Om att trösta, sig själv och andra

Self-soothing. Possibly the biggest
lie ever foisted on parents

Posted on January 4,
2013by uncommonjohn

I haven’t
blogged in over a month — busy with many things — Christmas, Christmas concerts
and my new part-time job as research associate with the Milton and Ethel Harris Research Initiative at York University.

It figures
it would be the latest propaganda about baby sleep that would wake me from my
blogging slumber. This time it was news reports of a study by Dr. Marsha
Weinraub, a psychologist at Temple University. In an article recently published
in Developmental Psychology, she reports on data (collected 20 years ago, oddly
enough) from a study which tracked patterns of nighttime sleeping and wakening
in babies aged 6 to 36 months. Sleep patterns were recorded at four points in
time – 6 months, 15 months, 2 years and 3 years. They found that 30% of the
babies were sleeping through every night at age 6 months, while another 29%
were waking one or two nights a week. The researchers decided for some reason
that 30% and 29% add up to 66%, and that this means that that most babies sleep
through the night at six months.

I don’t
agree with the math or the interpretation, but what really got me is the
egregiously inaccurate way these findings were spun in the news piece put out
by Temple University’s communications department and subsequently parroted in
web and news stories around the world. The University news story  is framed with the entirely
unjustified and arguably dangerous headline  “Let crying babies lie: Study
supports notion of leaving infants to cry themselves back to sleep.”

The study
does nothing of the sort.

I have to
wonder if that headline made Dr. Weinraub, who is an attachment researcher
among other things, cringe. But, upon reading the journal article it’s very
clear that she does support the mainstream idea that it’s important for babies
to learn how to “self-soothe” and that mothers who attend too often or too quickly
somehow interfere with this “ability.”

This is an
opinion, not fact. Nothing in her data supports this idea.

Further,
Weintraub’s opinion is based one the biggest lies that parents
have ever been told: the doctrine of self-soothing.

I gotta
tell ya. My blood pressure rises every time I hear or see the words
self-soothe. Because it’s such a crock. There is no research proof whatsoever
that babies who sleep through the night do so because they have learned to
“self-soothe.”

Oh, search
the literature and you’ll find all sorts of references to self-soothing, some
of which Dr. Weinraub quotes. I know those studies because I read them. I
traced my way back through the all the references on self-soothing, trying to
locate the study that actually proved that babies soothe themselves back
to sleep. I couldn’t find it  – just a bunch of people saying (claiming)
that babies learn to self-soothe around six months. But actually, all that’s
really been proven, as Dr. Weinraub’s data confirms, is that some babies are sleeping
through the night by age six months. But whether or not they do this because
they’ve learned to self-soothe, is an interpretation, not science-based fact.

How do I
know? I e-mailed Dr. Thomas Anders, the guy who invented the term self-soothing
way back in the in 1970s. Here’s what he said when I asked him if any studies
had documented that infants who go back sleep without crying engage in some
sort of soothing behaviour to help themselves get back to sleep.

“I know of
no studies that address either of your questions. Self soothing is a label we
coined to contrast it with signaling (crying) upon awakening. I would
bet that most non-signaling awakenings occur without active self soothing.”

That’s a
direct quote. I still have the e-mail.

So this
self-soothing that experts talk about is nothing more than a made-up research
term. But here’s what sometimes happens to research terms. Somebody coins a
research term in a study and then all the researchers doing similar research
start to adopt it because it’s “in the literature.”  But after awhile
people start to forget that it’s just a research term. And since self-soothing
appears to mean a certain thing – a baby actively soothing herself back to
sleep – people started believing that it meant much more than it was ever
intended to mean. This is the same sort of thing that happens in propaganda and
advertising. Repeat something over and over and people start to assume it’s
true.

But, 
no Virginia, there is no such thing as self-soothing, at least not the
self-soothing that conventional sleep pundits talk about.

I’m not
saying that babies don’t wake up and go back to sleep on their own without
crying. Some do. And I’m not saying babies never do things that could be
thought of as self-soothing. Obviously some suck their fingers and thumbs and
seem to be calmed  by that. I’ve seen it happen. But what isn’t proven –
even though lots and lots of experts will tell you it has – is that babies
learn the “skill” of self-soothing and that this “skill” is a developmentally
normal and appropriate milestone for all six-month old babies.

