Appalling New Sleep Training Technique Say’s “Don’t Feed Your Baby.”

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Two pediatrician brothers claim they have developed a “new” method of getting babies to sleep.  And, incidentally, I put “new” in quotes because their method is scary-similar to the method recommended by Babywise authors Gary and Marie Ezzo which was eventually condemned by the American Academy of Pediatrics because it caused failure to thrive and dehydration in babies.  How many ways can I say that this is a terrible, horrible, no-good parenting idea?  (Click here to read the FoxNews article)

Everything Old is New Again.

 

Well everything old is new again and Drs. Jassey and Jassey argue that children shouldn’t eat more often than every four hours (which is nonsense) so if they want to eat more frequently (which most do), then they will wake up through the night also wanting to eat (Well, ok…).  So, what’s the logical solution?  The good doctors’ answer is to refuse to feed your baby more frequently than four hours apart.   That’s right.  Just don’t feed your kid so darn often.  This supposedly “trains” the baby’s “hunger receptors to acclimate to a specific feeding schedule.”  WHAT UTTER QUACKERY!

The “explanation” for why this method works is complete wishful thinking.  I know of no evidence to suggest that the Jassey bros.’ theory actually constitutes the method of action for their technique.  Where is their proof that hunger receptors in baby’s can be trained by this method?  I defy them to produce any evidence to backup this wishful thinking.   Heck, I don’t even need proof.  Show me a peer-reviewed study that shows brain imaging that basically substantiates this claim.   I’ll happily wait while you look, but I won’t hold my breath.

Learned Helplessness Redux.

More likely, the baby simply develops learned helplessness.  As with the Cry It Out method for “sleep-training, evidence would suggest that this new sleep training “method” of food-spacing teaches baby’s that crying doesn’t work to get their needs met. Therefore the baby just learns to stop trying to communicate to mom and dad.  While there is no evidence I know of to support the Jassey’s claims of being able to reset a baby’s hunger receptors, there is a great deal of evidence to suggest that cry it out methods for sleep and, now, feeding, induce learned helplessness in infants, which puts children at high risk for future depression and other mental health problems.

You CAN Get the Sleep You Need WITHOUT Depriving Your Child!

I understand the desperation that motivates parents to try these techniques.  Parenting infants is hard work and sleep-deprivation makes doing that work so much harder. But there is good news!  There are sensitive and effective ways to get your baby to sleep AND get the rest you need.  Here are a number of great tips to get you started.    For more ideas on how to get your baby to sleep and meet your sleep needs as well WITHOUT having to force your baby to both go to bed hungry and cry it out to boot, check out Then Comes Baby: The Catholic Guide to Surviving and Thriving in the First Three Years of Parenthood

Theology of the Body & Sleep Training–Part Deux (Or, every time you sleep-train, does a puppy really die?)

My post on sleep training, learned helplessness and the TOB predictably netted a lot of comments.  Many of those comments were not posted because they did not reflect well on the correspondent and I feel strongly that it is my job to protect people’s dignity.  I’m happy to publish criticisms, but  I won’t post something that I think you’ll regret when you calm down.

But some comments were stellar.  One exchange I had with Dr. Kathleen Berchelmann was, I felt, worthy of it’s own post.  While, as you can see, I disagreed with her comments, I appreciated her points.  I hope you enjoy the exchange.

Dear Dr. Popcak,

I want to personally thank you for all your excellent writing.  I’ve been a fan of yours from a distance for some time.  I promote your work on my blog under “Parenting Resources” at: http://www.catholicpediatrics.com/resources/parenting

In general I am a supporter of most aspects of attachment parenting.  I would, however, like to bring to your attention a September, 2012 article from the journal Pediatrics.  In case you don’t have access to their full-text articles, here is a popular press summary of the study: http://healthland.time.com/2012/09/10/its-o-k-to-let-babies-cry-it-out-at-bedtime/

I am assuming the study you refer to in your post is the August 2011 study from Early Human Development, “Asynchrony of mother–infant hypothalamic–pituitary–adrenal axis activity following extinction of infant crying responses induced during the transition to sleep.”  It’s a very interesting study.  I agree that persistently elevated cortisol levels show that there isn’t a lot of “self-soothing” taking place.  But I think, as parents and health care professionals, we have to ask ourselves the larger question, “What are the negative consequences of this physiologic sign of persistent stress?” 

I feel it is a big jump to equate this persistent rise in cortisol of a baby who cries him or herself to sleep with the learned helplessness of the studies you cite above.  The stressors in each case were different.  They are not equivalent experiments.  There is no data to suggest that babies who “cry it out” have an increase risk of depression or anxiety disorders as you suggest in your second to last paragraph.  The Pediatrics study I cite above actually showed the opposite– that babies who “cried it out” did not have increased risk of emotional, psychological, or behavioral disorders at age 6.  In fact, babies who were in the control group (not left to “cry it out”) actually had a higher risk of behavior disorders. 

