Day 91: Book reviews continued

Continued from this post...

3. Healthy Sleep Habits, Happy Child, by Marc Weissbluth, M.D.

There was a good deal I liked and found useful about this book. However, in my opinion the most fundamental thing about this book -- the recommended "extinction" crying method is overly harsh and unnecessary for most babies.

But let's start with what I did like, most of all the maxim that sleep begets sleep. Here, I have found that Weissbluth is right and Ferber is wrong. Almost always, an earlier bedtime, not a later one, is better for Mari's sleep. She sleeps more and better than when I've tried to keep her up longer or later. Of course, there is a limit, though Weissbluth sometimes seems to imply otherwise. Mari cannot and will not sleep for more than 14 hours in a day at the most, and she averages about 13 hours, though if I recall correctly, Weissbluth recommends 14-15.

Another thing I liked is the emphasis Weissbluth places on baby temperament and his acknowledgment, missing in many other books, that some babies just aren't going to be as good of sleepers as others, and that what works for most babies may not work for a certain percentage -- especially those who were very fussy as younger babies, which Mari certainly was. It was reassuring to me to know that just because some techniques work with other babies and don't seem to work with Mari, it's not necessarily because I'm doing something wrong -- it's because Mari is a different baby.

For the above reasons, I am prepared to believe that there are some babies for whom the extinction crying method Weissbluth advocates may be the only thing that works. However, I also believe that it's highly stressful for babies. It's plain that babies don't like to cry. Their faces turn red, their temperature goes up, they give every indication of being in extreme distress. Babies cry to communicate. Whether it's because they're in pain or because they just want their mothers, for the baby, something is wrong. I believe those needs should be responded to promptly (though not necessarily immediately), unless there's a damn good reason to delay response. In my opinion, a parent should consistently and patiently try every other method possible before resorting to the extinction method.

It's true that babies need to learn to fall asleep and stay asleep on their own. It may be true that for some babies, a certain amount of crying is necessary before they learn. However, just plain ignoring the baby's cries, no matter how long it takes, ignores the possibility the baby may be in pain or discomfort, which if fixed could get him or her to sleep.

I did find Weissbluth makes good points about why it's so important for children to be well-rested. However, I thought he overstated the case. I found myself worrying as I read it that I had already caused Mari irreparable damage by letting her stay up too long in the past. I even wondered if that was the cause of her not doing things such as crawling as fast as some babies (though she is still very much within the normal range). With a little more distance, I found the book was making me worrying too much. More guilt is something parents don't need.

Another issue I have with the book is that it is overly long, repetitive and written in a convoluted manner. However, that may be the editor in me talking.

4. The Baby Sleep Book, by William, Robert, James and Martha Sears

I like Dr. Sears a lot. I find what he says about attachment parenting (I have the book by that name and love it) makes a lot of sense. Though I no longer follow it to the letter (I allow some limited crying alone, I no longer "wear" Mari much at home, we no longer co-sleep), I believe in the philosophy of maintaining a strong bond between parent and baby. I believe the amount of time I spent in earlier months wearing or carrying Mari, co-sleeping, responding immediately to her cries, bonding with her immediately upon birth, and breastfeeding (still going strong there) laid the foundation for us knowing her well and her trusting us. I also found The Birth Book, also by Dr. Sears, to be the best, most balanced resource I read about birth. So certainly I have nothing against Dr. Sears.

However, I did not find The Baby Sleep Book to be terribly helpful. When I tried to follow his suggestion of waiting until Mari had been asleep for 20 minutes before putting her down, I found she was more lightly asleep than when she had been asleep only about 5 minutes. It also delayed my going to sleep myself -- but then, generally, I found the book didn't give enough weight to parents' needs.

Really, I found the whole concept of actively putting her to sleep each and every time problematic. I do believe Ferber's assertion that babies develop sleep associations. If Mari is rocked or nursed to sleep, then put down once deeply asleep, she does indeed tend to wake up when her sleep cycle becomes shallow, probably because she's alarmed that the conditions she associated with going to sleep (rocking, nursing) are no longer present. It was only when I started working to break those sleep associations that Mari started sleeping better.

Basically, the message I took away from The Baby Sleep Book was that if I didn't like Mari waking up constantly, I should just be very, very patient and she would eventually, by the time she was a toddler or preschooler, learn to sleep better and more independently. In the meaning, Jon or I should always carry her until she fell asleep and then sleep with her, even if it meant a more disrupted sleep for everybody. I found this unacceptable.

To be fair, there are bits about other ways of doing things, and a good chapter about night weaning, but I generally found the book to be simplistic, not that informed about sleep and not very respectful of the need to teach a baby to fall asleep and stay asleep on her own. Though just as gentle, I found the No-Cry Sleep Solution to be better about all that.

