Definitions: 'Cry Method'

This is a method of teaching a baby to fall asleep without the help of their parents.  'Cry' methods are usually aimed at avoiding 'sleep associations' like breastfeeding, cuddling, rocking or patting to sleep so that babies can 'self-settle'.  Some methods encourage leaving the room until the baby falls asleep, this is called 'extinction' ( not a nice connotation!).  Other methods are called 'controlled crying' 'controlled comforting' or 'crying to settle'.  These can vary from staying in the room talking to and touching the baby, staying in the room and avoiding eye contact, touch and speaking, or leaving the room for longer and longer intervals with brief comfort in the form of touch, verbal reassurance etc.  The baby is not picked up, fed or otherwise interacted with, Typically, the baby is fed, changed and made comfortable before the crying method is implemented.

Ferber and 'Ferberizing'

I read Richard Ferber's book ' Solve your child's sleep problems', expecting to hate it.  After all, he advocates leaving a baby to cry for long periods, alone, doesn't he?  Didn't he make 'crying it out' acceptable?  Maybe these distasteful ideas are in one of his other books?

Later, I read the preface, in which Ferber explains his method of 'graduated extinction' ( leaving a baby to settle for longer and longer intervals and giving 5-10 minutes of comfort at each 'visit' as a reaction against full 'extinction' methods where small babies were left in their beds until to following morning, regardless of whether the baby settled and went to sleep or was crying for the duration.  Ferber has also done a lot of work with co-sleeping families and families who implement other 'attachment' methods of settling.  He only urges changes when they fit with the families and their parenting ideology.  What a guy!

Ferber's approach is of course, clinical, he is a pediatrican and the Director of a Pediatric Sleep Disorders Unit at a Children's Hospital.  His case studies generally feature children over 6 months up to 6 years of age. His book cites actual sleep disorders diagnosed and resolved, not your average baby that cries a few times a night.

A real strength of ferber's book is his knowledge of the physiology of sleep in adults and infants.  If you want to read about sleep cycles and REM and non-REM cycles, it is quite comprehensive.  However, if all you want to know is 'Why does my baby wake more between the hours of 10pm and 5 am?',  well, apparently babies enter deep sleep in the first part of their night and lighter sleep in the later part before re-entering deep sleep again between 5- 8 am.This is why babies may wake a lot more after a certain point but usually sleep really well in the early part of the night.  It is also why babies may still demand a feed at the time despite being strapping 15 kg toddler on three hearty meals a day.  These are usually the cases he works with.

Another helpful point Ferber makes is that 'naturally' our circadian clock is at odds with the 24 clock we all must work, eat, sleep and live by most of the time.  'Naturally' left to our own devices we would operate on a 25-26 hour clock, according to Ferber, which is why unless we implement a routine with babies, they take some time to 'find their own'.  Some babies never find their own and toddlers have long ranging sleep problems from being allowed to follow their own 'clocks', so if you were trying to find optimum nap time every day would be like hitting a moving target and that bedtime would get later and later until it was at 2am and then eventually became 7 again, you get the idea.
Hence he encourages  relatively set times for feeding and naps especially in the early days, even if these times don't really 'stick'. Don't have a cow about making baby have a X hour schedule and exactly two 2 hour naps a day and catnap, but keep persevering, as you are attempting to show an infant/child some order to give structure to their sleep.

Ferber doesn't only advocate crying methods but particularly when the disorders are extreme ( drinking 20 bottles a night and only taking a little bit then waking after 4 bottles with soaked nappies), Ferber recommends graduated ( with timed intervals set by parents and their capacity to cope) crying sleep methods. In some cases when parents do not want to use a crying method, such as the all familiar multiple bottles one above, a toddler was given fewer bottles in the night over the course of a few weeks and when the final bottle was removed, some crying 'for five minutes' over two nights occurred. Sounds ok, yes?

He gives a checklist to create good sleep habits, most of which we see echoed by the Gina Ford's, Tizzie Hall's and Tracy Hogg's of this world and it was frankly good to see where these (usually unreferenced) ideas come from.  Hogg doesn't like Ferber thoughand believes he does not pay enough attention to baby temperament, ( Cooke, p.139) I can't comment on that as it wasn't really apparent from this book. However, a lot of what we know about sleep, routines and the order ( or lack thereof) of baby sleeping and waking patterns is covered by Ferber in a well laid out sort of a way.

Anyhoo, here is that checklist he advocates for teaching your baby/toddler to sleep if you're unhappy with the current state of affairs.