So, anybody
who says things like,  “Learning how to self-soothe is a vital skill in
learning how to develop good sleeping patterns during infancy,”  (as one
news story posited) is either a liar or very careless with facts.

And anyone
who claims that it’s normal for all babies to sleep through the night at six
months is ignoring mountains of research evidence. In fact, the pro-sleep
training pundits’ own studies all show that night-waking is so common that it
can only be thought of as one kind of normal. To be fair, Weinraub doesn’t
exactly state that anything is wrong with babies who wake at night beyond six
months. Mind you she does suggest that some babies may have had their
“self-soothing” skills interfered with by parents who are too quick to comfort
them. Imagine! Parents wanting to calm an upset baby. Shocking!

Grrrr.

Night
waking is a tough issue for a lot of families. I know I’ve been there. (None of
our three boys slept through the night until they were three – consistent, by
the way, with one of the patterns noted in the Weinraub paper). Tons of
professionals, of varying opinions and philosophies, possibly including Marsha
Weinraub, are sincere in their intent to help parents.

I don’t
believe there is any one solution that will work for all families.

But a
couple of things are certain. It doesn’t help to keep repeating something (the
doctrine of self-soothing) that isn’t true. Nor do I think it helps to tell
parents that something that is within the range of normal is a disorder, or a
sign of weak parental limit-setting, a sign of a disordered baby, or that night
waking in baby and toddlerhood causes sleep and behaviour problems (I defy
anyone to show me a single study that proves this).

Some other
time I’ll get into the elephant in the room which is the colossal disconnect
between mainstream infant sleep ideology and the social and biological
realities of breastfeeding (something that all mothers are encouraged –
pressured, some say – to do these days). The biggest single predictor of night
waking in this study was breastfeeding at six months, something health
authorities want all mothers to be doing.

There’s actually
a lot of pretty interesting data in this study that was not reported in media
stories. In fact, I think the study could have been spun in a totally different
way. I’ll tell you about that in my next blog – very soon, I promise.

(This post
has generated an amount of interest that really surprised me. If you want to
read my take on what self-soothing really is, click here.)

Real Self-Soothing (It’s not what
sleep experts say it is)

Posted on February 14,
2013by uncommonjohn

Sorry for
the long absence.

Noticing
the great interest in my self-soothing post, I thought I’d go further into the
subject. It took me awhile to make sure I had it right.

So, if
there is a real thing that we could rightly call self-soothing,  here’s
how I would talk about it.

Regardless
of your position on sleep training, I think we can all agree that
self-soothing, meaning the ability calm yourself, is a very important life
skill.

The
questions are: How does that ability begin to develop early in life and how do
we, as parents, help babies develop that ability? And, OK, is there any conceivable
way that sleep training/controlled crying could help babies develop this
ability?

I don’t
think my elevator speech answer will surprise many people. Babies and little
kids learn to calm themselves from the experience of being calmed by others –
mainly their parents. I was aware of this on some level from my earliest days
as a parent, although I couldn’t have put it into words. All I knew was that
here was this little guy who was often upset, agitated and, at times, totally
discombobulated. And he needed us – our physical contact, being fed, carried,
sung to etc. to recover from that. I’m sure you’ve all felt like that.

But as time
goes on I continue to find new and deeper ways to understand and think about
how people develop the capacity to managing their inner feelings. And I keep
stumbling on more research that tells us how the process works. I want to share
some of that.

But first,
I have to say that I dislike the term self-soothing and I don’t normally use it
– except when I’m tearing a strip off conservative sleep pundits who try to
co-opt self-soothing to put a happy face on their methods.

I prefer to
talk about self-regulation. Because the ability to settle down is part of what
many scientists, psychologists and some educators call self-regulation. (I have
to credit my colleague and new boss, Stuart Shanker for some of the ideas I’m
presenting here.)

