"If it was as easy as you make it out to be, why do you think I'm back again? I've tried all that, and it just isn't working. My one year old still keeps on waking up and it's driving me and my husband crazy".
Despite the upbeat message in some of my previous postings on this subject, which could have been interpreted as if I was claiming that changing a toddler's sleeping patterns is easy and that it is only a matter of the parents simply making up their minds to "set things right", I am very aware that it is not always easy for some parents to break the cycle of sleep association behavioral insomnia in their toddler, who demands his parents' presence (sometimes the father's, usually the mother's) on multiple occasions across the night so that he can be lulled back to sleep. By "not easy" I am referring not to the technical aspects of this, which, I think, are fairly simple and straightforward, but to the guilt, angst and anxiety that develop and accompany the process itself, undermine the possibility of success, and leave those parents worried that they are causing more harm than good.
The hardest part for parents trying to do this seems to be reconciling the "rational" decision they have made to change the ground rules for sleep-related behavior in their child for the benefit of the family unit as a whole, with the emotions of distress and guilt aroused by the crying and screaming (sometimes to the point of vomiting) that this leads to. It becomes even more difficult when the child is otherwise an absolute delight to be with, interactive, smiling and playful, and the parents question whether causing so much suffering is worth it (though in all honesty, the suffering witnessed is no different from that seen in a 2 year old in a toy store who doesn't get to leave with the forty pound stuffed rabbit, or the 5 year old who doesn't get the ice cream cone she has decided she must have at that very moment).
When meeting with parents who are having a rough go of it back in clinic for the second (or third, or fourth) time, I often see a distinct pattern. The mother (and it is almost always the mother) will usually start by saying that she is torn between letting her child scream while slowly internalizing the new behavior and learning how to self soothe (which she knows, she says, is the right thing to do), and letting him wake up the rest of the household. In order to prevent this from happening (which, she points out, would not be fair to them), she winds up giving in and picking up her child after 20-30 minutes of screaming, bringing him into bed with her, and falling asleep with her son in her arms (and in doing so, unwittingly teaching him just how long he needs, or is expected, to scream for so that he gets what he wants). As the conversation proceeds, she will then start to talk about the guilt she feels about "torturing" her child, depriving him of the simple warmth and physical closeness which he desires and craves, in his innocence. Isn't it natural for a baby to want to be held by his mother, she asks? Don't most babies sleep with their mothers the world over, and haven't they always done so, since the dawn of human history? Isn't it wrong to impose a very modern convention on this sweet and innocent child?
This, I think, is the heart of the matter. People nowadays are pulled in so many different directions that they have difficulty reconciling the conflicts and contradictions between their obligations to work, family, and self, and even the different roles played within these categories (being a wife versus being a mother versus being an individual with needs of her own). Add to this the fact that, in this country, not only are many families separated from experienced extended family members (parents, grandparents, aunts, uncles, and siblings, who have all dealt with child rearing themselves), but many are single parent families where the parent lacks the support of another adult partner to see them through the hard times and affirm their decisions, and you wind up with a large number of well intentioned parents who simply don't know how to resolve these inherent contradictions, and wind up feeling terribly guilty about their choices, no matter what they do.
"If I let her cry for half an hour, only checking in on her briefly every 5 minutes until she falls asleep, will she get brain damage?" a very well educated parent (who hadn't slept in 2 years) asked me a few months ago. No, I replied, she will not. But I don't think she was convinced, and believe that this guilt and uncertainty were what got in the way of her being able to implement a regular bedtime routine and a consistent schedule, for her daughter, and to teach her how to fall asleep on her own without needing to be rocked in her mother's arms.
Was this wrong, or does it reflect weakness of character? No, of course not. In fact, one could argue that her perseverance in rocking her daughter back to sleep twice and three times every night while not giving into the temptation of putting her (the mother's) own needs first was THE true test of character, and reflected the ultimate giving and commitment to her daughter's needs and well being. But I think that it's safe to say that it wasn't working for her, and was turning night time into a nightmare for her, her husband, and the rest of the family. And as I have written before in some of my other postings, my belief is that there is no "right" or "wrong" way of dealing with a toddler's difficulties in falling asleep on her own, only what works best for the people involved: the mother, father, and child, and to a lesser degree, the other siblings.
Dennis Rosen, M.D.
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