Babies and CIO

I’ve gotten a couple of questions and comments lately asking about my well-publicized stance on the CIO (cry-it-out) method of getting your baby to sleep. Pretty much everyone knows that I’m opposed to CIO. But I think it’s important to clarify what I consider CIO, and why I really dislike it.

(If your baby is around 4 months, 8 or 9 months, or 18 months, read my post about "sleep regressions" once you finish this post.)

I think* that there are a couple different kinds of babies. There are babies who release tension by crying, and there are babies who increase energy by crying. If you treat them both the same way, you’re going to have trouble, so it’s key to figure out which kind of kid you have.

A kid who releases tension by crying will not always nurse or be rocked down to sleep. It may happen sometimes, but often times the kid will get progressively more active and jittery, almost manic, as the nursing or rocking session goes on. He or she may cry during the rocking/nursing, and not settle down in a few seconds. It’s almost as if the kid wants to cry. If you leave the child alone, the child will wail initially (for anywhere from a few seconds to a few minutes), but then settle down to a fuss or whimper, and will soon fall asleep. A child who releases tension from crying will often wake up happy and refreshed, and will play alone in the bed, co-sleeper, or crib for awhile before you come to get them.

A kid who gains tension by crying will go to sleep easily (and maybe exclusively) by nursing or rocking. It may take awhile, but rocking/nursing is a sure, gradual path toward relaxation and sleep. If left alone before s/he’s asleep, s/he’ll start to cry. And will cry and cry, increasing in intensity until the child goes hoarse or throws up or you give in and go to comfort him or her. Many kids who increase tension by crying, even if they go to sleep peacefully and happily, will wake up crying or grumpy and need to be gotten immediately from the sleeping area.

If you have a kid who releases tension by crying, the child seems to need to fuss or cry a little before falling asleep. If you don’t recognize it, you’ll be miserable. You can rock and rock and rock, and your child won’t go to sleep easily and will end up crying anyway, but you’ll think you’re doing something horribly wrong that you can’t comfort your baby to sleep. In reality, the child just needs to release tension by crying or fussing, and will go to sleep easily after a few minutes of this.

If you think this might be your child, see what happens if you say goodnight and walk out of the room for a few minutes. If your child starts to quiet down after a minute or two of initial crying, you’ve got a tension-releaser. Adjust your routine accordingly. (Some parents I know don’t want to leave a baby to cry alone ever, so they assign one partner the duty of sitting silently in the room being a comforting presence while the child fusses to sleep, but not interrupting the child’s fuss-to-sleep routine. Other parents just say goodnight lovingly and walk out, knowing the child will be asleep in a few minutes.)

Fussing to sleep, or crying to release tension to fall asleep, is not CIO by my definition. CIO is forcing a child to cry until the child falls asleep, even when the child is clearly in distress and gaining tension from the crying.

If you have a kid who increases tension by crying, doing full-blown CIO is, in my opinion, cruel. The books will tell you that letting your child scream and scream is teaching your child to go to sleep on his or her own, but let’s be real. Teaching involves showing someone how to do something, and staying with them until they learn. Would you just send your child out alone on a two-wheeler bicycle with no help and practice? Then why would you just decide that since the child is x months old or x weight, it’s time to just let the child cry and cry until the child shuts down and falls asleep out of self-defense? It makes no sense. And it can be dangerous to the children.

A kid who builds tension by crying will get progressively more and more upset by crying, and the effects last longer than just that night. There’s an American study showing that these kids maintain this tension, and that CIO "changes the nervous
system so they’re overly sensitive to future trauma."
There’s a British study showing that lengthy periods of crying can cause brain damage. I’d be interested in seeing a study that figures out if kids who were forced to do CIO have higher rates of insomnia in later life because they associate going to sleep with intense trauma.

Take a few days or weeks to figure out which kind of kid you have, and it will simplify your life immensely. You can try the go-in-every-10-minutes thing and see if it seems to be helping the child relax or making the child more tense. If you have a kid who releases tension by crying or fussing, then that’s going to be incorporated into your bedtime and naptime routine (although even releasers will sometimes go down easily and without fussing if you happen to hit the exact sweet spot of time and tiredness). And if you have a kid who gains tension by crying, then you know that CIO isn’t even an option to consider for you, as it won’t work for more than a night or two without making you both miserable (and maybe causing later problems). You’ll have to use other methods to get your child to sleep. It may take longer than you want it to, but it will happen, and eventually your child will go to sleep easily and happily, on his or her own.

