There are so many mixed feelings about sleep training (guilt, strident confidence, defensiveness, desperation, resignation, and so on) and I think, in part, it's a reflection of more general parenting philosophies. There are some of us that started out thinking that we'd be exceptionally responsive to our baby's needs and we'd give up taking care of ourselves for the privilege of taking care of an innocent baby. There are others of us who vowed to keep our own personal and professional lives while making reasonable compromises for our new baby. And still some of us went into this parenting thing with no clue that we'd have any "parenting philosophy" whatsoever until we saw that horrid woman with her sweet child and she… <you fill in the blank>. Somehow, many of us become so wildly committed to the paths that we chose explicitly or stumbled upon. Despite the wildly controversial issues that parents (mostly mothers) feel compelled to fight for (breast or bottle, daycare or SAH, CIO or co-sleep), the truth is that not much of it makes a reliable difference in the futures of our children. Short of flat-out abuse, neglect and SERIOUS conflict in the family context, most parenting is "good enough." And I for one am so grateful for that empirical fact.

I recently received the following question from a reader:

My short response is: you're doing everything right, your baby is following very normal sleep patterns, and I hope that the 4-month sleep transition doesn't make things harder. This really is a description of the average sleep pattern many 3.5 month olds experience. In response to the main question about whether there are benefits to sleep training (and not merely the lack of detrimental effects), no, there is no well-designed study that can answer your question. But researchers and consumers of research can use the data as they like. So… yes, good sleep has been consistently associated with better performance on complex problem-solving tasks, better memory, improved mood (decreased risk of depression) and better physical reflexes. But many babies suck at sleeping and this "suckiness" has NOT been proven to be associated with long-term negative outcomes. More to the point of the reader's question, being a "well trained" sleeper as a baby has not been shown to lead to any BETTER outcomes. That's because it is almost impossible to design the right study to answer this question rigorously. I'll save you the research methodology course that I suffered through, but suffice it to say that to really establish that there are actual long-term, IMPORTANT benefits to having been sleep-trained, you'd have to randomly assign parents to either sleep train their child or not, no matter their actual parenting philosophy, their own upbringing, their child's temperament, the amount of support they had in their lives, the necessity for parents to go back to work early in the child's life, and so on. In short, there's no ethical way to run such a study. So… what we're stuck with is a bunch of studies that look at some families that DO sleep train and some that DON'T. And guess what? These families don't only differ on whether they sleep trained or not. They differ on all the other variables that I just mentioned: parenting philosophy, family history, support, family structure, child temperament, and so on. And those factors have a complex, interactive effect on child outcomes. Some children's temperaments are easier than others and this makes some children easier to sleep train for some parents. For other parents, they don't feel the need to sleep train these children with easier temperaments. Both families and children fair well. You can see the problem when you then add all the other variables that I mentioned. In short, there's no ethical way to do this kind of science to answer the question absolutely.

So… what we do know is being a sensitive, responsive parent while at the same time setting reasonable limits matters for the long-term developmental outcomes of our children. So does being personally happy, emotionally resilient, financially secure, and happily married (or in a secure, non-conflictual relationship). And if we're none of those things, if we're financially stressed, a single mom, bouncing back and forth between depression and "ok-ness", we are STILL likely to bring up our children to be thoughtful, loving, resilient, motivated, successful adults. All the research I have read (way too much to link to here, but see the books I reference in the sidebar), reviewed, and conducted myself has led me and many others to the same general conclusion: We need to screw up BIG TIME to really put our children at serious risk for long-term negative outcomes. Oh, and BTW, we can also do everything "right" and still have children who take drugs, have unsafe sex, get arrested or end up sad and lonely at the end of their life.