Self-regulation,
as I think about it, is the ability to adapt your physical, mental, emotional
and social abilities and energies to the situation, task or challenge at
hand.  So, if you’re crossing the street and a Hummer is bearing down on
you, you need to be able to summon up the energy and will to get of the way,
real fast. And your body helps you do that by, among other things, increasing
your heartbeat and giving you a shot of adrenalin. If you’re a child in school,
you need to be able to stay calmly focused and attentive so you can learn. And
if you’re tired, you need to be able to wind down so you can sleep.  Your
brain and body need to help you do those things too. That’s self-regulation at
work.

Self-regulation
happens on various levels – physiological, emotional, cognitive (thinking) and
social.  But physiological self-regulation is at the root of it all. If
the physiological mechanisms of self-regulation aren’t working right, you’re
going to have trouble controlling your emotions & impulses, getting along with
people, recovering from stress and thinking clearly under pressure. That’s
because your brain must put your resources toward coping with how unsettled or
agitated you feel on a visceral level, instead of helping you to do what you
want or need to do at a given moment.

Physiological
regulation is even more important with babies because of their neurological
immaturity. I’m sure many of you have heard or read that human beings are born
neurologically immature compared to other mammals. Dr. James McKenna, an
anthropologist and pioneering co-sleeping researcher at the University of Notre
Dame, was the first person who pointed this out to me, but lots of people are
talking about it these days.

So we’re
born with this under developed brain and neurological system that, literally,
develops outside the womb after birth. For one thing, the basic internal
neurobiological mechanisms that our body uses to help us calm down are not
fully functional. And, as various scientific findings show, those mechanisms
become functional in the context of the caregiving relationship. The caregiver
basically regulates the baby externally through interaction, holding, feeding,
basic caregiving, talking, eye-contact, singing or making little soothing
sounds that help the baby feel OK. Those experiences also help build the brain
pathways needed for the emotion cognitive and social self-regulation.

Here’s just
one example of how this works on a visceral level. We have a nerve – a network
of nerves, really – called the vagus nerve. It connects part of our brain to
the workings of our internal organs and also the muscles of the face and the
middle ear.

One of the
things the vagus nerve does is regulate our heartbeat, keeping it from beating
too fast. However, when our brain detects a threat, the “vagal brake” as it’s
called, comes off so our heart can beat faster to help us mobilize our
physiological, wherewithal to deal with the threat. When the threat is over,
the brake goes back on and our heartbeat returns to normal, which enables us to
calm down. (BTW, the ideas I am presenting in this section come from the work
of a brilliant psychologist by the name of Stephen Porges.)

We don’t do
that consciously. It just happens – part of the workings of the autonomic
nervous system.  However, in some people (and some babies), that brake
doesn’t work as well as it should. This is called “low vagal tone.” It can be
assessed by measuring a normal variability in heart rate relating to
breathing.  When people have low vagal tone the brake doesn’t go back on properly
when the threat, crisis or stress is over, and the person remains more agitated
and reactive, and has trouble calming down. Nor surprisingly, people with low
vagal tone are at greater risk for all sorts of mental disorders and behavior
problems. There is some evidence that good parenting can sometimes correct low
vagal tone. I’ll get into that in another blog. But for now I want to help you
understand the role that the vagus nerve plays in self-soothing.

What
fascinates me is that the vagus is centrally involved in infant feeding. It
turns out that suckling places a lot of demands on a newborn’s resources, so
the vagal brake comes off when the infant feeds and goes back on when nursing
is over (except with preemies – one example of their neurological immaturity).

Thus,
infant feeding is not just about nutrition and satisfying a baby’s hunger. It’s
inherently regulating. By that I mean it also helps the infant feel “OK” on a
visceral, physiological level.  I’m sure that makes sense to anybody who
has breastfed a baby or watched one nurse.

In other
words breastfeeding is one of elemental mechanisms in the development of
self-regulation. In fact, in one of Dr. Porges’ presentations, which I found on
line, when he first presents the term self-regulation, his slide shows a photo
of a baby breastfeeding. That doesn’t mean a bottle-fed baby can’t develop
self-regulation. Other kinds of sucking and, obviously, other aspects of
parental care  – including things like physical contact between babies and fathers (like
me!)- are involved in the early development of self-regulation.

