Healthy Sleep Habits, Happy Child

by Marc Weissbluth, M. D.

  Some parents like their children to remain in one developmental stage because they themselves have certain needs that were never adequately met. For example, keeping a child up at night may fulfill a parent's need for closeness. Here the child is forced to ignore her own need to sleep in order to accommodate her parent's misreading: “I know you are up because you missed me. I am here now.” Like the grandmother who is cold and asks her granddaughter to put on a sweater, the mother who is lonely imagines that her daughter is lonely, too, and so she keeps her baby up with her late at night and hinders the child's sleep. The baby gets conflicting information and may not know what to read—her own signal or her caregiver's. The child may then have difficulties integrating new information because skills to manage this situation have not been taught.

  Let's continue with Esme's mother's story. Note where she writes, “I now miss having my mother as a grandmother to my daughter…. I also miss having her be a mother to me.”

  “ONE MORE STORY” (CONTINUED)

  Bedtime is a special time—sitting in the rocking chair, holding her in her jammies, the night tape playing softly, the whole house quiet, no phone, no distractions, no interruptions, no pressures or time constraints. It's a time of intense, focused interaction with my daughter. Not that I don't have plenty of time with her during the day—I'm a writer and I work at home two or three half-days a week. But only at bedtime does she really let me cuddle with her, hold her—during the day she's too busy running around playing and never wants to sit still. At night she strokes my hair, wiggles my nose, asks me to sing “Hokey Pokey,” reads Goodnight Moon or If You Give a Moose a Muffin one more time. We have so much fun together! I love our quiet time as much as she does, and I'm very guilty of letting it go on and on, into five, six, seven songs or books, another minute, another cuddle, until we're both exhausted.

  My husband and I discussed the complex reasons for my attachment to my daughter. I was very close to my own mother, although not so much physically, which is probably why I value that cuddle time in the rocking chair. My mother died seven years ago, when she was only fifty. I was on the cusp of my marriage and I went through a very difficult mourning period. I still miss her a lot, and having a child has made that loss even sharper. I now miss having my mother as a grandmother to my daughter. I miss sharing my baby with her. I also miss having her be a mother to me. I don't want to lay the burden of having to be everything for me on my child. My own mother, who had a difficult relationship with her mother, did that to me, which is maybe why I have separation anxiety to begin with. And, again, I don't want to love my child so much that I'm unable to effectively establish consistent, clear boundaries and rules.

  Marriage Issues

  Babies establish a new equilibrium in families. The couple is no longer alone, and the role of parent must be established. The importance of social and emotional support to the developing child must be emphasized. A positive emotional climate influences a baby's development. If the parents cannot create this support, development of the child may be hindered. Without support for both parents, caregivers are more likely to engage in dysfunctional parenting with their children.

  If adult intimacy needs are not being met by a marriage or the relationship is not supportive or is stressful, parenting tasks become difficult. Either partner may turn to their child to meet those needs. Toddlers exposed to parental conflict develop a negative response to this tension and are at risk to become aggressive toward peers. Infants as young as one year can sense this distress and develop an emotional response to it. Mothers and fathers may demonstrate two different regulatory patterns. Often in conflict-filled marriages, mothers become overinvolved with their infants and fathers tend to withdraw and not be as affectively responsive to their children. Both responses may be damaging to a child's sense of security and competence in the future.

  When both parents work together, as did Esme's parents, sleep problems are more easily solved. Note where Esme's mother writes, “And of course, when Esme goes to bed earlier, I have more time to enjoy a nice dinner with my husband.”

  “ONE MORE STORY” (CONCLUSION)

  As we cleaned the kitchen, my husband and I had a real heart to heart. He was proud that I saw my own part in our bedtime battles and acknowledged that it was not much easier for him when he put her down. We made an agreement that from now on the new bedtime would be 8:00 sharp, with a goal of moving to 7:30 to an even 7:00 in two weeks. That would be the final curtain call, no ifs, ands, or buts. But how to help mom stick to the rules?

  Dr. Weissbluth suggested setting a kitchen timer for an allotted time at the beginning of the bedtime routine, say thirty minutes or one hour. My husband and I agreed to try one hour—which would include bath, brushing teeth, diaper, jammies, story, and cuddling. The timer, Dr. Weissbluth said, would act as a signal for the child (and mother!) to understand that the bedtime routine together was over.

  The first night the ding of the timer seemed to come incredibly fast. Both my husband and I were enjoying singing an alphabet song to Esme, and we all three turned to look at the timer in a kind of dumb-faced shock. It seemed such an intrusive little fellow! Esme was curious and asked what the bell was for. “Time for bed,” we said, a little reluctantly. “Lights out.” But neither my husband nor I moved a muscle to put her in bed. We did hurry along our song, however, and limit our reading to two books instead of four or five. But the time had seemed to go so fast! We were both amazed at how poorly we'd organized that hour from bath to bed.

