Should I Sleep Train My Baby?

This is such a hot and controversial topic. I struggled to write about it. But it’s something that so many new parents will face, and most often with a lot of insecurity and struggle. 

Breastfeeding Success and Sleep Training

At Breastfeeding Success, we want all families to be successful, which to us, means healthy AND happy. All over social media and elsewhere, people are talking about what infant sleep is “supposed” to look like. We take a very evidence-based approach to every issue. We dig and learn everything we can so that we can offer families great information. And then we’re here to support you in your choices.

The most recent research, as well as natural history, shows us that babies will develop and change quickly. Babies will sleep differently (better) over time, and that can happen without any drastic measures. For this reason, a “wait and see” or baby-led approach is more than acceptable. We also understand that our societal norms and culture don’t always allow us to gradually adapt to a baby’s changes like our ancestors might have been able to. Short or non-existent maternity leaves, workplace restrictions, housing issues, and childcare limitations are all things that mean we sometimes have to intervene, and that’s OK too. 

We know that “sleep training” is an umbrella term that can mean a lot of things depending on the source. Every family will need to come to decisions about this on their own, and we see that what ends up working for most families is some kind of grey area. You can gather information and listen to advice, and then be the creator of your own “methods” when it comes to sleep parenting. You are most likely not doing anything “wrong,” whatever you decide. We do want to warn families about any methods charging money for a quick fix or making “too good to be true” promises. It might be true that following those plans in a very disciplined way works for a handful of families, but there are probably many more that do not have good experiences or success. And it’s very important to keep in mind that some of these methods can have a negative impact on breastfeeding and breast milk supply.

This article starts with a little history lesson, but bear with me! It will hopefully make sense in the end. 

A History of Birth in the US

Until about the late 1800s in the United States, births occurred in homes attended by midwives. It wasn’t until the early to mid 1900s that the majority of births were in hospitals. 

When birth first shifted from home to hospital, it unfortunately created a health crisis. Birth outcomes did not improve at first. Infection control was a big issue in hospitals before antibiotics, and mothers and babies were at risk. In an attempt to reduce those risks, there was a lot of mother/baby separation which severely undermined breastfeeding. Also, strong anesthesia and pain killers were administered to mothers which made breast milk unsafe or created extreme sedation in mothers and babies so that feeding was more difficult.

A History of Breastfeeding in the US

Before the early 1900s, mothers breastfed their babies. There were no other options. In the rare case that a parent could not breastfeed, a wet nurse would be found. That might have been a lactating friend or family member, or someone that could be hired to provide breast milk. Less safe options included using other animal milk, which often led to illness or infant loss.

At the turn of the century, infant formula was new and therefore became the standard for hospital births. Then “Breastfeeding became nearly extinct in American culture by the middle of the twentieth century.” (Tomori). 

Luther Emmett Holt was a physician who first introduced the concept of heavily regulated infant care. His book The Care and Feeding of Children: A Catechism for the Use of Mothers and Children’s Nurses was first published for the public in 1894. It became very popular and dramatically changed parenting as people knew it in the United States. The recommendations in his book related to feeding, did a lot more to undermine breastfeeding, almost ensuring that supplementation with formula would be necessary, including his belief that night feeding caused “disturbed sleep,” so he recommended formula feeding at least at night. It was not understood at the time that inconsistent or not enough breastfeeding leads to a drop in milk supply.

He also introduced the idea that if a baby wasn’t thriving or if the breast milk supply was lacking, it was likely due to a “nervous condition” of the mother. He states in his book that, “Very much more than her diet; worry, anxiety, fatigue, household cares, social dissipation, etc. have more than anything else to do with the failure of the modern mother as a nurse. Uncontrolled emotions, grief, excitement, fright, passion, may cause milk to disagree with the child, at times they may excite acute illness, and at other times may cause a sudden and complete disappearance of the milk’ (Holt 1917: 45).

