Putting the sleep wars to rest

Getting a baby to sleep these days is enough to make his mom and dad cry all night.

Faced with sleep-deprived couples at each other's throats in the wee hours, three major sleep experts and the leading organization of pediatricians are tweaking their prescriptions for infant sleep. But their wide range of advice might confuse parents more than ever.

Should they let the baby cry it out alone? Take him on 2 a.m. car rides? Nurse him no matter what the hour?

"It's already a tense situation because you're exhausted all the time," said Michele Mulligan, of Towson, Md., who had to negotiate with her husband, Kevin, on how long they would let their daughter, now 23 months old, cry at night.

"So if you don't decide ahead of time what you're going to do, if you're in the moment and you're trying to figure out what to do, that's really, really stressful."

Dr. Richard Ferber, known as the father of the "controlled crying" method, will de-emphasize that strategy in a future version of his book. Dr. Marc Weissbluth, who has advocated the even harsher "extinction" technique, now focuses more on preventing sleep problems for harried parents whose work schedules keep them from putting babies to bed at the right times.

At the opposite end of the advice spectrum, Dr. William Sears, the guru of "attachment parenting" — a philosophy in which parents stay close to their children, sleeping with them and breastfeeding on demand — offers tips in his new sleep book for mothers who are exhausted from responding to a baby at all hours.

Last fall, the American Academy of Pediatrics recommended that parents offer babies pacifiers at bedtime to reduce the risk of sudden infant death syndrome, or SIDS — raising eyebrows from those who worry about giving their babies a "sleep crutch" that will keep them from settling down for the night on their own.

The shifting advice is part science, part reality check: As researchers learn more about the harm of sleep deprivation for people of every age, doctors and a growing number of parent coaches see exhausted mothers and fathers arguing over what to do when the baby wails in the middle of the night.

"Ferber's method ignored what I think parents are going through today, which is separation during the day and wanting closeness at night," said Dr. T. Berry Brazelton, the eminent Harvard Medical School pediatrician.

Add to that the fact that today's generation of parents is already particularly sleep-deprived. Last year, the nonprofit National Sleep Foundation released a poll reporting that Americans sleep almost two fewer hours a night than Americans of 40 years ago.

In his book "Sleep: The Brazelton Way" (Perseus Books Group, 2003, $9.95), Brazelton tells parents to show children as young as 4 months that they can sleep on their own by sitting beside them and softly telling them so.

"I'd go to him and say, 'You can do it. I'll sit here until you can do it,' " Brazelton said. " 'I'll be here, but I can't take you out [of the crib].'

"Each time, you gradually, gradually teach them they can manage for themselves."

Dr. Alice Tanner, a Maryland pediatrician who has practiced for 20 years, gives similar guidance.

"My advice on sleep totally changed after I had children," said Tanner, whose children are now 9 and 12. "I used to think you never picked up a baby in the middle of the night. I've become more tolerant of comforting the baby and making sure the baby's needs are met."

All of this leaves parents in something of a daze.

"It is all too much," said Debbie Steinig, 33, of Guilford, Md., who tried several ways to get her 2-year-old daughter, Talia, to sleep through the night. "On the night she doesn't sleep well ... it doesn't help that you have read 800 books that all say that if your baby isn't sleeping well, it is your fault."

Ferber's 1985 book, "Solve Your Child's Sleep Problems" (Fireside, $14), outlines a method in which parents leave infants alone in their cribs, drowsy but awake. If they cry, the parents are to wait progressively longer intervals — in the beginning, just a few minutes — before comforting the child, until he learns to fall asleep himself.

But in the middle of the night, that's easier said than done.

Mulligan's daughter Maya, for example, seemed to get angrier the more her parents came in when she was crying, so they tried letting her go "cold turkey." But Mulligan, 36, said her husband, a software developer who had to work in the morning, wanted to stop the crying by bringing the girl into their bed. They compromised by putting a time limit on Maya's crying. Eventually, she learned to get to sleep.

Kim West, an Annapolis, Md., social worker known as "the Sleep Lady" who works with parents on sleep issues, says it's crucial for couples to agree on their approach during the daytime.

Her book "Good Night, Sleep Tight: The Sleep Lady's Gentle Guide to Helping Your Child Go to Sleep, Stay Asleep, and Wake Up Happy" (CDS Books, 2005, $22.95), outlines a "shuffle" method in which a parent sits next to the child's crib while he tries to fall asleep, then gradually moves out over several nights.

"I always tell parents I don't want you to create a plan in the middle of the night," she said. "There needs to be a united front."

Through a publicist, Ferber, director of the Center for Pediatric Sleep Disorders at Children's Hospital in Boston, declined to be interviewed. But in an interview last fall on NBC's "Today Show," he said that his 20-year-old strategy had been largely misunderstood. Crying it out, he said, "is only the instruction for one method for one problem" and won't work for all children.

He said the revised book, due out in April, will offer other, gradual steps to help children fall asleep on their own.

Weissbluth, a Northwestern University professor and practicing pediatrician, is emphasizing the importance of recognizing children's natural sleep rhythms in the latest version of his book, "Healthy Sleep Habits, Happy Child" (Ballantine Books, 2005, $22.95).

For those who aren't sleeping, he now offers a range of "no cry," "maybe cry" and "let cry" solutions. On the "let cry" list is extinction, which involves letting a child who is not hungry cry without comforting for as long as it takes him to fall asleep.

Weissbluth said he has noticed in recent years that friction in a marriage can easily keep a sleep prescription from working. "I become more aware that parents intellectually agree with me and want to help the child sleep better, but are incapable of changing their behavior so that the child will sleep better," he said.

As the advice evolves and the doctors debate, parents often follow their own course.

The mother of two teenagers, Jamie Kirk, 39, of Gambrills, Md., converted to the teachings of Maria Montessori for her third child, Will, now 1.

"Maria Montessori taught that if the child slept on a floor bed, it would foster freedom of movement and independence," said Kirk, who directs the education of toddlers at the Montessori International Children's House in Arnold. Md.. "If the child wakes, he is free to crawl and play and go back to bed when he is ready.

"I just take Will to his room. I lay him on his bed. Sometimes, he gets up and comes to the baby gate and cries two or three times a night, but I just go to his room and take him back."

With four children under 7, Christine Fischel, of Cedarcroft, Md., hasn't much time to read parenting books. She has gone with her gut, which, at the moment, tells her to sleep in the same bed as 3-month-old son Henry.

"He's my last baby ... so I kind of cherish the moments with him," said the 35-year-old mother.