Published in the Family Post Winter 2006

Contributed by Lindsay Dunckel First 5 Nevada County

A friend of mine, nine months pregnant, was approached by a frazzled-looking woman, who looked at her belly and said flatly, “Get your sleep now.” Everyone knows that newborns don't sleep through the night and that new parents go through a period in which they struggle with sleep deprivation. But what happens with sleep after that newborn period is up for grabs: the experts and the parents are divided into many camps. Family bed or crib? Put them down drowsy or nurture them all the way to sleep? Letting them cry it out—is it teaching self-soothing or is it being an unresponsive parent? What follows is a look at the many sides of the debate on how to get children to fall asleep and stay asleep, as well as some basic truths about children and sleep.

Recently, Dr. Richard Ferber and Dr. William Sears, two of the most well-respected authorities on children's sleep habits from opposite sides of the issue have modified their ideas: they both moved closer to a middle ground. This is happy news for most parents, many of whom felt terribly torn about what approach to take when facing sleep problems.

Dr. Richard Ferber, a specialist in sleep disorders, is renowned as an advocate of sleep training, a method of allowing children to cry for short intervals that grow longer over a period of days with the aim of teaching the child to fall asleep on her own. Ferber's book, “Solve Your Child's Sleep Problems,” was published in 1985 and was the first book on the market for parents struggling with sleep issues. Ferber's background in sleep disorders probably contributed to his emphasis on creating a firm foundation of early sleep habits that would lead to a child who went to sleep in the evening and woke up in the morning, end of story. But in March a new edition of his book will be released, and with it a slight change in emphasis. Ferber now acknowledges that not all children can be taught to sleep through the night, and that sleep training is not appropriate for all children. There are many parents who probably could have told him that.

On the other hand, Dr. William Sears, a pediatrician in private practice and the father of seven children, has long been the spokesperson for attachment parenting which includes a recommendation that parents and their young children co-sleep in the same bed. While his earlier writings seem to encourage mothers to always be available to their babies, he has lately added that mothers need to care for their own needs, too. There are many mothers who are probably relieved to hear that they can practice attachment parenting without giving up caring for their own needs.

In between the arguments of these experts are books by other experts who have developed viewpoints or systems of their own (all listed at the end of the article). Elizabeth Pantley's book is effective for some children who need time to wind down slowly; Marc Weissbluth's book has lots of good information about sleep needs and predominant patterns, as well as advocating for teaching your child to put herself to sleep; and Harvey Karp's book addresses those first months after birth when you are guaranteed to have to get up at night.

Remember that you are the expert on your child: no one knows more about him than you do. Note when he sleeps, how he gets to sleep, how long it takes for him to fall asleep, and how long he sleeps. Over a few days, most babies four months and older will exhibit a basic pattern—and you can build off of this as you create a schedule, though a flexible one, that fits your child. Some children are what we call arrhythmic, which means that they don't show predictable patterns in their body rhythms (like eating, sleeping, and pooping): these children need parents who respond to their cues and they can be slowly coaxed toward a little more predictability.

Babies are very different, and parents and experts need to respect this. My own daughter took two hours to nurture to sleep in the evening at two months—which led me to think there must be a better way. I tried a quick ritual of bathing her, reading “Goodnight Moon” to her, and singing to her while I nursed her, then I put her down, awake, in her bassinet next to my bed: she sucked her fingers and was asleep in five minutes—much to my astonishment! She was telling me that being alone was much less stimulating to her, and exactly what she needed in order to go to sleep. My son was just the opposite, and would have had no idea how to get to sleep without some help. They are both good sleepers today, though they started out very differently.

Despite the many differences in opinion, many, if not all, of the sleep experts would agree on these points:

children need a lot of sleep—up to 16 hours a day for a newborn, at least 12 hours a day for a toddler or preschooler, and at least 10 hours a day for a school child

cuing off their natural rhythms, babies and young children are generally ready to go to bed between 7 and 8 o'clock at night

babies should be put to sleep on their backs to lower their risk of Sudden Infant Death Syndrome

a drop in body temperature signals the body that it is time to sleep—so a warm bath is a great thing to include in a bedtime ritual, because children's body temperature will rise slightly in the bath and then drop after they get out

babies are not ready to learn to sleep through the night until they are at least 6 months old (though some babies do start to sleep through the night at 4 months)

establishing a bedtime ritual that is simple and predictable cues a child (even a young infant) that it will soon be time to sleep—and this can make it easier for her to fall asleep

bedtime, and naptime, should come before a child is over-tired because it is much harder for a tired child to actually surrender to sleep (a sleep schedule helps with this)

napping is an important part of babies' and toddlers' sleep

babies form sleep associations, so that when they awaken during the night, they like to fall back to sleep in the same manner in which they usually fall asleep: this means if they usually fall asleep while nursing, they will want to nurse in the middle of the night; if they usually fall asleep next to a parent, they will want that parent there in the middle of the night; if they usually fall asleep in the car, they will want a car ride in the middle of the night; and so on

putting babies down while drowsy, but not yet asleep, can help them learn to fall asleep on their own but not all babies will go for this

infants who sleep in the same room with their parents have a lower risk of Sudden Infant Death Syndrome (SIDS)

babies and children are individuals, with individual sleep needs and preferences—and these should be taken into consideration when parents make a plan for how, where, and when their children will sleep

Your nighttime parenting style should depend on your child's needs as well as your own. Even Dr. Sears' first two children slept in their own beds—but then his third, high-need child was born and “co-sleeping” seemed to be the answer for that baby. You need to make an informed choice: do you want to nurture your child to sleep and be available during the night when she wakes up so that you can nurture her back to sleep? Do you want to teach your child to fall asleep on his own so that he won't be as likely to wake you during the night? Do you want to share your bed with your child? How does your partner feel about it? Would a “co-sleeper” that attaches to your bed be a better arrangement for everyone's needs? Or would a crib? Do you sleep better with your child right there so you don't worry if he's okay, or do you sleep better with your child in a separate bed so you don't worry about rolling over on him? Do you need your space at night so that you can be the best daytime parent you can be? Or do you “recharge” just fine when you co-sleep with your child? These are a few of the questions that go into the decision you are making. Figuring out what your child needs is the other part of this equation. Find a system that is a good fit for you, your partner, and your child(ren) and read those books/web pages/articles that go along your system: parenting advice should feel right to you, not make you doubt yourself and feel guilty.

But sleep for babies will probably remain a controversial topic for years to come. Even the latest official health recommendation of the American Academy of Pediatrics (AAP) for preventing Sudden Infant Death Syndrome (SIDS) brought with it controversy, as advocates from other positions responded critically to some of the recommendations. The official AAP recommendation is that babies sleep in their parents' room, but in a separate bed. They should be put to sleep on their backs and should be offered a pacifier. All of these things, according to studies cited by the AAP, reduce an infant's risk of SIDS. However, family bed and co-sleeping advocates argue against the finding that having a baby in the parents' bed is a risk: the risk cited by the AAP is a very slight risk of suffocation from having a parent roll over on them—the risk of SIDS is the same, or even lower according to some. Breastfeeding advocates argue against offering a pacifier to an infant because of the risk of “nipple confusion” in which babies adapt their sucking pattern to the pacifier and no longer suck sufficiently when breast feeding.

So knowing what the experts agree, and disagree, on, you can seek more information from the following books and make an informed choice about how, where, and when your child will sleep. But whatever you choose, make sure you baby or young child gets the sleep she needs—it is crucial for healthy child development.

Lindsay Dunckel, Ph.D. and Grass Valley mother of two, is the Program Coordinator for Parent Support and Education for First 5 Nevada County.