Sleep Training Your Infant: Part 2

Infant Development and Emotional Regulation

•  The maturation of an infant's brain depends on experience (Schore, 2001, p 207)
• Caregiver-induced trauma (neglect) is more potentially psychopathogenic (harmful to psyche) than any other social or physical stressor (aside from direct physical abuse on brain.) In an immature infant with underdeveloped and restricted coping abilities, the primary caregiver is the source of the infants stress regulation, and, therefore, sense of safety. (Schore, 2001, p 7) 
• This means that the infant is no more capable of controlling their bowels than they are controlling their emotions. 
• The rest of my citations are really hard to understand if you don't know the lingo, so I'll translate:
• Babies cannot control their emotions or their mental processes. This doesn't start to happen until two years old (this is why it's called the "terrible two's"); you can see them trying to learn self-regulation  when throwing tantrums.
• When a baby cries its body is releasing all kinds of chemicals and hormones, most of which cause stress. This causes more crying, and the cycle just gets worse and worse because the baby does not have the ability to trigger happy hormones on its own. How do they finally calm down? The parent holds them close, touches them, talks to them, and feeds them. By doing this, the body releases happy hormones that counteract the stress hormones. 
• What happens when the baby does not get calmed down by a mother/father? They continue producing stress hormones which takes a serious toll on the developing brain. It also affects the rest of their body (throwing up, shaking, etc).
• Some infants' brains can get so damaged by these hormones that they stop working, or shut down. This does not happen often, but when it does it is fatal. Many SIDS victims are found to have issues with their brain stem. This is brand new research, so there are not very many study results out yet. It is important to know that although long-term crying does not cause SIDS, however,  there is correlation between stress hormones, brain damage, and SIDS.
• "Prolonged and frequent episodes of intense and unregulated interactive stress in infants and toddlers have devastating effects on 'the establishment of psychophysiological regulation and the development of stable and trusting attachment relationships in the first year of life." (Schore, 2001, p 9)
• Why are long episodes of crying potentially harmful to your infant? "In contexts of relational trauma the caregiver, in addition to dysregulating the infant, withdraws any repair functions, leaving the infant for long periods in an intensely disruptive psychobiological state that is beyond her immature coping strategies... When infants are not in homeostatic balance or are emotionally dysregulated (e.g. they are distressed), they are at the mercy of these states. Until these states are brought under control, infants must devote all their regulatory resources to reorganize them. While infants are doing that, they can do nothing else. (Glaser, 1997, p 56) (Dysregulated is British :) )

Ferber Method

• The Ferber sleep training method or "graduated extinction" was developed by Dr. Richard Ferber
• Babies are "trained" to fall asleep without a parent being present
• Parents leave infant in crib when he/she is NOT asleep
•  Parent then leaves for a short period of time (usually only a few minutes), returns, then leaves again for a longer amount of time. Parent should NOT hold or comfort child. 
• Rocking, nursing, and comforting will create 'wrong sleep associations'
• Not appropriate for infants under six months of age, some professionals advise no younger than twelve months.
• Children with severe separation anxiety or who react strongly to being left alone (throwing up, panting, etc.) should not be left alone.
• As Richard Ferber himself acknowledges, the Ferber method doesn’t teach kids HOW to fall asleep on their own (Ferber 2006). Kids are simply denied access to their parents, and left to work it out for themselves.
• In his 2006 edition of Solve Your Child's Sleep Problems, Ferber acknowledges that his method is not right for all infants and all families. Co-sleeping and other methods may be more appropriate for different infants.
• Ferber also points out that his method does not involve leaving your child alone and cry her/himself to sleep, he specifies that his method involves intervals of parental absence that work up to complete independence of child when falling asleep.
• Parents choose the Ferber method to foster independence in their child; however, studies show that children who have been sleep trained are less independent than their co-sleeping counterparts.

• "Children in solitary sleeping arrangements fell asleep alone, slept through the night alone, and weaned at an earlier age compared to co-sleepers. However, early co-sleeping children, as preschoolers, were reported by their mothers to be more self-reliant and reportedly exhibited greater social independence (able to dress oneself, work out problems with playmates) than solitary sleepers." (Keller and Goldsberg, 2004, p 383)

Why is the Ferber Method not appropriate for all babies? Let's use the information we discussed earlier and apply it to this theory:

• Infants are biologically programmed to form attachments to their caregiver(s). This attachment is based on consistent response to the infants' needs (rocking and nursing are NEEDS). When parents pay attention to their infant during the day, but then do not respond during the night, this can lead to disoriented/disorganized attachment. 
• Babies brains are not fully grown and are instable, and thus they are vulnerable to stress hormones that are created during long and intense crying episodes. The fear of abandonment also creates large amounts of stress hormones in the brain. Large amounts of these hormones are harmful to the developing brain.
• Infants are not physically or emotionally capable of controlling their emotions, they need their caregivers to help calm them down and produce calming hormones. 
• Some infants have temperaments that are more able to self-soothe themselves back to sleep, while other infants need more help from their caregiver to get back to sleep. 