(Incidentally, I thought this was all crap when my first son was my only child. He was and still is a kid who increases tension by crying, and if I had let him cry for more than a minute we would have been up all night recovering from it. But then his brother came along, and he’d cry himself to sleep while he was nursing. He needs to be left alone to fuss himself to sleep most nights. When we’re in the stroller he’ll start wailing out of the blue, then be dead asleep 30 seconds later. I was stunned, but then it all made sense to me that people would talk about how CIO was the greatest thing ever. It wasn’t that CIO was so great, it was just that their kids needed to fuss to sleep. As usual, the assumption that all kids are the same was causing huge problems for everyone.

Oh, and my first son, who gained tension by crying, goes to sleep on his own almost every night, with nothing more than a hug and an "I love you, Mom." So even "bad sleepers" will turn good eventually if you listen to what they need.)

* And reading the new Mary Sheedy Kurcinka book about sleep, I found that MSK thinks the same thing, too, which made me beyond happy because she’s the most knowledgable parenting expert I know.

Q&A: night terrors

Bernalgirl writes:

"Last night our 16-mos old daughter woke up screaming just 1.5 hours
after she went to sleep. She was inconsolable for 20 minutes. No
thrashing, and it wasn’t entirely clear she was awake, but she’s pretty
verbal, and was able to tell us that nothing hurt. As she calmed down
she just said "Hug, hug, hug" over and over again. She didn’t want to
go back to her crib (where she normally prefers to sleep) so for the
first time in a while we had a family bed. It was scary, and then
heartbreaking.

She had a HUGE day yesterday, I had her in one more activity than
was prudent (and realized it part-way through the day) and last night
she walked on her own more than she ever has in her life (possibly
cumulatively).

Does this sound like night terrors? And what should I do about it? Sears says nothing at all on this in his Baby Book; What to Expect said to leave them alone to self-soothe (no way, not when she’s muttering
Hug, Hug, Hug); and Brazelton described the lead-up perfectly,
although by his account she’s a little young yet. Then he scared me to
death by stating that night terrors show up as small seizures when
measured on an electroencephalogram.

Other than simplifying her schedule and holding her as long as she
needs to, I’m at a bit of a loss on diagnosis and response. Is this a
totally normal developmental phase or can I do something more to
prevent this from recurring?"

I don’t know if it’s "night terrors" specifically, but it’s definitely terror in the night. Poor thing. She reminds me of the monkey in the Jez Alborough book Hug.

I don’t have much experience with this, myself. There have been a couple of nights when my older son woke up screaming in the middle of the night. We did what you did–went and comforted him, tried to figure out if there was anything physically wrong with him, and then brought him in with us to sleep the rest of the night. For us it seemed like isolated incidents that were, just like they were for you, a result of overstimulation the day before.

I hate to have to say "I’ve got nothing" to people who write in to me, so I went looking to the "experts" for the thoroughly-researched theory behind and treatment for night terrors. I didn’t find anything helpful. Basically, the party line (that crosses sleep-theory party lines) is "Sometimes kids have night terrors. It’ll pass." Gee, thanks. All of you people and your collective pontification couldn’t come up with anything better than that?

So all of what I’m going to say is just a shot in the dark, but at least you didn’t spend $14.95 for it on Amazon.

It seems to me that night terrors (aka "waking up in the middle of the night screaming") could be caused by any or all of the following things (or, of course, something we don’t know about or understand):

* Too much activity or intensity the day before, or a few days before. Kids can seem fine with all the stuff that’s happening around and to them, but then it’ll come out in their subconsciouses while they’re sleeping.

* Movement, or new skills in general. The brain gets ahead of the body or the body gets ahead of the brain, and something’s got to give, so it vents off in the middle of the night.

* Food they’ve eaten that gives them bad dreams. I always thought the food-dreams connection was kind of bogus, but my husband swears that when he eats certain foods too close to bedtime he’ll have nightmares. If it happens to adults, why couldn’t it happen to kids?

