Dr Pamela Douglas – Medical Director
Are you looking for help with your baby or toddler’s sleep that is not sleep training? As we move through this year of drought, bush-fire, and COVID 19 on into the challenge of the 2020s, increasing numbers of parents are making a decision to avoid conventional sleep training methods.
This could be because they have tried sleep training and have decided it doesn’t work for their family. Experimenting is a great parenting strength and it makes sense that many of us experiment with what still remains the dominant approach to infant sleep.
Or it could be that parents have decided that sleep training doesn’t align with their parenting values. These values are unique to each parent and each family – and it is important to never judge another family’s decisions, since everyone wants to do the right thing by their child.
Some parents may even be aware that, despite many studies evaluating sleep training approaches internationally over the past two or three decades, the best, high level evidence tells us that sleep training actually doesn’t decrease the frequency of night waking in the first year of life.
Sleep training is a short-hand phrase for programs that combine some or many of the strategies which I’ve listed in Box 1. Technically, these programs arise out of the first wave of behaviourism, a school of psychology which swept around the world in the 1950s and 1960s and was popularised in ‘Scientific Mothering’. (Behaviourism is now into its third wave, and third wave behavioural strategies, known as Acceptance and Commitment Therapy, are integrated into the Possums Baby and Toddler Sleep Program.) In 1974, I was taught these sleep training principles of baby care in my compulsory Mothercraft classes in a Queensland high school. The boys got to do woodwork, lucky things! We girls had to draw clocks displaying feed-play-sleep cycles and memorise handouts with truisms like:
“Routine is good for the baby because …. good habits are formed which will last him all his life …. His nervous system develops best in calm, unchanging surroundings. … So much sleep is needed because his body is growing quickly and his brain is developing very fast and his nervous system develops best when he is asleep.” [Maternal and Child Welfare Service, Queensland, 1974]
Remember, this was well before evidence-based practice was a thing! In 2020, the research does not support these old-fashioned claims, despite what you might still hear.
I don’t believe sleep training harms babies and toddlers, but I do know for sure, from decades of work in the clinic, that sleep training often makes life a lot harder than it needs to be for families. There will always be families for whom sleep training works – often these are families with a high sleep need infant, in fact, for whom any approach seems to work easily. But sleep training can result in disrupted sleep patterns at night, not immediately but a few weeks down the track, due to disruption of the circadian clock. This happens gradually when the primary carer is advised to focus on trying to get good long blocks of sleep during the day, or on putting the baby down to sleep very early in the evening.
Baby and toddler sleep needs are incredibly biologically variable. The amount of sleep a baby or toddler needs will vary with their own unique genetic inheritance, and with their developmental stage, since sleep needs shrink as our baby or toddler grows. We can’t ‘teach’ our little ones to sleep, despite what you hear – that’s like saying we ‘teach’ them to digest milk or to sweat or to make urine! Sleep is under the control of the two biological sleep regulators, the circadian clock and the sleep-wake homeostat (or ‘sleep pressure’). All we can do is to keep these regulators functioning in a healthy way, so that the baby’s sleep patterns align as closely as possible with adult sleep needs. The Possums Sleep Program was the first to work with knowledge about human sleep regulators to create an intervention that improves infant sleep patterns.
In the Possums or NDC Sleep Program we never give estimates of how much sleep an infant needs. We also never give estimates of how long a baby should be awake for during the day before napping. We never give lists of ‘tired cues’. Only you know how to interpret your little one’s cues, as you experiment your way through – and often what is interpreted as the baby grizzling or crying due to tiredness during the day is actually due to the baby hungering for richer experience across all the senses. Inside the home, babies and toddlers quickly dial up just because they need much more complex sensory stimulation. They become bored, even from very early in life. Parents typically report that as soon as they step outside the house into the wonderfully varied sensory adventures of the external world, their little one dials down. This might be simply stepping out onto the deck or into the back-yard or the street. It may be visiting the shops or your friend’s interesting new lounge-room or parents’ groups, it may spending time in a café or any busy social or workplace context. Walking or playing in the park and creating opportunities to explore the natural world are especially good for our little ones’ development, from very early on!
These concepts of sensory hunger and the baby’s ‘dial’ are unique to the Possums Sleep Program. We explain that in the first six months of your baby’s life, you have two tools to experiment with as you dial down your baby and make the days as easy and the nights as manageable as possible: milk, and sensory nourishment.
I first began working as a GP with parents who had babies and small children in 1987. In 1994 I qualified as a lactation consultant, and I’ve seen many breastfeeding women and their families over the decades. All my working life I’ve had parents tell me they wake to their baby every 40 minutes or more throughout the night, enduring horrendous sleep deprivation. Often this was (and still is) erroneously attributed to medical conditions, or to breastfeeding itself.
Parents had only two options before I began to develop up the Possums Sleep Program: either you were reassured that night waking was normal and you had to put up with it, even when it was extreme, or you used sleep training methods. Yet I could see, from both my experience with families in the clinic and also when I looked closely at the research, that there was a difference between excessive night waking and what was developmentally normal amounts of night waking in our babies. Every couple of hours or so throughout the first year or more of life, with everyone returning quickly to sleep, is biologically normal, and usually manageable for parents – even if it still feels tough at times.
I could also see from the 2000s that the research was showing us that ‘environmental enrichment’ is best for infant developmental outcomes. This includes sensory experience and also many loving to-and-fro social interactions over time. I could see that there was no place for the old-fashioned concept of ‘overstimulation’.
If you need sleep help and don’t wish to use sleep training approaches, we have the following available:
Access to a lively and non-judgemental online community of support (AU $55 for both the sleep program and PIPPS parent support membership)
Group sessions (also known as ‘shared medical appointments’) on baby sleep for Medicare-eligible parents and babies
F2F consultation with an NDC provider near you
Free community room meetings weekly
Videos for strategies which powerfully protect your mental health during the perinatal period
Loads of YouTube videos, including on baby and toddler sleep at NDC Baby and Toddler TV
At Possums, we are passionate about growing joy in early life! You are the expert on your baby or toddler and only you will know what is right for your precious family – but we are proud to lead the way in offering you the original genuinely evidence-based alternative to manageable nights, which doesn’t let your baby cry.
Sleep training or first wave behavioural strategies
‘Sleep breeds sleep’
Lists of tired cues
Don’t let baby be awake for more than a certain amount of time during day depending on age
First tired sign put baby down
Try to get second sleep cycle in day-time naps
Teach baby to self-settle
- Put baby down in cot drowsy but awake
- Delay responses to grizzly behaviour
- Develop positive sleep associations with cot and other comforting items
Avoid teaching baby bad habits
- Don’t let baby go to sleep with breast or bottle
- Don’t let baby go to sleep in arms
Put baby to bed early in evening