  We resolved to do better the next night. Again that meddlesome little bell seemed to ring too soon, but this time not as much. Setting the timer had helped us make better use of the early time—in the bath, brushing teeth, and putting on jammies—so we'd have more time for stories. Again Esme was interested in the bell. “Time for bed. Lights out,” we said. Esme smiled. She actually smiled. My daughter thought this little strategy was a delightful game!

  “Okay, Mommy. Crib,” she said. Dumbfounded, I stopped rocking. We still spent a minute having the animals call her, one by one, into her bed, but one minute was a whole lot less than before.

  On subsequent nights, the timer became our friend. Without a doubt, it added a sense of structure to our bedtime routine and helped us organize our time.

  There have been a few nights when that bell still seems intrusive, when I want to read “one more story” as much as my daughter does. I realize that another part of my separation anxiety is that I felt I was an intelligent child who didn't receive as much stimulation as I might have. Fortunately, my parents made books very available—I didn't have a lot of toys, though I always had books—but I had to learn from them on my own. I have trouble limiting Esme's “reading” simply because I don't want to give up an opportunity for a potential learning experience that I perceive myself not having had when I was a child.

  So, with a little probing and the help of a plastic kitchen timer, we've turned our lives around. It's just amazing to see Esme respond to new limits with a kind of pride and resourcefulness.

  And, of course, when Esme goes to bed earlier, I have more time to enjoy a nice dinner with my husband, talk about our work or our child, rent a movie, whatever. And in the daytime, her naps are more regular, her moods are sunnier, and her appetite improved. Another trick I've learned is to build in more focused playtime during the day. Instead of jumping up to answer the phone when Esme and I are playing with Mr. Potato Head, I let it ring. I also allow for more reading time during the day, so that one of our favorite activities is not saved up just for bedtime.

  Now, when I hear those words “one more story,” I know that to respond with a “No. Tomorrow is another day” does not mean I don't love my child. Quite the contrary.

  P. S. As the weeks have gone by, there have been a few nights when I have forgotten to turn the timer on. Esme runs to get it off the bookshelf and says, “Mama! Timert!” She has a special place on the second shelf where she likes to put it while it ticks away (I t
hink it gives her a sense of control to place it within her reach). And when it rings, if we're in the middle of the story, she asks me to “please finish.” I find that to be a reasonable request, partly because I know I'm in control now, so I don't get all freaked-out about it being too late. And so we finish our story and then I remind her that the timer went off a minute ago. She studies me very seriously and says, “Okay, Mama. Time for nite-nite.”

  Summary

  Parenting is a process that reinforces itself: As confidence grows, so does a parent's feeling of competence. One of the most important concepts to remember is that there will be times when you will want to give less attention—even if this causes crying, even at night—in order for your child to develop skills of independence and self-soothing. Crying, in this context, does not damage self-esteem. Rather, the end result is heightened competence in your child and in you.

  The Pros and Cons of Other

  Approaches to Sleep Problems

  Notions, theories, and opinions on how to prevent or solve sleep problems abound. Let's look at some published ideas and see how they stand up to the facts about children's sleep habits that we've just explored together in this book.

  Proper Association with Falling Asleep

  Richard Ferber's Theory

  A child associates certain conditions with falling asleep, such as being held in a parent's arms, lying on a living room sofa, or rocking in a swing. When put to sleep in a crib or bed, those certain conditions are missing upon awakening, so the child has difficulty returning to sleep. The progressive approach is to not respond to the baby's cry at night for a brief period of time, say five minutes. After the child has cried for five minutes, the parents return and stay in the room two to three minutes but do not pick up or rock the child. This is thought to reassure the parents and the child that all is well. Parents then leave, whether the child is asleep or not, whether crying or not, and return in ten minutes for the same brief interaction, if needed. After leaving, parents would return again after fifteen minutes of crying for a brief curtain call. They would return every fifteen minutes for a brief encounter until the child fell asleep during one of their fifteen-minute absences. If there is no crying or mild whimpering, then there is no return. If the child awoke later that night with hard crying, parents would repeat the original progressive routine of five, ten, and then fifteen minutes of delay in response time. The second night would be a repeat performance, except the progression would be ten, fifteen, and twenty minutes. The third night would be fifteen, twenty, and twenty-five minutes, and so on. The child learns to associate her bed or crib with falling asleep and returning to sleep.

  My Comment

  Whether we call this method “developing proper association” or “learning self-soothing skills,” I'm sure it can work. The general problem is that it's very difficult to maintain any time schedule in the middle of the night for several nights in a consistent fashion—frustration and exhaustion often override planning and patience.

  Unrestricted Breast-feeding

  and the Family Bed

  William Sears's Theory

  Unrestricted breast-feeding and the family bed are how to get your baby or child to sleep.

