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Article:
The Washington Post
Tuesday, December 10, 2003
By Joanne Kenen
"Hush, Parents, Don't Cry When Lullabies Fail to Soothe Baby,
Enter the Sleep Lady"
CAt age 3, Amaya Jenkins had slept in her crib so seldom that her
parents decided to give it away. "It was brand new," said her mother,
La-Shawn Jenkins, who lives near Baltimore. "We had to blow the
dust off of it."
After her exhausted parents repeatedly left her to cry herself to
sleep, 6-month-old Catherine Lake of Ellicott City became hysterical
when anyone tried to get her near her room, even in broad day light.
Her mother, Tisha, said the child would sleep only in her-the mother's-bed.
My husband, Ken, and I understand these parents' frustration. Approaching
his second birthday, our own son, Ilan, was a sunny smiling easy
baby, except at 12, 2, 4 and 6 a.m., when he awoke screaming, no
matter what we tried. Clearly, this couldn't go on. That it didn't,
we owe to Kimble-Leigh West, the "Sleep Lady" of Severna Park.
A clinical social worker with a practice near Annapolis, the 38-year-old
West has developed an unusual specialty, giving several hundred
sleepy parents and sleepless babies a gentler alternative to the
"cry it out" approach popularized by Richard Ferber, the Boston
Children's Hospital sleep expert. She doesn't promise a tear-free
transition to good sleep. But for parents emotionally or philosophically
opposed to "Ferberizing" their babies, as well as for parents who
have tried Ferber's technique and failed, West's "fewer tears" attitude
is a relief.
"I am not going to suggest that you just close the door and let
your child scream," she reassures new clients, who pay several hundred
dollars each for her individualized plans. "I would never suggest
anything that would make you feel like a horrible parent."
Instead West, who has two children of her own, coaches clients on
how to help their babies and toddlers become more adept at self-soothing
and putting themselves to sleep and how to give the tykes confidence
that their parents are still nearby, attentive and responsive, even
when they are out of sight.
And while some skeptics might wonder how parents too tenderhearted
to hear their kids cry are going to weather the next 18 years or
so of child-rearing crises, West enthusiasts would likely answer:
On a full night's sleep.
Sleep researchers estimate about 20 to 25 percent of children under
age 5, have sleep difficulties. In some cases, there are physical
causes such as apnea (a breathing disorder) or digestive problems.
Sometimes too, there are emotional issues-anxiety or separation
problems that go deeper than run-of-the-mill nightmares or monster-under-the-bed
fears.
But often, according to Ferber and other experts in the field, the
children just never learned to put themselves to sleep alone in
their cribs.
"The need for sleep is biological, but the ability to sleep is learned,"
says Rafael Pelayo, director of pediatric sleep services at the
Lucille Packard Children's Hospital at Stanford University and a
member of National Institutes of Health sleep research advisory
board. "With babies, it's a learning issue, not a discipline issue."
Since the mid-'80's, pediatricians have recommended "Ferberizing,"
in which a baby is left alone to cry while the parent briefly reassures
the infant at regular, but less and less frequent intervals. The
theory is that if a child learns to fall asleep on his own, without
being rocked, nursed, stroked or serenaded, he will be able to go
back to sleep on his own during the brief awakenings that almost
everyone experiences every night and scarcely remembers the next
morning.
Hard Lessons
Sleep researchers have shown that "Ferberizing" usually works, according
to Jodi Mindell, associate director of the sleep clinic at Children's
Hospital of Philadelphia. What may work still better, according
to some studies, is a tactic known as "extinction"-basically, letting
the child cry and making no parental checks. But many parents, say
researchers, can't turn off their ears and heartstrings long enough
to tolerate it.
Whatever the reason, neither method works all the time. "It's not
one-size-fits-all," Mindell says. That leaves room, she says, for
alternative approaches such as West's. Pelayo agrees that gradual
techniques like West's are often effective. "The question is," he
says, "what are the parents comfortable with?"
Life Line
West accepts only four or five families at a time as clients. She
works with each intensively, starting with a detailed sleep history
and a 90-minute office consultation. Where separation issues are
pronounced, West says, some clients may get partial insurance reimbursement.
Follow-up involves 10 to 15-minute telephone calls almost every
morning for the first week, several days a week for another two
or three weeks and an occasional e-mail for three months.
Many clients say those morning phone calls- part pep talk, part
fine-tuning- are what helped them stick with the program, especially
in the first draining days.
"Having Kim call every morning was invaluable," said Cara O'Connor
of Washington, who consulted West about her daughter Caitlyn Shirvinski
when the child was 11 months old. "You could rehash the night before,
talk about what adjustments you need to make, whether it was great
or whether you caved and did something you probably shouldn't have."
