OCN L evel 4 P ostn ata l M ate rn it y N urs e C are A w ard Q 4

April 18, 2019 Critical Thinking

OCN L evel 4 P ostn ata l M ate rn it y N urs e C are A w ard

Q 4. Critically compare common sleep theories (write at least 250 – 300 words)

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Consider different philosophies including:

Babies should be seen and not heard strategies (Dr Ferber, Marc Weissbluth)

Prescriptive, routine based strategies (Gina Ford, Baby Wise)

Routine and different temperaments of babies (Tracy Hogg)

Baby-centred strategies (Elizabeth Pantley – The No Cry Sleep Solution)

Attachment focused strategies (Dr Sears, Sarah Ockwell-Smith)

It is very important that the most appropriate sleep training technique is carried out in
order to avoid the infant being affected emotionally and psychologically causing
hindrance to brain development.
For example if you leave a baby to cry, yes, eventually the baby may stop, but not
necessarily because they’ve settled happily to sleep. They might have given up and
'neurologically withdrawn’ because no one has come to them. This is not good for their
brain development.
Babies under 12 weeks genuinely aren’t capable of consciously self-settling. It is also
not crucial that your baby has this skill until they’re over 3 months old anyway, when
they start waking between sleep cycles. A baby under 12 weeks is able to transition a
lot easier between sleep cycles, regardless of how they went to sleep at the start of
each nap or at bedtime. It is however, good practice to put them in bed when they’re
awake but drowsy so they do the final bit of falling asleep by themselves if you think
they can.
Caregivers who respond to the needs of the baby before the baby gets distressed are
more likely to have children who are independent than the opposite Soothing care is
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best from the start. Once patterns of distress get established, it’s not good for the
infants well being. Therefore, this is where the Ferber sleep training is not in favour.

Extinction methods of sleep training “cry-it-out and controlled crying” claims to benefit a
infant to self soothe. Unfortunately extinction sleep training neither teaches to
self-soothe nor helps a infant emotionally and psychologically.

When a parent is nurturing towards their child in their early years the hippocampal
volume is greater and that’s important because the hippocampus is related to
behavioural regulation. Therefore leaving a child immensely distressed is not
recommended and this is where the Ferber method I believe is harsh in letting the infant
cry and not self soothe the infant even if the infant has vomited during long intervals of
crying.

Although, the Ferber method can be effective way to reduce nocturnal crying, protests
and requests for parental soothing. However, parents should not feel it is the only
effective method available or whichever common sleep technique they choose. If it
does not work they should not feel obliged to continue.

Moving on to Elizabeth Pantley’s gentle yet effective approach helps parents identify the
causes of sleep problems and provides practical step-by-step solutions. Which helps to
also avoid being harsh to the infant compared to the Ferber method. Ferber method is
in fact harsh to a certain degree. Elizabeth Pantley promotes a gentle, child-centered
approach to solving sleep problems. The solutions are relationship building.

The theory behind the No Tears method is that bedtime is a prime opportunity for
connecting and building a relationship with baby.

It is based on going to baby immediately when he cries during the night and creating an
environment of safety through constant contact, picking up and putting down as
necessary, and lots of attention.

It focuses on gentle nighttime routines and the need for consistency in training.

No Tears Method Pros

• It builds a healthy bond between baby and caregiver
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• It reassures baby and helps create a positive understanding of nighttime
• It encourages gentle sleep training
• Good method for babies and toddlers needing help

No Tears Method Cons

• It can take a while (several weeks) to show results
• It can create a habit in baby of needing props to fall asleep
• Caregivers are required every time baby wakes up, making it difficult for the caregiver
to fall asleep themselves

My conclusion of the common sleep training theories is that before you choose any
sleep training program review important factors such as;

•Make sure that the sleep training program is age-appropriate.
•Screen and address your child's specific sleep problem.
•Consider your child's individual temperament and personality.
•If your child has a conditioned fear of being alone or shows signs of conditioned
vomiting, consult a behavioral therapist.

The evidence based research I have carried out is outlined below which supports my
analysis and understanding that I have outlined above of how common sleep theories
are critically compared.
Some parents who try Ferber sleep training see improvements within a few days.

In studies testing graduated extinction, parents may complete training within 4 weeks
(e.g., Reid et al 1999). But some parent are disturbed by the notion of ignoring their
children, and concerned about the potentially harmful effects of training drop out before
they see any improvements in their children's behavior. Kids subjected to the Ferber
method may become much more distressed during training than they were before.
These so-called “extinction bursts" which include more frequent and intense crying,
protests, and tantrums persuade some parents to give up.

In addition, training may fail if parents are inconsistent and periodically “give in" to their
children’s pleas. Ferber advises parents to stick to the routine, even if the child
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becomes so upset that he vomits. In this event, parents should clean up the mess
quickly and then leave the room and continue training (Ferber 2006).

Arguments in favour of the Ferber method

According to scientific studies, extinction sleep training including Ferber sleep training is
associated with the following positive outcomes (Mindell et al 2006):

? Kids who complete training are less likely to throw bedtime tantrums

? Kids who complete training are more likely to settle down at night within ten
minutes

? Kids who complete training are less likely to awaken their parents during the
night

Parents who complete training report improvements in their own stress levels, mood,
and interactions with their children. In addition to these positive results, parents have
reported improvements in their children’s daytime behavior, perhaps because sleep
training “graduates" were getting more sleep at night (Mindell et al 2006).

