Confused about Weissbluth's sleep methods...

[juliasdad]

I'm reading "Healthy Sleep Habits, Healthy Child" and am finding it to be very interesting. The only trouble is, he's not very explicit when it comes to concrete recommendations.

One thing that seems confusing is his implied method of stopping night wakings for the 4-8mo group. There are plenty of stories in the book regarding using "extinction", whereby the parents place the child in their crib at bedtime and do not go back to that child, no matter what, until 6am the next morning.

On the other hand, when Weissbluth diagrams and describes a normal or ideal sleep cycle for a child of this age, it includes one or two wakings for a nighttime feeding. He acknowledges that these are ok.

So, if one is to undertake this "extinction" process, are we supposed to do a full 11-hour (7pm - 6am) stretch without feeding? If not, are we supposed to judge when it's appropriate to go back in for a feeding? Do we only do it at an awakening? I can't find anything that discusses this.

-dan

[COElizabeth]

I read the book a month or so ago and can't remember all the details, but I think he was recommending various techniques for getting the child to sleep in the first place but saying it was fine to feed a baby who has been asleep and then wakes up hungry. I myself am not entirely convinced of the "sleep begets sleep" principle. Yes, it's easier to get them to sleep if they aren't overtired, but James' longest stretches have usually been when he was completely exhausted because he didn't get to bed until late when we were gone somewhere. I do try to follow the sleep interval advice in general, though, because I would rather him be well rested all day and wake up a couple of times to eat at night than to keep him up all day and evening and have him be fussy until he just crashes.

Elizabeth
Mom to James
9-20-02

[Rachels]

The extinction thing is psychologically risky. However you feel about CIO, a baby is just not designed to be both awake and alone for 11 hours a day. There is new research out of Harvard that babies who are left to cry for long periods have a higher incidence of anxiety disorders in adulthood. That makes sense to me as a psychologist. When people feel extreme anxiety (as a baby certainly would if her usually-responsive parents were to ignore her cries for an entire night), the brain starts creating shortcuts in its neuropathways that essentially usurp the reasoning process, and you end up with an intense anxiety reaction to circumstances that don't warrant that. Is it medically safe to leave a baby all night long? Maybe. I don't know. (I do worry that crying babies get overheated, congested, and breathless, which are all risk factors for SIDS.) Is it psychologically safe? Absolutely not. If you decide to sleep train, talk to Lisa. Her ped helped her design a much gentler approach that is clearly MUCH safer from a psychological standpoint.

-Rachel
Mom to Abigail Rose
5/18/02

[Momof3Labs]

I just read parts of Weissbluth, and he specifically says a couple of times that you can expect a breastfed baby to wake once or twice during the night until 9 (I think) months of age.

I don't know what to tell you about distinguishing between hungry and not hungry (Colin only wakes to eat at night). If Julia ate two hours earlier, then she's definitely not hungry. But if it has been 5-6 hours, I would think that she is probably hungry. 3-4 hours is a grey area. I wasn't clear on your last question, but you don't want to wake her to eat (he specifically says that) - but if she wakes to eat, it is okay to feed her (for now).

That's my understanding of Weissbluth's technique... I'm curious to see what others have gotten out of his book.

[Rachels]

I don't know...breastmilk is digested in about 2 hours, so it's possible she feels hungry then. I find that this changes, too, based on growth spurts and developmental milestones. Also, nursing can help relieve teething pain, so there are considerations other than hunger.

-Rachel
Mom to Abigail Rose
5/18/02

[egoldber]

The way I interpreted this was that the extinction was to be used to get a baby to sleep in the first place. And that this process was to be used only if you had an older child who had already developed poor sleep habits. This was a way to help break that habit. I didn't think (or don't recall) him saying to use extinction as a way to help your child develop good sleep habits in the first place. I think Julia is around 6 months? In my experience, while some babies are capable of going to sleep on their own at this point, many are just not ready yet. My DD did not go to sleep on her own consistently until she was 7-8 months.

As a I remember Weissbluth (and its been awhile) he was mainly about developing healthy habits to prevent sleep issues in the older infant (10-12 months) and toddler. I recall him saying that if you have a child with generally good habits, then you can be confident that when they DO wake in the night, it is because they need you and you should go to them promptly.

