Pediatrician Dr. Jennifer Thomas on Sleep | Is Your Baby Sleeping Through the Night Yet?

If you have a little one, want to have a little one, or provide health care to people with little ones, you really ought start following the wise words of Wisconsin pediatrician and International Board Certified Lactation Consultant Dr. Jennifer Thomas. An easy way to do so is via the facebook page of Dr. Thomas and her partner, fellow pediatrician and IBCLC Stephanie Behnke. Dr. Thomas is a welcome voice of reason and sensibility in a world where all too often the advice that mamas get from their postpartum doulas, labor and delivery nurses, midwives, ob-gyns, and lactation consultants requires a diagram to sort out. So many parents feel very grounded in the advice they receive from their chosen birth team (often a combo of doula and midwife in my work) and then feel completely undone when they go their first pediatrician appointment and are told to let their babies cry it out and to start a sleep training schedule. To many mamas, this feels instinctively wrong–and these instincts are incredibly important. The instincts that we have about how to best care for our babies have been in place since life began, and are what allowed the species to propagate. Dr. Jen (as she goes by) shares some deep and needed wisdom about babies and sleep that will help you understand why your instincts are the way they are, and why you should heed them:

If Your Baby Sleeping Through The Night

written by Jenny Thomas, MD, IBCLC, FAAP, FABM

The answer is almost always “no” but when we give that answer, we feel like bad parents, and we start to believe that something is wrong with our child. As if normal babies were never meant to be held all the time and were meant to sleep all by themselves.

We spend so much time dreaming of what our children will be and very little time realizing what they are. Let’s say, for the sake of argument, that human evolution is like a football field. Human beings as a genus start at the far end of the field, and we as a species show up at about the opposite 10 yard line. At about the one inch line (and that’s generous) we as an industrial society show up. Why am I rambling about this? Because we have to understand that the way we do things is a new idea…but the babies we bring into this world don’t know about the way we do things. They are programmed to do things that normal, vulnerable human babies have been doing for thousands of years.

And human babies are really vulnerable. If you’ve ever seen what baby elephants or horses can do at birth, you know that they can walk shortly after birth, and are running soon afterwards. Why can’t humans do that? Well, if we waited until the brain was mature enough for our kids to walk, nevermind run, the baby’s head would be too big to come out safely. We don’t need to run to stay safe. Our gestation period is designed to make sure that our kids arrive in the world with their future intact– our kids arrive in the world when it’s safest for the brain to come out.

Our children arrive in the world as the most neurologically immature primate of them all, and remain the most dependent on a caregiver for the longest period of time. Our kids can’t keep themselves warm, get food, walk, speak, or reason. They can’t manipulate us and they can’t consciously choose to make you look like a bad parent.

What do we know about their sleep patterns? Well, they need to be near a caregiver– mostly mom. It makes sense if you think about it. This immature baby, with little in the way of self-preservation skills, needs to hang out with the source of food and warmth, with the person who is most likely to wake up to meet the needs that they express in the middle of the night. There are beautiful videos of moms and babies who are almost totally in sync in terms of sleep cycles, showing them waking at about the same time several times during the night, with mom responding to the baby and the baby, who rarely cries, getting their multiple needs met.

Normal babies sleep during the day and are up at night. That is normal and expected and nothing we can do to change that. The predators that hunt humans hunt at night. Instinctively, that means they should be up and night and sleep when the threat is less. That also means that parents need to sleep when the baby is sleeping to avoid all the great things that go along with sleep deprivation. Doctor’s orders: forget about “thank you” notes, visitors (until you’re ready), laundry, cleaning. Really, what you are doing is very valuable, even if you feel as if you aren’t doing much.

Older infants get up at night, but less often, and it is normal for one year olds to not be sleeping through the night. How ’bout this idea that we have to teach our kids to “soothe” themselves? I would argue that a several month old child is still not able to feed themselves, find food, or do any other thing that it would take to live independently. How could they soothe themselves? Soothing yourself is a complex emotional task, hardly one that we would expect from a creature who can’t walk or talk. They are speaking up because they need something. If they need something, even if it just to feel safe, why shouldn’t we help them? And imagine this- you are up crying at night and the person you love decides to ignore you. What might happen the next morning? What might happen is that person continues to ignore your cries for help and comfort?

Sleeping Arrangements

The choice of where our children sleep affects (and there is research to show all of this): breastfeeding duration, feeding frequency, infant sleep position, arousal patterns, temperature, carbon dioxide levels, crying, heart rate, parental emotional expectations.

Babies who have more skin to skin contact with their parents show better oxygen delivery, less frequent crying, higher temperatures, better weight gain, better digestion and less physiologic markers of infant stress. (It’s why kids who are held more have less colic.) So, based on that, it makes sense that more contact with mom and dad makes for a more physiologically sound child.

How come my friend’s baby sleeps through the night?

I don’t know. I don’t even know what that means. When I ask about what that means, I get a great variety of answers. Some people think 6 hours of sleep at night is “through the night” other people want to sleep like they did before they had kids. I would guess that the kids aren’t sleeping through the night, but that the implications of admitting that your kid isn’t sleeping are too nasty to admit. We equate “good sleepers” with good kids, and “bad sleepers” with bad kids. Really, we make moral implications from normal baby behaviors. And of course, parents of good sleepers are good parents.

Plus, feeding choice plays a role here. Formula fed kids sleep differently than breastfed kids. Formula fed kids sleep for longer stretches of time and therefore have less contact with their parents at night. Formula fed children are much more likely to be sleeping alone.

The sleep training techniques that have been sold in the US have never been shown to be associated with anything good for infants but it has been associated with bad stuff, like more anxious children and behavior disturbances. There is no emotional, social or intellectual benefit to the kids, nor has it ever been shown to help us develop into healthy adult sleepers.

So…we have to decide what we want from our kids sleeping through the night. I would guess that all the good things that we want for our kids’ futures mean that we don’t have them sleep through the night.

For more information or to seek out Dr. Jen for your family’s healthcare check out: www.drjen4kids.com

By the by, my favorite quote from this piece is, “Soothing yourself is a complex emotional task, hardly one that we would expect from a creature who can’t walk or talk.” I just had my 39th birthday yesterday, and I have to say, I still find self-soothing hard from time to time! I think Dr. Jen makes this point so well, and that it is a good example of one of many inappropriate expectations (projections really) that we put on our children, and try to bake into our child care philosophy. I’m appreciative of the sound reasoning about why attempting to instill self-soothing, in teeny tiny brand new babies, is not the right developmental task for the first months of life.