* Scary sounds or images. Little kids are sponges for things they hear and see, even when they don’t understand them. If they overhear scary (or even just intense) things on TV or movies or catch glimpses of images they don’t understand, those things can ricochet around in their little brains and turn into something really frightening in the middle of the night. At our house it’s a constant battle to mute the TV or change the channel when a scary trailer or commercial comes on because the baby sleeps on the other side of the wall the TV’s against.

* Things that go bump in the night. There could be noises she’s hearing as she sleeps that wake her up, but she’s incorporating them into dreams that scare her. You know what I’m talking about–your alarm’s going off but your mind makes it the sound of a fire alarm ringing in the dream you’re in the middle of. If there are noises in your child’s room at night, they could be morphing into whatever dreams she’s having and making the dreams more intense.

* Fake panic attacks. She could be having blips in her nervous system. (Stay with me here.) During both of my pregnancies, I’ve gone through phases in which my hormones were raging so much that they stimulated my nervous system to produce all the symptoms of panic attacks. (Despite what I say about him otherwise, I will always be thankful to Dr. Sears for mentioning this as a possibility in The Pregnancy Book. I haven’t read about it anywhere else, and I thought I was actually having real panic attacks for awhile.) It really feels exactly like a panic attack–racing pulse, confusion, sweating, closed-in feeling, desire to scream, fear–except that the only thing causing it is hormones, not feelings. It makes complete sense to me that a growing child (hormones!) could experience the same thing in the middle of the night. How could you not wake up screaming from that feeling?

I guess the upshot is that if you try to calm down her activity level, bland down her before-bedtime foods, and keep the noise pollution out of her hearing, there’s not much else you can do to prevent night terrors. And they obviously do pass eventually. You’re absolutely handling them the right way by comforting her. If she’s fine going back to sleep where she usually sleeps, that’s great, but if she needs to come in with you, a few nights in with you for the rest of the night isn’t going to have much long-term effect on your sleeping arrangements. But knowing that her parents will come help her when she needs it will stay with her forever.

The "good news" is that once they’re older and potty-trained, overstimulation results in wetting the bed instead of night terrors. That may not be good news for everyone, but I’d much rather have sheets to wash than have my sweetheart screaming in fear in the middle of the night.

High Stakes

At brunch the other day one of my friends was holding my 1-year-old. He was chomping on a sour pickle (and flicking the juice all over my friend, who thought it was funny), and reached for the piece of cake on my friend’s plate. "Can he have that?" my friend asked. "Sure. He’s the second child. He can have pretty much anything," I replied.

I’ve been thinking about that conversation, and why it is that the experience of parenting the second child (or subsequent children) is so different from being a first-time parent. The recent exchange I had with Jody and Elizabeth on the posts about the woman who didn’t want to spend a weekend with her friends got me thinking about even more, specifically about how sometimes as mothers we can’t let anyone else take too much care of our children. But then I read Kateri’s latest post, and thought, "Aha!"

"Aha," because Kateri wrote in the most direct way possible about why being a first-time parent feels so high stakes and raising subsequent children does not. Go read her post. It’s short (something that can’t be said about any of my posts) and pithy and hit me right between the eyes because it’s the essence of why parenting’s so hard emotionally. I’ll wait. No, seriously–click and read it, leave a friendly comment, then come back here.

Now that you’re back, can we talk about two things? The first is how it feels to let go and let other people take some of the emotional burden of parenting, and the second is how to give yourself a break and avoid putting yourself in a perfectionistic parenting box.

Letting other people take over some of the care and emotional energy of thinking about your child is rough. That’s been one of the hardest things for me as a mother–the letting go of needing to be the one in charge all the time, or the repository of knowledge (and let’s face it, I’m Cliff Clavin), or the one the baby really wants. And I think that I had an easier time than lots of mothers do, all things considered. I had to make a serious effort to force myself to allow my husband to do things the way he wanted to with our son when he was tiny. It was hard to listen to my son crying, knowing that I knew how he wanted to be held and that my husband wasn’t doing it "the right way." I started leaving the apartment so I wouldn’t have to swallow my words of "advice" to my husband.

But it got easier and my husband started to know what our son needed more and more. The feedback loop worked like a charm. And then, when my husband was laid off and home all the time, he and my son really learned each other. He had 15 months of being at least as hands-on as I was, and I think that’s still a major influence on our relationship and my identity as a mother. At one point I started being afraid that my husband might be a better parent than I am. When I realized how scared I was of that, I forced myself to really consider that it might be the case. And you know what happened? Nothing. If my husband was a better parent than I was, it was still OK. I was still a great mother, my son still loved me, and the world kept turning.

