Local experts debate whether it's best to pick up your infant or let him or her cry

October 18, 2012|By MEG TULLY | Special to The Herald-Mail
  • A study published in Pediatrics, the journal of the American Academy of Pediatrians, studied the emotional and behavioral impact of two sleep-training techniques on 7-month-old babies after five years. The question is whether a infant should be comforted by a parent or ignored and left to cry at bedtime.
Photo illustration by Ric Dugan/Staff Photographer

As a mother of two children younger than 2, Chancity Barnhart knows just how hard it can be for new parents to get a good night's sleep.

The Hagerstown parent had her own challenges helping her first son to sleep on his own, and plenty of her friends have turned to her as they struggle to find ways to help their babies sleep.

"Sometimes I couldn't even remember getting up and feeding them, I was so tired," Barnhart recalled.

New mothers are often asked how their babies are sleeping — and for many, even babies 6 months and older still get up multiple times a night.

A new study says that sleep training techniques can help those babies sleep better.

But the old debate on whether parents should let a baby cry on his or her own still rages, even with the new information.

"The newness is that someone actually studied it," said Dr. Paul Shuster, a Hagerstown pediatrician.

The study was published in Pediatrics, the journal of the American Academy of Pediatrics. It evaluated the emotional and behavioral impact of two sleep training techniques on 7-month-old babies after five years.

That study was in addition to studies published earlier by the same researchers, which stated the techniques were effective in helping babies learn better sleep habits in the short-term.

For Shuster, the study is interesting, but it will not change his advice to parents. He has been in practice for 19 years. As a physician at Opal Court Pediatrics, he discusses the issue several times a week with parents.

He said that the "controlled comforting" technique discussed in the study is not one he advises. Following that approach, parents put the child to sleep drowsy and then leave the room. After increasing intervals, they come in to comfort the child and then leave for a longer period of time. The baby almost always cries, but eventually learns how to fall asleep on his or her own.

Shuster said he has asked parents how they felt when they used this technique. It made them feel horrible, he said, and they thought the baby felt horrible too.

"I don't believe in letting kids scream in the dark by themselves for a protracted period of time," Shuster said. "On the other side, we don't want to send a message 'I'm going to do anything you want to get you back to sleep.'"

He tells parents to follow a bedtime routine, put the baby down drowsy and respond with patting and reassurance before the baby starts crying too hard. He tells parents not to pick up or rock the baby, and then leave when the baby has calmed down. They should return when the baby starts crying again — not follow a prescribed time, he said.

"You may be up for an hour or two doing this, but the child's not going to be alone for an hour, and there's a major difference," Shuster said.

He also doesn't like the "camping out" technique discussed in the study, which is similar but involved the parents remaining in the room with the child while he or she falls asleep. He said then the baby wakes up and is surprised that the parent is not there.

Both techniques were found to be effective in the studies, however.

Hagerstown pediatrician Dr. Vandana Sajankila has found that the techniques discussed in the study are a good way to help parents. She especially recommends the camping out technique, because it is a little gentler on the babies and parents, she said.

This is the technique that Barnhart used when she was helping her then-1-year-old son, Cruz, learn to sleep in his own bed instead of with her. As a new parent, she was too nervous to put him alone in his crib from the beginning — something she changed when she had her second son this summer.

She never really slept well when Cruz was in bed, as he took up a fair amount of space and she would stay awake worrying about him. When it came time to transition him to his crib, she set up a strict bedtime routine and would stay with him until he fell asleep. Sometimes he would cry but she just left him there as long as it wasn't very long. He learned how to fall asleep on his own, with minimal crying, and has been sleeping through the night in his toddler bed ever since.

But Barnhart said she understands the hesitations of parents who don't want to let their children cry.

"Sometimes he'll pretend he's crying and I'll just do the same exact routine," Barnhart said. "If they're crying more than 10 minutes, I just don't like that, but I will let him cry for a little bit. "

A friend of hers is struggling with the same problem, and her pediatrician suggested she let the baby cry for 15 minutes, comfort her, and try again.

"My one friend's doctor said leave them cry 15 minutes, try again. What do you do when the third 15 minutes didn't work? You just have to try something totally different," Barnhart said.

That friend ended up staying in the room with the baby until she fell asleep, and the baby girl was comforted enough by her presence that she is able to fall asleep, Barnhart said. Another friend tried letting her daughter cry, but when she started crying at the top of her lungs, she ended up bringing her back into bed with her.

Barnhart said it can be hard for parents to figure out what to do, and the only advice she's sure of is to follow a bedtime routine that will make the babies feel safe and loved.

For instance, her son looks up at stars projected on the ceiling with her, and her new three-month-old son, Colt, also has his own projector.

Sajankila, or "Dr. Van" as her patients call her, said the study makes her more confident recommending the techniques to parents for babies older than 6 months, as the five-year timeframe is a good long-term measurement for the well-being of the child's emotional development.

"Medicine is all evidence-based now," Sajan-kila said. She has been practicing for six years at The Children's Doctor, which is the largest pediatrics practice in Hagers-town, she said.

The study found that allowing babies to cry as part of a consistent, structured behavioral training technique resulted in no difference for emotional health or chronic stress levels compared to a control group.

And other studies show that following these guidelines consistently will result in a better sleeping child within two weeks — even though the first week may be exhausting for parents, Sajankila warned.

Sajankila said she does not recommend just letting the baby cry it out, because studies have shown that parents could miss medical problems affecting the baby.

Both Sajankila and Shuster recommend that parents take other steps in addition to helping babies learn how to fall asleep by themselves. For instance, they both said that older babies do not need to feed in the middle of the night, as that can disrupt sleep. They also recommend a bedtime routine like the one Barnhart uses.

And while it is a common concern, Sajankila said that babies will eventually learn how to sleep well — some just take longer than others.

"Most of the babies do learn how to sleep on their own," Sajankila said. "I have a 13-year-old son who didn't sleep for a year. I don't know what was that one-year magic, but after that, I never had a problem."

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