Save Our Baby... From Tizzie Hall

New parents talk endlessly about sleep. There is a huge industry built around providing advice to sleep deprived parents, from self-help books and consultants, to 'sleep schools'. People often ask me, “Is she a good baby? Does she sleep well?” in one breath, as though the two questions are synonymous.

What makes the topic particularly difficult for new parents is that many sleep 'experts' are particularly forceful in pushing their particular method, making unrestrained claims about its success (if it fails, you're just not doing it right), and fear-mongering about other methods (other methods will make your child stupid / obese / spoilt etc.) These forceful opinions are usually expressed without citing any evidence, as though the facts are self-evident – sometimes with vague or selective references to 'studies', but no serious analysis or exploration of the research that is actually available. Mostly, these opinions are supported by de-identified anecdotes that may or may not even have occurred, selective testimonials, and sentences that begin 'in my experience' – there is nary a footnote in sight.

Tizzie Hall... helping parents put their babies to sleep or making a f*ckload of money by giving parents a guilt complex? Perhaps both?

Some sleep gurus, like Tizzie Hall, who has no qualifications to speak of, have webpages which provide some 'tastes' of advice in order to try and induce you to spend ridiculous amounts of money on them. She will sell you a .pdf with some 100 pages or so of general advice for $38, and for no less than $350, Tizzie will personally... wait for it... reply to an email from you!

Buy! Buy! Buy! (Tizzie's homepage with advertising highlighted.)

But while I find Tizzie's exploitative marketing a bit vomitous, I have to admit that I know a number of people who swear by her advice – stating that Save Our Sleep saved their sanity. I should also admit that Tizzie Hall went from being vaguely not for me to Someone I Hate because someone recommended her to my husband in the early days, and then for the first two months every time the baby did anything difficult, he'd say, “You wouldn't have this problem if you just used Save Our Sleep.”

We were out of sync because before we had the baby we both agreed that routines and consistency were crucial for children, but what we hadn't discussed is our views on letting babies cry. This was because I didn't really have a view on crying before I had the baby. Then when I had a sleepy newborn, I didn't need to think about it because she only cried if she needed feeding or changing, basically – so I always just responded. But then at 3 weeks when she became more awake and developed grizzling and a witching hour (or 5 hours), I didn't know what to do. I asked a child health nurse and she told me that the baby was just overtired and I had to let her cry to sleep – that she would just be crying because she was tired, not because she was really unhappy. She said babies would reach a peak in crying then drift off. She showed me how to settle her in her pram by patting and shushing her while she cried for about 10 minutes until she fell asleep. It was horrible – she really screamed - but it worked.

Feeling newly empowered, I attempted her method the next time she needed to sleep. She cried, and cried, and cried – no matter how much I patted and shushed. Eventually, I picked her up and settled her, but thereafter whenever placed in her pram, even when happy and awake, she would become instantly distressed and start to cry. If I put her down asleep then her eyelids would flutter open five minutes later and if she found she was in her pram, she screamed. I was up and down with her that night as I tried to get her to sleep in the pram, she did not sleep for more than 5 minutes at a time, just kept waking and crying until she crashed out exhausted at 3am. It was such an astonishing change in behaviour, from a baby who had always been happy to be put in the pram unless she just didn't want to be put down at all, to a baby who always hated it, that it was hard not to see a link.

I wondered if she had just developed a fussiness with being put down to sleep (rather than the pram in particular), so I tried to put her in her cot – she was happy to be put in there awake, and if rocked to sleep in my arms, she would do several sleep cycles happily in the cot as well (except at witching hour, when she would not sleep anywhere very well).

It was at that point I decided that I was not going to do any method that involved letting her cry. I couldn't know for certain, but it seemed that the crying had 'trained' her to understand that her pram was a nasty, nasty place. My husband thought I was jumping to conclusions. Maybe so, but it had been a horrible night and I was not about to chance her developing a phobia of her cot as well.

Fortuitously (or, because I am such a nerd that when pregnant I had spent many a happy hour reading reviews on Amazon and purchasing books I thought might be useful), I had a copy of Elizabeth Pantley's The No-Cry Sleep Solution, which I was able to put forward as a legitimate alternative approach.

The No-Cry Sleep Solution or the No Sleep Cry Solution? Views differ, but I found it useful.

