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Web Extra

Extended Q & A with Dr. Marc Weissbluth

The renowned Chicago expert on infant sleep answered some frequently asked questions

Twenty years ago, the Chicago pediatrician Marc Weissbluth published a book titled Healthy Sleep Habits, Happy Child, a modest volume that laid out the doctor's findings about the mysteries of infant sleep patterns. With more than half a million copies sold since its debut, the book consistently tops Amazon.com as one of its best-selling parenting books. Weissbluth recommends giving children up to an hour to fall asleep on their own, much of it typically spent crying, an approach that has both its share of fans and opponents who reject it as cruel.

At the kinder, gentler end of the spectrum, the well-known pediatrician and author William Sears promotes "attachment parenting," a method that includes sharing a family bed and actively responding to children's needs. The more middle-of-the-road approach belongs to Richard Ferber, the Boston pediatrician who first advocated the tough-love approach of leaving babies alone for increasing intervals until they fall asleep.

Weissbluth, who founded the Sleep Disorders Center at Children's Memorial Hospital in 1985, points out that of the three experts cited, he alone conducts sleep research. He has found that children are biologically wired to nap and go to bed most easily at certain times of the day; miss that window and you end up with a cranky, overtired kid who can't fall asleep.

His treatment of fussy children may be strict, but in person Weissbluth, 65, comes across as soft-spoken and grandfatherly. He sat down with Chicago magazine's Karin Horgan Sullivan to discuss what he's learned.

You're often referred to by some as the Sleep Nazi. Does that bother you?
The book has information that's based upon very good research. But some people find it objectionable because they focus on this notion of when, or how long, or why it's important that my child cry. If that's what's top of your mind, then you're missing the point. Which is that sleep is a health habit for children, and parents can encourage it or mess it up. Around three or four months, children have the capability to learn some self-soothing. Parents who don't [allow that] wind up with major bedtime battles, night waking, and [children who have] the inability to fall asleep and stay asleep without assistance.

Which leads thousands of parents to co-sleep and swap beds with their kids, even though they say they hate it. What's the problem?
Part of the reason why you have programs like Nanny 911 is parents who have difficulty setting limits. They fail to recognize there's a direct connection between their behavior and their children's behavior. Sometimes it's as simple as parents need the tools; they just don't know enough about child rearing to understand how they can help their children, in this case, sleep better.

So is it just a matter of finding the will to stick with your program?
Well, we know that if we give our children junk food, it's harmful to the child. Sometime in the future parents will understand that the quality of sleep is healthy or unhealthy. Junk sleep would be sleeping at the wrong time, or sleep that's too brief, or too fragmented. But that's not yet at the top of parents' minds.  Because they need sleep [themselves], they will do things for their child to sleep through the night but not necessarily appreciate the harm.

Which is where musical beds comes in.
One of the first questions I ask, especially to the father, and the mother, too, if she's working outside the house, is, "What time do you come home from work?" Because you'll have parents who are keeping the child up way too late at night simply because they would rather play with their child than put the child to bed early, then complain about them not waking [in the morning], complain about sleep-deprived behavior during the day.

Couple that with daycare, and the problem with daycare is naps. For the group under one year of age, [most] don't have napping rooms. So some kids nap well; those who don't might be extremely tired by 4 or 5 p.m. Plus, you have more and more parents with their BlackBerrys, cell phones, partly working when they're home and on weekends, getting a little bit distracted from the child's need to sleep.

A couple of years ago, Richard Ferber shocked people by saying bed-sharing is OK for families who prefer it. Sounds like you wouldn't agree with that.
If the family bed is used in a situation where the child is put to bed way too late when the parents go to sleep, then that child has a bedtime that's too late, and that's not healthy. It's not because of the family bed; it's because the child is going to bed way too late.

Why is the debate over sleep methods so inflammatory? At one point iVillage.com actually banned discussion of particular approaches on one of its parenting forums.
I don't know why it's become so polarizing. But we do know that there are individuals who form opinions with no biological basis and are popular at promoting their opinions.

Care to name names?
[Weissbluth points to the section of his book where he criticizes William Sears.] You have the attachment people who say they're very child-focused, and that the lifestyle that they propose is better for children. You would like some data [showing] better outcomes [from that approach]. There is no data. Ferber has been contrasted as being parent-centric: Ignore your child's cries so that you as parents get to sleep. The criticism there is it's harsh to the child because you let the child cry. 

But how do you know that it's not damaging to children to let them cry?
My book references three or four studies by child psychiatrists studying the question of whether allowing a child to cry causes some harm in the child or the mother-child relationship. In one population mothers were hospitalized because of schizophrenia; their children weren't sleeping well. Under controlled observation, the children got less attention so they could self-soothe to sleep, and researchers observed to see whether there were any "substitution behaviors"—nail biting, thumb sucking. The conclusion was that by giving these children less attention they slept better. If the initial sleeping problems have been due to lack of affection or attention, then giving them less should have made things worse. But in fact, everything improved, suggesting what they needed more was sleeping and less attention from parents during sleeping times.

How did you arrive at one hour as being the right amount of time to cry? In the first edition you said up to three or four hours was OK.
There is that common [perception of my book], "Oh, yeah, let them cry a long time." But in my practice every day, I thought no one would. So I've made that correction.

Did you feel guilty when you heard about kids crying for three or four hours?
I don't know whether parents did let their kid cry for hours and hours. It wasn't part of my experience, nor did I encourage it. But I said it could be done, I did say that. But I'm trying to move the focus to promoting sleeping. If people focused on the different elements of sleep, they never would have had a child who cried for hours and hours. It never happened in my experience. 

Is there long-term harm from not getting enough sleep?
Sleeping is good for adults because it's better for your skin, for your disposition, for your sense of humor, for your energy level. When you are well rested and go to a musical event, the sound is sharper. If you go to an art show or the movies, the colors are more vivid. When you're overtired, you don't enjoy yourself as much. Cranky, tired kids are in the same state all the time. And parents don't see it because the kids are animated, they are walking, talking, learning at school—but they're not at their optimal best in performance. So they're not enjoying life as much as they could.

Around age ten, they'll be challenged with what we call "executive functions"—organization, planning, multitasking. At 10, 11 years of age the challenges in school are different, and the sleep-deprived child starts to fall off. Executive function is entirely tied to sleep, and it is dramatically impaired even with a single, one-hour restriction on one night of sleep. It's a hidden problem. Not sleeping well in the first five or six years of life puts a great stress on how you perform academically later on in life. That's proven.

So parents who have trouble sticking to a nap schedule or being stricter about bedtimes get a short-term gain, but ultimately their kids are going to pay for it?
Absolutely. The entire family will.

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