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Dear Dr. Yael,

I am writing to you about my baby who cries a lot and always ends up sleeping in my bed. I am a nursing mother, so the baby often falls asleep in my bed in the middle of the night. I put a railing on my bed and I sleep very lightly, waking up often to make sure my baby is safe. I know this isn’t an ideal way to sleep for me or the baby, but the baby refuses to sleep in his crib. If I put him in the crib to sleep, he cries until he vomits. After this happening a few times, we stopped trying to put him to sleep in the crib. My husband and I adore this baby who we were zoche to have after two years of marriage naturally, but I am losing my mind without any sleep for over a year. Everyone tells us that we must let him cry and some suggest letting him sleep in his vomit. We’d rather not sleep well than let our precious child cry for a long time and we would never let him sleep in his vomit!

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We always hear from well meaning people to read Dr. Gerber and to FERBERIZE him, but this method just doesn’t seem appropriate for us. One of my friends even told me she let her baby cry it out and it worked! He cried for two hours! While she was proud of herself, I was horrified! How can you possibly let a baby cry for two hours?! That sounds abusive to me. On the other hand, I don’t want to mishandle the situation and not give my child what he needs. Many people tell me, he needs to learn to self soothe and what I am doing isn’t helpful. While in theory, I understand what they are saying, in practice, I can’t let my baby cry for long amounts of time, especially because it then causes him to vomit. What is your opinion on this matter?

 

 

Dear Reader,

Ferberizing is a method that Dr. Richard Ferber coined by writing books to train parents to allow children to cry for a predetermined time and therefore learn to self soothe in order to fall asleep. The Ferber method is also known as “graduated extinction,” and when done correctly, it trains parents to leave their children alone for strictly-timed intervals, ignoring any protests and cries they might hear. When the method works, children eventually accept that no one will come to their aid, and as a result, they stop crying/protesting. This method is recommended after age 6 months. Additionally, the Ferber method is NOT appropriate for kids who have a conditioned fear of being left alone in their beds or who have a conditioned vomiting response (which you indicated your son has). Furthermore, the Ferber method is NOT designed to treat most of the sleep problems that cause bedtime battles and night wakings. For instance, the Ferber method doesn’t address

  • nighttime fears and separation anxiety
  • daytime stress
  • nightmares
  • snoring and other forms of sleep-disordered breathing
  • nocturnal headaches and other painful medical conditions
  • circadian rhythm sleep disorders
  • sleep walking and/or night-terrors
  • sleep schedule problems caused by bedtimes that are too early

 

If any of these conditions is the cause for your child’s bedtime problems or night wakings, it’s imperative to find appropriate treatment. Using the Ferber method in these cases would risk worsening your child’s psychological problems or ignoring potentially dangerous medical conditions. Lastly, the Ferber method does not teach children how to fall asleep. Graduated extinction basically just denies access to their parents and children are left to figure out how to fall asleep on their own.

If you want to teach your child to sleep, there are other methods to do so. One such method is, positive routines with faded bedtimes. The theory behind this method is that children will fall asleep more easily if they are able to experience a series of predictable, pleasant, quiet, bedtime rituals. This method teaches parents to introduce a soothing routine that leads up to bedtime each night. The routine should be about 10-20 minutes of quiet, calm, and pleasant activities, such as a warm bath, short baby massage, soothing books and/or songs, etc. Once your baby is soothed, he will likely fall asleep easily on his own.

However, the timing has to work for your child. You may have to observe your child in the evenings to see when he is becoming somewhat drowsy because if you pick a bedtime that is too early, your child won’t feel drowsy, and he may resist falling asleep which will frustrate you and make it seem like this method doesn’t work. With this program, you train your infant to associate the bedtime routine with feeling drowsy, and you do this by waiting until you are sure your baby is ready to fall asleep, even if this means starting bedtime later than you want. Your baby will learn to associate the new bedtime routine with falling asleep, so once this lesson is learned, you can titrate the timing up to make bedtime earlier if needed. You can gradually move your schedule, making bedtime 10-15 minutes earlier every few days until the desired, final bedtime is reached.