What are some side effects of disoriented/disorganized attachment?

•  "The quality of early attachment is known to affect social relationships later in life. Therefore, it is conceivable that the level of opiate activity in a mother and her infant may not only affect behaviors during infancy, but may also affect the development of an individual’s style of engaging and seeking out supportive relationships later in life." (Schore, 2001, p 5)

• "Early relational trauma serves as a matrix for maladaptive [inability to adjust to particular situations] infant (and later adult) mental health." (Schore, 2001, p 5)
  
  
• "The longitudinal study by Egeland and Erickson (1987) included a proportion of children whose mothers were neglectful and/or emotionally unavailable… Follow-up findings show the emotionally neglected children to be socially withdrawn, inattentive, and cognitively underachieving in their elementary-school years." (Glaser, 2000, p 98)
  

You're probably thinking, "How am I going to teach my baby and/or child to sleep through the night? Will he/she be sleeping with me until their ten years old?"

Although parents see results in their infant's sleeping habits after using the Ferber method, there are risks. If you are still not a believer in co-sleeping (you and your baby sleeping in the same room) there are alternative methods to sleep train your baby that studies show are effective and do not carry any risks. Once again, infants and children are unique and no one method will work on all your children. You know your child better than anyone, so find the method that works best for your child and adjust it as needed. Don't let the opinion of others determine how you will raise your children.

Here is a site that has alternative methods to Ferberizing:
Parenting Science

I tried to keep this as unbiased as possible and I hope that you find this useful in deciding how you will parent your children, and it will make you more informed of the amazing and important development that your baby is going through! If you have questions or would like my reference list, please email me at jessr90@gmail.com


UPDATE Instead of writing a new post on sleep training, I would just like to clarify a few things:

1. The crying it out method that I am addressing is the idea that you can start leaving your young infant (2-6 months) alone in a room and let them cry for over 30 minutes, WITHOUT checking back. Young infants do not have the cognitive capability to understand you are still in the house. It is better to at least let them know that you haven't abandoned them by going into the room and verbally reassuring them.
2. I don't want parents to feel judged based on these two posts; I simply want to share some research I have found based on neurological development.Parenting practices are deeply personal. My opinion is that each parent should be able to do what they feel is best for their children without feeling rejected and/or judged by their friends and family.
3. Each baby is different. I can't emphasize this enough. My parents tried CIO with me and I vomited and threw myself out of the crib. This is dangerous (duh). My brother, however, thrived sleeping on his own. When he was two he wanted his own room where he could be undisturbed by anyone else. he just naturally self-soothed without any sleep training. Same parents, same parenting practices, completely different children (and results).
4. There are so many books that outline similar, but different methods. Read and adjust as needed. There are quite a few books that offer more gentle options of sleep training, and I would encourage you to explore all the options before committing yourself to one :) 

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Sleep Training Your Infant: Part 1

This research project has been one heck of a beast to tackle.

In my Advanced Writing Class (Writing in the Social Sciences) my final project is a research project on the topic of my choice; The *Ferber Method, or 'Crying it Out' was my choice.

Many, many parents have to make the choice of whether or not to use this method. Before this research paper I did not have a favorable opinion of it, and the professors in my classes didn't say much about it other than they don't believe it is healthy for an infant.

I decided to get down and dirty and find out whether or not it works. After hours of reading hundreds of pages of intense research papers (I literally read two to three hundred pages) I created my thesis:

Contrary to popular belief, the ‘self-soothing’ approach to sleep training is ineffective at fostering independence in young children and may produce negative side-effects such as developmental delays, insecure attachment with the infant's caregiver, and **externalizing behaviors later in life.

I will keep this as short and as sweet as I can. If you would like to read more in-depth on a certain section, email me and I will send you the sources I used. The articles and research I used are only available through the university, I only used sources that are academic or written by professionals, therefore they are usually not available through Google (sadly). I will start out by laying down some cold hard facts and then use those facts to support my argument that sleep training is not beneficial for all infants.

FYI: Infants are younger than 2 years.

