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Hush-a-bye Baby

To sleep train or not? We explore all the latest methods and why they work

Words by Beth Cooper

Every tired parent faced with a wide-awake baby has yearned for the magic ingredient to a good night’s sleep. There are several schools of thought when it comes to “teaching” your little one to sleep but any plan should be tailored to suit your own family.

With information that researchers have discovered while investigating the science of sleep, parenting experts have created programmes to assist moms and dads with “training” their babies to fall – and stay – asleep. Some methods involve a lot of crying, while others embrace a more handson, gentle approach, and what works for one baby may not work for another.

Sleep training is big business and has become a super-important topic in parenting circles. Why is this?

“I think that we’ve had a swing away from the distant parent to the very involved parent,” says sleep expert, Dr Alison Bentley, head researcher at the Wits Diala- Bed Sleep Laboratory. “Parents are bombarded with information, particularly about the damage they could do their child at every step of upbringing. They feel they should be sensitive to their children’s needs, very often at the loss of their own. Children do need to develop their own skills, especially for falling asleep, and too much attention can restrict that learning; hence the development of sleep problems and the need to fix them.”

We’ve chosen and reviewed four popular sleep training methods – three created by local experts, and one by American mom and author, Elizabeth Pantley.

The Alison Bentley method

“My approach has four main anchors and is designed to have the least amount of fighting, so that it’s doable for parents,” explains Dr Bentley, who has spent 10 years in private practice seeing patients with all types of sleep disorders. “My own interest in sleep disorders in children started when my daughter was born 22 years ago, and I’ve been involved ever since, in one way or another.”

The four steps are as follows:
- Go into the bedroom and lie your child down in the cot or bed. This might involve some hard work, especially with older children. Lie your child down and keep her lying down with talking and gentle, firm actions.
- Stay in the room. Find a chair, or even another bed. You may touch her (pat her if she cries, for example) or just talk while she calms down and lies in her cot, trying to fall asleep.
- She must fall asleep without any crutches. This means she must have nothing to touch or suck, unless she has it available all night and can comfortably get to it herself. It’s a great idea to give a child a teddy or blanket they can use to comfort themselves with to eliminate the need for mom to be around – especially in the middle of the night.
- Only do this once a night. The best time to do it is the first time your child wakes up during the night.

Dr Bentley says, “What the process means practically is that you go into the room at 11pm, fight a little with your child to make her lie down and then stay in the room until your child goes to sleep. The second time, and subsequent times, that she wakes up, you can do whatever you like to get her back to sleep.”

After four nights, the fighting should end and you can choose to continue this method in the first part of the night only (which resolves itself) or repeat it every time your child wakes during the night. By teaching your child to sleep, rather than asking her to figure it out on her own, the process is more logical.

Dr Bentley says that she has had great success with this method over the last 20 years.

The Baby Sense method

Occupational therapist, Meg Faure, runs The Infant and Toddler Support Centre in Cape Town and is co-author, with Ann Richardson, of Baby Sense and Sleep Sense. About 80% of the babies and toddlers she sees in practice have sleep problems.

Meg says, “Sleep is an extremely complex area of development and there are myriad reasons why babies wake at night, or don’t have healthy sleep habits. The Baby Sense method differs from more harsh approaches because it’s gentle. Sleep training is only advised once many other variables are ruled out. Often if these are dealt with, many babies will sleep through the night without being ‘sleep trained’.” result, be upset while learning how to re-settle themselves. In these cases, Meg suggests that parents shouldn’t leave their babies at all, but rather sit with them, helping them to access new methods to self-soothe.

The Baby Sense method usually lasts four to seven days and most babies sleep through the night thereafter.

