Pillow Talk

By Paul M. Fleiss
Issue 96, September/October 1999

Little boy asleepThe subject of child sleep is of interest not only to parents but also to scientists. Entire medical conferences are organized around the fascinating subject of sleep. Medical journals regularly publish the latest scientific data on child sleep. Unfortunately, not all “scientific” studies on sleep are correct, and not all self-appointed sleep experts give accurate, child-nurturing information. Too often, cultural biases regarding sleep predominate over genuine biological facts.

Many of the so-called “sleep problems” that parents report in their children are actually the result of rigid and unreasonable expectations that are based on unnatural and unrealistic myths about how children are supposed to be. The incorrect advice on sleep that is found in so many childcare books is based on such expectations.

Babies, however, cannot be tricked into yielding to unreasonable expectations. The baby’s refusal to cooperate with feeding schedules and rigid “training” indicates that these expectations are unnatural and don’t meet the baby’s biological needs. There are several mistakes that parents commonly make in the attempt to help their child sleep. Many childcare books, including new titles, recommend these things. They fall under the category of “Don’ts”.

DON’TS
1. Don’t ignore your children’s cries. After all, they may be sick, in danger, or in pain. Babies and young children are emotional rather than rational creatures. They can’t comprehend why their cries for help are being ignored. Even with the best of intentions, ignoring children leads them to feel abandoned. The result will be insecure, unhappy children. You cannot “spoil” children by responding to their cries. “Spoiled” children are those who don’t know what to expect from their parents. They are often alternately punished or praised for the same activity at different times.

Infants cry for a reason. We may not always know what the reason is, and we may not always be able to solve the problem, but we can always try. If a baby cries at night, it may be because he or she is hungry, thirsty, sick, uncomfortable, agitated, lonely, or frightened by a nightmare. Whatever the problem, the fact that the babies cry indicates that they are unable to solve their problem alone and require the assistance of their parents.

Expecting babies or young children to “self-soothe” is unreasonable. Responding to children’s cries, comforting them, and trying to help them overcome whatever it is that is bothering them is not only effective, it is the only proper way to help them fall asleep.

2. Don’t let children “cry it out”. Many best-selling childcare books actually instruct parents to let children cry themselves to sleep, suggesting that this will teach children how to “self-soothe”. Wiser parents and doctors find this an unacceptable and self-defeating practice. While babies may learn to cry themselves to sleep, this practice also seems to have the undesirable effect of teaching babies that they cannot trust their parents to respond to their needs. It also inculcates low self-esteem. Children who cannot trust their parents are emotionally unbalanced. They are abandoned children. To some degree, they will be psychologically impaired and may manifest this by being clingy, needy, whiny, and demanding. Even though it is in direct contradiction to the unfortunate advice given to parents in the 1950s and 1960s, the best way to help your children become secure, independent, and emotionally balanced people is to respond to their needs rapidly, intelligently, and with care.

If you believe your child is crying simply because he or she is fussy rather than because of a “genuine problem”, carefully evaluate why your child might be fussy. Eliminate from your child’s day stressful things that induce fussiness. If your child sleeps alone, lie down and stay with your child until he or she is asleep. Your presence will be reassuring and calming.

3. Don’t expect your infant to sleep through the night. Any sort of “training” to make babies sleep through the night is unnatural and possibly dangerous. Infants are biologically required to feed several times during the night. They do not and should not engage in adult sleeping patterns. Infants should be expected to sleep lightly for several short periods throughout the night. Older children, however, will generally sleep through the night without any “training”.

4. Don’t give children drugs of any kind. Never give children Phenobarbital, Valium, or other sleep-inducing medications. These brain-altering chemicals are dangerous on their own and can quickly become addictive.

5. Don’t give your children alcohol in any form or quantity. Some misinformed parents mistakenly give their infants and children small amounts of bourbon, whiskey, scotch, gin, beer, or wine, thinking that this is an acceptable method to induce sleep. Other parents apply small amounts of alcohol to the gums while babies are teething. Alcohol will not help children sleep but rather will result in restlessness and agitation. Alcohol is inappropriate and unacceptable for infants and children.

