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Newspaper Article: "Pillow Balk" The kindergartner was overtired and overwrought. “I tried to get her down at nine,” says Jane, who lies next to her daughter every night until the child is asleep. “She kept thrashing and sitting up. ‘I need a drink of water.’ ‘I need something to eat.’ I told her to go in with Daddy, but he kicked her out after two minutes. It was 10 o’clock. She wouldn’t go to bed. I got so mad that I just had to get in the car and go drive around. I just couldn’t take it.” When she got back 10 minutes later, her daughter was a hysterical mess. “After another half-hour, she finally went to sleep,” says Jane, who did not want her full name for this story. “It was a nightmare.” Bedtime wasn’t always like this. Babies used to sleep more like babies and so did toddlers and elementary school-age children. But talk to parents, pediatricians, and sleep experts today, and bedtime looks a lot like bedlam. According to a 2004 poll commissioned by the National Sleep Foundation, 50 percent of American infants, 34 percent of toddlers, 32 percent of preschoolers, and 27 percent of school-aged children don’t get enough sleep. Partly as a result, neither do their parents. A combination of factors leads to this sleep shortage among youngsters: Both parents work and want to spend time with their children in the evening; children drink caffeinated beverages during the day; and children watch too much television, which polls show has a direct correlation on how much and how ell children sleep. The upshot is a nation of kids who get to bed late, don’t stay in their own beds all night, wake frequently demanding attention-and who tyrannize their exhausted parents. This leads to the heart of the matter. Today’s parents are less willing or able to do what their own parents did: set bedtime rules, stick to them, and put up with crying. Now, however, many parents are afraid to lay down the law with their kids. “Families used to be autocracies, but now we have democracies in our households,” says Dr. Lauren Bogue, a part-time instructor of pediatrics at Johns Hopkins and a pediatrician at Pavilion Pediatrics at Green Spring Station in Lutherville. “We’ve lost the distinction that there has to be somebody who’s in charge. Our job as parents it to nurture our children so they can fly and be independent, and sleep is the first thing they ought to be independent about. You have to hear crying to have it not happen anymore.” Jane agrees. “It’s gotten so namby-pamby,” she says of her own and her generation’s fear of causing psychological harm by letting children cry. She exaggerates for effect: “We’ve been so mistreated by our parents; we’re all desperately trying to overcompensate. But the bottom line is you have to be consistent and firm.” So has she attempted tough love with her daughter at bedtime? “I try now and then, until she starts crying—and then I stop.” Sleep coach Kim West’s message to parents is: You cannot “do” for your child. You cannot put your child to sleep, what you can do is help her learn to put herself to sleep. This means establishing a bedtime routine and sticking to it. Consistency is key, West emphasizes. In her new book, Good Night, Sleep Tight, West offers some tips to help your small one slumber soundly till morning:
INTO THIS SLEEPLESS FRAY HAS COME a new kind of specialist: sleep therapists who work with families to get kids to nod off with as little trauma as possible to all involved. Kim West, an Annapolis-based clinical social worker, has worked with more than 1,000 families nationwide (and some abroad) over the past nine years. Known as “The Sleep Lady” (she’s gone so far as to trademark the name), she helps parents gently teach their children how to put themselves to sleep. “I won’t promise you no tears, but I do aim for fewer tears, and I never tell you to just shut the door and let your baby bawl alone in the dark,” she writes in the introduction to her new book, Good Night, Sleep Tight (CDS, New York). This is tremendously reassuring to parents who can’t bring themselves to follow the advice of pediatricians or books that advise just letting kids cry themselves to sleep. Dr. Richard Ferber, author of the best-selling Solve Your Child’s Sleep Problems, attracts particular venom from some parents. Though his advice is in fact far more nuanced, “Ferberizing” has come to mean “putting the baby in his crib and letting him scream until he passes out.” (In fact, Dr. Ferber advocates “progressive waiting” for parents—letting children cry for set periods before going in to comfort them.) The mother of two girls West got into the sleep business after watching her brother and sister-in-law struggle with child sleep problems. “I researched and read and talked to a million people,” says West, who has a master’s degree from Simmons College in Boston and has practiced clinical social work for more than 10 years. What she came away with was a step-by-step method that she calls “The Sleep Lady Shuffle.” West stresses three main points: One: Children need an early enough bedtime. “It needs to be in sync with their circadian rhythm,” she says. Once kids get overtired, a vicious cycle starts: Their adrenal glands begin secreting the stress hormone cortisol, which makes them wired, which makes it harder for them to get to sleep and to stay asleep. Two: children need to be drowsy but awake when they get into bed. West advised parents to sit next to their children’s beds while they learn to go to sleep. The “shuffle” part of her method consists of parents’ moving their chair farther and farther away from the child’s bed every few days. “A healthy attachment means we are a secure base---an available, responsive parent, but we are not doing ‘for’ our child,” she says. That means no nursing, feeding, or rocking children to sleep. Three: Parents must decide on a consistent response to their children’s awakenings, and then really stick to it. “It’s not enough just to get bedtime right,” she says. “We need to be consistent.” West insists that parents not begin sleep training---she prefers the work “coaching”---if