The first step in sleep training your baby is to rule out the basic reason underlying her night waking. There are eight issues that need to be ruled out:
- Realistic expectations Have age appropriate expectations and understand the stages your child passes through when sleeping. Young babies should not be sleep trained.
- The sensory environment and experiences have a great impact on Some babies may need to learn new methods to fall asleep and may, as a sleep, and need to be addressed to facilitate good sleep habits. In other words, babies cannot be expected to go from a busy game of tickle with dad, straight into bed without some calm time before she tries to sleep.
- The sleep space The environment in which your baby sleeps is essential for good sleep. Make sure your baby’s room is not too hot or cold, and that the blankets she sleeps under are suitable for her age, stage and the season.
- Nutritional needs Very young babies will wake for hunger but as they get older they no longer need to feed at night and waking up will either be out of habit or for a different reason entirely. Babies have different nutritional needs at different ages too. Very often adding more protein and iron to the diet does the trick. It’s vital that these nutritional needs are dealt with before you can even contemplate sleep training.
- Health factors If your baby is sick or uncomfortable, she won’t sleep well and may wake during every light sleep state. Before embarking on a sleep programme, your baby should get a clean bill of health from a doctor.
- Day sleeps are essential for night sleep to develop well.
- Self-soothing skills Babies need to be able to self-soothe in order to fall asleep, and settle back to sleep during the night. Take the time to establish a soothing strategy with your baby.
- Emotions The emotional aspect of sleep can’t be ignored. Separation anxiety, for instance, can be very real and will impact on sleep. Take note of this and work around emotional reasons for your baby’s sleep problems.

In essence, only once these areas are dealt with in great detail, can you proceed to coach your baby to sleep independently. The steps are as follows:
- At six months, Meg and Ann suggest that you can leave your baby to niggle (not full-blown crying) for no more than five minutes. This will to allow her time to settle by herself if she can. If she does not settle, use soothing strategies such as placing a hand on her back and patting her or giving her a dummy, teddy or comfort object.
- Stand next to her cot, talk to her in soothing tones or stroke her gently.
- If she does not calm down, pick her up, rock her gently and put her back down when she’s drowsy, but not asleep.
- If she cries once you have left the room, allow another five minutes for her to self-soothe and go to sleep on her own. If she does not settle in this time, return to her room and talk to her reassuringly, or gently stroke or pat her back.
- If crying persists you can either stay in the room and place a firm hand on your baby’s back to reassure her or leave the room, returning in intervals of one, then two, then four and six minutes, increasing the interval by two minutes each time. If your baby becomes hysterical, she may need to be picked up, but put her down once she’s drowsy.

Baby Love

Baby Love specialises in routine and sleep guidance. Owner and mom of two, Jacqui Flint, says every Baby Love Consultant is a mom who personally experienced sleep deprivation and the negative impact it had on her baby and family.

Jacqui says, “Although sleep training is a sensitive topic, Baby Love approaches the issue head on. There’s a stigma attached to sleep training which is unfounded and just because a parent needs to implement sleep training, it doesn’t mean they have failed as a parent. It simply means that they want what’s best for their baby and family.”

Sleep training, adds Jacqui, does involve some crying. “Your baby will cry because she isn’t getting what she wants and Baby Love advocates that as a parent, you need to be guided by your baby’s needs and not her wants.”

Baby Love embraces two sleep training techniques, each dependant on the age of your baby. These are “The Tender Touch” and the “15 Minute Rule”.

“Parents need to understand that the better your baby sleeps during the day, the better she will sleep at night. Baby Love works with your baby’s natural biorhythm, so an age-appropriate day-time routine is critical.”

Jacqui explains that sleep training is “just one piece of the puzzle”, so it can’t be implemented until other issues such as feeding, length of awake times, and number of day naps are addressed and corrected first. The basic steps to the Baby Love sleep routine are as follows:
- Set the stage for sleep. Allow for about 5 to 10 minutes of quiet time before day naps and bedtime, so that your baby can mentally and physically wind down.
- Don’t make eye contact, drop the tone of your voice and say your sleepy-time word, like “dudu”.
- Do the bedtime ritual; close the curtains, dim the light, turn classical music on, give your baby her dummy or dudu blankie, all the time repeating your baby’s name and the sleepy-time word.
- Love and cuddle your baby and then put her down awake and walk out of the room.
- If your baby starts to cry (this must be an I’m-not-getting-my-own-way cry and not a pain, hunger or hysterical cry), time it for 15 minutes. This gives her a chance to self-soothe without interference. Listening to your natural intuition when you allow your baby to cry unattended.
- If after 15 minutes your baby has not self-soothed, go into the room, don’t make eye contact, repeat her name and the sleepy-time word, make sure all is okay, and then leave.
- Baby Love advocates one 15 minute check, as going back multiple times is more stressful for the baby and the parent, as many parents who have followed other controlled crying methods have found.

