- The Washington Times - Sunday, September 24, 2000

There is a definite bedtime routine at the Pippins' house in Reston. There is bath time for 4-year-old Trevor and nursing for 9-month-old Jillian. One parent stays in the children's bedroom until Trevor is asleep, then the other puts Jillian down.

Then Tony and Laura Pippins back out of the room, fingers crossed that dreamland will last until morning.

Sometimes they get their wish. Even when they don't, a bad night today is better than most of the nights when Trevor was an infant. Trevor would fall asleep nursing and awaken every 90 minutes. Laura would try letting him "cry it out," but it made Trevor and Laura both cry. She read the magazines and tried the different methods rocking him, holding him, delaying going to him, putting him in the crib awake rather than asleep.

Trevor would sleep better for a few weeks, then be back to getting up three to six times a night.

"He just had his own opinions," Mrs. Pippins says. "It was very frustrating. He would scream hysterically. He started sleeping well at about age 3. We just kind of got used to being sleep-deprived."

Getting a baby to go to sleep and stay asleep can be among a new parent's biggest frustrations. That is because most babies younger than about 4 months are not ready to go long periods of time without eating, nor are they able to get themselves back to sleep when they reach the lightest part of their sleep cycle.

Even when they do reach these milestones, separation anxiety, illness and teething can start the process all over again, says Dr. George J. Cohen, a pediatrician at Children's National Medical Center in the District and the editor of "The American Academy of Pediatrics Guide to Your Child's Sleep."

"Babies probably wake up because of a combination of empty stomachs and cycling in and out of deep sleep," Dr. Cohen says. "It is also hard to know which advice is going to work for you. There really isn't any right way or wrong way to get your baby to sleep through the night. Different families come with different experiences and temperaments. Probably what works best, though, is time."

Indeed, a wide range of advice exists on how to get a baby to sleep through the night. There is also a range of opinions on what "sleeping through the night" means. The medical definition is about five to six hours, pretty skimpy in comparison to the nine hours that new parents may crave.

The sleep-deprived Pippins tried many methods and gleaned a little advice from each. In the end, Trevor slept when he was ready to sleep.

But they also learned that different tips work for different children. Jillian turned out to have other sleep issues she would only fall asleep lying on one of her parents, refused to sleep alone in her bassinet and sometimes would wake up every 45 minutes.

In the end, crying it out for a few minutes worked for Jillian at about five months.

"Unless I knew she needed to be fed, I let her cry for a few minutes," Mrs. Pippins says. "Nothing worked with Trevor. With Jillian, I was stricter."

Becoming 'Ferberized'

The "crying it out" method has been popularized in recent years by Dr. Richard Ferber, a Boston pediatric sleep specialist and author of the book "Solve Your Child's Sleep Problems."

One of the main points of Dr. Ferber's book is that babies should develop healthy sleep associations. Babies should be placed in the crib while drowsy, not asleep. They should learn to fall asleep by themselves and not depend on rocking, nursing or drinking a bottle to get them there.

Dr. Ferber's advice with the biggest impact, however, is letting babies cry for gradually longer intervals until they learn they don't need their parents to get them to fall asleep, either at the beginning of the night, or during the times they awaken.

Dr. Ferber recommends trying this for babies more than 5 months old. Prior to that, most babies, particularly those who are breast-fed, cannot go all night without eating.

When babies learn to fall asleep without relying on their parents, their waking episodes will get shorter and finally disappear, Dr. Ferber says.

But that doesn't mean sleep problems won't come back. Dr. Ferber points out that a bout with teething or illness means parents may have to start the process all over again.

"Knowing how sleep works, you can understand what the problem is and know how to get out of it," he says.

Parents should let waking babies cry for 15 minutes or so the first night, before going to comfort but not feed, pick up or play he says. if the baby continues to cry, go in every 15 minutes until the baby finally gets to sleep. The next night, she might cry for 10 minutes, the following night, not at all. It might take a few days longer for some children, but the eventual result will be the same, Dr. Ferber writes.

"Any time habits have to be changed, a child is going to be unhappy about it," says Dr. Ferber. "And when he is unhappy, he is going to cry. Simply putting a child in a room and letting him cry should not be anybody's goal."

Co-sleeping, best for everyone?

Dr. William Sears, a California pediatrician, a father of eight and author of several books on child rearing, takes a dramatically different view than Dr. Ferber.

He says babies who cry when going to sleep and when waking up during the night are trying to tell their parents they need more time together.