So, Question #1 for you: Do you feel like you’ve come to terms with other people being good at caring for your child? If yes, how did you do it, and if no, what work do you think you could do to get there?

On to the second thing, which is giving yourself a break and making parenting decisions less high-stakes. I’m not sure there’s really any good way to do it. First-time parents are, by nature, concerned about everything they do in taking care of their children, and that’s the way it’s supposed to be. I just wish we could put less pressure on ourselves to do things perfectly all the time. That pressure leads to stress, depression, and the one-upsmanship that makes interactions with other parents so much less helpful than they could be.

I don’t tend to feel guilt very often or to let others’ opinions of me guide my thoughts or actions. (I think that’s a result of the way I approach decisionmaking about parenting and in general, but that’s a whole different post.) But even if I did, I think I’ve devised a pretty decent strategy for putting parenting decisions into perspective. When I was pregnant with my first son, I made a parenting mission statement for myself. I figured out what were my main goals as a parent, and then some smaller goals, too. When I started to get stressed out about what I should do, I referred back to my mission statement. If it didn’t have anything to do with one of those goals, I just took the path of least resistance or more fun. It’s been remarkably freeing.

So, Question #2: How do you keep yourself from sweating every small decision you have to make as a parent? Is it getting easier as your child(ren) grows older?

I’m hoping we can start to find some way out of the mental and emotional mazes we keep ourselves running around in. So please share your experience, whether you’ve gotten to where you want to be or not. As usual, you can post anonymously if you want to by putting "www.google.com" or "www.fake.com" into the "URL" box and only I’ll be able to see whatever real or fake email address you put in the "Email Address" box.

Q&A: monster nursing session in the middle of the night

Deb writes:

I have read many times on your site that the baby will eventually
sleep through the night, but I am really feeling like my son will not
learn unless I do something like CIO (although I’ve been opposed to it
since he was born). 

My 15-month old is an
avid nurser, and has been since birth.  I’ve mostly weaned him during
the day because I work and did not want to pump any longer.  I nurse
him to sleep though, plus once during the night when he wakes up
between 2 an 4.  Which sounds good, but that nursing session usually
lasts 2 hours!  I also nurse him when he wakes in the morning between
5:30 and 6:30 am.  If I try to send my husband in, the baby goes crazy,
thrashing and screaming, so having my husband tend him is not an
option.  It is obvious that even though my son naps doing the day
without nursing (usually in a bouncy seat or in a porta-crib that is
shaken to relax him), he NEEDS it during the night.  I am about ready
to let him cry to teach him to sleep – he is starting to be cranky
because he is not getting enough sleep, but I don’t want to damage him
or instill fear in him…  Other than the sleep issue, he is a GREAT
baby.  He walks and talks up a storm.

So,
my question is, do you actually know children who were spoiled (as I
think my son is) and then eventually outgrew it without any action?  I
am afraid that I am now postponing the inevitable by avoiding doing CIO
and I want it behind me rather than in front of me.  How exactly does
it happen if no action is taken."

The instructor of the newborn care class I took 4 years ago told us a lot of things, but the only thing she said that stuck with me was "’Spoiled’ means something went bad from lack of use or attention. Giving too much love or attention to a child is only going to help the child." It’s obvious that your son is used to having his needs met. In the long run that’s going to be the best thing that could happen to him. It’s just now that you need to figure out another plan for this one thing.

And, yes, he’ll grow out of it eventually if you keep on as you have been. Maybe not soon, but eventually. There is no 10-year-old in the country who still wakes up and nurses for two hours in the middle of the night.:) If you aren’t particularly bugged by his nursing and just think you should want to stop it for philosophical reasons, don’t worry about it and just lie to anyone who asks. But if the long 2 am session is making you want to gouge your eyes out with a grapefruit spoon nuts, then you should try to figure out a plan to stop it. You know CIO doesn’t actually teach a child how to sleep–teaching means showing someone how to do something and being with him while he’s working on it. CIO could make his waking even worse. And there are plenty of other points on the continuum between CIO and "nurse all night long"–you just have to find the point that works for you.

