Wednesday, May 31, 2006

The Hard Line on Sleep

Two reviews appeared in Slate today on the new and revised edition of Richard Ferber's Solve Your Child's Sleep Problems. (You can read them here and here).

Now I haven't read this book and happily fall into the class of parents that doesn't need to. But in reading the reviews it occurred to me that we had pretty much taken the Ferber line with our babies anyway. That line is this: let them cry. The book is then about various strategies for parents to use to achieve this. As one reviewer, Emily Bazelon, wrote: "his parenting book is read and reread in our house, because we rely on Ferber for backbone." She goes on:

Ferber's method rests upon the sensible idea that children have to learn to go to sleep by themselves. To do that, they need a set of "sleep associations" that don't require your presence, which means at bedtime no nursing, rocking, back rubbing, or singing to your baby. Ferber provides a vivid analogy for adults: "Think again about having to sleep without your pillow," he writes. "You would no doubt curse your bad back and your doctor vehemently. … The only way you would learn to fall asleep without your pillow would be to actually practice doing so." So it also goes for a baby who since birth has been nursed to sleep and is now going off the boob. She needs to practice and that means some crying—and not crying followed by a guilt-ridden rush to make the wailing stop. When parents cave, "their child only learns that he must cry longer to get what he wants." According to Ferber, your impulse to give unconditional comfort is misguided, and maybe you'll even be able to conquer it. "Once you understand that your child's need is simply to learn a new way to fall asleep (whether it is what he wants or not) it is easier for you to see that this need is met," Ferber says.

This highlights the issue. The theory is simple: if you make a big deal about bedtime and associate it with things that require your attention then that is what will happen. Bedtime is a first hit at independence and, of course, it is a rare baby that doesn't react to that very fact. After all, from their perspective they are the centre of the universe and everything else about their lives at the time is reinforcing that belief.

It is implementation that is hard. This is especially the case for first time parents. And what you need to do it is support.

That is what happened to us. Our first child spent the first six weeks of her life not sleeping. We were getting four hour breaks at best. I was hallicinating. (I saw a horse running on the freeway and still remember it vividly!) We took her over to a friend's place. They had more children. We put her down and they stopped us from going in. 30 minutes later she was asleep.

That night we implemented the hard line. Through the baby monitor was screaming. My partner said that she "couldn't stand listening to it any more." So I went to the monitor and turned it off. "Problem solved." 10 minutes later we determined with our ears to the door she was asleep. 4 hours later we didn't get her. She screamed and then went back to sleep. 8 hours later we woke up, panicked, ran to her room and she was lying there happily smiling at us.

We never had another problem night from her again. And when I say never, I mean never. She would go down at 6:30 and stay there until 6:30am. 12 hours per night without fail. Now it wasn't just the hard line that allowed this but also the fact that we made sure she wasn't hungry by engaging in a 'feeding frenzy' between 4pm and 6pm. But with that mix we definitely got results.

So how did all this knowledge translate to our second child. There, it was a hard line pretty much from the start. And the result was 8+ hours sleeps at night at 4 weeks. Alas, however, our cockiness stuffed it up again when we put him on solids at 4 months (that was the recommended date way back then in 2001) and got over-enthusiastic about it. He had stomach cramps, had to be taken off food and didn't sleep through properly again until 10 months.

Sleep performance does to a large extent depend upon the child. Child No.1 was well suited to it. She ate like a big that meant she could eat enough before bed. She also is a great sleeper. To this day (she is now 7) we can move her around in her sleep without her noticing.

On the other hand, Child No.2 would throw up feeds all the time and was a light sleeper. He also doesn't need as much sleep. To this day, he bounds up out of bed at 5am ready to go. He is the ultimate in morning people even before it is officially morning! Compared with Child No.1 who thinks that morning is an afront to her rights and grumps for a good hour, our son is disturbingly happy and cheery at sunrise.

Finally, on to Child No.3. We had a hard line from the start (partly because we didn't realise the old baby monitor wasn't working too well and so we got our 'spine' for free; we didn't know she was crying!). But nothing we would count as sleeping through until 10 months. This is because our daughter reached a compromise solution. She wanted 5 minutes of our time sometime between midnight and 2am for a feed and that was it. We hardly felt it and when it comes down to it we effectly got 90% of the Ferber-type independence anyway.

Nowadays when she wakes up at the crack of dawn she is greeted first by our son who, let's face it, is the right person for the job. That buys us extra sleep time.

In conclusion, the Ferber approach has lots of merits but it is implementation that you have to concentrate on. Absent that the defective baby monitor will work wonders.

Saturday, May 27, 2006

Toilet Training and Incentives: Child No.2 (Part I)

In my last post on toilet training (over three years ago) on our experiences with incentives on our first child, I ended with the following hope:
... the management process was painful and it is unclear whether this wouldn't have all happened of its own accord anyway. Next time around we will wait a little longer, check for signs of readiness and go for a big bang behavioural change. Let's see how that goes.
It is time to report just how it went. The answer, very very mixed.

Our son proved to be a very different ball game from our first daughter and not for gender differences. Our daughter possessed several qualities that lent her to the useful application of incentives. First, she was highly strategic and easily understood what rewards meant. Second, she had some basic motives -- most notably food -- that made it easy to give her high motive rewards.

Our son possessed neither of these qualities. He was not strategic and hardly had a self-interested bone in his body. He didn't care about much that was material. For him, toilet training was something that was going to please us and for that reason he was interested. Read him a book and he will stay on the potty. The attention would do.

Nonetheless, despite this, very little has happening. So we decided to implement our more explicit incentive system that had worked well with Child No.1. But there was a twist: Child No.1 was around and in many ways we need her help. So Child No.2 would receive a sweet reward -- one or two jelly babies as the case may be. But also where he was successful, Child No.1 would receive the same. We viewed all this as a team effort and Child No.1 was part of the team. To align her incentives we gave her a share of the pie.

That part worked swimmingly. She encouraged our son to sit on the potty and spent time showing her books. It seemed that we may have efficiently outsourced this activity: something valuable in our time strapped lives.

Alas, it was not quite to be. We had to put a stop to it all when we discovered Child No.1 feeding Child No.2 copious amounts of water to help the process along! (By the way, in case you are wondering Child No.1 was 4 years old at the time).

Nothing seemed to work with Child No.2 and a deadline was looming. He was turning 3 and could go to pre-school so long as he was toilet trained. We were three weeks away and desperate (Not just for us but for him. Pre-school was much more fun than child care).

So we established Toilet Training Boot Camp. The nappies were confiscated. The rug was removed from our wood floors and we would do this as long as it took. He understood the basics but just needed intensive experience and so that is what we provided.

Now you may think that this seems somewhat cruel. Well, I did some research and this was nothing compared with a book tantilizingly entitled, Toilet Training in Less Than a Day by Nathan Azrin. This book is ranked in the top 1000 of books sold even today. But if you read the reviews the results are definitely mixed and even those who liked it said it took many more days than one. I didn't buy the book and we persisted with our methods.

The first week was tough: he definitely wanted his nappie back and we had to buy more cleaner. The second week had more successes and we were getting close: 100% results on number 2 but still problems with number 1. But in the final week he got it.

We turned up to school and announced our success. They then told us pull-ups would have been just fine. So much for rules. Sigh.

In the end, it was the attention and intensive experience that did it but all indicating a message: it will happen when it will happen.

But we were not done yet: incentives came back inforce when we moved on to night training. A much longer story for another time.