152: Everything you need to know about sleep training

Jen Lumanlan  00:02

Hi, I’m Jen and I host the Your Parenting Mojo podcast. We all want our children to lead fulfilling lives, but it can be so

 

Jenny  00:09

Do you get tired of hearing the same old interest in podcast episodes? I don’t really but Jen thinks you might. I’m Jenny, a listener from Los Angeles, testing out a new way for listeners to record the introductions to podcast episodes. There’s no other resource out there quite like Your Parenting Mojo, which doesn’t just tell you about the latest scientific research on parenting and child development but puts it in context for you as well. So you can decide whether and how to use this new information. I listen because parenting can be scary and it’s reassuring to know what the experts think. If you’d like to get new episodes in your inbox, along with a free infographic on 13 reasons your child isn’t listening to you and what to do about each one. Sign up at YourParentingMojo.com/subscribe. You can also join the free Facebook group to continue the conversation. Over time you might get sick of hearing me read this intro so come and record one yourself. You can read from a script Jen provided or have some real fun with it and write your own. Just go to YourParentingMojo.com/recordtheintro. I can’t wait to hear yours.

 

Jen Lumanlan  01:26

Hello, and welcome to the Your Parenting Mojo Podcast. Today we are going to be talking about a topic that we have addressed a number of times recently. We’re coming back for another go at it from a different angle. We’re looking at sleep and specifically this time we’re looking at sleep training. Before we do that, I wanted to let you know that I am reopening the course that I ran with Hannah and Kelty from Upbringing in a few weeks and it’s called right from the start. And it’s really about how to get parenting right for you from the start, rather than that, there is one right way to parent. And so we cover all the essential topics that are really relevant to parenting in baby’s first year, from sleeping to feeding to supporting physical, mental and emotional development. But the parents who have taken the course tell us that the part that they really needed that they didn’t know they needed was the part that really speaks about “What is my experience as a parent? What are my needs as a parent? And how do I get those met along with meeting my baby’s needs as well?” So, the course is designed for both first-time parents as well as those who have a child already and who know that parenting cannot be the same with this child as it has been with previous children because we don’t have enough hands to go around. There isn’t enough of us to give this child the same experiences our previous children have had. So enrollment for right from the start is open between April 3rd and 13th  and we all start together as a group on Monday, April 18. So, gift certificates are also available, so if a new baby is not in your present or in your future, then you may find that it makes a great gift for somebody if you’re going to a shower or potentially an even an early Mother’s Day gift for somebody who’s important in your life. So if you would like to help somebody in your life to get the right start for them with their baby, then I invite you to go to YourParentingMojo.com/rightfromthestart to learn more. Today I’m here with Macall Gordon, who is the senior lecturer in the Department of Psychology at Antioch University Seattle. And she has been interested in the topic of baby sleep for over 20 years now. And it’s a topic that took her back to graduate school in 2001. She’s a certified gentle sleep coach at her company, Little Live Wires, as well. And Macall may actually, in addition to obviously being on the same page sartorially with me (we’re both here in our navy blue shorts) she may be the best-prepared guest I’ve ever had on the Your Parenting Mojo podcast. She actually reached out to me and said, “Could I be on the show?” And I said, “Well, I’ve done a couple of episodes on sleep already. What new angle do you think we could take on this?” and she responded with a long list of topics that really get into the weeds on the research. So if you are the parent of a child who isn’t sleeping well and particularly if that child is under a year of age, then do listen up, because today we’re going to spend quite a bit of time talking about sleep training, and we’ll learn what we know from the research as well as where that research base really lets us down, and what all of that means for struggling parents, particularly parents who have what researchers call a “Difficult Temperament,” but I imagined Macall might call a Little Livewire. So welcome, Macall. It’s great to have you here.

 

Macall  04:16

Thank you. I’m so happy to be here.

 

Jen Lumanlan  04:18

All right. And so you have been at this for a while now. This is a long time to be interested in baby’s sleep. What was it that really drew you to this topic?

 

Macall  04:28

That’s such a good question. I started on this journey back with my first child that I had right at the very start of the internet so it was so early that all the websites that were on the web could fit in a book. It was actually a telephone directory of the internet, so we relied very heavily on books and then all these parenting magazines that you’d see in the pediatricians’ offices and the magazines I was noticing that this was the era of critical periods of brain development, right? It’s a big deal about the first three years, so important for brain development. And so, they were talking about the importance of responsiveness for brain development and attachment, and everything. And then, literally on the next page, they were saying, but for sleep, you gotta let your baby cry it out. And what I noticed was that the age to start was getting younger and younger. When I first started looking at was six months, and then it was five months, and then it was four months, and I thought, “Boy, this just doesn’t totally make sense to me.” There must be research to show that this is safe and a good idea. And back then I didn’t really have a lot of resources to dig into the research but as the Internet became more and more available, I started poking around. And once I figured out, first of all, what researchers called “crying it out,” which was a whole project by itself, once I kind of unlocked the research base, honestly, the more I looked, the less I found. And I kept thinking, “Okay, I’m just not finding it.” It’s out there. I just haven’t found it yet. And even when I went to my very first conference to present my lit review, I was standing there quaking in my boots because I thought there’s going to be some massive researcher who’s going to come along and just look at me and shake their head and pity, and say, “Oh, honey, didn’t you know about the whatever study?” That I had missed some huge piece, but really, what I found is that there wasn’t a lot there, and in the ensuing 10 or 15 years, still not much more on this particular question, so many levels we’re still in the same boat as we were even 20 years ago.