As far feeding at night, when my DD is really hungry, she will NOT go to sleep (or go back to sleep) until she eats. She is 18 months and STILL occasionally wakes to eat. Not very often (maybe once a month or so), but occasionally (like last night). I guess I figure that sometimes I wake up hungry or thirsty in the night, so is it reasonable to expect a very small baby to be able to go that long? And I defintely agree with Rachel there are other needs than hunger. Sometimes a baby may cry in the night because they are gassy, teething, pooped, because they had a bad dream or are just frightened for some other reason.

In the end, Weissbluth gives a framework. It is up to us to interpret the framework.

HTH,

[hbangthompson]

We have read Weissbluth's book many, many times and we also go to his pediatric practice here in Chicago (he gives you age-specific handouts at every visit). As someone mentioned in the thread, we have found that Weissbluth's guidance is just that and you should follow what you are comfortable with and what seems to work for your baby. But here's some info we've also gotten from going to his practice that you may find helpful. The extinction method refers to the way you put them to sleep and does not mean that you don't go to your baby if he wakes up during the night. It's not until babies are about 9-10 months that they don't NEED to eat during their nighttime sleep. At about 4 months, the first night waking may occur 4-6 hours after your child's last feeding. So if you fed your baby at 6pm and put her down at 7pm, you should feed her if she wakes up between 11pm and 1am, for example. And she may again wake up around 4 or 5am for another feeding and then go back to sleep until 7 or 8am. When our son was about 4 months, he went to sleep around 9 or 10pm after I nursed him, woke up for a feeding around 4 or 5am and slept until 9 or 10am. I knew when he was going through a growth spurt because not only did he wake up for perhaps a third feeding during the night, but during the day, he nursed a whole lot more, and this usually lasted about 3-4 days before he went back to his usual schedule.

I think Weissbluth says this in his book, but we've found that it was very helpful in establishing our son's sleep during his first year by keeping very regular nap schedules and bedtime. But then again, once he turned a year, he decided he didn't want to do naps and after about 2 months of terrible naps, we are slowly getting back to normal. (But thank goodness, his nighttime sleep has stayed intact and he still sleeps 11 to 12 hours straight.)

Hope this helps a little,
Hyeyoung (mama to Nicholas 12/13/01)

[LisaS]

I didn't read Weissbluth's book but I did read Gina Ford's Contented Little Baby Book - all of her sleep reccommendations are based on Weissbluth's research and book. She gives incredibly specific suggestions for how to deal with night-wakings - for feedings and for other reasons. I found it to be a very helpful guideline.

That said, my DD slept 11-12 hours from 14weeks - I stopped BF at 3 months, so I know that BF babies do sometimes need to wake up at night for feedings. But, BF aside, as far as eliminating a night feeding (if you've determined that a waking is from habit and not hunger), I knew she was ready to drop the 11p.m. feed when she started taking less and less - initially, she'd have 5 or 6 oz, then it was just 3 or 4 (I always offered the 5 or 6) and by the end of a week, she'd drink 2oz, and just rub her eyes and try to go back to sleep while I was holding her. One night, she drank the 2 oz and threw it all up...and wasn't interested in any more. So, I put her to bed for the night without it and she's rarely needed to eat between 7pm and 7am since.

Another thing you can do is try to structure the night feedings so we'd get the longest stretch of night possible. If DD went to sleep for the night at 7 or 8pm with the capacity to go a 6-7 hour stretch, I'd wake her before I went to bed at 11p.m. for another feeding so she'd have the stretch from 11p.m. -6 a.m. rather than from 1a.m. - 7a.m - so her sleep schedule and mine would be more in sync.