6. Don’t watch television just before going to sleep. Infants and children are fully drawn into the fantasy and chaos of television programs in a way that adults cannot appreciate. Children are unable to distinguish between reality and fantasy as presented on television. As a result, they may outwardly appear calm but inside may be very agitated and emotionally distraught. Even seemingly calm and happy television programs can have the same effect.

7. Don’t play computer games before going to sleep.

8. Don’t fight just before going to sleep. Do not fight with your children and don’t fight with anyone else in the house. Being emotional creatures, children are far more affected by the negative emotions aroused by conflicts than adults. Adults may brood longer, but children are more deeply affected by emotional disturbances.

If you find that you regularly have to battle with your child to get him or her to go to bed, you will already have learned that battling does not help. Rationally determine why your child resists going to bed. Is it because your child is simply not sleepy at the prescribed bedtime? Is it because you have neglected to provide your child with pleasant bedtime rituals?

9. Don’t feed your children right before putting them to sleep. Food requires time to digest. While sleeping, however, digestion does not progress in the same way it does when we are awake. It slows and even stops. The result is gas, cramps, and stomach pain. None of these conditions induce a restful sleep. We should not, however, confuse eating with breastfeeding. Breastfeeding promotes sleep. Infants and young children who are still nursing should be allowed to nurse as often as they want.

10. Don’t “train” your child to sleep by regulating feeding times. When in good health, a baby will signal when he or she needs to feed. Feeding should never be governed by a time schedule. The idea, currently promoted by some childcare book authors, that babies can be “trained” to “sleep through the night” by restricting, regulating, and managing feeding is unrealistic and cruel. When an infant wants to feed, it is because his or her body requires nourishment. Depriving an infant of nourishment when he or she needs it is, frankly speaking, abusive. Even the American Academy of Pediatrics is very worried by the rise of so-called “parent-directed” feeding schemes as alleged methods of “training” infants and children to sleep through the night.

A newborn breastfed infant will usually want to nurse every one to three hours. There may sometimes be one stretch in 24 hours where he or she might go five to six hours before wanting to feed. Remember that breastfeeding is much more than feeding: Infants may be hungry, thirsty, frightened, loving, dreaming, or sick when they want to be placed at their mother’s breast. They may be there a long time or sometimes for just a quick little kiss on the nipple. Whatever the reason, they should never be denied access to it.

Infants and children cannot be “trained” to sleep. They should not be treated as if they were circus animals. Infants and children have differing sleep needs and sleep patterns. They both require the safety, security, and emotional sanctuary of responsible parents, and also frequent nursing. Not all infants are alike, however, and the amount of nursing that your infant needs cannot, therefore, be precisely predicted or regulated. There is an association between nursing and sleeping, but only insofar as an infant will sleep best if he or she is assured of a constant supply of mother’s milk. Sleeping with your infant so that he or she is close to the mother’s breast is the ideal way of ensuring that the baby gets the optimal amount of sleep.

Positive Bedtime Rituals for Optimal Sleep

Sleep problems are usually caused by unrealistic expectations of parents. They may also be caused by a lack of soothing, pleasant, and reassuring bedtime rituals. Bedtime should be one of the most enjoyable parts of your child’s day. Effective rituals calm the mind and relax the body. They strengthen the bond between parent and child and thereby strengthen the family unit. If your child is having trouble falling asleep or is troubled by waking up during the night, incorporate some or all of the following bedtime rituals into his or her daily routine.

1. Lullabies. Lull your child to sleep with soothing music. A lullaby ritual is a proven way of helping babies and children to fall asleep. Parents have been singing their children to sleep since the dawn of time. Even animals lull their offspring to sleep with special vocalizations. The deep purr of the mother cat has the effect of lulling her kittens to sleep. It may be, therefore, analogous to the lullaby of humans.

Music affects the deepest structures in the human brain. Therefore, the choice of music is important. Babies respond best to soothing, quiet classical melodies — Mozart, Brahms, or Debussy. Soft classical music has the effect of focusing the attention and inducing a deep state of relaxation and calm. Bach composed his famous Goldberg Variations for this very purpose. If you are a pianist, you may even want to try playing a few relaxing pieces at bedtime.