 

Jen Lumanlan  06:44

Yeah, and on that issue of the age at which to start sleep training. When I looked at one of your conference posters, and it has the bars showing the age at which the resource or the book or the study recommends sleep training, and the vast majority of them, they’re doing a study on children who are aged between six months on the very young end, but usually around 12 months, and like 50 months, right? parents in the real world. Yes, there are a small fraction whose children are not sleeping through the night by then and they need help, but who are most of the parents who are searching for information on sleep training?

 

Macall  07:19

Right. They are parents of young babies. Yes, that’s perhaps one of the most startling findings to me was that the research that we often use to support the need and effectiveness of sleep training in young infants was not even done on infants, but we know very little about how any infants in those studies experienced the intervention for being, you know, so big on precision, sometimes research really misses the boat on development so I think you probably saw, there’s one study that had the sample was 4 to 52 months. If you do that math, 52 months is a four-and-a-half-year-old. You can’t possibly tell me that a four-and-a-half-year-old experienced that intervention the same way a four-month-old baby did. But the results of that study didn’t even parcel things out by age at all. They just reported it for the sample. That’s what I knew when we started poking at it and saying, “Okay, what do we really know, in a nuanced, developmentally aware way about sleep training?” It really is a bit of the emperor’s new clothes, right? I’ve consistently gone, why is no one else seeing this? No one else is seeing what I’m seeing here.

 

Jen Lumanlan  08:32

And so I think that’s super important to understand for this topic and for other topics as well. I mean, this is not uncommon in the literature, right? To study a sample that is convenient to you. Maybe those were the babies that the researcher had easy access to, for whatever reason, and they didn’t know how to go about analyzing the data, or it wasn’t convenient for them to analyze the data in multiple cohorts, maybe there was only one four-month-old and all the rest of us are much older, and they would have had to throw that one child out and then report a much older dataset, and they didn’t want to do that. These concerns exist throughout the literature and it’s a pervasive problem. What other kinds of disconnects did you find as you’re digging into this research?

 

Macall  09:08

Oh, goodness, well, what we’re really talking about is the difference between how researchers characterize effectiveness and then what happens to those findings when they’re reported in the real world and the problem is that the findings from research have been expanded to such a level that when you really start looking for nuanced, developmentally appropriate information, it’s just not there, so, for example, that study the four to 52 months, some of these don’t even say how many infants were in the sample, and then they just say “extinction,” which is really what we’re talking about here. Extinction is the main focus of, I would say, 99% of the research on sleep interventions. Extinction is basically the idea that whatever you don’t pay attention to will go away. The old behavior modification behaviorist idea that what you pay attention to persists and what you ignore goes away, so essentially, crying it out, there are at least a couple of forms of crying it out extinction. There’s pure extinction, which has been researched, which is you just close the door and you don’t go back until morning, some people call that cold turkey and there are books who recommend doing that. The second one is the graduated extinction, which we think of as Ferber, so you leave for progressively longer periods of time. There are some variations of that, were ones called like time checks, where you go in at regular intervals. Then there’s this funny one called “camping out,” which is a little bit blurry because it can mean what they call “extinction with parental presence,” meaning you do pure extinction but you stay in the room, so the parent stays there and pretends they’re asleep, while the baby or child is freaking out. It can also mean what we refer to as parental fading, which means that you start giving a lot of support at first and then you fade that out. Those two things are lumped together under the same title, which I don’t personally fully understand so that one’s a little bit unclear, but for sure, pure and graduated extinction are the big ones, and because they’re the big ones, we have to think about the business of research, right? because it’s an industry. It’s business. What happens with research is that once there’s a finding and people start building on or replicating those findings, it becomes a thing, right? That you just keep, you know, not really regurgitating, but definitely recycling, adding, reciting, and suddenly it becomes a mountain and then A it becomes evidence-based and B no one wants to question it, right? It’s really becomes like this juggernaut that no one can sail because there’s this mountain of evidence but there’s also a mountain of evidence because people keep asking that same question, right? There’s a reason there’s a mountain of evidence. It’s not because it’s the best, it’s just because most people are researching it because they want to build on an existing body of literature, so that’s definitely where we’re at right now. I continue to be surprised at the number of studies that just ask and answer, “Does extinction work? Does it work?” We need to start asking other questions like, “Who does it work for?” Who does it not work for? At what age is it maybe not recommended? How much crying is too much? At what ages? ” So more of a dose-response, rather than just this global, it works for everyone at all times, in all situations, across all amounts of crime. I really think we need to really start deconstructing it, really taking it apart and looking at each piece more carefully, which is kind of the focus of my work, I would say.

 

Jen Lumanlan  13:01

I’m 100% agree. And just on that sort of mountains of evidence point, I mean, I see that over and over and over again, where whatever study I’m looking at, it was just released, cites a study from a couple of years before, and what they’re citing is not necessarily the findings of that study, but just a comment that the person in that study who was doing that study made, which was then citing a previous study, which was about a comment that person in that study may not their actual results. And so you build on this series of comments that people have made that aren’t actually even related to their results, and then you get finally back to the beginning of the evidence chain and you’ll find that what was described in the original research is nothing like what you ended up, it’s like that game of whispers, right, where you’re whispering one to the next, and it gets changed throughout the way that it’s cited, and it’s built on as if at each stage, it still represents the truth, right?