they are not absolutely ready to adhere to a routine. “No intermittent reinforcement,” she says. “That’s our biggest pitfall as adults, myself included.” WEST’S “SHUFFLE” SETS HER APART FROM other sleep specialist. Ferber advised parents to get the nighttime separation over with quickly, tears and all. On the other end of the spectrum, the well-known pediatrician William Sears and his wife, Martha, encourage parents to sleep with their children and disapprove of sleep advisers. “They don’t teach the baby how to sleep. They force the baby to sleep,” Dr Sears told the Wall Street Journal in December. “Babies who are forced to sleep in my opinion grow up regarding sleep as a fearful state to enter.” West takes a middle road. While she, like Ferber, believes that children must learn to put themselves to sleep, she does not urge parents to suddenly sever the cord. “What about something in between?” she asks rhetorically. What she recommends is a balance between “having no structure, no routine” and the draconian method of simply leaving children alone and letting them cry it out. West estimates that her approach has worked for 90 percent of her clients; she bases that rate on the number of parents who have said they are satisfied with how their child is sleeping. Deb and Bill Burton of Silver Spring are among West’s satisfied clients. Their son, Joshua, had been sleeping with them since he was a few months old and was year old when they contacted West this past fall. “We were afraid of the emotional suffering that we would cause by all of a sudden saying, ‘That’s it, you now have to sleep alone,’” Bill says. “We knew that we did not have the heart to Ferberize him. The sound of one’s own crying infant is enough to just tear your heart out. We wanted to minimize that to the extent possible.” Bill and Deb had “co-slept” (slept with the baby in their bed) since Joshua was about five months old, but wanted to end the arrangement when he reached a year. Because they had to lie down with Joshua every night until he was asleep, and because they were afraid to leave the room in case he rolled off the mattress, Deb and Bill were effectively held hostage in the evenings. “We were having dinner by candlelight on the bedroom floor
while he slept,” Deb says. “We knew that we lacked the discipline to do what we needed to do for Joshua,” Deb says. The first night was “awful and horrible,” Bill remembers, but he and Deb stuck to their guns. The couple---but usually Bill, because Mommy meant milk----sat by Joshua’s bed, reassuring and soothing him, and every few nights pushed their chair back a few feet. After several days, Bill moved his chair out into the hall. “I would be sitting in a chair in the other room around the corner with the door open to the nursery and my feet on an ottoman,” Bills says. “He could at least see my feet.” Within 10 days, Joshua was usually sleeping through the night. Now he’s a champ. “He usually sleeps through the night, 10 to 11 hours, sometimes 12,” Deb says. “He does occasionally wake up and fuss for a minute or so, but then puts himself back to sleep. I can’t remember the last time I went in there in the middle of the night.” Bill says they couldn’t have done it without West. “As we were going through the process, both Deb and I were suffering from extreme sleep deprivation and we were not thinking straight. To have [West] on the phone to sympathize and empathize but also to be able to think straight, to guide us through the process, was very, very helpful.” Not everyone is sold on the notion of sleep coaches, though. Jane, for instance, says she doesn’t need someone like West---in fact, she finds the concept somewhat appalling, considering how many humanitarian causes could use that money instead. “Think of the tsunami,” she says. (Sleep coaches can cost up to $300 an hour; West charges $125 for an hour-long session, though group classes conducted via telephone are less expensive. Insurance does not always pay for such consultations.) Besides, says Jane, she already knows what she needs to do; she just needs to actually do it. “I need to be more consistent,” she says. “It’s my problem, basically.” Pediatrician Dr. Travis Ganunis, also at Pavilion Pediatrics, agrees that parental follow-through is crucial. He has referred a handful of families to West, and says all of them found her useful, although not all families saw their sleep problems solved. “[With] half of them, she solved the sleep problems in a major way,” Ganunis says. “The other ones still had sleep problems, but at least the parents didn’t have as many complaints.” BUT NO WONDER PARENTS HAVE TROUBLE enforcing bedtime with their kids; after all, most adults don’t get enough sleep, either. A 2000 “Omnibus Sleep in America” poll revealed that American adults slept an average of 6 hours and 54 minutes during the work week, instead of the recommended 8 hours. “We as a country do not value our sleep,” West says. “We’re constantly run-run-running. We model that and create that in our children’s lives.” Indeed, a National Sleep Foundation (www.sleepfoundation.org)
study last year found that America’s children are frequently
sleep-deprived. Infants (3 to 11 months) should sleep 14 to 15 hours
total per 24-hour period, but are getting an average of only 12.7
hours. Toddlers (12 to 35 months) should sleep 14 to 15 hours total
per 24-hour period, but get 11.7 hours. Preschoolers (3 to 5-year-olds,
plus 6-year olds in kindergarten) should get 11 to 13 hours of sleep,
but get only 10.4. And school-age children (grades 1 through 5)
should sleep 10 to 11 hours a night; they sleep only an average
of 9.5 hours. To make life easier for parents who want to try her method, West
has broken her book down into chapters that recommend a specific
“shuffle” for different age groups. “A lot of us have been in our own individual therapy and are struggling to find how we can do less damage than our parents---or different damage,” she says, laughing. “I’m not perfect; my kids won’t be perfect. My goal is just to reduce what they’ll have to work out in therapy.”
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