I do not like to think of any mother trying to feed her baby as a “failure”, but what this did was put the fault on the mother. It allowed for women to begin questioning their bodies and their abilities to feed their own children even though the truth was something very different.

A History of Sleep Training in the US

With the shift away from breastfeeding, and a focus on more controlled and regimented child feeding and care, practices to “improve” baby sleep were introduced. What was not well-understood is that when a parent is not breastfeeding, there are different circumstances related to sleep. Waking up to prepare and give a bottle is different from the way a breastfeeding mother would have handled nighttime feedings. That, combined with the fact that a birth parents’ hormones are different when not lactating, makes it more difficult for the parent to sleep. 

For these reasons, in his book, Luther Emmett Holt also recommended giving babies their own bedrooms and enforcing very strict sleep schedules. This included the idea that a parent should allow a baby to “cry it out.” This was the first time this concept and term was introduced. 

Effects of Our History

Since that time, other professionals have capitalized on the popularity of Holt’s book, and have taken these concepts and created their own methods or systems of infant care. Some very popular experts like John Watson even proposed the idea that showing affection should be limited for children. They should not be held, kissed, hugged or praised. This carried into nighttime parenting. Some believed that children did not need human contact to be soothed. While some of these concepts were more controversial, the recommendations relating to routines and schedules were widely accepted.  

It was believed that, especially members of the medical community, had a particular expertise related to the care and feeding of infants, and parents needed to modernize. It got to the point where the prevailing wisdom inferred that only people who were old-fashioned or poor or negligent had home births, breastfed, or shared a room with their babies. This has led to a dramatic drop in breastfeeding rates and a huge spike in struggles and controversy related to infant sleep. 

What is True? 

Since then, parents, anthropologists, and scientists have been questioning the prevailing wisdom related to sleep for decades. There is more research and data to show what the effects of some of these hyper-controlling parenting recommendations have had on families. A lot of experts have modified their sleep strategies to be gentler, and the research supports those changes. There are also a lot of parents who question the need for “sleep training” at all. There is also a lot of research to support that belief. 

The truth is that there are a lot of different sleep training methods out there. There are some that might be harmful, but also plenty that don’t seem to have any negative long term effects. It’s also true that doing nothing can be good too, and that children still learn to sleep well. 

What Else Can Sleep Training Look Like? 

We can’t know what is right for every family. Every parent has different needs and abilities, and it’s the same with babies. There are some babies who seem to be naturally “good” sleepers, and others who don’t ever seem to want to sleep at all. Some might need more or less intervention. 

Most babies are neither good nor bad, but they don’t sleep like adults. At Breastfeeding Success, we have classes about infant sleep and offer virtual sleep consultations with our resident sleep expert, Cassie. Our classes are focused on the normal biology of infants and sleep because we believe that when a parent truly understands and has realistic expectations about infant sleep, they will experience less stress about how their newborn is sleeping. And of course our classes also focus on the very intricate relationship between sleep and breastfeeding so parents can maintain a healthy breastfeeding relationship. There is so much great research about the hormonal changes caused by breastfeeding and how it can support good sleep for infants and for the breastfeeding parent. Our classes also discuss strategies for setting up good sleep habits and safe sleep. 

Sleep training can just be about education and shaping your expectations and environment to help your baby adjust to life and sleep outside the womb. 

Starting small, and starting early with some very simple expectation shifts, and environmental and routine modifications, can often mean that further intervention is not even necessary. We hope that all families can develop healthy and positive sleep relationships with their babies so that the children can grow up with positive sleep associations and habits. That can make life for your future self easier too! 

References

Mother-Baby Behavioral Sleep Laboratory

Sleep Training Truths: What Science Can (And Can’t) Tell Us About Crying It Out

RESEARCH ARTICLE Toward an Integrated Anthropology of Infant Sleep

<1>Changing Cultures of Nighttime Breastfeeding and Sleep in the US