
with until the next morning no matter
how much they scream or cry parents
should ignore them after all if they
learn the Tantrums lead to the
appearance of a loved one they'll only
continue that behavior in the future
the official name for this intervention
is extinction which sounds pretty grim
the downside of extinction of course is
that it's unbelievably stressful for
parents many can't do it further not
holding fast to the plan can make
everything worse
responding to an infant's crying after
an extended period of time makes the
behavior harder to extinguish for a baby
it's like a slot machine that hits just
as you're ready to walk away it makes
you want to play more a modification of
this strategy is known as graduated
extinction which is still pretty grim
their parents allow their infant to cry
it out for a longer period each night
until the infant eventually puts himself
to sleep on the first night for instance
they might commit to not ironing the
baby's room for five minutes
the next night ten minutes then 15 and
so on or they could increase the
increments on progressive checks each
night for the record this is what we did
when they do go in the room it's only to
check and make sure the baby is okay no
picking up or comforting it's not meant
to be a reward for crying but to allow
the parents to be assured that nothing
is wrong another choice is bed time
fading the point of this plan is to
teach your child how to fall asleep on
their own at bedtime in the hope that if
they develop this skill when they wake
up in the middle of the night they'll
choose to employ it rather than call for
you with fading you temporarily set
bedtime later than usual and preface it
with a good bedtime routine your baby
learns the bedtimes fun and has little
trouble falling asleep since they're
more tired at that later bedtime then
you move the bedtime earlier and earlier
so that infants are forced to learn how
to put themselves to sleep when they're
less and less tired a final method is
known as scheduled awakenings in this
method a parent wakes up the child
fifteen to thirty minutes before they
usually wake up on their own in the
middle of the night and then helps them
fall back asleep this is thought to
disrupt
spontaneous awakenings and the scheduled
ones can later be phased out of course
as I've said before only a fool wakes a
sleeping baby so I've never really fully
understood scheduled awakenings even
though it does seem to work of course
even with fading and scheduled
awakenings it's possible that your baby
will wake up in the middle of the night
scream and then you're faced with the
same choice of what to do go to them or
wait it out some people always choose
the former they think that making a baby
cry it out is inhumane and could even
lead to future psychological problems
other feel that giving into a baby
prevents them from learning needed
skills and leads to later issue final
thing parents can do is known as
parental education it's more preventive
than actually treating a problem doctors
talk to parents about things they can do
to help infants fall asleep and to
manage the problems before they actually
occur as a pediatrician the first thing
I do when confronted with this issue is
try to calm the parents down while this
sometimes feels like a problem that will
never go away I try and remind them that
few teens have this issue they go to bed
fine and if they wake up in the middle
of the night they go back to sleep
without anybody's help this almost
always eventually gets better on the
other hand I don't want to minimize the
short-term problems for parents nor do I
want to do nothing
sleep deprivation leads to significant
and serious consequences an adult as
we've discussed in many previous
episodes a 2008 study published in
Pediatrics found that mothers of infants
with sleep problems where no
intervention was tried were more likely
to report symptoms of clinical
depression when their child was two
years old sleep problems also lead to
significant parental stress and
potentially physical punishment for
children the good news is that almost
all of these interventions work in 2006
a systematic review was published in the
journal sleep that examined all the
relevant research on the efficacy of
these interventions versus each other on
placebos 94% of the 52 reviewed studies
found that interventions led to improved
sleep and more than 80% of kids treated
significantly improved over those not
the strongest evidence supported
extinction and parent education about
sleep still evidence existed that also
supported graduated extinction fading
and scheduled awakenings people gets
sizing the heated about which method to
use this isn't just because they think
one works better than the other but also
because they think that some are harmful
they worry about the long-term effects
of some of these methods those concerns
may be overblown though a small study
published recently followed kids
randomized to graduated extinction
fading or parent education besides
looking at the effectiveness of the
intervention on sleep they measured
infant salivary cortisol levels as a
measure of stress as well as mother's
mood and stress again all of the
interventions worked on sleep more
importantly none of them caused any
concerning levels of stress this
confirmed the findings of two previous
studies that found that infant sleep
problems and the interventions used to
remedy them do not predict long-term
outcomes even at six years of age and
stress about infants who don't sleep
well that's understandable what they
don't need to stress about is that
fixing it will cause more harm than good
or have long-term negative consequences
a good night's sleep makes almost
everything better
you
healthcare triage is supported in part
by viewers like you Thor patreon.com a
service that allows you to support the
show through a monthly donation we'd
especially like to thank our research
associate Jo civets and our surgeon
Admiral Sam thanks Jo thanks Sam
more information can be found at
patreon.com slash healthcare triage