Dr. Popcak, I also love Theology of the Body, and as a pediatrician I have found TOB an invaluable tool for teaching healthy sexuality to children and adolescents.  Please see my project, Text4RealSex, http://www.Text4RealSex.com.   To the best of my knowledge, however, Blessed John Paul II never mentions baby’s crying and sleep patterns in his development of Theology of the Body.  When we elaborate on TOB themes and apply them to new situations, as I often do, I think it is important to indicate that these are our thoughts, not JPII’s. 

There are many tired parents out there struggling to deal with crying babies.  I think we have to be very careful before we lead parents to think that they are causing irreparable harm to their infants or violating the teachings of the Catholic Church. 

Thank you for your faithfulness and your beautiful commitment to Catholic parenting and mental health. 

Warmest Regards,

Kathleen M. Berchelmann, MD Pediatrician Washington University School of Medicine and St. Louis Children’s Hospital

 

Dr. Berchelmann,

Thank you for your excellent comments. I appreciate your wisdom and your expertise.

As you know, good vagal tone  (note:  the vagus nerve resets the stress-out body to a normal unstressed state.  “Vagal tone”  refers to the efficiency with which the vagus nerve rests the body’s stress signs) is associated with healthy emotional regulation and greater resistance to both depression and anxiety. I’m sure you are also aware that long term cortisol exposure is antithetical to developing good vagal tone.

I want to be clear that I am not saying–as some have accused me in an attempt to exaggerate my point to make it easier to dismiss me–that sleep training causes “brain damage.” (Or, for that matter, as some have accused me of saying, that parents who sleep train are “abusers”  or “bad Catholics”  or for that mater, that every time a parent sleep-trains a baby, a puppy dies.)  What I am saying is that the idea of self-soothing in infancy is a convenient fiction.  What is the mechanism or process infants use to self-soothe?  How does this magic happen?  Everything I know about developmental psychology says that it isn’t possible.  Unless someone can show me the process of self-soothing, I have to assume that the idea that babies can self-soothe is wishful thinking at best and junk science at worst.  There is just no evidence that it can be done.  So, if the baby isn’t self-soothing, what IS happening?  Well, the evidence would appear to show that what is happening is learned helplessness.  When cortisol levels are elevated for a long-enough period that help seeking behavior is extinguished in the presence sustained stress, that is learned helplessness.

Now, it is a fair question to ask just how damaging this degree of learned helplessness really is, but I don’t think there is a question that it is, indeed, damaging to at least some degree. I don’t know of a single study that suggests learned helplessness is a good thing.  How helpless should anyone want to feel?

I appreciate the study you cite, and I have read it before, but to my eyes all it is saying is that sleep training gets babies to sleep and when babies sleep moms and dads are happy.  But to go from that to say that sleep training is safe begs the question of how sleep training actually works.  What is the mechanism?  If the mechanism is self-soothing, then how does that actually happen?  If the mechanism is learned helplessness, well then, let’s admit that and deal with the reality of the situation.  Maybe a little learned helplessness is a good thing maybe its not, but let’s not be too cowardly to ask the question.  Any pharmacologist will tell you that one really can’t say something is safe if one is unwilling to look at the mechanism of action.  That is where the study you cite over-reaches.  You cannot say something is “safe” if you don’t know how it works.

Likewise, the study indicates that sleep-trained children were easier than children who were not sleep-trained, but if the mechanism of action of sleep-training is learned helplessness, this makes perfect sense.  Parents typically report quiet children as better behaved. Children who have learned the pointlessness of crying through sleep-training will be quieter and seen as better behaved by parents.  But is a quieter baby really a healthier baby?  Or is a quieter baby a depressed baby?  We don’t know because the study you cite refuses to look at the mechanism of action behind the efficacy of sleep-training.

Finally, regarding TOB. I don’t believe I claimed JPII wrote anything on sleep training or crying-it-out but don’t make the mistake of thinking that TOB is just about sex.  JPII is the father of the theology of the body, but the theology of the body is it’s own theological discipline, like Christology or ecclesiology.  Just because JPII didn’t write about it doesn’t mean it isn’t consistent with the principles of the TOB. I am happy to take full credit for being among the first people to apply the principles of TOB to parent-child relationships and family dynamics.   That said, in my response to Terri, I referenced the work of Dan Seigel, author of Parenting from the Inside Out and Editor-in-Chief of the Norton Series on Interpersonal Neurobiology.  It might interest you to know that JPII was an admirer of Daniel Seigel’s work, and that he brought Dr. Seigel to the Vatican to present on Mother-Infant bonding and the developing brain.   There is a great deal of evidence showing that JPII was very interested in understanding the process of attachment and bonding and his interest is reflected in his work on the feminine genius–which is foundational concept of TOB.