"Various methods of letting a baby cry it out have been around for 100 years," he said from his California office. "You can train a pet that way, but not a baby. A baby's cry is a baby's language, and they are trying to tell you something. Some babies have a need for nighttime touch. If you were a baby, would you rather sleep alone, behind the bars of a crib, or next to your favorite person? The ability to wake up easily is a normal phenomenon. The key is to work out an arrangement that gets the parents the most sleep [while meeting the baby's needs]."

Dr. Sears is an advocate of co-sleeping, which is baby sleeping within an arm's reach either in the same bed or inches away in a cradle for easy nursing and touching.

"Sleeping with baby is contemporary for today's busy lifestyle," Dr. Sears says. "This way you are able to make up for missed touching time during the day. It helps keep the mother's milk supply up. Most parents nowadays want convenient parenting. I tell them that this high-maintenance stage does not go on forever. And for the child, the memories of love and availability will last a lifetime."

However, a recent study at Washington University in St. Louis indicated that adults who share a bed with an infant may be putting the child at a greater risk of suffocation.

Researchers studied the deaths of 119 infants younger than 2 in and around St. Louis between 1994 and 1997 and found that half of the deaths occurred when the baby was sleeping with one or more bed mates. Of the 119 deaths, 88 were attributed to sudden infant death syndrome and 16 to suffocation. The cause of 15 was undetermined.

Even if a baby is to sleep away from his parents, he should be put to sleep in a soothing manner, Dr. Sears says. This includes being nursed to sleep by his mom or rocked to sleep by his dad. This is Dr. Sears' "gentle-to-sleep" approach, a large part of his method of attachment parenting (which includes nursing on demand and co-sleeping).

Dr. Sears blasts stricter sleep training methods as unhealthy for infants.

"Many babies, particularly under 6 months, cannot go all night without eating," he says. "The problem with sleep training is these babies don't thrive. I see parents who say 'baby sleeps through the night,' but I see a baby who is not gaining weight from lack of a night feeding.

"Getting a baby gently to sleep is a long-term investment," Dr. Sears says. "It is one of the best investments you can make. You want them to learn that sleep is a healthy state to enter and a fabulous state to remain in. That is what they learn with an attached parent."

Babywise: Is it parentwise?

An attached parent is an exhausted parent, maintains Gary Ezzo, author of the book "On Becoming Babywise." Mr. Ezzo is the founder of Growing Families International, a controversial parenting organization that advocates strict schedules and discipline.

Mr. Ezzo, who could not be interviewed for the story, writes that getting a child on a schedule of parent-directed feeding (PDF) is a way to promote parent-and-child bonding while still letting parents attend to their own needs and the needs of their other children.

PDF is a 24-hour-day management plan that breaks up an infants' day into strict blocks of feeding, wake time and sleep. By sticking to that schedule, routine will lead to consistency, Mr. Ezzo writes.

By training baby when to expect to be hungry, a mother can organize a baby's hunger cycles enough so that baby should sleep seven to eight hours a night at age 8 weeks and nine to 11 hours by 3 months.

The American Academy of Pediatrics maintains that the best schedule is the one babies design themselves.

"Scheduled feedings designed by parents may put babies at risk for poor weight gain and dehydration," states the academy's most recent position statement (1998) on the issue.

Mr. Ezzo advises against the main points of attachment parenting. He says nursing and rocking a baby to sleep, as well as co-sleeping, are all sleep props that create an abnormal dependency to the point where a child fears falling asleep without them.

"Feed your baby, rock him and love him," Mr. Ezzo writes. "But put him down before he falls asleep."

That is the advice that Liz Muhalda, a Cincinnati mother of 8-week-old Marley, tried upon the advice of her pediatrician.

"I feed her, play with her and put her in the crib, awake," Mrs. Muhalda says. "My plan was to go in and soothe her every 10 minutes until she fell asleep. As time passed, 20 minutes of fussing turned into 10. Now she may cry for a few minutes or just go right to sleep. Last night, she slept 11 hours.

"I have learned to listen to her. She has very distinct cries when she is tired or hungry or in pain. It took a very long time to learn this with my son (now age 2) because I would automatically nurse him as soon as he would cry. Now with Marley's cries, I know what is going on with her and can better meet her needs.

"Babies have a few basic needs," she says. "Eating is one, but so is sleep. I think many parents underestimate the need for sleep. I am a much better parent when I am well-rested."

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