Children are naturally musical and will have no hesitation in revealing their favorite bedtime songs. Many children will prefer to sing to their parents. The soothing effect of music, especially that produced by the human voice, is ideal for lulling your child to sleep.

2. Bedtime stories, tales, and poems. Reading or telling stories and poems to your children while they are curled up in bed is another important and effective way of inducing sleep. Reading to your baby and child has long-term benefits as well. Children whose parents read to them grow up to be adults who read. Naturally, scary tales or stories that might agitate your child are best avoided at bedtime.

As with music, children have favorite stories and poems. While it is good for parents to introduce new stories and poems, many children seek the comfort of an old favorite. The child’s mind seems to take comfort in repetition.

3. Daily exercise. A good night’s sleep is the culmination of a day’s activities. Therefore, what the child did (or did not do) during the day will affect how he or she sleeps. One simple and beneficial way to ensure a good night’s sleep is to make certain that your child gets adequate exercise every day, preferably in the morning or afternoon. One is never too young or too old for healthy exercise, and the best form of exercise is walking. Playing outdoors is also a good form of exercise. Take your child for a good walk every day.

4. Sunshine. Exposure to morning sunshine is said to trigger brain chemicals into establishing the normal diurnal cycle. Try taking your child on a morning walk in the sun for a restful night’s sleep.

5. Adequate magnesium in the diet. A nutritious diet is necessary at all times and for every reason imaginable, but it’s especially important for healthful sleep. Magnesium has been called “nature’s muscle relaxant”. The best sources of magnesium are green leafy vegetables, salad, and “green foods”, such as the various algae and seaweed products now available. A green drink or a fresh green salad for mother in the evening when she’s breastfeeding will help impart to nursing babies the magnesium and other nutrients babies need for healthful sleep. Weaned and weaning children also benefit from a diet rich in salads and other green things.

6. Chamomile tea. A warm cup of chamomile tea is a time-tested remedy for sleeplessness that really does work. Taken without any sweeteners, a small, soothing cup or even just a few sips of chamomile tea will help both mother and child relax. It is very important to mention, however, that black tea and Japanese green tea contain caffeine and should be avoided.

I don’t recommend hot milk or hot cocoa at bedtime. The commercially available hot cocoas on the market today are filled with chemicals, sugar, and additives. Even by itself, cocoa is loaded with drugs such as theobromine, a xanthine compound similar to caffeine. Such substances are not helpful at bedtime. While infants thrive on mother’s milk, and generally fall asleep after nursing, hot cow’s milk before bed is not the same thing, especially for older children.

While a glass of warm milk is often recommended at bedtime, it’s not advisable even though it contains Tryptophan (an amino acid with tranquilizing or sedative effects). Milk may be a possible source of allergy and increased respiratory mucus, which can cause a stuffy nose and restlessness. Additionally, cow’s milk requires prolonged digestion and is, therefore, not compatible with restful sleep.

7. A warm bath before bed. A nice warm bath (or shower) before bedtime is a delightful, relaxing, and healthful way of inducing sleep for children as well as adults. A nightly bath soothes the body, cleans the skin, invigorates the respiratory system, and relaxes the mind. Try adding a few drops of lavender oil to the bath. The rich aroma will induce deep and restful sleep.

I always advise parents to avoid giving their children bubble baths. Bubble baths irritate and dry the skin and may also irritate the urinary tract and thus increase the need to urinate, further disturbing sleep.

8. Bedtime attire. Changing out of one’s clothes and into special attire (or no attire) for bed is an effective ritual for focusing the mind and inducing sleep. It is most likely unimportant whether your child sleeps in a nightshirt, pajamas, or in the nude. Weather conditions will determine what form of attire, if any, is best at any given time of the year. It is important only that your child does not sleep in his or her clothes. Sleeping in clothes is not only unsanitary and unhealthy, it also deprives a child of the psychological benefits to be gained by establishing a clear demarcation between wakefulness and sleep.