1) Correct the sleep association for the CHILD's benefit, not your own convenience ( i.e decide what they need and be consistent, don't pike because you are having second thoughts or chop and change to a different way each night)

2) Sleep associations/conditions ought not be stimulating or continuous.  ( i.e baby falls asleep in moving car/swing/arms/near buzzing tv) How can a baby stay in deep sleep if the swing stops, the sucking of a dummy stops ( when it falls out) the bottle is empty or the tv changes from soothing infomercials to reruns of 'Two and a half men?' Also, the quality of sleep while in motion is less beneficial than sleep in bed/motionless place according to his studies of brainwaves. He doesn't rule out motion methods but when sleep training he recommends a bed and no tv!

3) Baby wakes where baby falls asleep.  Don't transplant baby from your arms to bed and expect him to stay there all night! When he wakes again, he will need your arms again. He does an illustration for you about how you would feel if you went to sleep in your bed and woke somewhere else - i.e the floor and the blanket was different or you were suddenly wearing pajamas.

4) Wait until the baby is old enough to have props changed/removed.  Ferber suggests 5 months as a good age to change sleep associations although he does say you can change things for little babies ( maybe not breastfeeding to sleep for example can be changed relatively easily earlier) but to be quick to stop if baby responds badly. Tread carefully, a lot of sleep props can be fixed later so don't stress too much.

6) Different sleep associations can exist at different times and places - this is ok.  You may take baby for a walk for afternoon nap and not need to walk them at bedtime, they may need their alligator at Nana's but their cuddle blanket at home etc.  You might find feeding your baby to sleep for naps is fine but bedtime causes middle of the night waking for unnecessary feeds... Whatever the associations, they are not necessarily problematic in themselves for some conditions. They can be changed if they start to cause trouble.  You may find a similarity with Pinky McKay here.

7) If baby can settle well during naps but not in the middle of the night, don't fret, the self settling itself shows they will sort it out and that they are able to re settle. He doesn't say not to do anything but just says that it is a good thing.

8) Back to sleep cycles and times of night, waking is more frequent between the hours you REALLY need to zzzzzzzzzz. ( 10pm to 5 am)

9) Don't worry about 'spoiling' your baby by breaking the rules for travelling, sickness, nightmares etc.  Just be firm and go back to the limits you originally set when illness is over and you are home from holiday.  He has a chapter on nightmares and night terrors that I didn't read which you may find helpful if you have a child with these issues. The complexity of sleep phases is something I would like revisit some day.

10)  LOTS and LOTS of love during the day is vital if you allow some crying methods for settling at night, the context of a loving home is essential or don't bother with a crying method.

11) Be consistent in what you do. ( notice a trend?)

12) Be consistent in the amount of time you leave a child to cry to settle ( i.e don't shorten the time to 2 mins if it was 5 mins the night before - however if baby sounds likes they are settling and you think they are not stressed but falling asleep, wait longer if need be)

13) Share settling responsibilities if you have a partner, the milk lady can often have trouble re-settling a night waker who no longer needs the milk but can smell it maddeningly within reach.

14) Vomitting.  Hmm, this is where I think most people would pull the plug or throw the book across the room, he says toddlers can often arc themselves up to vomit a lot and that it often passes, just clean it up and stay the course ( don't forget we're talking a doctor who works with extreme sleep disorders, not a tiny baby whose needs are not being met). Robin Barker says something about this too but dryly mentions that vomitting is pretty inconvenient so it may be hard to stay the course if you are cleaning up vomit 4 times a night.

15) Stick to the settling technique, if its crying, don't fear waking an older child as they tend to be more resilient than you. ( ??? Not sure about this one)

16) Explain crying to neighbours and that you are not just off watching tv or surfing the interwebs but poised outside toddler/baby/s door.  This if just for your own peace of mind, or not, if your walls are paper thin.

17) DIY - don't get babysitters to look after kids with settling regime in place, unless you can involve them in the process. (Again ?) Trusted babysitter is emphasised, no strangers, preferably family and someone who can stay the course.

18) Last but not least, once your baby knows how to sleep, try not to stress if things fall apart temporarily but stay the course and don't let slips become the new settling regime.

So there you have it, Ferber.  A very interesting and helpful read.  Overall, quite reassuring that often night waking is more sleep than hunger after a certain age and that changes can be made - it will be difficult, but there are ways to make it happen if you are committed to it.

Baby Sleep Series

Oh, patient reader, you may have noticed I have become somewhat preoccupied with the topic of babies and their sleeping habits.