 

Macall  13:52

There’s some new work now called I just dipped my toe into it, but it’s about what’s called citation networks. It’s very much this. It’s about how people citing and reciting certain pieces of evidence builds a kind of belief system that then gets sort of entrenched, right? And then you have review articles that summarize the things that people have already said again and again, and then meta-analyses that re-review, and then you have levels of evidence, right? We have this chambliss criteria of evidence-based practices, and you start really looking at it, and then I, of course, compare it to what the books are saying, because then this information gets funneled into more popular consumable information, then I do a comparison of like, well, the book said this, what is the research say? It is like whispers, right? It is like, I think we call it “rumors” or something, yeah, where things get altered in the translation, so, that’s very much true. I always have to do a disclaimer that this work is not about slamming extinction as an intervention. It’s not at all. It definitely works for some families and lots of babies and lots of children. It totally works without a lot of stress and drama. However, it does not work for everyone and I don’t think parents get that message really. As far as parents are concerned, this is literally the only option and that is very much not true, so it’s more a call for the idea that we need to know more about the ins and outs of using extinction and what the alternatives are because they’re out there. They just don’t get depressed. And also, it’s gotten so polarized to pro and anti-crying it out and I really think that’s leaving out a lot of struggling people in the middle, so this is also a call. And also, the people on either side of that debate, whatever they are lobbying for worked for them, then I say, there’s all these people in the middle for whom neither option worked, right? And they are really struggling and so I think that by giving parents options, we can defuse some of the sleep war piece and we can give struggling parents a little bit better information, I think.

 

Jen Lumanlan  16:11

I totally agree. Okay, so another thing that I want to be really clear about is that when we’re talking about doing a study on a method of supporting children’s sleep, the way the researchers are doing that study is very different from the way a parent at home, who is struggling and right in the thick of this and has a sleepless baby in one hand and their sleep book in the other hand, and these are two very different experiences, right? Can you talk a little bit more about what it’s like to be a parent in a sleep training study?

 

Macall  16:40

Oh, boy, that’s such a big, great question. In research, we call that transportability, right. Does what we find in the lab translate into real-world experience? In studies, they rarely just hand the parent a pamphlet or a book and say, “Let us know how that goes.” Almost all the time, someone meets with the family and then does a whole intake history. Often, they craft a plan with that family and then there is a follow-up for questions even if that follow-up is just a research assistant asking questions, we would consider that interest and a form of support. So the context of a research study almost mirrors a coaching context, so what we do as sleep coaches, and sometimes I honestly think that the active ingredient is sleep coaching, is not necessarily what we’re telling parents to do. It’s the support we’re giving them and the validation. In research, they zero that stuff out because they say, oh, no, no, no, the focus of the study is the intervention. It really doesn’t matter where or how we give parents that information. That doesn’t count. I mean, it’s some of these studies it was done in an inpatient population, so people have checked into a clinic for sleep problems and in one study, at least nurses did the sleep training, so the parent wasn’t even doing it. I know, right? I mean, it’s another little story about the infancy conference and I was just terrified because I thought I was going to be completely hauled in front of the tribunal for being a rookie. And this wonderful woman—her name is Matilda Paposek, she’s a famous developmentalist and she’s from Germany, this lovely, lovely woman and her poster was a couple of posters down from me. And we were talking and she was just like, you know, “I just don’t think extinction is as bad as you think. You know, we use it in our clinic.” And I said, “Yes.” But in your clinic, you’re meeting with parents, you’re giving them support, you’re evaluating them and assessing them. I said, “In the United States, parents are at home with a book.” And she went, “Oh, no, no, no, no, no. Like, we would never make people do that.” So, the way that we say that we characterize the use of extinction for families, it’s a whole different ballgame than the way that it’s been studied. And again, the intervention is sort of pulled out of the system that it resides in and so does the research. The research, you know, if they’re studying the intervention, they don’t really care about any other factors or influences because they’re just testing whether the intervention works. So, any other kinds of family variables or infant variables are not usually looked at.

 

Jen Lumanlan  19:32

Yes. They are irrelevant.

 

Macall  19:43

They are irrelevant because we say so.

 

Jen Lumanlan  19:38

Exactly. Yeah, that reminds me of a study when I looked at this research on sleep, it was describing the process where they were training. The researchers were training the parents on how to do the cry it out and the parents where they did not want to do it after they’d done it for a few nights and it was emotionally exhausting. And the parents are starting to drop out, and they’re getting calls by someone on the research team on a regular basis to offer “support.” And I’m wondering to what extent the parents stuck with it just because they were afraid to report to this person who was going to call them up again tonight that they were quitting. I mean, how is that transportable?