9. Ventilation. Be sure that the room in which your child sleeps has adequate ventilation. A stuffy, overheated room is unhealthy and not conducive to restful sleep. If it is hot and dry inside but cold and wet outside, the result may be a stuffy nose and the inevitable difficult sleep patterns this brings. Our need for fresh air is just as strong during the night. The old-fashioned screened sleeping porches of older houses were a rational and beneficial answer to the need for fresh air at night during good weather.

10. Massage. Humans thrive on touch. Sadly, it’s been shown that, if deprived of skin-to-skin contact, babies may become sick and die. We never outgrow our need for human touch, and it is especially important for infants and children. Massaging, stroking, patting, or even just running your fingers through your child’s hair tells your child at the deepest level that he or she is loved and safe. Gently massaging your child as he or she lies in bed is a lovely way to strengthen the bond with your child. Massage is also a perfect way to relax your child’s body and mind. A back rub with a few drops of lavender-scented oil is a great way to end your child’s day.

11. Planning for tomorrow. As your children lie in bed, quietly make plans with them for the next day’s activities. Reinforce the idea that tomorrow will be a good day.

It does not really matter what you say at this special time before sleep, as long as your words are positive, supportive, and loving. The underlying message is that you love your children and that they are important to you. No matter how old they are, your children will hear this underlying message. These reassurances are vital to your children’s emotional well-being. Frequent reminders of your love will help them to become secure, balanced, self-assured, and confident.

12. Physical affection. Touch, hold, cuddle, kiss, and hug your child before saying “good night”. These classical physical demonstrations of a parent’s love for a child are enormously important. It is also important that parents overcome their inhibitions in this area. Children need physical affection and bodily contact with their parents and other adults for their mental health and inner security.

It’s especially important for fathers to lavish uninhibited physical affection on their sons. Roughhousing isn’t enough. Boys particularly need comforting body contact and generous displays of physical affection from their fathers. Holding, hugging, kissing, and massaging your child is as beneficial to the parent as it is to the child. While physical affection should not be limited to bedtime, bedtime is an ideal time for this healthy contact.

13. Cosleeping. For most of human history and in most human societies today, parents sleep with their children. This is not because they do not know any better or because their economic circumstances prevent them from having separate beds. Sleeping with your child is simply the most effective way of helping your child get a good night’s sleep. It strengthens the bond of love and safety between caregiver and child. It’s also important in helping your child to develop into a loving, balanced, self-confident, self-reliant person.

Researcher James J. McKenna, professor of anthropology and director of the University of Notre Dame’s distinguished Mother-Baby Behavioral Sleep Laboratory, has confirmed the importance of cosleeping in his many studies and publications. Professor McKenna cites important medical research that demonstrates that adults who coslept with their parents during their childhood are more likely to be more secure, have greater self-esteem, and be more independent.

Some doctors claim that cosleeping increases the risk of sudden infant death syndrome (SIDS). What they fail to mention is that, according to the study that yielded this controversial finding, there was a slight increase in SIDS only for babies whose mothers smoked. Mothers who go to bed drunk or intoxicated by narcotics are also hazards to their child’s health. Clearly, the real problem in such circumstances is irresponsible parents. Cosleeping itself isn’t the problem. Objective studies consistently show that as long as the parent is a responsible nonsmoker, as long as the mattress is not too soft, and as long as the baby sleeps on its back, cosleeping isn’t only perfectly safe but safer than forcing the infant to sleep alone.

Babies are simply too little to sleep alone. Babies should, therefore, sleep beside their mother. Additionally, sleeping has the interesting effect of regulating the infant’s breathing patterns and body temperature in a healthy way. It permits the child to enjoy the security and comfort of body contact with its mother throughout the night and to breastfeed whenever he or she needs to, without crying.

If you find that you’re uncomfortable about having your child sleep in your bed, you should examine your own feelings carefully. Depriving your child of the security and reassurance of sleeping with a responsible adult is not an appropriate response to this anxiety.