I completely disagree with extinction on a baby of any age because even a baby who consistently sleeps through the night for 12 hours still might occastionally wake up for any number of reasons - nightmares, thirst, illness and to think that parents would leave them without determining the cause seems a bit extreme to me. I know Weissbluth is discussing this method for a 10+ month old, but having a 13 month old who does consistently sleep from 7-7/8, I always listen to the cry first and wait 4 minutes b/c often after 4 minutes, it just stops - sometimes it happens during a change in sleep cycles and it just stops on its own - and you'll recognize your DDs cries - if they're hunger or just cranky tired. If it doesn't stop, I go and see what the problem is - usually, its a dirty diaper or a nightmare or if she's sick or has lost her pacifier. As soon as I go in and resolve the cause, she goes back to sleep. If there is no apparent cause, that is when I try to comfort her and would leave her to cry for a little while. But it usually ends up being only 5 minutes.

Anyway,

[juliasdad]

Thanks for the input, all.

Yes, I do agree that our 6-mo-old may well require one or two night feedings, and we don't intend to ignore that need; the question was specifically for the one or two nights of "extinction". Weissbluth is somewhat contradictory in several areas, and this is one of them. And yes, he does indeed imply that this is a technique that he believes appropriate for a 6-month-old.

I'm not a fan of Ferber-style CIO; the approach just seems a bit misguided and cruel to all involved. But I can't imagine extinction, as a singular episode and done intelligently, to be damaging in any way.

Anyway, I'll give a brief summary of what we've done in the last 72 hours. Julia is 6 months. She used to sleep well, even giving us a few nights of 9-hour stretches when she was 3mo. For a while now (at least 2 months), though, she's been a horrible nighttime sleeper. Her schedule was: wake anywhere from 8 to 9, nap starting at 11 or 12, after about 3 hours of awake time; other naps whenever she seemed tired, bedtime at 9pm after a brief spell of sitting with mommy or daddy in the glider reading a book. She would go down at naptime fairly easily, and a bedtime she usually needed to be soothed down (my hand resting on her chest, a bit of singing, etc.) Wakings during the night were generally every 2 hours, sometimes even more often. We could generally get her back down easily with similar soothing (or nursing, if the time seemed appropriate). But the interrupted sleep wasn't healthy for anyone involved. Here's what I did after reading Weissbluth:

Saturday, woke Julia a bit earlier than usual (7:45) in preparation for a schedule shift. Made sure there was plenty of light shortly after awakening (reinforcement of desired circadian pattern). Nap 1.5 hours after awakening. Her next nap occurred after 2 hours of being awake. Then a brief nap at 4:30pm (woke her after 45 minutes), and in the crib for bed at 7:30pm. She did well with the naps, needed minimal soothing at bedtime. At 9:45, she cried loudly, and when I went to her it was obvious that she was giving feeding cues. Her feeding had been a bit strange and with the schedule change, we didn't want to stress her out further, so DW nursed. She woke briefly at 11:30pm and 1:30am; the first one I went and soothed her for 30 seconds, and the second one she drifted back off to sleep on her own. Next thing we knew, she awoke for a feeding at 6:30am, and went right back down after.

Sunday, again I woke her at 7:30. Same nap schedule. Same 7:30pm bedtime. This time, we decided that if she awoke before a reasonable feeding time, we'd try our best to ignore her. She woke at 8:35pm, cried hard for a half hour (as did we), then started playing, then cried a bit more, on and off until 9:57pm, when she conked out. We waited 15 minutes (we could hear her breathing in the monitor), then went in to check. She was scrunched up at the foot of her crib, poor thing, on her belly (she flips over from time to time now). At 11pm, we went to bed, but didn't want to leave her in that position all night, so we gently tried to move her and turn her over. She woke and cried to be fed, so DW nursed. She went right back down. Next thing we knew, it was 5:15am. She nursed, went right back down.

Monday, once again I woke her at 7:30. It seems that even with this earlier bedtime and better napping, she'll still sleep well beyond this if we let her! Same nap schedule, same 7:30pm bedtime. This time, she went right down to bed unassisted, went until 1:30am when she woke for a feeding, then went until 6:00 am for a 2nd feeding. I woke her again at 7:30am this morning.

It's been an amazingly short amount of time for such a huge change. An early bedtime, a shortened morning awake time, better attention to nap schedule (rather than waiting for her to be clearly tired), and that one 1.5-hour episode of CIO seem to have made a world of difference.

Just a data point for anyone who's interested!

-dan