“Because the mothers in our study described infants with many awakenings per week as creating problems for themselves and other family members, parents might be encouraged to establish more nuanced and carefully targeted routines to help babies with self-soothing and to seek occasional respite,” said Weinraub.
The above quote, taken from a news story in the Temple University website, suggests that Dr. Weinraub, author of a recent and widely reported study on infant and toddler sleep and night waking patterns, sees only one possible solution for parents who are stressed by their babies’ nightwaking.
Yes, we agree…that NUANCED and carefully targeted routines are ESSENTIAL for infants’ development and family wellbeing. After all, nuanced simply means taking care of each child based on who that child is and what that child needs.
BUT, can care of infants be NUANCED and carefully targeted, if it IGNORES BABY’s needs…if it focuses only on self-soothing and respite for parents? No, nuanced care can only be provided if it does look at the needs of each child and focuses on what is important for babies. So,
What is important for babies?
- Nuanced and carefully targeted routines for infants, especially those with have difficult temperamental characteristics
- Care for the specific needs of the caregivers, such as when mothers are depressed
- Learning healthy sleep patterns, that ensure that everybody in the family gets sufficient rest by supporting emotional and physiological regulation in the first year
Letting crying babes lie ISN’T nuanced care. It is the exact opposite. Letting crying babes lie presumes that what is wrong is the crying. And it presumes that the crying stems from either wrong types of care or infants’bad habits. Contrary to the conclusions they draw, Weinraub and colleagues (2012) clearly find that the majority of babies who continued to wake at night were not “bad sleepers.” Instead, they were babies who needed attention and guidance, in the form of comfort, physical contact and, in some cases, their mother’s milk, to help them regulate their responses.
Letting these crying babies, who have specific needs (such as difficult temperaments), lie would create harder to manage sleep routines and leave infants with an overactive stress response system that would make settling of any sort—day or night—even more difficult.
Every baby has INDIVIDUAL Developmental, neurologically-based Needs…needs that are not BAD, but needs that help them grow and flourish.
Why do sleep researchers imply that it is all right to ignore these needs?
Weinraub’s team explained throughout the report of their research that babies who were waking were those babies who had a reason for waking. Some infants were reported to have a difficult temperament. What does this mean? Temperamental characteristics associated with a difficult temperament include being very sensitive to stimulation, environmentcontext, and to change. This is why research has often reported a connection between these temperamental characteristics and infants’ sleep.
So, what will help these babies? Certainly not leaving them to cry and become more distressed and unsettled. Although parents may be able to “train” these infants to sleep through the night, what these infants need is help in guiding them to regulate their responses. And parents need to understand what type of NUANCED and CAREFULLY TARGETED routines will help their infants—not just help their infants’ crying. Parents need to know what will help to regulate their emotional and physical responses. With this type of care, infants will grow to be children who have learned to deal with some of the temperamental characteristics that are part of who they are. This is type of NUANCED CARE is called goodness of fit.
Depression as a risk factor. As noted in her research, some of the mothers whose babies were waking had experienced depression prenatally and were still experiencing depressive symptoms. This presence of depression has resulted in two concerns…all related to cortisol responses to stress, not to parenting choices! First, the infant has experienced higher levels of cortisol from the mother’s depression duringpregnancy, thus changing their developing stress responses system. Second, mothers’ responses during early care can be impacted by the continued presence of depression.
Given these two factors, what is needed is guidance in helping to establish physiological and neurological systems that will support infants’ ability to settle. What is not needed is the continued overstimulation of the infants’ stress responses system that would from leaving infants to cry.
So, what advice should NOT be given to mothers with depression? Telling them that infants will and easily can sleep better—this contributes to a misconception about sleep and sets up the mother for failure—both in getting the infant to sleep and caring for her families’ needs.
What might families do when faced with the challenges of mothers’ depression? Thome and her colleagues (2005) have found that NUANCED UNDERSTANDING helps. Understanding that some infants do not sleep well because they have difficult temperamental characteristics was successful in achieving both reductions in mothers’ depression AND better infant sleep. Again, this is NUANCED CARE.
The bottom line is that NUANCED CARE addresses the needs of infants and families. A focus on only whether babies wake and cry in the night is an absurdly unhelpful approach. WHAT IS NEEDED is to look at what babies need, provide that, guide them gently to healthy outcomes, and be comfortable with the ability as parents to provide that guidance. WHAT IS NEEDED is NUANCED CARE focused on EACH INFANTS’ NEEDS.
Almost none would recommend that parents routinely leave a baby to cry if the baby had a cold and had trouble breathing. Rather they would advise parents to be responsive and caring in ways that are nuanced to the baby’s needs. Parents would suction their noses, provide for their needs, hold them or rock them because adults have seen firsthand how such actions help babies to settle. Care would be NUANCED to the baby’s needs because babies are too young to care for themselves.
The babies still waking in Weinraub and her team’s study are infants who needed guidance and nurturance to sleep. NUANCED CARE is the OPPOSITE OF Letting Babes Lie and Cry. Indeed, the essence of nuanced care is being attentive in order to see what this baby needs and responsive so we can help the baby accordingly. This approach, which human beings are wired to do, and which babies are wired to thrive under, is beneficial not only for the baby, but also the parent and the family as a whole
Thome, M. & Skulladottir, A. (2005). Evaluating a family-centred intervention of infant sleep problems. Journal of Advanced Nursing, 50, 5-11.
Weinraub, M., Bender, R.H.l, Friedman, S., Susman, E.J., Knoke, B., Bradley, R. , et al. (2012). Patterns of developmental change in infants’ nighttime sleep awakenings from 6 to 36 months of age. Child Development 48, 1511-1528.
Other posts in this series:
6. The illusions of self-soothing
7. Making breastfeeding and sleeping easier
8. Gentle strategies for encouraging toddlers to need less parental intervention at night
9. Controlled crying techniques: Difficulties and dangers
10. What are parents’ moral responsibilities about infant sleep?
Wendy Middlemiss, University of North Texas
John Hoffman, uncommonjohn.wordpress.com
Sarah Ockwell-Smith, babycalming.com
Helen Stevens, Safe Sleep Space
NOTE on BASIC ASSUMPTIONS: When I write about parenting, I assume the importance of the evolved developmental niche (EDN) for raising human infants (which initially arose over 30 million years ago with the emergence of the social mammals and has been slightly altered among human groups based on anthropological research).
The EDN is the baseline I use for determining what fosters optimal human health, wellbeing and compassionate morality. The niche includes at least the following: breastfeeding on demand for several years, nearly constant touch, responsiveness to needs so the young child does not get distressed, playful companionship, multiple adult caregivers, positive social support, and natural childbirth.
All these characteristics are linked to health in mammalian and human studies. Thus, shifts away from the EDN baseline are risky. My comments and posts stem from these basic assumptions.