Sleep training matters in the day-to-day way that parenting always matters. But we're all trying to do our best, working with what instincts we have and compensating for what we don't with as much reading and surfing the web as we can fit in. Most of us will muddle through because we care enough to do our best (yes, it sounds like a commercial and I am SO cheesy sometimes). And chances are, our kids will be just fine, no matter if we Ferberize, co-sleep, CIO, use "no-cry" strategies, or say to hell with all of this sleep training.

Many of you have written about being in the middle of one of the major stage transitions in development and not knowing what to do if sleep-training isn't a good option during these sensitive ages. Here's a typical question, from K:

Oy indeed! Most of what I've got for you is huge amounts of sympathy; this really is so hard. I think you have a very good grasp of what's going on in your little girl's head and anxiety is exactly the root of the problem. Unlike before the age of 18 months or so, she's now able to hold in mind her own goals and intentions (I must keep Mama HERE!) while simultaneously being aware of your conflicting goals (Mama wants to leave/get a life away from this bed). This is a phenomenal achievement! But the fact that she now has this advanced social understanding also means that she is in a constant state of negotiation with you for MORE! NO GO! MOMMY STAY!

The toddler at this age is somewhat of an addict. She wants nothing more than to continue to have access to your attention, your approval, and your presence. ALL. THE. TIME. That’s why 18-21 month old kids repeatedly call after mother, even though she is RIGHT THERE. (I remember distinctly when my boys were this age and they'd both be in my arms, climbing "uppy, UPPY" ever higher until there was no where else to go, no closer they could come to me, no more smashed up against me than they already were… and still they'd wail MAMA!). So, as I've mentioned before, your child at this age, though feisty and independent, is also insecure and often anxious, especially during times of impending separation (as you described perfectly in your question).

Given the powerful emotional vulnerabilities of this stage, now is not the time to entirely reconstruct bedtime habits, centered as they are on closeness, shared routines, mutual affection, and assurances of continued emotional connection. Ideally, now is a time to comfort and reassure, not to challenge or withdraw. But what on earth do you do when your regular acts of comfort, valiant and consistent as they have been, are not enough anymore?

I think the key goal here is to try to minimize your little girl's anxiety levels. That requires a context or routine that is completely predictable. I suspect that if she knows exactly what to expect from you and your husband and she knows that she can't do anything to change that, then her anxiety about figuring out how to keep you there will be start decreasing over time. This isn't about "breaking her spirit" or anything nutty like that. It's about letting her know that she doesn't have to WORRY about finding the right thing to say, do, yell, cry, whatever so that mommy stays with her. You will provide her with nourishment, love, physical comfort, and then you will let her fall asleep. So… what can you do to create an environment that decreases her anxiety? Unfortunately, I can't think of any magic bullet here. There's probably 3 general approaches:

1. The first is the "grin and bear it" approach. Given that she'll be out of this stage in a month or so, you can try to resign yourself to a longer bedtime routine. Lie next to her, nurse her, repeatedly tell her it's time to sleep and provide lots of warmth but as little stimulation as possible. This might really suck if she's still tap dancing on your head to the tune of "Mama, mama, mama", but if you show her that you'll consistently stay until she's asleep, then her protests may become less intense and shorter lived. At this point, her refusal to sleep might be in large part about not knowing whether this will be one of the nights you'll stay or finally get fed up and go.  

2. You can try to go with the old routine which will surely now require some distress on her part. In other words, you can lie with her, nurse her, and then after 30 min or so, leave, saying that it's time for bed, not playing. This will feel like you're actually sleep training her. And in a way you are, but back to the OLD routine. If you come back and check on her regularly, but stand firm on staying out of the bed with her, then she will eventually realize that her protests don't work to get you back. Although in some ways that sounds heartbreaking, the other way to look at is that you are actually RELIEVING her of her source of anxiety. If you know for sure you can't get what you want, you stop being preoccupied with that goal. Without that preoccupation, she may actually enjoy her time WITH you more and feel less anxious after, when you do leave.

