Australia: "Just send the baby to 'sleep school'"!

I tried not to look completely surprised when I heard the following statement from the young father who checked us into our hotel room in Melbourne:

"My wife was just exhausted! She couldn't sleep more than a few hours at night. And then the baby would nurse all day long as well. But, we heard about sleep school and took our baby there."

Still not quite able to grasp what he is telling me, I ask what age his baby was when baby and mother went off to school.

"Oh, just 6 weeks old," he explains. "I took my wife and baby to the 'sleep school' at our local Early Parenting Center. Usually the fathers spend the night too, but I couldn't get off work. They gave my wife a sleeping pill so that she could sleep, and kept my baby in the nursery so that he could learn to sleep. We were lucky because our insurance [Medicare, Australia's national health care plan] paid for it all."

The Parenting Center explained to this upset mother and father that "settling techniques might appear to cause your baby some distress at first. This will pass. Stick with it. Before too long, you'll have a far more rested, contented baby. You'll be better too."  This father continued, "The Center said we could come back for a 'tune up' if the baby stopped sleeping at night again."

Australia has researched this issue. The Infant Sleep Study (2003-2006) studied families with 7-month-old babies who had sleep issues. Participants in an intervention group were given extra visits from their Maternal Child Health Nurse and more information on handling sleep issues, including the approach known as "controlled crying." This study showed reduced sleep problems in the intervention group for up to one year, and reduced maternal depression for up to two years.

The KIDS Sleep Study (2009-10) followed up on these same children at 6 years old and found that there were "no lasting ill effects of the infant sleep program on children's emotional and behavioral well-being and stress, parents' well-being, or children's weight, height, and general health." This data caused researchers to conclude that controlled crying techniques should be used with young babies, since there appears to be no long-term detriment to the children.

Baby Business is a current Australian sleep intervention study hoping to identify what techniques are effective in calming a fussy baby and helping the baby (and her parents) get a better night's sleep.

However, those who write passionately about negative effects of "controlled crying" state that the child does not learn to "self soothe," but instead learns "not to communicate their distress to their parents." They agree that the early years are a time to learn resilience and good mental health, but they assert that these qualities are a by-product of a securely attached child, not one who feels abandoned by a parent. A child left to cry, they say, will be a fussier, more clingy child later. Pinky McKay, a popular parenting writer in Australia, is particularly well spoken on this subject.

Without a doubt, parents who are not sleeping while caring for a young baby are desperate. For years I have quoted USA statistics: "sleep problems are described by parents of all newborns, 20-40% of 6-12-month-olds, and universally in children 2-5 years old." I have counseled parents with "troubled sleepers" for thirty years and given workshops to parents and professionals on this subject for decades. (See this blog on my approach to helping a lovely Melbourne family with sleep problems.)

In anticipation of the controversy about "controlled crying," my talks and workshops in Australia highlighted the following aspects of the HUG Your Baby teaching that might prevent and treat sleeping issues:

1. During prenatal care and classes, be honest about the reality of early parenting. Help pregnant women (and their partners) explore their images of early parenting, identify family and friends who can be called upon to help, and develop realistic expectations about how life with a new baby will be different.
2. Put newborns skin to skin and provide exclusive breastfeeding.
3. Ensure that parents understand "active" versus "deep" sleep. Once breastfeeding is well established, allow babies (two to four weeks old) to wiggle through active sleep back into deep sleep.
   
4. Include the step-wise ("TO Do") approach to calming a baby in order to see and encourage a baby's competencies: "T" - Use a sing-songy, comforting voice and see if baby starts to calm. "O" - Observe your baby's efforts to contribute to calming down: bringing her hand to her mouth, making sucking movements, "Spacing Out," or using the fencing reflex. "Do" actions include bringing a baby's hands to her chest, swaddling or swaying the baby, and encouraging sucking of the breast or a parent's finger.
5. Teach parents about a baby's normal increase in crying patterns beginning at two weeks, peaking at 6 weeks, and decreasing over 12 weeks.
   
6. Understand normal developmental events from birth to 2 years which predictably cause a baby to have temporary changes in sleep patterns. (See Brazelton's Touchpoints and Tedder's "Roadmap to Breastfeeding Success").
7. Counsel parents to respond to these changes with a loving but less involved approach. (Parents usually talk to, look at, pat, pick up, rock, and breastfeed a crying baby--all at once.) Encourage them, instead, to respond to the child by looking slightly to the side of the child and without speaking. After a night or two the child settles and then the parent can try patting instead of picking up.

Breastfeeding as the only means of nighttime comforting can exhaust some mothers, cause sore nipples and contribute to parents giving up breastfeeding before they wish too, while at the same time missing a golden opportunity to promote competent state regulation on the part of the infant. Education described above both enhances continued breastfeeding and promotes self-regulation in the child.

Though I was unable to find the cost to Australian tax payers of the "sleep school" program, I couldn't help but wonder if helping parents "read" their baby's body language and anticipate (and plan for) normal developmental events that impact sleep might be a more cost-effective approach. Perhaps getting "The HUG" from nurses recently trained in the HUG Your Baby program will be one more step toward supporting parents who struggle with the critical, but normal, challenges of early parenting.