  My Comment

  Beware of writers who have never had the opportunity to study sleeping and who have a strong personal opinion regarding parenting. You are a good parent if you practice “attachment parenting,” which by definition includes “natural mothering,” which is unrestricted breast-feeding and sharing sleep in a family bed. This is in contrast to “detachment parenting,” which involves “escape mothering,” which is the term used for mothers who wish to pursue a career outside the home. The use of these terms is not surprising when you realize that La Leche League International, a breast-feeding support group, published the original book. As a father whose four sons were breast-fed and as a pediatrician in practice with a full-time certified lactation consultant, I certainly support breast-feeding. But there is more to being a parent than just the method of feeding.

  Overreliance on vague psychological terms and unsupported psychological mechanisms serves the sole purpose of advancing the author's cause. For example: “An unfulfilled need is never completely erased; it is only temporarily suppressed and will flare up again in a different way.” Advocating unrestricted breast-feeding and the family bed is the main message. To be fair, the author does have one sentence in the entire book where he states, “The sleeping arrangement whereby all three of you (mother, father, and baby) sleep best is the right one for your individual family.” But he basically ignores the enormous individuality of temperament differences, experience of the parents, and age-specific sleep patterns of children.

  What does the author suggest you do if “natural methods of nighttime parenting” fail? Try another, presumably “unnatural” method? No! The author says to use the strong hypnotic prescription drug chloral hydrate to knock out your child. Yet there is not one good study that supports this practice.

  Summary

  The major problems with these other methods are that insufficient or no attention is given to the importance of prevention or treatment of sleep problems by focusing on naps and schedules. There is more to healthy sleep habits than not waking at night. Children who don't sleep well usually have developed this pattern as a result of parental mismanagement. Too much attention, irregularity, or inconsistency in bedtime “policy” and routines can interfere with the development of healthy sleep habits, and accepting this responsibility is the first step in developing a treatment plan.

  You may be uncertain as to whether you want to try a gradual, “fading” approach or an abrupt, “cold turkey” extinguishing approach. If I were exclusively a specialist doing research on sleep problems and providing consultative services, I could devote a great deal of time to coaching parents and helping them maintain their resolve to carry through with a gradual approach. As a general-practice pediatrician, though, I find that the time demands of a busy office make it more difficult for me to be as available for this as I would like to be. So when you try to decide between the gradual approach versus an abrupt approach in putting to rights your child's sleep habits, consider not only your own resolve but also the external supports that you know you can count on.

  Many parents start with a gradual approach, see partial success, but then get worn down and recognize their evolving inconsistency. Feeling a bit more confident and competent, many parents then shift directions to a more abrupt approach. But some parents cannot even start to correct their child's sleeping problems at all, because the same personal stresses that created the unhealthy sleep habits in the first place—revolving around the child's emerging independence, marital discord, and other problems with the parents—are still present. To maintain or develop healthy sleep habits for your child, have the courage to do what is best for the child. In less time than you think, you will wind up with a loving home, a happy, well-rested child, and well-rested parents.

  References

  Chapter 1. Why Healthy Sleep Is So Important

  Bernstein, D., Emde, R., and Campos, J. (1973). REM sleep in four-month infants under home and laboratory conditions. Psychosomatic Medicine, 35, 322-329.

  Coons, S., and Guilleminault, C. (1982). Development of sleep-wake patterns and non-rapid eye movement sleep stages during the first six months of life in normal infants. Pediatrics, 69, 793-798.

  Emde, R. N., and Metcalf, D. R. (1970). An electroencephalographic study of behavioral rapid eye movement states in the human newborn. Journal of Nervous and Mental Disorders, 150, 376-386.

  Fish, B. (1963). The maturation of arousal and attention in the first months of life: A study of variations in age development. Journal of the American Academy of Child Psychiatry, 2, 253-270.

  Harper, R. N., Leake, B., Miyahana, L., Mason, J., Hoppenbrouwers, T, Sterman, M. B., and Hodgman, J. (1981). Temporal sequencing in sleep and waking states during the first six months of life. Experimental Neurology, 72, 294-307.<
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  Jacklin, C. N., Snow, M. E., Cozahapt, M., and Maccoby, E. E. (1980). Sleep pattern development from 6 through 33 months. Journal of Pediatric Psychology, 5, 295-302.

  Klein, K. E., Hermann, R., Kuklinski, P., and Hans, M. W. (1977). Circadian performance rhythms: Experimental studies in air operations. In R. R. Mackie (ed.), Vigilance: Theory, Operational Performance and Physiological Correlants (NATO Conference Series III, Human Factors, Vol. 3). New York: Plenum Press.

  Salzarulo, P., and Chevalier, A. (1983). Sleep problems in children and their relationship with early disturbances of the waking-sleep rhythms. Sleep, 6, 47-51.

  Schulz, H., Salzarulo, P., Fagioli, I., and Massetani, R. (1983). REM latency: Development in the first year of life. Electroencephalography and Clinical Neurophysiology, 56, 316-322.

  Still, G. E (1931). The History of Pediatrics. London: Oxford University Press.