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 60: Taking stock

Wow, it has been 60 days since I started the No-Cry Sleep Solution. While I don't consider Mari's sleep issues 100% "solved," her sleep habits have improved out of sight. Two months ago:

• She was waking up about a dozen times a night
• Her longest sleep stretch was typically about two hours
• She had to be rocked (or occasionally nursed) to sleep each and every time
• She rarely napped outside her sling; if she did, she had to co-nap snuggled up to me or Jon. At night she slept in our bed. (Please note I don't consider co-sleeping necessarily a problem for everyone at all times -- we loved it when Mari was younger. But it was becoming a problem for both us and her.)

Now:

• She typically wakes up just once a night to feed. Sometimes we hear her "talking" or fussing a bit other than for that one feeding, but she usually manages to put herself back to sleep within a few minutes.
• Her longest sleep stretch typically ranges from about five to nine hours; occasionally we have had up to 11.
• She sleeps and naps alone in her crib and doesn't seem to have a problem with it
• She no longer has to be rocked to sleep; after a relaxing bedtime/naptime routine (including brief rocking but not all the way to sleep) she goes into her crib awake and usually falls asleep fairly quickly (though that still varies, especially for naptime).

We have accomplished most of the goals I set out when we started this journey. However, there are still areas for improvement:

• I still think Mari generally needs to nap more. She's often tired and cranky in the late afternoon, but it seems like she's really and truly giving up the late-afternoon nap because she just will not take that nap anymore (though for now I will continue to try to get her down if she does seem tired, on the off chance she actually manages to fall asleep). On days when she has good morning and early-afternoon naps, she isn't cranky, or not until it's pretty much bedtime anyway. But if one of those naps is short, or worse, both are, watch out!
• Lately the morning nap has been the biggest problem. She really does best when she naps at least an hour, preferably an hour and a half, in both the morning and early afternoon. But she often wakes up from her morning nap after not much more than 30 minutes, and she won't go back down.
• Sometimes, particularly in the afternoon, I still rock her back to sleep after a premature nap waking. I am somewhat torn on this. I don't want to continue this practice, but I do it if I go in and she still seems obviously sleepy. If she doesn't fall back asleep quickly or seems to be waking up good and proper I abandon the attempt. Maybe I need to have more faith in her ability to put herself back to sleep, even from naps. But my fear is that if she wakes herself up completely she won't be able to go back to sleep even though she needs the sleep, and she'll be a mess.
• She's still highly unpredictable in terms of when she will nap and for how long. However, her morning wake-up time and night going-to-bed time have become more consistent.
• Occasionally, though, she wakes up really early and won't go back to sleep. I don't really know what to do about that.
• Our doctor says Mari doesn't really need night feedings anymore. She wants Mari completely weaned from them by the time she's nine months, which is also the age Healthy Sleep Habits, Happy Child author Marc Weissbluth says is the limit for needing night feedings. I am now trying to restrict her to one night feeding, usually successfully, and will continue to do so. But I'm not going to start trying to night wean her completely until she's eight months. 

Despite the above issues, in the past two months I feel I've learned a fair bit about baby sleep in general and quite a lot about Mari's sleep in particular. So I will spend the next week or so writing down various aspects of what I've learned and creating a new hybrid plan with elements that work for us taken from various books. I hope other parents will find my experience useful.

Day 36: Temperament and sleep

I'm still not done reading Healthy Sleep Habits, Happy Child by Dr. Marc Weissbluth, but the book's discussion of infant temperament made me wonder how much Mari's temperament affects her sleep.

The widely accepted measures of infant temperament are as follows (more details at http://en.wikipedia.org/wiki/Temperament#Nine_Temperament_Characteristics_of_Thomas_and_Chess):

Activity (General motion and energy):  Mari is pretty squirmy, always has been. Even when she's on her back she's always kicking and flailing in a jerky way. Though she's not yet creeping or crawling, I would put her activity level at fairly high.

Rhythmicity (Regularity of bodily functions): Mari is definitely not regular or predictable. Today was a fairly good day -- she napped regularly and was pretty happy and energetic. But I swear, I didn't do anything differently than I did yesterday, when she hardly napped at all. I can never predict when she'll nap or for how long, when she'll poo, how much she'll eat, etc.

Approach/Withdrawal (first reaction): Hmm, I'm not sure on this one. Mari has some pretty fierce stranger aversion, so she's definitely withdrawing when it comes to people. But she's not necessarily fearful of new places, experiences or tastes, as long as we're with her.

Intensity: Mari is very intense. When she's happy she's ecstatic. When she's unhappy she screams like a dying jet engine. She can careen between the two in less than a second.

Mood: Not sure I get this one. Mari's moods vary a lot, but don't most babies' moods vary? When she's well-rested she's generally cheerful. When she's not she's fussy. So I suppose she's somewhere in the middle of the scale.


Persistence: Mari is very persistent, for better and for worse. When she was learning to roll over or to sit up it was all she wanted to do for days. She can also be extremely persistent in crying and resisting sleep even when she's tired.

Distractibility: Mari is quite distractible, though she's not on the extreme end of the scale. She's very easily distracted by unusual or new sights, noises, and toys. Picking her up can distract her from fussing quickly, but it doesn't last. Same goes for novel soothing techniques -- they seem to work quickly at first, but she goes back to fussing quickly.


Threshold (sensitivity): Mari is very sensitive, especially to noises. She's easily startled by even not-so-loud noises such as a wooden block falling into a small box. Truly loud noises such as the sound of the vacuum make her howl. When she's sleeping she's very easily awakened even by tiny sounds such as the rustle of paper or the crinkle of plastic.

According to the book, intense babies also tend to be slowly adaptable, negative in mood and withdrawn. These traits make for a "difficult" temperament. Well, I'd say Mari is very intense but in the middle on the other supposedly related measures. So I suppose she has an "intermediate" temperament by the book's classification system. But Weissbluth also notes babies who are highly active and highly sensitive are also at risk of sleep problems, especially when routines are disrupted. This is obviously true for Mari. So despite her natural lack of regularity she really needs me to try my best to impose a routine and a schedule. Too bad it's so hard.

There are other ways of measuring temperament. According to The Baby Whisperer, Mari is "spirited" -- a baby who knows what she wants and doesn't want and doesn't hesitate to let people know, and loudly. (An abbreviated version of the quiz in the book is available here: http://quiz.ivillage.com/parenting/tests/knowyourbaby.htm)

Mari is also a "high needs" baby according to Dr. William Sears, the guru of attachment parenting. She fits all 12 of the characteristics listed here <http://www.askdrsears.com/html/5/T050400.asp> to a tee.

All this adds up to Mari not being hard-wired to sleep well. Dr. Sears has a good article about it here: http://www.askdrsears.com/html/5/T050900.asp. So I suppose sleep will always be somewhat of a struggle. Still, the changes I've made so far have made a world of difference, though I clearly still need to do more work on trying to get her to fall asleep on her own, especially for naps, since I'm still having difficulty putting her down before the very-nearly-asleep stage.