3. If the crying gets unbearable for you and the hours of lying with her becomes equally crazy-making, then you can just bite the bullet and try your preferred sleep-training method that will teach her new sleep habits altogether (this can be where your husband really steps up to the plate). This isn't what I usually recommend during this stage, but if the alternatives become too unbearable, it is doable, it's just really, really hard.

To sum up: I think what you want to avoid are those acts that heighten her uncertainty. Walking away because you (understandably) have had enough may be the first step to triggering her distress, but what keeps it going is her knowledge that you MIGHT come back. So, predictability is key — in whatever form you feel you can provide. Walk out and stay out (within reason of course) or hop in bed for the night with her until this freaking awful stage passes. Because it WILL pass.

Anyone else in a similar situation, stuck in a sensitive stage with no way out but through? Does knowing it IS just a phase and it WILL pass help at all?

Although I started to write about the 4-month stage transition yesterday, I want to return to the 8-11 month old stage we've already touched on for a reader's question. I've got a few thoughts about the issues she raises and then I'm hoping that the rest of you can chime in with additional suggestions/words of advice/encouragement. I. is a mother of an 11-month old who has had severe reflux problems from birth. She wrote:

Right now, his good nights look like this:

10:00 – Nurse. Asleep by 11:00, in his crib.

12:00 or 1:00 – Wake up. Nurse for 20 minutes, followed by
20 minutes of holding to get into deep sleep before he goes into his crib. (If
he's put down before then, he cries and we risk a complete wake-up.)

2:00 or 3:00 – Wake up. Nurse for 20 minutes. Go back to
sleep, but only on a person; at this point, he just will not go back to sleep
if he's not with a person, so one of us ends up sleeping in the recliner with
him.

7:00 – Wake up for the morning.

And on his bad nights, anything can happen – he doesn't go
to sleep until 12 or one, then he's up every hour all night long, with an hour
and a half in the middle of the night where he's totally awake and ready to
party. Or he just won't sleep at all except on a person.

He tends to make up for it by sleeping more in the daytime;
after bad nights, he'll get more sleep during the day (always and only on a
person, though; I cosleep with him at every nap, because otherwise there is no
napping) than he did at night.

It's not really a sleep pattern so much as a sleep
dysfunction at this point. We'd cheerfully cosleep with him in the bed if we
thought it was safe, but our bed is really high and has no rails, so he'd have
to sleep between us, and we're both large people and my partner is a heavy
sleeper, so we're a little worried about that. (One possibility would be to get
a new bed, or to get bed rails for this one. If that's what it will take, we'll
do that.)

Our pediatrician has advised crying it out. But intense,
long crying spells tend to lead to reflux episodes, which leads to a) more
crying and b) vomiting, and by the time he's soothed, cleaned up, and changed,
he's awake,
so crying it out seems like a bad idea for him. (Also, I really don't
think we can take it; time and again, we've been the parents who caved
after a minute of crying. We'd both rather be up all night than let him
cry, in all honesty.)

Other people keep telling us that it's the nine-month sleep
regression, but – he's eleven months old. It seems like this is more than that.

Any advice would be very, very welcome. I'd especially welcome
suggestions for a sleep training method we can use, and some idea of
when to start it, and any ideas about what we can do in the meantime."

Oh man… this sounds so hard for everyone: your poor baby and his "growing pains", what with the reflux, teething, and first cold and poor you coping with trying to soothe a baby in pain all the while terribly sleep-deprived . As I see it, there are many parts to this sleeping "question":

1. Reflux problems and the associated sleep situation that requires mom or dad to sleep with the baby upright on a recliner.

2. The child's developmental age.

3. Frequent night wakings, sometimes completely unpredictable.

4. The child being overtired when nights are bad and compensating with longer naps during the day.

5. The desire/need for you guys to co-sleep but the obstacles therein.

6. The need to change the sleeping situation with an appropriate method that works for the whole family.

PHEW!  Did I get it all? It really does seem like some change is required for the whole family to get more rest and feel better. I know there are many parents out there who have dealt with reflux
problems and have found various solutions along the way. Given that you've been dealing with reflux problems with your boy since birth, you're probably an expert yourself by now. That's not my
area of expertise, so I'm hoping others will join in with their words
of wisdom on that front.

