Friday, May 25, 2007

The sleep externality

New research finds what we all knew was there: a child's sleep habits and parental health are related. And not just mental health, physical health too; although that part is less convincing. That all motivated Sydney Spiesel to consider how to assist parents in helping children sleep better. His solution was to remove the subsidy to waking up:
My advice to parents in my practice is based on my sense that children wake in the middle of the night seeking the reward of the warmth and affection they have come to expect. In 25 years practicing as a pediatrician, I've found that mothers in particular are often as reluctant as children to give up the nighttime cuddle. It is, after all, a time of pure and intense pleasure with a child, free of worries about hurting someone else's feelings or the need to put breakfast on the table or to answer the phone. The problem, of course, is that eventually the early-hours pleasure makes mothers miserable in the morning. When you get to that point—and if your baby is at least 4 months old—it may be time to decrease the child's reward for waking so as to make it not worth the trouble.

I start by recommending that parents ignore fussing for at least five minutes every time a child wakes. Give the kids a chance to settle down on their own. (Though, contra Ferber, don't wait more than 10 minutes or they're likely to become so anxious that you'll never get them back to sleep.) If this step fails, go to the child but keep it very low-key and unrewarding. Talk as little as possible. Don't turn on the light. Don't look the child in the eye. Pick her up slightly awkwardly, so she's not sure you have a good grip. If it's a cold night, let her tush collect a few icicles. Above all, don't hug or kiss her or tell her how wonderful she is. Also, don't nurse or give formula. A bottle of plain water will reduce the return for waking (and encourage the development of a good pitching arm).

Not a bad strategy. We ended up doing something similar but with perhaps a harder line. But this gradual removal of the waking subsidy is not a bad place for some parents to start. The point is that in the end, if you want sleep, the subsidy has to be entirely removed.

Sometimes the problems persist beyond the toddler years. This hasn't (at least not yet) been an issue for us. Interestingly, the solution there appears to explicitly make the subsidy scarce.

Put children to bed with a card they can exchange for one "free pass" to leave the bedroom to get a drink or a parental hug. (Not on the list is permission to stay up later.) Once the child enjoys his free pass, he has to turn in it in for the night, and his parents must ignore all subsequent bids for attention.

Moore and Friman tracked 19 normally developing children between the ages of 3 and 6 who strongly resisted bedtime by crying, calling out, escaping from their bedrooms—as I like to think of it, the usual stuff. They divided the kids into two groups. About half of them got the "free pass." The parents of the children in the comparison group did nothing special.

Remarkably, to me at least, the free pass was quite successful. After just four days, the kids in the experimental group showed substantial improvement by crying and calling out less often, making fewer flight attempts, and quieting down much faster. Their parents reported that they were very satisfied with the results—only 7 percent said the strategy made them uncomfortable, and none thought that their child experienced discomfort. Follow-up studies after three months showed sustained gains.

Anyhow, there is some good basic economics to this. But you would have to keep strictly to the pass system. Relent and it will surely fall apart. It would be interesting to see how it worked for parents without researchers they had to report back to.