In conclusion, I thank you for taking the time to write.  I do appreciate and respect both your expertise and your tone and I hope you will be a regular reader/commenter.  But until someone can show me how, exactly, an infant self-soothes, I cannot in good conscience do anything but remind people that the idea of self-soothing is a myth and that the mechanism behind sleep-training is, by all indications,  learned helplessness.  I believe parents should have the right to use it as long as they can give informed consent and they can’t do that if they aren’t told the truth.

May God Bless you abundantly,

Dr. Greg

Parenting and the Theology of the Body– Can Babies “Self-Soothe”?—(UPDATED 4/4)

The Theology of the Body teaches us that the body has an innate self-donative meaning.  That is;  we are, literally, wired for love and connection, and that God’s plan for relationships can be discerned by prayerfully contemplating the bodies God gave us.  Science is actually backing this claim up, and is giving us some important insights into what–given this mindset–is God’s intention not only for adult pair bonding (i.e., marriage and sex) but parent-child  bonding as well.  This line of thought has significant ramifications for important parenting questions like, “How do we get our babies to sleep!”

It is conventional wisdom that infant “sleep training” teaches babies to “self-soothe.”  These are comforting ideas to tired moms and dads who are eager to be great parents and get a decent night’s sleep but what does it mean for a baby to “self-soothe” and is it even possible for infants to exhibit this skill

 

Proponents of self-soothing point to the fact that after several days of sleep training–which involves parents incrementally delaying their response to an infant’s night-time crying–the baby decreases the time crying and, eventually stops and goes back to sleep.  This is what happens, and it has been assumed that the baby is able to return to sleep because of “self-soothing.”  The problem is, until fairly recently, researcher never had a way to test the “self-soothing” hypothesis and that’s an important problem.

While, again, its a nice idea that would be lovely if true, infant self-soothing makes no sense from a developmental psych perspective.  For anyone–you, me, any human being–to self-soothe, two skills are required; self-talk and intentional, conscious redirection.  When you are upset, to get yourself back under control, you need to be able to 1) Talk yourself down (“Calm down, Greg.  You can handle this.  It’s going to be OK.”)  and 2) You need to be able to intentionally direct yourself to engage in some self-soothing activity (e.g, make a plan to solve the problem, do something that reduces your stress, etc).  The problem is that babies don’t have either of these skills.  Children don’t develop any self-talk capacity until at least 4yo (usually later) and although babies do have some soothing rituals like thumb-sucking, it is not known how effective these strategies are.   New research is showing that the answer is, “not very.”

Learned Helplessness and Physiological Stress

It turns out that after several days of sleep training the baby’s behavior and biology become un-hooked.  The sleep-trained child does stop crying, but research shows that the child’s stress homone level remain as high as when he was crying.  If the baby was actually self-soothing, the cortisol levels would decrease as the crying behavior decreased.  But that isn’t what happens. Instead, the sleep-trained infant’s cortisol level remains high, but the help-seeking behavior stops.  There is a disconnect between what the baby feels and how the baby acts.   In animals, we call this disconnect between the physiological stress response (i.e., high cortisol levels) and behavior, “learned helplessness.”

Learned helplessness is a well-established psychological fact. The classic learned helplessness experiments were done years ago and over 3000 studies later, learned helplessness is a foundational concept in the study of depression and anxiety disorders.  In the first experiments in learned helplessness, a dog was placed in a box that had a metal plate at the bottom.  A lid was placed on top of the box and a mildly painful electical shock went through the metal plate.  The dog would try to jump out of the box, but be thwarted by the lid.  After several repetitions the dog stopped trying to escape the shock. He just lay there helplessly.  This continued even after the lid was removed.  The shock would be delivered but even though the dog could escape, he learned not to try to help himself–he, literally, learned to be helpless.  Superficially, you could theoreically claim that the dog learned some mysterious way to “self-soothe” and ignore the shock, but you would be wrong.  Physiologically, the dog’s cortisol levels were elevated with the shock, but the help-seeking behavior stopped.  This is the exact same dynamic seen in sleep-trained infants and that should alarm us.

Learned helplessness actually damages the human and animal brain’s ability to process stress and is an established risk factor for depression and anxiety disorders in later childhood and adulthood.

If we take the Theology of the Body’s claims seriously,  that God’s intention for relationships is written into God’s design of our body, we need to listen to research that shows that sleep-training is antithetical to the donative meaning of the body.  Genesis tells us that “it is not good for man to be alone.”  Science confirms that this is true.  Especially for infants.

UPDATE: Be sure to check out the comments, especially the exchanges I’ve had with “Terri” and Dr. Berchelmann, a pediatrician and instructor of pediatrics at St. Louis Children’s Hospital.

–For more information on how the principles of the Theology of the Body apply to parenting, check out Parenting with Grace:  The Catholic Parent Guide to Raising (almost) Perfect Kids.