Baby Love firmly believes in “different strokes for different folks”. As parents you need to find a concept that works for you and your baby, as no one else has to live with your baby but you.

Contact Jacqui for consultations by phoning 082 851 2141 or go to their website: www.babylove.co.za for more information on this sleep- training method.

The No-Cry sleep solution

American parenting educator and author, Elizabeth Pantley, devised her sleep plan because she felt there was a gap between two schools of thought on the subject: one advocating leaving your baby to cry and the other saying that parents should just tough it out and live with sleepless nights.

Her book, The No-Cry Sleep Solution, works on the premise that your baby should never have to cry when she is being sleep trained and promises “gentle ways to help your baby sleep through the night”.

The method is based on a personalised, 10-step plan, centred around an individual baby’s sleep patterns. It also deals with different approaches such as where your baby sleeps (co-sleeping, in a cot in her own room, in a cot in your room, etc), how she feeds (breastfeeding or bottle), whether or not she uses a dummy, bottle or breast to fall asleep and which other “crutches” she might use before naps or at bedtime.

The plan advocates a gradual process involving analysis and assessment of your baby’s sleep patterns during the day and at night and offers specific sleep solutions to fit your own parenting style. Parents are asked to fill in a log, charting night-time wakings, feeds, day naps, length of sleeps and awake times. The special “pull-off” technique, which gradually helps babies to fall asleep on their own, is a unique feature of the plan.

Elizabeth also busts the myth that sleeping through the night means sleeping all night. Biologically, she explains, a baby who sleeps for five consecutive hours has, in fact, “slept through”.

If you don’t want your baby to cry – or wish to wean her off needing a dummy, bottle or breast to fall asleep – the No-Cry Sleep Solution offers a practical solution. Visit www.pantley.com for more information.

The steps laid out for each sleep method are the “bones” of the individual sleep-training methods only. All of these experts and authors recommend that you attain more information before embarking on these programmes.

Tips from the sleep doctor

- Shop around Dr Bentley says, “When considering a sleep training method for their baby, parents should ‘shop around’ to find out about different options and then pick one with which they feel comfortable.”
- Do what feels right “When I was in practice, says Dr Bentley, “I used to get a fair number of parents who walked into my room and said, ‘are you going to tell me to leave her to scream?’. When I said ‘no’, they said, ‘right, then we’ll stay!’ Parents know what feels right for them.”
- Look after your own sleep If you become exceptionally sleep-deprived and your baby is over 6 months old, consider approaching your doctor for a slight sedative for a few days only.
- Get support Ask grandparents to provide sleep-overs for your baby so that you and your partner can get some sleep. After a few nights of better sleep, you and your partner will be more likely to find a solution for your baby’s restless nights.

The evolution of sleep training

The original book on babies’ sleep was written by Dr Richard Ferber, an American paediatrician who introduced the world to “controlled crying”. This method first involved leaving your baby to cry and then evolved into returning to the room at set intervals. Parenting author and expert, Gina Ford, refined the method, but essentially, the philosophy is still the same.

Dr Bentley says, “I used a version of controlled crying for a year in practice and then swung away from it completely. I couldn’t do it with my own child and I also didn’t see the sense, particularly after nine months, when children can stand up on their own. Every time you leave the room, they stand – nobody can fall asleep like that!”

While she doesn’t agree with controlled crying, “crying down” or “cry-it-out” methods, Dr Bentley says that some parents prefer this route and like the control and routine embraced by Gina Ford parenting styles.

“Gina Ford is very popular in the UK but doesn’t seem to be that popular among the parents I have seen,” says Jacqui. “She is known to Baby Love as your ‘hyperschedulist’ parent – no room for flexibility.”

Meg says that it concerns her greatly when sleep training methods such as controlled crying are advised to parents of young babies. “Generally, these methods are quite harsh and presume that the baby is ready to sleep through the night. There is no doubt in my mind that a method such as Baby Sense is kinder on both baby and parent. No baby vomits or becomes very distressed as parents are there, supporting the baby, and are emotionally present for the process.”

Credit: Your Baby/Beth Cooper
Published: September 2009
www.yourbaby.co.za

Your Baby