 

Macall  20:14

Yeah, some of the older studies, there’s one that the researchers were surprised at the level of problems that parents had and that there were people who dropped out of the study just on the possibility they’d get assigned to the extinction. The way that researchers interpret this again, they don’t go, “HA!” This isn’t the right intervention, they say, “Parents just need cognitive restructuring. Parents just need to be taught a different way of thinking about their child’s crying.” And often, parental instincts and parental feelings about their child’s crying are highly sort of stigmatized, and almost critiqued by researchers as being unfounded and unwarranted, and then they cite whatever research there is that we can totally talk about, about the lack of effect of crying it out on children and babies. So they’re kind of saying, “Oh, silly parents.” They’re just overreacting, right? Rather than taking it really seriously. There are a couple of researchers who are really big on this particular theme. Sarah Blunden out of Australia, Pam Douglas, Wendy Middlemiss, they really have written several papers on like, shouldn’t we be taking parents’ feelings more seriously? Why are we forcing them to do something that clearly a lot of parents don’t want to do? And I think it’s an excellent question.

 

Jen Lumanlan  21:38

Yeah, and it’s interesting. It sounds to me from the names that you mentioned that you are identifying female, identifying researchers, and so many of these researchers are male identifying, and what I’m picturing is, you know, the White middle-class man in a lab coat saying to possibly the White middle class but certainly the mother, is going to be the one who’s currently the primary parent involved in the sleep study, you know, your instinct, your intuition, everything you know about your baby is irrelevant, because it is not grounded in scientific research. And if you would just see things from my rational perspective, then you would know that this way of doing things is the better way of doing things, right?

 

Macall  22:15

Well, actually, it’s interesting and I think, to a great extent, that’s true. Some of the biggest extinction researchers, however, are women. I know It’s really interesting. Karen France is probably the seminal person and there’s another researcher named Judith Owens, and then there’s, you know, Jodie Mindell, to a certain extent, probably she’s a little more towards the middle but yeah, that’s a really interesting topic. Because really, parents get told constantly that there are no negative effects of using extinction and they really say it quite forcefully but that’s another area that when you look at the research, it’s like the researchers have been looking for something they don’t want to find, right? You know, “Oh, where is it? I have no idea. It’s not over here.” Research, to me, is quite poor in terms of a solid investigation of effects that you might actually be able to detect. Now do I think because people have asked me all the time, “Do you think crying it out will derail attachment?” And I’m like, “Attachment is a big construct. It’s a big, strong construct and I don’t think that just doing sleep training can totally derail attachment.” That said, I just think there could be other effects of certain amounts of crying for certain infants that we have not looked at that I think we should because you can’t just say it’s never harmful. Just like you can’t say it’s always harmful, neither of those are true, so let’s start asking, “Are there situations where it might not be warranted to use this intervention?” Or let’s not let a five-month-old cry for longer than X amount of time? Because everybody knows horror stories of kiddos that cry for hours and hours for days on end, and I just don’t know about that.

 

Jen Lumanlan  24:07

I totally hear you on the not looking for what you don’t want to find and it reminded me of a study where they were looking at cortisol levels in saliva. The following morning, after a crying-out night, when cortisol has a half-life of about 15 minutes, are we surprised that we didn’t find any elevated levels of cortisol in the child’s saliva and not particularly. When you say that the effects are not necessarily harmful for all children completely on board with that. How would we go about identifying the characteristics, the temperament traits of children for whom it might be harmful? What kinds of things should we be looking at?

 

Macall  24:39

Yeah, this is probably why it’s not researched because it would be difficult. What would we be looking at? Because I think you know, if that same conference had a conversation with Allan Schore, who’s the famous, you know, Guy on Affective Neuroscience, and I asked him this question about using extended crying for younger babies, and he said, these windows of brain development that happen where if something happens at a particular moment, we just don’t know what those effects could be. Now, are those even effects you could measure? Probably not. Probably not. So yeah, that’s a bit of a pickle in terms of, well, what do we think the effects might be? I’m going to leave that up to smarter people than me to figure that out but I can tell you that asking about like you said, cortisol the next morning, or attachment three years after sleep training and not having done a baseline, right, there’s one famous study that everybody cites that sleep training doesn’t affect attachment. They did sleep training at like, let’s say, nine months and then they assessed attachment at three years. They didn’t assess attachment at nine months so we don’t know if any of those kids changed status. All they said was that the kids who were sleep trained didn’t have higher rates of insecure attachment, but we also don’t know where they started from, or see this child behavior checklist. They only measure it two years later, so we don’t have any comparison, or they assess some huge, big construct that sleep training wouldn’t necessarily have an impact on, so I just think it’s because the research industry is so invested in there not being effects. We just haven’t pulled it apart and said, “Are there effects for babies under six months? Are there effects for six to nine months that have nine to 12 months?” You know, the older a child gets, the more distress they can handle capably, and the younger they are, the less they can handle, and I don’t feel like that inquiry has really been done. There are a couple of outlets currently that are recommending pure extinction, cold turkey, for eight-week-old babies. I don’t even know what to say about that, right? Pure extinction, there’s no research on babies under like nine months so I don’t know the rationale behind it. I don’t know if anybody’s researching that.

 

Jen Lumanlan  26:58

Right. What is this based on, like? Where’s this recommendation coming from? I mean, isn’t it a parenting magazine or

 

Macall  27:03

One is a pediatric practice in New York and the other one is a popular kind, like an online program. Even Weiss Blue talks about some extinction as early as six weeks.

 

Jen Lumanlan  27:17

Yeah, and for those of you who are not familiar, he’s a pretty famous author of is it healthy sleep habits, happy child, or something like that.