 West's
plans generally involve having the parent start out sitting next
to the bed or crib and stroking or soothing the child without picking
the baby up. The parent can make calming "night-night" sounds, but
does not converse. Every three days the mother or father moves a
little farther away, until the parent is sitting right outside the
bedroom door, dimly lit and still in the child's view. Then the
parent moves out of sight but still in earshot. Finally the parent
is ready to leave the child for five-minute intervals, after telling
the baby where she will be and what she will be doing.
"I wasn't just leaving my child in a dark room by herself to cry,"
said Pam Brooker, a Towson-area resident who consulted West last
spring about her then 7-month-old daughter, Anna. "It helped me
to be able to be in there and soothe her."
Nighttime awakenings taper off once the child learns to go to bed
independently. Nighttime nursing schedules are adjusted or eliminated
depending on the infant's size, age and nutritional needs.
Each case is a little different, though. Tisha Lake for instance,
spent two weeks just reintroducing Catherine to her dreaded room,
putting in new toys and books before she tackled the sleep problem.
She slept in Catherine's room for a few days to ease the transition.
Amaya Jenkins has cystic fibrosis, and the choking and gagging characteristics
of the disease affected her parents' willingness to leave her unattended.
But West developed a routine that addressed the parents' anxiety
about Amaya's health and still got the child happily sleeping in
her "big girl" bed on her own and through the night in about two
weeks.
Firetrucks and Night-Night
Ken and I first saw West in late August. Ilan was almost 2 and we
were going through bedtime contortions involving tapes, books, big
beds, small beds, rocking chairs, back rubbing, head-stroking and
hand-holding. It was hard to get him to sleep in his crib once he
awoke, and he awoke almost every night, repeatedly. We usually surrendered
and brought him into our bed, and while there is nothing sweeter
than a little head of soft blonde curls tucked next to my own cheek,
he was not a peaceful sleeper, even with us.
While Ilan retained his cheerfulness, my husband and I were losing
ours. I was always grateful that somehow, as a seriously sleep-deprived
working mother of two, I had managed to stumble through another
day without falling asleep at the wheel, setting my house on fire
or nodding off too conspicuously at a Capitol Hill press conference.
Even for someone whose livelihood involves tracking down information,
finding help wasn't easy. I surfed the Web, scoured Montgomery County
libraries, ordered books off Amazon, quizzed pediatricians and therapists,
phoned all of the sleep clinics in Washington and surrounding counties
in Virginia and Maryland, only to be told that they did not treat
very young children or they only treated children with sleep difficulties
arising from breathing disorders. One day, Angela Gadsby, a Maryland
pediatrician I know socially, mentioned Kim West. "I send about
five families a year to see her," she told me, "They all sleep."
I suspected, and West agreed, that Ilan's sleep problems were an
outgrowth of his reflux, a digestive disorder common in infants.
He had outgrown the reflux but hadn't broken his poor sleep patterns.
Although he was young to switch from a crib to a bed, we knew he
hated anything with bars. So we put a gate on the door, a mattress
on the floor, found some glorious red firetruck sheets and made
a huge deal about his new firetruck bed. Thrilled, he accepted the
change and brought along several stuffed animal friends who he thought
would like the firetruck bed, too.
With West's help, we tweaked his evening rituals. We began putting
him to bed earlier after West helped us recognize his "sleep window"-
the natural wind-down before that lethal second wind of toddler
energy kicks in. If my son rubs his eyes and asks for his special
songs, I now know to get the bedtime routine moving quickly. If
he starts leaping up and down shouting, "I jump on bed like monkey,
Mommy!" I know I miscalculated.
I adapted a song he liked by tagging on a verse about firetruck
beds, love and night-night, and sang it each night. He protested
each time I moved the rocking chair farther away, but it was nothing
either of us couldn't handle. By the time I left the room the first
few nights, he was asleep. Then we had a few nights of tears until
I realized that, while he resented my leaving him for work or household
tasks, he was perfectly ready to share me with his big brother.
"Go Zachy homework," he now says as I prepare to leave his room.
"Ilan night-night."
We've had delaying tactics, but within normal 2-year old realms.
One week he came up with a series of pressing errands: "I fly kite."
"I get e-mails." "I make coffee." But mostly he'll just lie down
when told. We still have some bad nights and too-early mornings,
but his sleep has improved significantly.
West reports some failures, but not many. She estimates that fewer
than one in twenty cases show no progress, usually because of such
complicating factors as marital problems, a physical disorder that
had not been detected or an otherwise competent parent or caretaker
who can't or won't get with the sleep program. But for the most
part, patients speak about West with awe.
"I absolutely have my life back," said LaShawn Jenkins, who was
convinced that Amaya's illness would stymie West. "Our life does
not revolve around getting our baby to sleep. We can talk about
things other than what an awful night it was."
Joanne Kenen is a Washington-area writer.
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