Be assured I am blessed to have in my possession a baby that is yet to develop sleep problems, or well, the appearance of them.  He falls asleep in his own bed by himself and can take longer naps if he needs them usually, although he does catnap a fair bit.  He also sleeps quite well at night, enough to leave me fairly lucid during the day. However as a second time parent whose daughter was sleeping through the night at the age her son is still demanding night feeds, I'm curious as to why and how this sleep thingamajig works. I'm also just interested in learning about stuff and need a new hobby horse.

I am reading across the parenting style spectrum to see what various 'experts' say and giving a general summary of them for my own interest, and hopefully yours, long suffering reader.

Summary of 'The Spectrum'

What do I mean by parenting style spectrum?  I mean the spectrum between 'parent-directed feeding' (PDF) and their commonly associated settling methods and 'attachment' parenting style feeding and subsequent settling methods. I'm not really going into feeding routines or demand feeding, although these may effect sleeping and settling.

At one end of the spectrum may be the extreme of PDF settling methods where babies are left to cry for long periods ( perhaps as long as an hour) with varying degrees of attention, from listening/watching baby but not intervening, to entering the room at 2-20 minutes intervals to reassure without feeding or picking up the baby. Some methods have parents staying in the room but not picking up the baby, or making eye contact. Parent directed settling may arise out of ideological conviction or apparent necessity when other methods of getting a baby to sleep fail.  Sometimes they are successful and the crying is of short duration, other times they are ongoing and upsetting for the family and then abandoned.

The other end of the spectrum may be the attachment style in which babies are rocked, cuddled, breastfed to sleep share a bed with their parents.  Again many parent practises vary a lot and may involve feeding to sleep but baby sleeping in a separate room and bed, or feeding to sleep but sleeping in the same room or same bed.  Or rocking to sleep or wearing baby in a front pack and then putting baby to bed.  Or holding the baby or child until they are in deep sleep before putting them to bed. Attachment parenting can arise out of a deep philosophical conviction or just pure pragmatism - that it 'works'. Sometimes bed sharing in particular is enjoyed and other times tolerated.

Where do I fall, you may ask?  Well, I'll get to that in due course and you may have already guessed. ;)

One thing I have found from my reading is that both 'camps' inevitably have their own kind of 'scaremongering' and mythology.  For instance, parent directed models often assure parents that their child will never EVER leave their bed if they sleep with their baby, or that if they breastfeed their baby to sleep they will have to do it every time they wake in the night.  In contrast, many attachment based approaches assure parents that allowing their baby to cry for 'x' amount of minutes will permanently damage their child emotionally.  Maybe you yourself have stumbled into one camp because your fear of say 'never EVER sleeping again' was greater than your fear of what crying may do to your baby? Or Vice versa?

Or maybe, happy Socrates, you just fed your baby to sleep one day and voila! it worked and now they are 6 and happily go to bed without it? Or maybe you stood nervously outside your baby's door for a few minutes while they cried, or perhaps you just needed the loo and went guiltily while your baby was crying in their bed, you were gone but a minute, but voila! Your baby slept and now they are in kindy and are the sunniest of little people.  Oh happy Socrates!

I, a former systems analyst cannot let things be, I hanker to understand night waking and sleep cycles, crying and cortisol, overstimulation and understimulation.

My first step into this murky subject is to read Dr Richard Ferber MD's 'Solve your child's sleep problems'.

However, now I have to go and feed the baby.

have trod?

My daughter took her first steps today, holding some blue explorer socks ( for balance?)in each hand. 1, 2, 3, 4 and over to the laundry basket. It seems the next generation has finally 'trod'.

The Lord is good and I know He is guiding me, to what or where or how is another matter that I leave to His disgression. I want to stop complaining and trust more and praise more. I want to rest in Him more and stress less.

I want to be one of those organised people who keep a tidy house and who fits in 'quiet times' exercise and kitchen cleaning all before the children and husbands eyes open. Perhaps this is more of a summer goal as I find myself wrenching my eyes open at 8 am to the sound of my daughter talking to her dolly in her cot, or even my night owl husband bringing my daughter in for a morning feed.
I am thankful. What a loving husband I have. What a beautiful daughter I have. What a generous and merciful God I worship - and the rest of sleep and sleeping in is such a gift after this year of alarm clocks and night wakings and early starts and broken sleep. Hibernating is a gift I did not think I would get to enjoy until my forties. Ah, Sleep.