 

Macall  27:25

Yeah, I’m always kind of mixed up. I always say it the wrong way. Something about healthy and happy. Yeah, a very popular book. Yeah, the study on real-true extinction. I mean, I think the idea is that the younger you do it, the faster it will be, but again, self-soothing has to develop. A baby doesn’t learn self-soothing by being in a really drastic situation that’s coping or survival. Self-soothing happens gradually, with manageable amounts of distress over time. It has to be manageable for them to be able to practice, so I often say that you know, it’s like, if I picked up a 20-pound bag of sugar, I could say, “Wow, this is heavy, but I could totally hold it.” If I picked up a 100-pound bag of concrete, I either couldn’t lift it, or I dropped it immediately. It’s too much. I don’t have the capacity for that and that’s a little like this, we’re throwing younger babies into levels of distress that and having them try to manage it by themselves. That’s where I get worried because all of the work on emotional regulation on the development of the HPA system, you know, the fight or flight system, all of that is happening early on and happens, gets tuned, gets kind of primed in relationships by parents really helping babies regulate and we don’t really know what happens when babies go through this, plus we don’t really want babies eight weeks old sleeping through the night. I had thought that that was not an ideal situation. Now if they are, if you have a baby sleeping through the night, good for you. Yay, don’t worry, but I don’t know that it’s a goal.

 

Jen Lumanlan  28:59

Right. Okay, so let’s tease that apart a little bit because I think there’s a couple of things you said in there that are really important. Firstly, there’s the sleeping through the night, which to researchers tends to mean different things than what it means to parents. Can you speak to that for a minute?

 

Macall  29:10

Well, it changed actually. It used to be five hours, right? Five hours of consolidated sleep was through the night. Judith Owens, who I mentioned, suggested that she did some, you know, large population work on sleep kind of norms and she said in her sample “most,” most babies were sleeping an eight-hour chunk by three months. Now, here’s the interesting thing about the three-month mark, because a lot of them are saying, “Oh, sleep consolidates around three months,” and that’s why you can start sleep training at four months, completely ignoring the four-month regression where everything goes haywire. Everything goes haywire. So sure, babies might be sleeping eight hours at three months and then might start waking up again a lot at four months, so she found this magic moment of eight hours at three months among a certain quantity of babies, and therefore they’re now saying eight hours is kind of through the night, but then you’ll read other people who are like, “Night Waking is normative throughout the first year.” You know, I think it’s a matter of degree and in my coaching practice, I tell parents look, “You get to decide what’s the problem. If waking up for a feed is not a problem for you, There is no problem.” Yeah, there’s no problem.

 

Jen Lumanlan  30:28

You know, ding ding, ding. I think that’s where the money is, right? When we’re talking about, what are we trying to do here? We are trying to get our babies to sleep for a long time because we feel as though we need to get a long period of time for ourselves to care for our rest, for our sleep as well. And very often, because of the paucity of resources to support new parents, we’re going back to work before we’re potentially even ready. If we’re lucky, we’re getting three months of maternity leave in the US. If we’re not, we’re taking three or four days off after the birth and then we’re back to work and pumping breast milk and bathroom. It’s a funny coincidence, I was on an interview this morning, actually, with Renee Reyna, who hosts the Mom Room podcast, and she was saying she’s in Canada. She got a year of maternity leave, and she and her husband worked out this arrangement where she would go to bed at six o’clock in the evening and wake up at midnight, or not purposefully wake up, but she would get uninterrupted sleep until midnight and her husband would take that shift, and then he would go to bed and she would be on from midnight until you know the morning. She was fine in that first year because she had found this arrangement that worked for their family. And yes, it’s unconventional but from her perspective, even if her baby’s waking up three, four, or five times a night, there’s no problem here, because she is still getting the rest that she needs because she is getting 12 months of maternity leave. She doesn’t have to get up and go to work the next day. How do you see this issue of the child sleeping through the night fitting in with the context of the family and also the context of society as well. We demand women do, right after they’ve had.

 

Macall  32:06

There’s all of that, 100%. And there’s another piece where I see parents because I work on a telehealth platform so I talked to brand new parents all the time. Yes, they would like huge blocks of sleep but what I see more that actually breaks my heart is this feeling that I have control over my baby’s sleep and my baby’s waking up means I’m not doing my job. I have parents who express high levels of shame and guilt because they’re feeding their two-month-old baby to sleep, and the minute I say, “That’s exactly what you should be doing,” you can see the anxiety and how shame and guilt just lifted off of their shoulders because there’s also this pressure to say, “Your baby’s sleep is your responsibility and if they’re not sleeping, you’re doing it wrong.”

 

Jen Lumanlan  33:01

Responsible for all the brain development problems that come down the line.

 

Macall  33:05

Oh, yeah, the baby is now going to have ADHD, is going to be overweight, and you know all these horrible things. I mean, people literally are saying, “I just don’t want to start bad habits with my six-week-old,” and I’m like, “Your six-week-old has no capacity to develop a habit.” They have none. Nothing. This idea that it’s like make or break in those first few months, I think, is a huge disservice to parents because it doesn’t give them time for trial and error. It’s like every choice is fraught with like a lot of weight. And they’re so worried that they’re going to make one false move, and their child’s just going to be toast like they’re ruining their child because they’re feeding them to sleep. I really think the whole tone of advice has to change. It really does. I think we have to support parents in the process of becoming parents. We have to let them figure it out and trust themselves and know that they’re not going to make some dreadful mistake. It’s just not possible, right? I kind of joke with them. And I say, “Look, it would be like me saying don’t carry your baby, or else that baby will never learn how to walk.” No, we know that a child will learn to walk when they have the muscle strength, the visual skills, the balance, all those skills in place. Then we can start saying, “You know, I’m not going to carry you everywhere because you can totally walk.” We allow them to grow that way, and I think that sleep has to be the same way. I think we’re making parents a little nuts over it.