Next up: The No-Cry Nap Solution, The Baby Whisperer

Day 84: Book reviews and update

Sorry it's been so long since I posted. Mari's been having a more or less good run of sleeping lately, though she's still waking up about twice a night to feed. I've been thinking again about weaning her off the second night feed, since she doesn't really seem to need it -- she's fine when she sleeps well and gets up only for one feed. Also, if she has a second night feed she won't feed again when she wakes up in the morning, not until nearly time for her first nap. I would rather she feed when she gets up too. Also, she still quite often wakes up from a nap after only one sleep cycle, despite being obviously tired. I don't know what more I can do about that than what we're already doing. However, her naptimes have stabilized a little. I'm doing everything I can to ensure she sleeps at least 13 hours total a day, but she really does best when she gets 14 hours. More about that in the book reviews below.

I'm a big researcher, arguably an over-researcher, so I have read all kinds of books on baby sleep. All have had good points as well as not-so-good. Here's the lowdown on what I think of all the books I've read, in order from the ones I've liked most to least.

1.  The No-Cry Sleep Solution, by Elizabeth Pantley

The book that started me and Mari on this journey, and in my opinion, still the best. I like that it offers an organized way to create a sleep plan and to track progress. It also offers plenty of suggestions to create healthy sleep habits. You don't have to follow them all; just the ones that work for you. In fact, it offers a lot of flexibility, including no guilt about co-sleeping or crib sleeping. Most important, unlike most other baby sleep books, it doesn't involve making the baby cry it out, which despite my having dipped a toe or two into those waters, is in my opinion still an admirable and loving goal.

However,  as I have mentioned before, I have come to believe it's not always possible or necessarily desirable to achieve no crying at all. At least for Mari, I have not been able to prevent her from crying entirely, and until I stopped taking the book quite so seriously, I felt a lot of guilt about that. I believe there are different types of crying that should be treated different ways. There are indeed times when she seems to need to fuss a bit before falling asleep, and if I keep trying to comfort her, it actually takes longer or even prevents her falling asleep. Having said that, if I get the timing just right, she fusses little or not at all. She cries when she's overtired, so it's best to prevent her from getting overtired.


2. Solve Your Child's Sleep Problems, by Richard Ferber. M.D.


I've never systematically Ferberized, but I found this book very informative. It has the best explanations about child sleep that I've ever read and the chapter about sleep associations, I found to be better than in the NCSS. I read the whole thing out of interest, even though Mari doesn't have problems with things like narcolepsy or sleep apnea, and now I feel I know what to look out for if she should ever develop more serious sleep problems.

I had formed a bad opinion of Ferberizing before I read this book. However, once I read the book, rather than just what other people had to say about it, I found the description of the method to be more logical and less harsh than the extinction method of crying it out. I think the method could work for parents who don't have the patience to implement the gentler but more time-consuming methods of the NCSS first, but after a couple of months on the NCSS, I found that Mari's sleep habits were already mostly good enough that it was unnecessary to let her cry for increasing intervals. Most of the time now she goes down pretty easily and if she doesn't, it's either because she's not tired enough yet to go to sleep or because she's overtired, in which case it seems too harsh to me to leave her to cry for very long. 

I have, however, taken some things from Ferber. When necessary, I use the idea of increasing intervals between responses and keeping my time in the room short. If Mari cries after being put down, I will first respond and comfort her after about two minutes of full-on crying (I let her fuss longer if she doesn't sound very upset). At all times I limit my time in the room to two minutes unless of course I'm nursing her. If she still keeps crying, I next respond after five minutes. After that, 10 minutes and so on until half an hour has passed since I first put her down. If she's still upset at that point, I let her get up and play for a little while before I try again, because I figure she either wasn't tired or is overtired but has gotten a second wind. I have only had to let her get up for naps; never for bedtime sleep. I have not, however, increased time between responses from day to day.

There is one major area in which I tend to disagree with Ferber. Ferber constantly contends that sleep problems can be solved by at least temporarily making bedtimes later so the child is more tired when he or she is put to bed. Maybe, just maybe, this is something that could work for older children, but it certainly doesn't work for Mari and probably not most babies. The more overtired Mari gets the LESS she sleeps and the HARDER it is to get her down to sleep. 

Also, Ferber says a six-month-old should be getting about 12.5 hours total sleep a day. I find this just barely in the adequate range. Mari averages about 13, and she's happier when she gets 14 hours of sleep or more in a day if I can manage to get her to sleep that long. In the three weeks since I have been using babybix.com to keep track of her sleep, Mari has slept a maximum of 14.5 hours and wow, she was in a great mood that day. Nor do I believe it's just that Mari needs more sleep than most. On the online message board for moms that I visit, it would seem the majority of 7-8 month-olds need 13 hours or more of sleep a day.

Wow, that took longer than I expected. I will post this now and continue the book reviews another day. Next up: Healthy Sleep Habits, Happy Child; The Baby Whisperer; The Baby Sleep Book.