Another method that parents like is extinction with parental presence. With this approach to infant sleep training, you put your baby to bed while he’s still awake, and you lie down with him or next to him until he falls asleep. However, each night, you pay progressively less attention to him and move farther away.

For example, after a few days, you might move farther away from the baby and touch the baby less often. A few days after that, you may sit up in bed rather than lie down next to the baby. The next step is to sit in a chair alongside the bed, and the step after that is to move the chair a bit farther away. Eventually, you can move the chair to the door and to the hallway. You can read or do some other silent activity while you sit next to your child. This will help your baby feel safe, but also teach him to self soothe and will help your baby gradually move away from sleeping next to you.

If your baby is in a crib, I would recommend your first step being putting the baby in his crib and sitting next to him while holding his hand or stroking him. He may resist at first, but you can tell him you will leave, if he doesn’t lie down. You can even leave the room if he doesn’t comply and come back a minute later to show him you will only stay if he lies down and tries to fall asleep. Just keep saying, “lie down” so he understands and show him if necessary. Eventually, he will understand that you will not take him out and your presence will soothe him enough to lie down and go to sleep. By making these gradual changes, the baby is weaned from relying on extensive parental soothing rituals. After several days, you can try leaving the room for a few seconds, returning before your child starts to cry. This may help your child learn that you can be trusted to return after an absence. This method can also be used when your baby wakes up in the middle of the night. You can also try leaving for a few minutes once your baby is adapted to the program, so he doesn’t become dependent on your presence, but always return after a minute or two of crying, so he trusts you will be there for him.

The Ferber method is controversial and while some studies say the stress caused by letting babies cry will have negative long term effects, other studies show that it had very positive effects on parents and no ill effects on the babies, which was an overall positive effect in the long run, as happy parents will help keep a baby happy. Because of the controversy, your hesitation is understood.

Personally, I also take issue with the Ferber method and question if in fact it can cause long term problems. Do children develop low self esteem from this method because in essence they feel uncared about or abandoned when left to cry for long periods of time? We don’t really know how sleep training can affect our children, but it is clear that different children need different methods. Some children only cry for 5 to 15 minutes and do fine with the Ferber method for sleep training. Other children do not self soothe as easily and cry for longer periods. It is these children that I believe may suffer from the Ferber method.

Raising children is not easy and each child will need different methods to reach them. I personally like to use a combination of the second and third methods listed above. Using a bedtime routine can get your son to associate this routine with sleep and will help relax and soothe him. Then, you can try to sit near your child’s crib and soothe him by touching him gently and/or holding his hand. Since your baby is already programmed to sleep in your bed this may not be simple. Please DO NOT allow your child to sleep in vomit. Perhaps creating a love cd where your child hears your voice singing may help your child stay in his crib. You also noted that since you are nursing, you fell asleep often in bed with your child. This was comforting to him and he developed an attachment to sleeping in your bed. This will be a bit more difficult to break.

You must slowly move him out of your room and use this method during the night as well. You can nurse in a rocking chair to try to help you break this habit. Try to be as soothing and comforting as possible when making this transition even though it may be difficult and frustrating to you. Babies can pick up on our emotions and if you’re frustrated, your baby will not soothe easily as he will also be agitated. Please ignore all the critics. You are trying to be a loving mother and deserve only praise for doing what you think is right! Hatzlocha in this journey.

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Dr. Yael Respler is a psychotherapist in private practice who provides marital, dating and family counseling. Dr. Respler also deals with problems relating to marital intimacy. Letters may be emailed to deardryael@aol.com. To schedule an appointment, please call 917-751-4887. Dr. Orit Respler-Herman, a child psychologist, co-authors this column and is now in private practice providing complete pychological evaluations as well as child and adolescent therapy. She can be reached at 917-679-1612. Previous columns can be viewed at www.jewishpress.com and archives of Dr. Respler’s radio shows can be found at www.dryaelrespler.com.