 

Jen Lumanlan  34:32

Yeah, there’s this sort of sense that well, if I start doing this now, then I’ll never be able to stop, and that any pattern that I write in these first few weeks even, but certainly a few months, is going to be something I have to live with for the rest of my life.

 

Macall  34:44

Right. And there’s literally no research on that. There are meta-analyses and literature reviews that basically say there is no research on the need or benefit of starting sleep training early. In fact, all the research on prevention of sleep problems is I don’t mean it’s bad research, it means they really haven’t found a lot. So any little tweak that they made often they’re pretty vague about what the sleep advice is in these. They say, “Parents were educated about the appropriate responsiveness to night waking,” but they don’t say what that is. I know you have no idea. Do a little dance? I don’t know what the advice was, but the results of those studies were that either there was no change, or the change was so tiny that it didn’t even make it really worth it, or the effect wore off in like a month. So this idea of you having to start early is just that’s definitely one that’s, you know, made up for sure. Well, I was just gonna say the other piece about, you know, even after six months about, you know, we’re told in books, at least, or advice that’s out there, on Instagram, wherever, you know, that crying it out works. And it’s true, it does work. But that’s another area where when you look at the research, we have to remember that in research, it didn’t work for everybody, right? In research between 25 and 50% of samples, it did not work at all. I did a big parent survey and asked it was basically on temperament, but it was all different parents with babies and kids of all different kinds of temperaments. You know, large percentages, maybe 40%, would say that crying it out didn’t work for them at all. So we get this image that’s like, Okay, we’re going to sleep train. We have to sleep train. And if we just grit our teeth in three or four nights, we’ll have a baby who’s sleeping through the night. While that does happen for some people, for sure. Lucky people “Yay, you.” It doesn’t work for everybody. And then when it doesn’t work for you again, parents are like, “What’s the matter with me? What am I doing? What am I doing wrong?” I wish there was more out there about that to say, “Hey, if this doesn’t work for you, here’s some other things. Here’s a plan B.”

 

Jen Lumanlan  36:57

What is the plan B? Should extinction even be Plan A? What are the kinds of progressions we should be looking at? Where does extinct right onto this? And if extinction doesn’t work? What else is available to us?

 

Macall  37:08

Right. Such a great question. Really, that’s another piece we see these shelves of sleep up and they look like all completely separate methods. All these different methods, it all boils down to one idea. And only one, which is you have to change your child’s usual go-to-sleep pattern from one where you’re doing all the work to one where they’re doing the work and you can do that really fast. And that’s basically cold turkey. You can do that really, really slow, which would I would be like the no-cry sleep solution or some of the other gentler methods, and then there’s a few that are kind of in the middle, fast or slow, you can go in big steps or little teeny tiny steps, but the idea is that you’re progressively helping your child take on a little bit more of that work of going to sleep. Leaving the room is not totally required. It works better for some kids. And I do know this to be absolutely true. For some children, you standing there and trying to help them just makes them mad. Then, of course, you should leave the room because you’re not helping. You are not helping. But parents could essentially cobble together their own approach, you know, I have parents who are full-on co-sleeping or they have a three-year-old who’s an octopus going to sleep, you know, needs full body contact. You can literally just start moving and that would be, maybe you sit up in the bed at first, and then maybe you sit on the floor, and then maybe you can just keep moving away. But there’s no magic to sleep training, unlike what it may sound like, it’s not magic. And you can do a process that makes sense for you, as long as you’re consistent and as long as you kind of keep going you don’t even have to buy books.

 

 

Jen Lumanlan  39:01

And of course, what all of this assumes is that our goal is to get our child to go to sleep by themselves in their own space, often that’s their own room, but in their own bed and in their own space. And I think what we should also keep in mind is that were those conditions are not present. Families don’t do sleep training, they don’t have sleep problems. I’m thinking back to a study. I think it was a Guatemalan mother’s, and they were talking about their children’s sleep problems and the mothers were like, “What do you mean sleep problems? We don’t have sleep problems,” because the way that they use their time is aligned with their child’s needs, right? There’s always five or six adults hanging around after dinner, and they’re chatting, there’s always somebody to carry the baby. It doesn’t always have to be the mother. And the child just falls asleep whenever they’re ready to fall asleep, and everybody transitions to bed and there’s no sleep problem. And so I think it’s really important to keep in mind that the reason we have sleep problems and we need sleep training is because we have this single idea of what good sleep means, which means going to sleep in a room by yourself. And if we had different ideas about what good sleep means, then we wouldn’t necessarily have sleep problems either. Do you concur with that?

 

Macall  40:10

Oh, yeah. I mean, it’s heavily cultural. We’ve also, I think, medicalized the problem as well, right? There’s a category of sleep disorders called limit-setting disorder, and they are not talking about the baby.

