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David Eddie (Tibor Kolley)
David Eddie (Tibor Kolley)

What's the best way to get your baby to sleep? Add to ...

No matter how many people tell you how tired you're going to be when you have a baby, it's all white noise until you experience it first-hand.

At night, you walk, rock or drive your kid around the block to stanch the crying -- or perhaps simply pretend to be asleep, hoping your spouse will deal with it (exhaustion has made you a much less noble person than you used to be). During the day, you are a zombie, an empty shell. Work suffers. Relationships suffer.

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All of which explains parents' near-cultish devotion to experts such as Dr. Richard Ferber and Dr. Harvey Karp. And the rise of sleep doulas -- night nurses who will come to harried homes and swaddle, shush and swing babies to bed (among other techniques) for $150 and up.

As for which approach is best? Not surprisingly, given how tired and irritable everyone involved is, this can be quite a contentious issue. People fervently cling to their favourite methods and denounce those of others -- all in the name of having happy, calm babies.

Take Ferberization. Named for the Boston pediatrician who wrote How to Solve Your Child's Sleep Problems, this method advocates letting kids cry for increasingly longer periods of time -- without picking them up -- until they gradually fall asleep on their own. In his book, Dr. Ferber writes that even if a baby cries so much that he or she vomits, the parents should simply go in, briskly clean up and leave again.

Nicky Cohen, who has a PhD in clinical psychology and works with many parents in Toronto experiencing difficulties getting children to sleep, says research supports such "sleep-training" methods -- moms suffer less depression and parents experience greater marital satisfaction. Kids' daytime behaviour improves as well: Often, she says, sleep-deprived parents forget that "babies who aren't sleeping are sleep-deprived themselves."

But many find this approach to sleep training too harsh. It can mean agony for both babies (who, so the thinking goes, are waiting to be "rewarded" for their wailing) and parents (who want to put their natural instincts to work and "reward" them).

"Hundreds of thousands of years ago, what was a mother going to do? Put the baby down in another part of the cave?" Toronto doula and nurse Wendy Goodman says.

Indeed, Dr. Ferber himself has, if not exactly recanted his position, at least significantly softened it by saying parents are probably the best judge of what works for them (much like Dr. Benjamin Spock, who 40 years before Dr. Ferber counselled parents to walk away from their babies and let them "cry it out," but later modified his views).

Some experts, then, have come to espouse a softer approach to sleep training. For example, Jodi Mindell, the associate director of the Sleep Centre at the Children's Hospital of Philadelphia, advocates what has been described as a "kinder, gentler" Ferberization. This means putting babies down while they are awake -- but if they're having trouble, bringing them into bed for a week or two before trying again.

However hard-core they are about it, most experts seem to agree that "sleep training" should be begun only after a baby is about four months old. Before that age, babies wake up naturally every few hours for breastfeeding. They also lack the ability to "self-soothe."

As for doulas? Mrs. Goodman is an advocate of the Five S's: swaddling, carrying babies while they lie on their sides, swinging (which includes any kind of motion), shushing (meant to replicate the sound of blood rushing through the womb) and sucking (breastfeeding or pacifiers). Based loosely on Dr. Harvey Karp's The Happiest Baby on The Block, these techniques have helped to calm the progeny of ordinary parents as well as Madonna and Michelle Pfeiffer.

Then there's the other end of the spectrum from sleep training -- "co-sleeping" and "attachment parenting." Advocated by groups such as Attachment Parenting International, this approach holds that since babies don't have to cry as long to get care, and mothers don't have to wake up fully to tend to their needs, both parents and children sleep better when they sleep together. The proximity of the parent, supporters suggest, acts as a natural soother that helps to regulate babies' breathing.

But bringing baby into your bed can potentially be dangerous. The Canadian Pediatrics Society points out that adult beds were not made with infant safety in mind: The baby can fall off the bed, an adult can roll over and suffocate the baby, duvets and comforters can cover a baby's head, increasing the risk of sudden infant death syndrome.

Instead, the CPS tells parents that for the first six months of babies' lives, they should sleep in a crib, in the parents' room and on their backs. (Moms and dads who worry they may develop a flattened head can switch their heads from side to side.)

Regardless of which method parents choose, though, consistency is key. And, says Cathryn Tobin, a Toronto pediatrician and the author of The Lull-A-Baby Sleep Plan, parents should start bedtime training when kids are young. When babies are born, they keep their eyes closed to shut out the neurological overload of the external world. But some time between four and eight weeks of age, parents can become pro-active. Sit next to a crib and talk, for example. "People don't use their voices enough," Dr. Tobin says. "Talking to babies settles them."

All experts say that parents should rule out any medical reason for the baby having difficulty sleeping -- ear infections or teething, for instance -- before pursuing any form of "sleep training." If children appear to be having unusual difficulty falling asleep, they should also consult a doctor.

It's important, too, for parents to look after themselves. It's like when they tell you in airplanes to put the oxygen mask over your own face first, then attend to your child -- you are no good to your child if you are unable to function.

"I don't think sleep is a luxury," says Dr. Tobin, who advocates that new parents set aside their guilt about daytime napping in order to preserve some semblance of sanity. "The biggest problem this generation of parents has is it thinks it can get by without sleep."

In the end, the most important thing for parents to do in the first few months may be to adjust their own expectations. "People get freaked out when the baby cries and think, 'Oh, my God we're already not meeting the baby's needs,'" Mrs. Goodman says. Just because your child isn't sleeping doesn't mean you're doing something wrong.

 

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