But the
take home points are that a)babies are not created equal in terms of
physiological self-regulation (some require more external regulation than
others and, b)two key ingredients in the early development of the higher levels
of self-regulation that people have more conscious control over are physical
contact and interaction with a caregiver. (This is what English psychoanalyst
Donald Winnicott was talking about when he wrote the now famous line: “There is
no such thing as a baby. There is a baby and someone” or whatever it is he
actually said.)  We often think of that dynamic as primarily emotional and
social in nature. And, of course, it is. But the roots are physiological – a
parent “regulating” a baby externally.

There’s 
more to say on this, and it’s pretty interesting. But this is already pretty
long for a blog post. The next one will come in a couple of days. Promise.
(Part two has now been posted. You can read it here.

Here’s the
link to the Steven Porges presentation I mentioned earlier.

Part 2: Real Self-soothing.(It’s not
what sleep experts say it is)

Posted on February 18,
2013by uncommonjohn

This is the
second of a two-part post. If you haven’t seen Part one I suggest you read it first.

When I left
off I was talking about self-regulation in children and how its early
development begins with parents “regulating” babies externally.

Another
great piece of concrete scientific evidence on how this works comes from Dr.
James McKenna’s co-sleeping studies, which some of you may be familiar with.
Among other things, his work showed that sleeping next to a parent (mothers in
his studies) helps to regulate a baby’s heartbeat, breathing, body temperature,
sleep state and arousal level. The famous kangaroo care studies (by other
researchers) have shown similar sorts of things. Near-constant physical contact
with an adult body helps premature babies regulate their body temperature and
breathing, and simply helps them to thrive.

So, as a
parent, your body has a physiological, regulating impact on your baby. 
You probably already knew that. I sensed it as a new parent but had trouble
putting it into words. I touched on that in a previous post.

Back to the
specific link between infant feeding and self-regulation, which I explained in
my last post. Here’s a really cool thing you might not know.  Dr. Stephen
Porges’ research (see Part one) has shown that along with providing nutrition
and comfort, infant suckling also helps develop the facial muscles and other
neural pathways that are essential for smiling and other aspects of social
interaction. Some of these mechanisms start to become more functional at
around the age of six months, when he says infants become able to engage in
self-soothing.

Yikes!
Doesn’t this sound like Dr. Porges is saying the same thing as the sleep
pundits whose mantra is that infants become capable of self-soothing around
sleep at age six months?

Not at all.
Which leads me to the even cooler part.

The
self-soothing that Porges is talking about is not a solitary pursuit. Rather
it’s the enhanced developmental ability to seek out the social
interaction that is an infant’s primary source of comfort. Babies
have ways of getting us to interact with them before age six months – crying,
smiling, waving their arms and legs, looking cute and vulnerable etc. But at
around six months they become more aware and consciously active participants in
the process, plus they are more capable of being comforted by things other than
feeding and physical contact (although those remain important), such eye
contact or your soothing voice. Here’s how Porges puts it in one of his
articles:

“For
humans, maturation does not lead to a total independence from others, but leads
to an ability to function independently of other people for short periods.
Moreover, humans, as they become more independent of their caregivers, search
for appropriate others (e.g. friends, partners, etc.) with whom they may form
dyads capable of symbiotic regulation.”

In other words,
self-soothing is not about a little baby lying there crying for comfort and
then somehow having this eureka moment where he thinks, “You know, I don’t
really need Mom or Dad to get back to sleep anymore…. Zzzzzzzzzz.”

It’s more
like, “Hey, I’m starting to figure this thing out about how to get Mom or Dad
or big brother or Grandma to interact me. And, come to think of it, I’ve
noticed that sometimes I can get by just knowing that Mom or Dad is there and
paying attention to me.”