 

Jen Lumanlan  40:26

Yeah. Okay, tell me more. How does one diagnose limit-setting disorder in a mother?

 

Macall  40:32

It’s just when they would basically say it’s when parents don’t have a plan, you know, that parents just let the baby stay awake and they just respond, I mean, yeah, it’s a disorder now.

 

Jen Lumanlan  40:44

Right. Let’s just give that the weight that it deserves, right? We cannot go into something without a plan because otherwise, we have a medical disorder. There’s something wrong with that perspective, I think. Not with people who are going into sleep or being with their children in whatever way is most natural for them. Sorry, I almost don’t even know where to go with that.

 

Macall  41:06

I know, I know. It’s also the whole process of, you know, when I talked about medicalizing it, it’s going back to that behaviorism paradigm, which is that a baby is a blank slate, and the only thing it learns is based on what you do or don’t do. Therefore, then the parents’ behavior is also the source of the problem, possibly the solution, but it’s also the source of a problem, so a parent’s responsiveness is seen as weak, it’s seen as permissive, it’s seen as disordered because there’s a lack of, you know, setting some kind of limits with their kid, whatever it is, it’s that thing of saying that parents’ natural instincts to respond and support their younger babies is really seen as problematic, you know, we’re getting parents to doubt themselves right out of the gate and I think that’s just wrong. And then we are heavily reliant on experts, you know, the consumerism of our culture, right? We want babies in a separate room but to be in a separate room, you need monitors, and you need this, and you need stuff.

 

Jen Lumanlan  42:12

And a house big enough to have a separate room for each child.

 

Macall  42:16

True. And if you can’t trust your own instinct, then you need to be buying the books and buying the programs, and because goodness knows, you don’t know, as a parent, I call this a risk society right now. Parenting in a risk society means parenting has become about avoiding things like landmines. A risk. I get that some of that’s, you know, a reality, but we also set the stage by undermining parents’ instincts right from the beginning and causing parents to really worry about the consequences of whatever choices they make. And I really think it’s time to back that train up and to say, “No, we need to validate parents’ instincts, help them trust that they know that they can figure out what to do, give them options for when something doesn’t work.” The lack of options also means if something doesn’t work, you just need to do it harder, or longer, or more rather than, “Oh, that’s not working for you here. How about this? Try this?” Yeah, try this other option.

 

Jen Lumanlan  43:14

So I know the other sort of big thing that you’ve spent a good deal of time looking at is the intersection of temperament and sleep. And the idea that these “difficult children” are potentially having a harder time sleeping and different tools might be more useful for them. What do we need to know about more sensitive children and sleep?

 

Macall  43:36

Well, this is my second major soapbox, which is that if we know that extinction doesn’t work for many kids as a baseline, it really doesn’t work for kids who are more intense and sensitive. And the research on sleep training virtually never looks at temperament. There was one study that did and they basically said, and again, difficult is a research term that’s not or temperament researchers. That’s not a term I like but the more intense difficult to soothe infants did improve in the sleep training, but not nearly as much as other kids. We know very little about how children with a more sensitive, intense temperament react to sleep training, I can tell you, from just my experience working with families that often it doesn’t. It’s either a non-starter. It was for me; it was a total non-starter. I knew my persistent, intense little girl would cry for three solid hours and never give up ever, ever, ever so I just didn’t even try it, because I knew what I’d be up for. And there are a lot of parents like that. They’re like, I’m not even going to attempt that. And then there are other parents were like, “I really don’t want to do this and I’m just going to try it.” And sure enough, these kiddos are crying for hours and hours, nights upon end, like not just one or two nights, and then the promises of the sleep books really start crumbling, because the sleep books are like, look, the first night is going to be terrible but by night three, you’ll be sleeping through the night almost. And when parents have been going at it with hours and hours of crying several times a night over many nights, they’re like, “This is not worth it, I can’t keep putting my child through it because it not seem to be working.” And for these parents, they may not even really make the connection between their lack of success and temperament, so when you tell them, It’s not you, this is the way this child is wired. It’s another big aha moment for them. In this big parents survey, I looked at temperament to see if higher levels of this difficult temperament were associated with sleep problems, and also how parents experienced a variety of sleep training strategies. And for sure, shocker. The more intense the kids were, they had every conceivable sleep problems. Challenges on every front. And their parents had tried a higher number of strategies with less success. So it wasn’t for lack of trying.

 

Jen Lumanlan  46:00

These are parents who need the most help. Right? What do you tell his parents?

 

Macall  46:04

Yeah, exactly. Well, they’re getting the same message, “Oh, you just have to let them cry it out. I always just have to let them cry out,” parents are either like I did that. What else have you got? Right? Heard one parent whom I think pediatrician or nurse said, “Well, you just have to do it harder, right?” I mean, that’s just not helpful. So again, these slower, more supportive strategies really work. There’s other things that I talk about in terms of setting a different stage for these kids, they need more transition, they need an earlier bedtime, and they need a lot of support and consistency, but you really can give them a lot of help at first that you just fade out over time. And if you can be really consistent and really methodical and really supportive, those sleep problems will eventually move without them getting crazy hysterical. That’s another piece of advice. Just real quick, that is also doesn’t make any sense that I tell parents all the time, is that the advice will say whatever you do, don’t pick up your baby out of the crib. Soothe them. If you have to go check on them, soothe them, but do not pick them up. And that if I can tell everybody, I don’t understand that piece of advice. Children are not learning things when they’re hysterical. Pick your baby up, calm them down, put them back, and keep going, but once they get into that, what Daniel Siegel calls it, you know, they “flip their lid”, you know, when they’re into that hysterical zone, they’re not learning anymore. So get them back to manageable and keep going.

