start

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

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especially like to thank our research

associate Jo civets and our surgeon

Admiral Sam thanks Jo thanks Sam

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