For parents enduring nights of sleeplessness and emotional turmoil, these outcomes
are extremely important. Advocates of graduated extinction out that parents who are
sleep-deprived are at higher risk for depression and marital conflict (Mindell et al 2006).
Such parents may develop negative feeling towards their children and the parent-child
relationship suffers as a result. If parents can stop or reduce their children’s disruptive
nighttime behavior, the whole family will benefit.

But the Ferber method isn't the only sleep training program that delivers these benefits.

As noted below, alternatives to the Ferber method training programs that don’t involve
leaving children alone to “cry it out" have equally successful track records (e.g.,
Skulladotir et al 2003; ). For this reason, it’s important to consider the potential costs of
graduated extinction.

Arguments against the Ferber method

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Our evolutionary past has left its stamp in our brains. When babies and children are left
alone at night, they are likely to experience one of the most primal and powerful
stressors known to young animal separation anxiety (Panksepp 2000). Separation
anxiety is a panic response arising from a primitive part of brain that also processes
information about physical pain (Panksepp 2000).

Concerns about separation anxiety and stress have led some pediatricians,
researchers, and therapists to worry about the adverse effects of the Ferber method on
a child’s health and well-being (e.g., Sears and Sears 1996; Commons and Miller 1998;
Sunderland 2006).

How does the Ferber method affect a child’s stress response system? His relationship
to his parents? His developing personality?

Advocates of extinction training note that no studies yet have demonstrated that the
Ferber method harms children over 6 months old. But the truth is there hasn’t been
much research to resolve the question. Studies of human infants confirm that crying is
physiologically stressful increasing a baby’s blood pressure, heart rate, and cortisol
levels (Levesque et al 2000; Luddington-Hoe et al 2002).

Moving onto Sarah Ockwell-Smith who is against the Ferber sleep method and has
stated her argument within reasonable grounds of research.

If you practice sleep training (that could be controlled comforting, spaced comforting,
controlled soothing, controlled crying, cry it out, rapid return, spaced soothing, gradual
withdrawal or pick up put down – call it what you will, really they’re all the same in their
intent and actions) are you teaching your baby to self soothe?

What is really happening? In most cases something is happening on a very basic primal
level. Let’s go back to the hindbrain and the fight or flight response. What happens
when those stress hormones reach such a level that they are toxic yet you can’t take
flight……..or fight…..another ‘F’ comes in, this time it’s F for ‘Freeze’. You freeze all
activity in order to try to conserve homeostasis, or more simply put – conserve life. Dr
Sears calls this ‘Shutdown Syndrome’.

Do you remember that NSPCC advert with Baby Miles? Baby Miles doesn’t cry
anymore because nobody comes”.
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Or footage of Romanian orphanages with rows upon rows of cots with eerily quiet
babies? They don’t cry, not because they don’t have needs, or feelings, but because
there are too many of them for the staff to respond to unless it is for a basic physical
need. They’re in Shutdown Syndrome, they have ‘frozen’ in order to conserve life.
They know nobody comes, why cry?

Check out this research which shows what happens during ‘selfsoothing’ teaching,
highlighting how stressed the baby still is, despite their quietness and apparent
‘sleeping’. Chemically we can now prove that the baby is neither soothed or settled.

This study examines change in the synchrony between mothers' and infants' physiology
as 25 infants (11 males; 4 to 10 months of age) participate in a 5-day inpatient sleep
training program in which they learn to self-settle through extinction of crying responses
during the transition to sleep. The mothers' and infants' experience during the extinction
protocol was "yoked" by the infants' behavioral signaling during the sleep transition
period. Saliva was sampled for mothers and infants at initiation of infants' nighttime
sleep and following infants' falling to sleep on two program days and later assayed for
cortisol. As expected on the first day of the program, mothers' and infants' cortisol levels
were positively associated at initiation of nighttime sleep following a day of shared
activities. Also, when infants expressed distress in response to the sleep transition,
mother and infant cortisol responses were again positively associated. On the third day
of the program, however, results showed that infants' physiological and behavioral
responses were dissociated. They no longer expressed behavioral distress during the
sleep transition but their cortisol levels were elevated. Without the infants' distress cue,
mothers' cortisol levels decreased. The dissociation between infants' behavioral and
physiological responses resulted in asynchrony in mothers' and infants' cortisol levels.
The findings are discussed in relation to understanding the determinants and
implications of maternal-infant physiological synchrony in early childhood. (1
University of North Texas, TX, USA)

After concluding in depth research and outlining the evidence based research above my
final conclusion is that parents need to give lot of consideration which sleep programme
they choose and if it does not work then to choose another sleep training strategy. As
otherwise the consequences of sleep programme that is not being suited and still being
introduced can result in a very damaging and alarming detrimental outcome.

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One of the potential devastating effects is that if a baby has been trained to be quiet and
to not call for their parents to meet their emotional needs at some point something might
happen. This is where the infant could get in a very dangerous situation i.e entrapped
in a blanket leading to a SIDS statistics result.

SIDS can be associated with a potential correlation with sleep training. Therefore,
careful consideration/analysis needs to be given in choosing which sleep programme to
undertake.

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