If it were me in your situation, I would keep the nursing to sleep (because it’s easy and gets him to sleep with no fuss and is a great way to reconnect at the end of the day) and wouldn’t worry about the 5:30 nursing session right now (because it’s probably the thing you have the least control over). I’d focus on getting rid of the 2 (two) hour session in the middle of the night. Yowza. I don’t think there’s any practical way you can do this without having your husband go in to him. And, yes, he is going to go nuts the first few nights he doesn’t get you at 2 am. But it’s better to have him angry that your husband’s there than scared and angry that no one comes when he cries, or clawing at your chest wondering why you won’t nurse him now when you normally do.

It sounds like he’s gotten used to waking up and nursing then. (Obviously.) More than that, though, is what we need to figure out. Is he hungry? Does he want connection in the middle of the night? What’s causing him to wake up then in the first place–is there a consistent noise outside that’s rousing him? The only way to figure out which of these things it is is to try them out and see what works.

Despite what some of the experts would tell you, it’s entirely possible that he’s hungry in the middle of the night. 15-yearmonth-olds expend more energy than, well, anyone. That takes a lot of calories to sustain, so he might just be needing to tank up for the rest of the night. In which case you could try feeding him solid food at night. Crackers, cubes of cheese, etc.–whatever he likes that will fill him up and sit in his stomach for awhile. Even if he rejects food the first couple of nights, keep offering it a few nights after that. I’d be surprised if the solution is as simple as tossing him a few Cheddar Bunnies in the middle of the night, but it might help out, even if all it does is distract him from nursing or confuse him into going back to sleep. If you don’t already leave a bottle or sippy of water with him in case he’s thirsty, start doing that, too. (Do they market cupholders for cribs?)

He may be waking up because he’s scared or wants some connection in the middle of the night. There are a couple of different ways you could go with this. You could leave a CD player on low in his room. You could get one of those crib music thingies that he could turn on himself to hear the music play (and help him practice with it during the day). You could work on getting him to snuggle with a lovey and help get himself back to sleep with the lovey. Or you could go hardcore and put a twin-sized (or larger) bed in his room. Put those flexible rails on all sides so he can’t fall out. Then when he wakes up and your husband goes in to him, your husband can just lie down in bed with him to soothe him to sleep. When your son falls back to sleep your husband can roll away and go back to bed as usual. (And if he falls asleep himself he’ll at least be in a decent bed instead of in a rocking chair or on the floor.)

The first week of your husband going in to him is going to piss him off royally. But if your husband’s got something new for him (food, or lying down in the same bed, etc.) instead of just a lack of breasts, your son may switch gears in a few days and start to accept your husband. Then gradually he will just drop that wake-up because there’s no real reason to wake up if he’s not getting any milk. (Unless he’s super-hungry, in which case you could just start leaving a snack where he can reach it so you get to be out of the loop.)

Your husband’s going to have to take the hit for the team for the 2 am wake-up. The first few nights could be extremely rough, so you should probably start on a Friday night (assuming your husband works M-F) so he can nap the next day. But if you’re consistent that the 2 am nursing doesn’t exist anymore but someone will always be there to comfort your son, he’ll figure out that he should just accept your husband in the middle of the night instead of you. (That’s a important concept for him to know–someone will be there for him when he asks for help, even if no milk is involved.) And he will gradually stop waking up at that time, so soon your husband will be out of the loop, too.

Good luck. It’s so hard to make a change when you know your baby is going to be angry and tantrumy about it. But if you can make it past the first 3-4 nights it’ll start to get easier.

Edited to add (thanks to PumpkinMama): Before you start this you should talk to your son about what’s going to happen. Tell him that you aren’t going to nurse in the middle of the night anymore ("when it’s dark out") but if he wakes up Daddy will come to help him, and then you can nurse again when it’s light out. Keep talking to him about this for a few days before you start. Then the night before you start, make sure you have a good chat about it before he goes to sleep, and your husband can remind him of it when he goes in to him, and when you nurse him in the morning be sure to reinforce the "now it’s morning so we can nurse!" idea. I think this is helpful even with little babies, but a 15-month-old is absolutely old enough to understand and it will help him accept it more easily if he’s aware of the plan and knows it’s going to happen. At this age they have so much more receptive language than they can indicate, so make use of that.