It is interesting that this book is written by a family of medical professionals: Dr “Bill” who received his pediatric training at Harvard Medical School's Children's Hospital in Boston and is presently an Associate Clinical Professor of Pediatrics at the University of California, Irvine; his wife Martha,
a mother of eight children, a registered nurse, a former childbirth educator, a La Leche League leader, and a lactation consultant; and two of their sons who are also pediatricians. I like the way this book has referenced research along with insights from the authors' professional and personal lives.
All four doctor authors have experience with their own children and children in their pediatric practice. They emphasize that this book is a book of options and not “shoulds”, and that new parents need to find solutions that they are both comfortable with and that allow adequate sleep. Parents should not become martyrs, and be so sleepy during the day that they can not have fun and interact with their baby. In chapter 1 they quickly get into strategies for improving sleep for the whole family, but before I mention them I want to tell Dr. Bill's and Martha's own personal experience.
Dr. Bill and Martha's first three children were easy sleepers and did not come into their parents bed except to snuggle in the mornings. Their fourth child, Hayden, was fine for the first six months in her cradle right next to Martha, but when she graduated to the crib she woke more and more often until one night, out of sheer exhaustion from being wakened every hour, Martha brought Hadyn to bed and they both slept for hours. For years Dr. Bill and Martha had believed the books that said no co-sleeping, but now Martha said, “I don't care what the books say, I'm tired and I need some sleep!” (ch 5, Our Co-Sleeping Experiences, ¶ 1 & 2).
Being a researcher, Dr. Bill did an experiment on another newborn daughter, Lauren. Lauren was wired to a computer to monitor her heart, breathing, and oxygen levels while she was sleeping with her mother and while she was sleeping alone. Baby Lauren's “breathing and heart rate were more regular during shared sleep, and she experienced fewer 'dips'—low points in respiration and blood oxygen from slower breathing episodes. On the night Lauren slept with Martha, there were no dips in her blood oxygen, where on the night Lauren slept alone, there were 132 dips” (ch 5, Our Co-Sleeping Experiments, ¶ 2). Other research shows that both human and animal babies who co-sleep with their mothers had more balanced levels of cortisol, higher levels of growth hormones which are essential for brain and heart growth (ch 5, Science says: Co-sleeping is healthful, ¶ 2, 5).
They also refer to some recent studies that suggest the risk of SIDS increased with co-sleeping, but they were not comfortable with the way the data was collected. They explained that researchers looked at death certificates in the United States for the years 1990 through 1997 and found 515 cases in which a child under two had died in an adult bed. Of these deaths, 394 were caused by entrapment in the bed structure, and the other 121 deaths were reported to be due to overlying of the child by the parent, another adult, or a sibling. The study failed to use matched controls nor explain other studies that show co-sleeping decreased the risk for Sudden Infant Death Syndrome (SIDS), except for smokers, and that countries with the highest levels of co-sleeping usually have the lowest levels of SIDS. “The fact is that many more infants die when sleeping alone in a crib than when sleeping in their parents' bed” (ch 5, co-sleeping is safer, ¶ 6, 7).
As a reader, I wasn't able to sort out the contradictions without further research, but I do believe they show that co-sleeping is a viable option. It does require safety precautions, such as preventing the child from sleeping on too soft a surface, soft pillows, piles of blankets, or near an edge where they could be wedged between the bed and a wall, etc. Also, parents who smoke, drink alcohol, take sleeping pills, or anything that could impair consciousness, should not co-sleep.
Co-sleeping was not the only method they recommended. They said if the child was doing well in a crib, and was thriving, that was fine. They also recommended room sharing, or a bed next to the parents bed. Five steps to improving infant's sleep are: 1. find out where you and your baby sleep best; 2. Learn baby's tired times; 3. Create a safe and comfortable environment conducive to sleep; 4. Create a variety of bedtime rituals; 5. Help baby sleep for longer stretches. They warned “If your baby is a newborn (less than two months old), do not jump into this sleep plan or any other sleep plan. Newborn babies are not ready to learn more mature sleep patterns (ch. 1, preview, ¶ 4).