 

Jen Lumanlan  47:32

Yeah, when you say keep going, I think that’s super important, right? So when you’re describing this, what I’m hearing from you is that it’s almost like a ladder of interventions and we’re going to see not just where do I want to be on this ladder but where does my child need me to be on this ladder at this moment, not even overall, but at this moment, are they needing me to come in with more support right now, and if so I’m going to provide them, or if I go in and I pat their back, I’m not going to pick them up just because I always pick them up and that’s what I need to do, but because if it seems like they need picking up this time, I’m going to pick them up, if it doesn’t seem like they need it, I’m maybe not going to pick them up, I’m going to pat them on the back, that’s going to be okay. And so if I can just kind of conceptualize this, just to make sure it’s super clear for parents who are new to this, who are struggling with this, it’s all about how slow do we want to go, um, you said this, I just want to make sure that this really, really comes out that we can go fast, we can go incredibly, incredibly slowly, and it’s about matching your pace along that journey with what your needs are and what your child’s needs are. And potentially, I’m gonna go out on a limb here and you can push back if I’m not right. The closer you are to where your speed your child needs to move, the easier this is going to be overall. And if you try to rush it a little faster than they need because it meets your need, you may end up sort of creating a problem where you have to step back a little bit and you have to slow down a little bit more. Is that right?

 

Macall  48:53

Well, that’s a tricky one. It’s generally right. I would say though, that especially with very strong-willed babies, you can’t wait for them to be ready because they won’t, they will not be ready. So if what you’re doing if you know that what you’re doing is not sustainable, because the parents I work with are really going way above and beyond, or we’re talking about a kiddo that’s waking every hour. That’s a lot. So, if you know that it’s not sustainable, and things have to change that you’re going to do something that’s developmentally appropriate for your kid and you’re going to give a lot of support and you’re going to make sure that you’re not leaving your kiddo alone to figure it out. It’s okay to push them a little because again, it’s working for them, whatever you’re doing is working for them and they have no reason to change it, so sometimes as parents, it’s okay to say, “I cannot keep waking up every hour to rock him back to sleep. I have to get him to learn how to fall asleep where he’s going to wake up.” So it’s a balancing act. And I think that’s the important part as well as we have to take everybody’s needs into account. We do. We have to take the baby’s needs into account but parents who have intense kiddos are often ground down to a powder, they are so tired. And when I work with these folks, I sometimes have to sort of hold the parents before we can even really start working on the kid, it takes such a toll energetically because these kids are often, they’re not just intense, they’re like, super social, and they don’t want to play by themselves, and they’re talking all the time, and they never want a nap. So, these parents are just at their wit’s end, you can’t just say, “Oh, just put your child in a room and let them cry.” The parent can’t do that, so it’s about really finding a middle ground where we can take into account everybody’s needs for change and how fast can we go. Can we go a little faster than that? Or can we go a little slower than that? As long as you’re not trying something new every single night? I think it’ll be okay.

 

Jen Lumanlan  51:01

All right. So if parents are really appreciating what they’re hearing today and want to learn more, where can they find you?

 

Macall  51:08

That’s a good question. My information on temperament is on my website, and Facebook, and Instagram under Little Live Wires. My research work is actually more on Research Gate, if you really want the researchy stuff. I’ve got the update of the lit review that’s on there now, it’s back from 2007 but spoiler alert, it hasn’t really changed a lot since then but I will be having an update of that information, I hope really soon. But always you can contact me on my website if you have questions or want to learn more about the research.

 

Jen Lumanlan  51:37

And the website is?

 

Macall  51:38

LittleLiveWires.com

 

Jen Lumanlan  51:40

Awesome. Well, thank you so much for helping us to really break this down into something that I think is actually usable by parents. This topic seems so mystifying, right? There’s all these different books, there’s all these different studies, how can I possibly understand it all and make the decision that’s right for my child? And I think to have that framework of how fast do you want to go, how fast can your child go. It brings a lot of clarity. So thank you so much for walking us through that and helping us to see how we can apply that in our situations with our children.

 

Macall  52:08

Oh, of course, I think it’s hugely important, for sure.

 

Jen Lumanlan  52:11

And don’t forget that you can find all of the references from today’s episode, as well as Macall Gordon’s website, Little Live Wires at YourParentingMojo.com/livewires. And if you are about to have a baby or already have one under the age of one, or if you know somebody else who is expecting a baby or has one under the age of one, you can find information on our right from the start course at YourParentingMojo.com/RightFromTheStart.

 

Jenny  52:37

Hi, this is Jenny from Los Angeles. We know that you have a lot of choices about where you get information about parenting, and we’re honored that you’ve chosen us as we move toward a world in which everyone’s lives and contributions are valued. If you’d like to help keep the show ad-free, please consider making a donation on the episode page that Jen just mentioned. Thanks again for listening to this episode of The Your Parenting Mojo podcast. Don’t forget to head to YourParentingMojo.com/RecordTheIntro to record your own messages for the show.