If your child needs the security and comfort of cosleeping, support that need and find a loving and compassionate way to meet it. You will find that sleeping with your child is as natural and as simple as I have described it. It may be hard for you at first, but you will find that sleeping with your child is comfortable and reassuring for you as well. Not only will you have the security of knowing that your infant or child is safe, but your child will also know it and will be much less likely to cry during the night.

I should mention that not all children want to cosleep. Even those children who do express a need to cosleep, generally only do so for a few years. Often around age six or seven, children may express a desire to sleep by themselves. This desire should be supported lovingly.On occasion, older children may express the need to sleep with their parents or another responsible caregiver, such as a grandparent or an older sibling. This desire should also be lovingly supported. McKenna cites authoritative studies which show that boys who coslept between the ages of six and 11 had higher self-esteem than boys who did not. Cosleeping fosters a more independent, confident, and intimate adult with higher self-esteem. Since one of the goals of good parenting is to foster these positive qualities, cosleeping is obviously one of the best and easiest ways to achieve this goal.

By meeting the emotional and physical needs of your child in an intelligent and compassionate manner, you will provide your child with the security he or she needs to get a peaceful night’s sleep. By avoiding the things that hinder healthful sleep and by actively promoting and enjoying the things that foster restful sleep, you’ll fortify your child’s emotional well-being. You will also strengthen the bond between you and your child and thereby strengthen the family as a whole.

For More Information
Brooke, H., et al. “Case-Control Study of Sudden Infant Death Syndrome in Scotland, 1992-5″. British Medical Journal 314 (1997): 1516-1520.

Jackson, Deborah. Three in a Bed: The Benefits of Sleeping with Your Baby. Great Britain: Bloomsbury, 1999.

Lewis, R. J., and L. H. Janda. “The Relationship between Adult Sexual Adjustment and Childhood Experiences Regarding Exposure to Nudity, Sleeping in the Parental Bed, and Parental Attitudes Toward Sexuality.” Archives of Sexual Behavior 17 (1988): 349-362.

Liedloff, Jean. The Continuum Concept. New York: Penguin, 1986.

McKenna, James J. “Cultural Influences on Infant and Childhood Sleep Biology, and the Science That Studies It: Toward a More Inclusive Paradigm.” In: J. Loughlin, C. Marcus, J. Carroll, eds. Sleep in Development and Pediatrics. New York: Marcel Dakker, 1999.

McKenna, J. J., et al. “Bedsharing Promotes Breastfeeding.” Pediatrics 100 (1997): 214-219.

McKenna, J. J., et al. “Sleep and Arousal Patterns of Co-Sleeping Human Mother/Infant Pairs: A Preliminary Physiological Study with Implications for the Study of Sudden Infant Death Syndrome (SIDS).” American Journal of Physical Anthropology 83 (1990): 331-347.

McKenna, J. J., and S. S. Mosko. “Sleep and Arousal, Synchrony and Independence, among Mothers and Infants Sleeping Apart and Together (Same Bed): An Experiment in Evolutionary Medicine.” Acta Paediatrica (Supplement) 397 (1994): 94-102.

Sears, William, MD, and Martha Sears, RN. The Baby Book: Everything You Need to Know about Your Baby – From Birth to Age Two. Boston: Little, Brown and Company, 1993.

Sears, William, MD. Nighttime Parenting. Franklin Park, IL: La Leche League, 1984.

Small, Meredith. Our Babies, Ourselves: How Biology and Culture Shape the Way We Parent. New York: Anchor Books, 1998.

Thevenin, Tine. The Family Bed: An Age-Old Concept in Child-Rearing. Garden City Park, NY: Avery, 1987.

Also see the following articles in past issues of Mothering:

“Sleep with Me”, no. 91;
” The Truth About Nightwaking”, no. 76;
” Tossing and Turning over ‘Crying It Out’”, no. 74;
” That Family Bed…Shhh!” no. 53, and
” An Informal Sleep Survey”, no. 35.

Paul M. Fleiss, MD, MPH, is assistant clinical professor of pediatrics at the University of Southern California Medical Center and is in private pediatric practice in Los Angeles, California. He is the author of numerous scientific articles published in leading national and international medical journals.

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