Pantley, I suppose, is also a 'sleep expert'. But her book comes from a different perspective. She wrote it as a mother who found that letting her baby cry was too distressing, so she started to look for alternative methods that could work. The only thing Pantley sells is her books, and on her website she offers most of her advice in summary form for free.

The other alternative source of advice comes from Pinky McKay's Sleeping Like a Baby. Pinky provides lots of vigorous pep-talky articles on her website for those who are resisting the advice to cry. I feel a bit uncomfortable that she runs it like a business, but at least her rates are a lot more reasonable ($295 for a 2 hour visit to your home, plus a book and DVD, plus follow-up phone consultation – and she will advise on breastfeeding and baby massage, both of which she is qualified to advise on, as well as sleep).

But like crying didn't work for me, the No-Cry Sleep Solution and Pinky McKay don't work for everyone either. Like I said, Tizzie's advice does work for some people.

But before you hand over your hard-earned dough to Tizzie, consider the following:

Does a schedule suit you?

Which best describes you?

a) I like to roll out of bed at 6am pronto every morning and hit the gym, eat a precise (perhaps calorie controlled) breakfast, get to work at time x etc. If someone or something disrupts my routine, I feel lousy and out of control.

b) I suppose I have some patterns and some favourite things, but I'm not strict. I sometimes like to be spontaneous. Following a strict schedule would make me feel tied down and miserable.

If you strongly align with answer 'a', then you are probably going to warm to a Tizzie Hall-style 'sleep expert' approach. But you don't need to pay Tizzie Hall for them. Jo Ryan (BabyBliss) has a bunch of baby sleep routines similar to Tizzie's freely available on her website (http://babybliss.com.au/services/babybliss-routines/).

If you strongly align with answer 'b', even if you can get Save Our Sleep to work for you, you may hate it. Putting your baby on a schedule means putting you on a schedule too, and it may make it impossible for your baby to sleep anywhere except in his or her cot at home – which can be awful if you need or want to go somewhere else. Remember that a schedule is different from a routine (even though some experts call their schedules 'routines'). A routine is where you have a sequence of activities leading up to a sleep (eg. feed, play, feed, sleep. Or bath, massage, feed, cuddle, bed.)

Are you exclusively breastfeeding?

You can only follow a schedule-based approach if you do at least some bottle feeding. Breastfeeding requires you to feed on demand, so breastfeeding to a schedule does not work. Your baby goes through growth spurts and needs to feed more to trigger you to make more milk etc. If you have amazing milk supply you may be able to express enough for all your bottle feeds to be expressed milk, but beware that most women are unable to express as much milk as their baby can extract, because babies are naturally better at it. I never could express as much as my baby needed, and even to get most of a feed took about an hour and a half.

Even Tizzie Hall is explicit that unless you can express as much as she suggests, you should not follow her routines. Nevertheless, she and many other sleep experts give advice on breastfeeding such as 'feed for x minutes from left breast' etc. This is rubbish breastfeeding advice and can lead to supply issues and mastitis.

When do you plan to go back to work?

A number of women I know who like Save Our Sleep or its equivalents had to go back to work pretty early in their baby's life – and so did not have the time to do a more baby-led approach.  But if you are not going back to work so quickly, maybe you don't need to.  When considering timing, remember most sleep experts reckon their methods work within a couple of days to a couple of weeks.

What is your view on crying?

a) You have to be tough. If you always respond to the baby, you'll teach them you come running every time you cry.

b) Well, I don't think crying's a good thing, but quite frankly, I don't have the energy, patience, or time to be helping them every single sleep. I need them to learn to do it themselves. And if that takes a little bit of crying I can tolerate it.

c) I won't let the baby cry if I can possibly help it. End of story.

If you align with view (a), then you should probably be aware that even the majority of sleep experts would disagree with you. Before you go down this track, you should read about some of the arguments against letting your baby cry it out. In particular, you should read the Australian Association for Infant Mental Health's position papers on the issue: http://www.aaimhi.org/policies.php. Some other website you might look at are the collection of articles on this blog: http://bawlingbabies.blogspot.com/2006/07/comfort-babies-rather-than-let-them.html, and this website dedicated to discussing some of the problems with Gary Ezzo's strict approach in On Becoming Babywise: http://www.ezzo.info/. If, after reading this material, your views haven't changed, then rather than just leaving your baby to cry for hours, you could try the controlled crying technique suggested by the paediatrician Richard Ferber – described here (http://baby.about.com/od/sleep/ht/How-To-Help-Baby-Sleep-Using-Ferberization.htm)