So, let me start with #2: Even though he's 11 months, he most certainly still can be in the throes of this developmental transition that starts around 8/9 months. He should be heading out of it soon, and in the next couple of weeks, you can start trying to implement a new plan. IOW, it's good timing to make a change.

#3 and 4 are connected. The frequent night wakings may be in part a function of your child being overtired which, in turn, has an impact on his napping situation, and so on. You may have heard from way too many people that children often have a harder time going down, sleep fitfully, and LESS, when they're overtired. Although Weissbluth seems to suggest that this is a new insight, our grandmothers and nannies have known this forever. My first suggestion to you would be to try to put your baby down "for the night" at an earlier time, especially given how early he still wakes up (7 am). Some kids wake up late (at around 9pm) and so they go to sleep for the night later as well (10 pm or so). This difference in sleep windows is often culturally determined and often reflects a preference for later nights and mornings on the parents' part (as well as the child's). That's all good if the child is getting adequate amounts of sleep. But in your case, that may not be the case given your description. So, my first suggestion would be to try aiming for a significantly earlier bed time, like 7 pm or 8 pm. You probably won't be able to make this change immediately (although it may be worth a try). So, you can gradually inch his bedtime earlier and earlier over the course of a week or two. Although not all babies respond well to this, many do. And counter-intuitively, many babies sleep longer when they're put down earlier.

#5 may be the most straightforward one to tackle. If you and your husband want to co-sleep and you think this will be the best way for all of you to maximize your sleep, then go for it. If you can afford a new, bigger bed that will make everyone more comfortable this may help. Some bed rails may work, but I'd be cautious about how safe they are for wriggling, soon-to-be toddlers. Also, keep in mind that this is a change in your sleeping situation that may last for a long time. If you and your husband like the idea of long-term co-sleeping, great. But if you want to just do it for a month or two to get out of a "bad patch", then you might want to consider what your ideal sleep situation would be instead and work towards that. Your baby is entering a great, relatively stable, resilient stage very soon. This new stage is a window during which you can shift sleep patterns; a lot easier than making changes during the 18-21 month period!

Finally, #6: I'm not big on advising any sleep-training method over another without knowing a family very well. My approach is more along the lines of providing all the possibilities and letting you choose what best fits your parenting style. In our book, I reviewed the main sleep-training methods and the pros and cons of each (it would take pages and pages to do that again here and it probably infringes on some copyright issue or another). You're obviously not into CIO methods, so stay clear of any of those. For the life of me I can't understand why pediatricians advise families to carry out sleep-training methods that go against the parents' own general approach: it's insensitive for one, there's no empirical research to suggest any of the more extreme CIO methods work any better than the more systematic non-CIO method, and the advice is doomed to fail if parents don't feel comfortable following through with the method consistently.  (Gah. I'll get off my soapbox now. Sorry.) More importantly, full-out CIO sounds like it would not be a good thing for your baby, given his serious reflux problems that get exacerbated when he cries a lot. There are gentle, "no cry" techniques that have worked for many families (Pantley is the guru for this approach). These are methods that allow you to gradually change sleep conditions while still providing some level of comfort and support for your baby. There's more graduated methods like Ferber's, that does allow for kids to cry, but for short periods that you can control. Other "controlled crying" approaches suggest allowing the child some fussing and crying before falling asleep, but remaining with him while he does so. And of course there's various co-sleeping arrangements, which the Sears folks have written about extensively.

Can anyone suggest specific methods that have worked for you in a similar situation? Any words of advice for I. on transitioning to a co-sleeping arrangement? What about the problem of reflux and how it fits into solving these sleep problems?