Six-month-olds
don’t really think like that, of course, but you get the drift. If there is
such a thing as “self-soothing” between 6 and 12 months of age, it is the beginning of
an enhanced ability to manage the way you seek out social sources of comfort
and support. Improved internal biological calming mechanisms, which
the baby does not consciously manage, play an important role. They help the
baby stay in the calm and alert state which enables her to focus on and
participate in back-an- forth social interaction.  This “social engagement
system,” as Dr. Porges calls it, is a crucial mechanism for recovering from
stress and, more generally, managing physiological, emotional, cognitive and
social self-regulation (see previous post) throughout life.

Does this
relate at all to the self-soothing sleep professionals talk about? Mostly no,
but the confound here is that some babies do wake up and go back to sleep on their
own. I’d guess that many are physiologically calm when they do so and that
their internal calming mechanisms help them go back to sleep.  I can’t
tell you why some babies are like that and others aren’t – although I’ll bet
variations in vagal tone have something to do with it some of the time. 
Dr. Porges’ research has shown that babies who cry excessively tend to have
poorer regulation of the vagal brake. That could explain why some babies are
less upset than others when they wake at night and why sleep training goes so
much harder with some babies than others.

Bottom
line, it’s safe to say that babies who go back to sleep on their own do not do
so because they are employing self-calming techniques they learned while being
Ferberized.

In fact
research by Wendy Middlemiss, of the University of North Texas, suggests that
in some cases at least, it’s the opposite. She monitored cortisol levels
(cortisol is a hormone that helps mobilize our physiological resources to deal
with a challenge or threat) in babies at a New Zealand clinic where they
practice a sleep training technique that really does warrant the term “cry it
out.” In this clinic, after mothers and babies went through their normal
bedtime routine the babies were left in a room to, well, cry themselves to
sleep, and the mothers were not allow to go back in (nurses went in to check on
the babies but they didn’t offer comfort). Middlesmiss (who does not espouse
controlled crying sleep training methods, by the way) and her
team measured the babies’ levels of cortisol on the first and
third nights of treatment. On the first nights, when the babies were wailing
away, they had elevated levels of cortisol (and so did the mothers).  On
the third night, most of the babies were going to sleep with little or no
crying. But their cortisol levels were still elevated.

That’s a
pretty clear sign that these babies were not physiologically
calm when they fell asleep, even though they weren’t crying. Actually, their
stress response systems were active.

Now, this
does not prove that the methods used in that New Zealand sleep clinic, or any
other of the variations in sleep training methods, damages babies. Human beings
are resilient and can recover from setbacks – the stress of sleep training is
far from the biggest bump in the road a child can encounter. But if someone
wants to use sleep training and self-soothing in the same sentence, the most
scientifically accurate thing to say would be that ignoring a baby’s cry is a
disruption of the social process by which babies learn to self-soothe. Dr.
Porges refers to it as “a violation of the child’s biological expectation of
safety from an external source.”

Keep in
mind that all babies will experience these violations from time to time – not
just in the context of sleep training, but for all the myriad reasons that
parents can’t necessarily attend to babies immediately: having other children
to care for, other responsibilities to attend to, being exhausted or frustrated
or ill.  (Children will also experience similar violations many times in
interactions with peers and other people as they grow up.) Babies are designed
to withstand some of these violations, provided that for the most part parentsdo respond,
not just to a baby’s distress, but also to their other bids for social
interaction.

So with
respect to sleep training, for me, it’s not a question of absolute right and
wrong, it’s about a risk/benefit question for each family. If parents feel that
their functioning is greatly compromised, or they are highly stressed by lack
of sleep because of an olderbaby’s night waking (or that their baby
is adversely affected by night waking) it’s not our place to second guess them
if they want to try sleep training. Highly stressed, unhappy parents aren’t the
best thing for babies either. So if a family tries sleep training and it works
relatively quickly, and they don’t have to keep doing it over and over again,
and the parents understand that the non-responsiveness required in sleep
training is an exception to the rule, and if less interrupted nights help the
parent(s) be happier and more responsive and sensitive to their babies, then
sleep training could be helpful for a family.

But at the
same time, if parents want to soothe their babies at night, because they think
that’s what their child needs, or they find it easier, or because they’ve tried
sleep training and it didn’t work (which happens frequently), sleep training
proponents have no right  to tell them that they are
failing to teach their babies to self-soothe. Science suggests
otherwise.