Sleep

• Infant and adult sleep patterns are completely different. They eat and defecate more often than adults do, and therefore they wake up more often. 
• Infants need active sleep (REM) for their brains to develop, active sleeping means that there is more waking up in the night. i.e. waking up every couple hours is NORMAL. In fact, it is unhealthy if your infant does not wake often in the night. 
• In order to fall asleep, babies need to be rocked and/or nursed by their caregiver (Sears, 2011). 
• Infants will eventually learn how to soothe themselves BACK to sleep if they wake up in the night but this will take a while (usually around eight months to two years, depending on your baby). However, by one year your baby will again start waking more often in the night, usually because of teething, development of separation anxiety, etc. Do not worry, this is normal (Porter, 2007). 
• Summary: do not expect your baby to sleep like an adult: their brain is different, their body is different, their logic is different, etc. It is normal for them to wake up often to eat or seek comfort. 

Infant Temperament

• Some babies are capable of self-soothing while others are not. These babies are the ones that can sleep for long periods of time and their parents brag about it, making other parents feel that their child is abnormal. If your child wakes up every three hours needing to be fed or soothed back to sleep, your baby is just fine. Just remember, "baby sleep habits are more a reflection of their temperament rather than your style of nighttime parenting." (Sears, 2011) 
• Overall, boys cry more than girls do. When a mother is required to respond more to a crying infant a stronger attachment is built. Professionals believe this could be why mothers and sons build a strong attachment as early as infancy. 

Attachment
Here's a little lesson for those of you who are not familiar with child psychology. Attachment theory states that human beings form attachments to each other. Pretty simple, right? Mary Ainsworth expounded on this theory and came up with three different types of attachment with infants and children. These characteristics are secure, ambivalent, and avoidant.
Secure Attachment is when a child feels secure with their parent because the parent exhibits caring and consistent parenting. Benefits of this kind of attachment are: feelings of self-worth, social competence, and fewer behavioral problems (Leerkes, Parade, and Gudmundson, 2011, p 1)
Ambivalent Attachment (also known as disorganized or disoriented) is a result of poor maternal availability. These children cannot depend on their mother to be there when the child is in need. They are confused and do not trust their mother for consistent caregiving or comfort. Studies have shown that these children seem to fight for their mother's attention; they may also exhibit random and sporadic behavior to keep their mother's attention on them.
Children with an avoidant attachment tend to avoid parents or caregivers. When offered a choice, these children will show no preference between a caregiver and a complete stranger (how sad!). Research has suggested that this attachment style might be a result of abusive or neglectful caregivers.

This video has examples of all three attachment types. I find it extremely fascinating! Especially when I can tell which children in primary have secure, ambivalent, and avoidant attachments to their parents.



Why is attachment so important? "Without bonding, babies fail to thrive, and even risk death." (Porter, 2007)

Positive, nurturing parental response impacts the brain in two very important ways:
Decreases the impact of subsequent stress on the brain
Enhances brain growth and the development of brain systems that support attachment, emotional regulation and problem solving. (Porter, 2007)
On the flip side, babies who experience neglect or abuse are at greater risk for mental illness, behavioral problems, cognitive impairment, and brain damage. (Porter, 2007)

Wow, that is A LOT of writing and I'm sure you are all tired of reading, so I'm going to continue this discussion in a couple of days. The next post will be about infant development and emotional regulation, Ferber method, and healthy alternatives.

*Ferber method: sleep training method that became popular in the 1980's and 90's. It consists of intervals of training your infant to soothe himself to sleep.

**Externalizing behavior: when a person experiences stress or disturbing experiences they either externalize their feelings in the form of hitting, pushing, or bullying, or internalizing their feelings in the form of anxiety, depression, or low self-esteem.


UPDATE Instead of writing a new post on sleep training, I would just like to clarify a few things:

1. The crying it out method that I am addressing is the idea that you can start leaving your young infant (2-6 months) alone in a room and let them cry for over 30 minutes, WITHOUT checking back. Young infants do not have the cognitive capability to understand you are still in the house. It is better to at least let them know that you haven't abandoned them by going into the room and verbally reassuring them.
2. I don't want parents to feel judged based on these two posts; I simply want to share some research I have found based on neurological development.Parenting practices are deeply personal. My opinion is that each parent should be able to do what they feel is best for their children without feeling rejected and/or judged by their friends and family.
3. Each baby is different. I can't emphasize this enough. My parents tried CIO with me and I vomited and threw myself out of the crib. This is dangerous (duh). My brother, however, thrived sleeping on his own. When he was two he wanted his own room where he could be undisturbed by anyone else. he just naturally self-soothed without any sleep training. Same parents, same parenting practices, completely different children (and results).
4. There are so many books that outline similar, but different methods. Read and adjust as needed. There are quite a few books that offer more gentle options of sleep training, and I would encourage you to explore all the options before committing yourself to one :) 

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