Twenty to 30 percent of preschoolers have difficulties falling and staying asleep, mostly because of behavioral insomnia of childhood. This can occur because a child learns to fall asleep only when something (or more often, someone) is present or in direct physical contact with him. It can also be because the child's parents allow him to set the rules of how and where he sleeps, for example, by refusing to sleep in his own bed or only if his mother sleeps on a mattress alongside his bed on the floor of his bedroom.
As a pediatric sleep specialist, I meet many chronically sleep-deprived parents and their otherwise utterly-charming children whose ability to sleep seems to be inversely related to that of their parents for precisely these reasons. Most of the parents have sought out solutions in different books, online, or with their pediatricians but have not been able to translate the guidance they've received into success. They're frustrated, but at the same time concerned that by being too strict with their child, or by allowing her to cry "too much" (yes, sometimes even to the point where she vomits), they may be overly cruel to their child because of their own "selfish" desire to get a good night's sleep themselves. More than one mother has asked me in all seriousness whether letting a child cry for 45 minutes straight might not cause irreparable brain damage.
This is why the study published this week in Pediatrics by an Australian group that found no evidence of long-term harm to the wellbeing of children who underwent sleep training in infancy is so important. The researchers followed 326 children, 173 of whom underwent sleep training to improve their sleep with an extinction protocol (cry it out), modified extinction ("controlled comforting") or "camping out" (remaining in the infant's room as he fell asleep without interacting with him).
The children and their parents were later assessed at age 6, and no differences were seen at that time in a variety of measures, including the child's emotional, conduct, behavior, sleep habits, psychosocial functioning, stress, or child-parent closeness. Likewise, there were no differences found between the parents of the children who had and had not undergone sleep training in measures such as parental depression, anxiety, or authoritative parenting.
I was really pleased to read this study. As far as I know, it is the only one with this kind of longitudinal monitoring of the effects of sleep training on both parents and children. Its findings confirm what I have repeatedly seen in my own practice (and family): kids are very adaptable, especially when it comes to how and where (and with whom) they fall and stay asleep. It also confirms that no matter how difficult it might seem, in advance of doing so, to change a child's habit of only being able to fall asleep in his mother's arms in the rocker, or snuggled up between both parents in their bed, not only can this be changed with targeted interventions, but that the kids adjust to the new rules very easily and without long-term ill effects.
To some, this may seem like straightforward common sense. After all, kids in other places and other times have had to deal with far more difficult things than learning to adjust to falling asleep on their own and have come out just fine. But for some, especially those who are raising their children far away from older generations of family who can share of their own experiences and help the new parents overcome their sometimes crushing self-doubt, watching their child scream because he's not getting exactly what he wants (a back rub) when he wants it (at 3 a.m.) can seem overly cruel, even abusive. He's only 2, after all. Is it really unreasonable to rub his back until he falls back asleep three times a night if that's what makes him happy?
When asked that question, my answer is: No, it's not unreasonable, provided that it works for you and for the family unit as a whole. If you're fine with waking up three times a night, every night, to rock your child back to sleep, then no, there's nothing wrong with that. Likewise, if you want to buy a king-size bed and have the whole family sleeping together until they leave home (with the exception of infants, for whom co-sleeping can be dangerous), more power to you.
But if it's not working for you, if you find that it's interfering with your marriage, job, quality of life, interaction with your other kids, etc., then the findings of this study are like manna from heaven. Because what many of us who deal with children's sleep issues have always felt (and seen) to be true in our practices and personal lives, namely that sleep training works and doesn't have any negative long-term consequences, has now been borne out by scientific research. And I hope, for the sake of those who struggle with their children's sleep but haven't felt secure enough to make the changes necessary so that everyone in the family can get a good night's sleep, that this will help convince them that it's more than OK to go ahead and do so.