Being a devoted father, Dr. Bill
gave fathering Tips. He asked, “What is the biggest contributor to mother burnout? Father walk-out!” (ch 8, ¶7) and gave these suggestions among many others: 1. Understand the switch to mother mode: respect the wife's desires to nurture the baby and herself, which will increase her romantic feelings; 2. Keep the nest tidy: Take Inventory Daily Yourself. Don't wait to be asked; 3. Be sensitive: Notice that the wife is trying to be the perfect mother and homemaker. Intervene before she begins to feel overwhelmed and depressed. Have a willing attitude. Resentment won't help the Dad feel more rested and it won't earn points with the wife. This goes along with research that parents need to be proactive in their parenting. They need to be invested and feel empowered. That is why fathers need to be involved. (Bredehoft & Walcheski,2009). Chapter 8 of The Baby Sleep Book gives Dads a total of 23 nighttime fathering tips to help with this proactive process!
Though the authors are open to ways to make it so parents will be able to get their sleep and maintain intimacy, they had great concerns about the Let Them Cry It Out (CIO) philosophy. As a physician, Dr. Bill could often sense when parents began to use the method. When they came in for check-ups, they seemed to be less sensitive to their baby, sometimes leaving the baby in the car seat as they talked. One couple's baby, who had been previously thriving, began what Dr. Bill called "shutdown syndrome". The baby only gained a few ounces in a couple of weeks, had lost the sparkle in his eyes, and had poor muscle tone. When he pointed this out to the parents, they changed back to their former ways and the baby began to gain healthy weight and muscle tone in the next few weeks, although the parents admitted he wasn't as "good" when it came to sleeping (ch, 4, Baby training, ¶ 3-5).
The authors admitted Crying It Out (CIO) may work for some easy babies without harming the child. It is important for the parent to remain sensitive to signals from the baby. Watch for signs of distress and detachment during the day. Also, if crying goes on too long, the baby may be going through a growth spurt and need more nutrition during the night, which could lead to learning disabilities later on. Studies show that infants who have been left to Cry It Out are ten times more likely to have Attention Deficit Hyperactivity Disorder (ADHD) (Wolke, 2002 as cited in Sears, (2005) chapter 10, Science says..., ¶ 4) . Extended crying may signal that this baby is overwhelmed with fear and needs nurturing. Babies do not have object permanence, and when parents leave the room, babies believe they are all alone. They may stop crying, but not because they have soothed themselves, but because they have given up sending the signal, which may affect their intelligence. Dr M. R. Rao and colleagues at the National Institutes of Health showed that infants with prolonged unattended-to crying in the first three months of life had an average IQ of 9 points lower than average at five years of age (Rao as quoted in Sears, 2005).
Nature has made a mother's biology to respond to a crying infant. There is an increased blood flow to the breasts and blood samples show a sharp increase in oxytocin. This is because these attachment behaviors increase the survival rate of infants by provoking a response from the parents, especially the mother. The authors say the baby is not trying to manipulate, they are trying to communicate (ch 10, What crying “it” out really means). A mother does not need to feel guilt, or think she is weak, or worry about her baby's adjustment if she wants to respond to her baby's cries. It is biological and healthy, claim the authors.
The topic of getting enough sleep with a baby is very current and controversial, getting over 900 comments on Amazon for this book and other books on the subject. Good sleep is essential to good emotional and physical health, so anything that helps new parents and their babies sleep well is valuable. I believe this authors presented a reasonable and persuasive argument for their point of view, and I recommend this book to all parents to try if it will solve their family sleep issues.
More questions can be answered on the authors' website at "http://www.askdrsears.com/topics/attachment-parenting/4-ways-ap-can-reduce-risk-sids">
Bredehoft, D. J., Walcheski, M. J. (2009). Family life education: Integrating
theory and practice. St. Paul, MN: Concordia University.
Rao, M. R. et al. (2004). Long-term cognitive development in children with prolonged crying.
National Institutes of Health. Archives of Disease in Childhood 89:989-992 as quoted in Sears
The baby sleep book: The complete guide to a good night's rest for the whole family.
Sears, W., Sears, R., Sears, J., Sears, M. (2005). The baby sleep book: The
complete guide to a good night's rest for the whole family (Sears parenting
library). New York: NY: Little, Brown and Company, Hachette Book Group.
Available in paperback and eBook Edition.
Wolke, D., et al. (2002) Persistant infant crying and hyperactivity problems in middle childhood.
Pediatrics 109:1054-1060 as cited in Sears The baby sleep book: The complete guide to a
good night's rest for the whole family chapter 10, heading Science says: Crying it out may
harmful to your child's health, ¶ 4).