If you align with view (b), then advice from routine-based sleep experts may be helpful. Aside from Tizzie Hall, you could look at:

• Sheyne Rowley (Dream Baby Guide. Australian. Flexible routines, some limited crying but if crying try for no longer than a few days. Rowley's focus on communication eg. Role-playing routines before trying them, are probably best suited to an older baby http://www.australianbabywhisperer.com.au/html/methodology.html)
• Jo Ryan (Babybliss. Australian. flexible routines, some limited crying but crying for no longer than a few minutes) (http://www.babybliss.com.au/)
• Nicole Johnson (American. Advocates a range of non-crying and crying methods. Most advice freely available online. http://www.babysleepsite.com/)
• Gina Ford (The Contented Little Baby Book. British. But, like Tizzie, charges for any information at all – and doesn't give any advice you can't get from the others.)

Before you embark on these programs, it is worth pointing out that routines and crying methods are not necessarily quick fixes. Some babies adapt to them well. Others fight and fight them, and then just as soon as you have them cooperating, you have to start again with every growth spurt, every cold, every trip away etc. But these authors have a large range of ideas for settling and guides for routines and sleeping that may help you.

If you align with view (c), know that this is not a view just advocated by mums like me who are too wussy to let their babies cry. It is supported by infant mental health bodies on the basis of research into attachment, because it is thought that regular unresponsiveness to your baby's crying disrupts the process of attachment, which leads to lower self-confidence and a more clingy, needy child as your baby gets older, followed by a less empathetic and more rebellious teen. You should consider Elizabeth Pantley, Pinky McKay, and Nicole Johnson, all of whom are already mentioned above.

How old is your baby?

a) Is your baby younger than about 4 months?

If yes – relax and stop worrying about 'bad habits'. Babies don't begin to develop their understanding of cause and effect until about 4-6 months (see this entry in Cornell University Medical School's Child Health Library). Before this, your baby, as far as he or she is aware, lives only in the present. Your baby may be developing memories (although how well they can store and retrieve memories is debatable), but no sense that time is directional or that events can be purposeful. For this reason, it is unlikely that a baby could learn that crying makes you come running in the first few months of life, because that would require your baby to grasp cause and effect. This doesn't mean that your baby can't form associations. So, if you always wrap and rock your baby to sleep, your baby may start to associate rocking and wrapping with sleepiness, and rocking and wrapping may induce sleep. But this is quite a different thing from a baby learning a sequence of events leads to sleep (knowledge which requires an understanding of causality and time). So rock and wrap and feed and your baby to sleep to your heart's content. You can try and put your baby down sleepy but awake if you want to, and maybe they will drift off to sleep, but even if they do, they probably aren't learning to drift off to sleep unassisted, they just happen to be doing it. As you approach 4 months, they become more alert and their sleeping patterns change, so you will probably find it all goes haywire anyway.

Rather than worry about bad habits, focus on getting your baby to relax in order to get to sleep. If you are having trouble, a good place to start is the 5 S's method advocated by paediatrician Harvey Karp in his book, The Happiest Baby on the Block, summarised here (http://www.colichelp.com/shop/happiestbabyontheblock.html) – or explained by Karp here in this freely available video. I found it was useful to see exactly what Karp meant by the 'Swinging', since what worked for us was the gentle jiggling he advocated, but which I would never have thought to do because I would have been worried it was too close to shaking a baby.

If your baby is an escape artist, here is another swaddle. As Karp points out, babies don't usually like initially being swaddled so many parents give up on the swaddling before giving it a chance, but once they are swaddled, using one or more of the other 5 S's frequently calms them. It is a bizarre thing that they resist the swaddle and then calm right down with the other S's, but doesn't calm if you do the other S's on their own. I found I needed a wrap that was at least 120cm x 120cm to do a proper swaddle. One of the nice things about Karp's techniques is that all 5 S's are things fathers as well as mothers can do.

The only disadvantage of settling to sleep in your arms prior to about 4 months is that the baby goes to sleep one way, and at the end of their sleep cycle (usually 40 minutes) wakes to find up to find himself somewhere else, which can freak him out. If your baby wakes up every 40 minutes through the night, every night, then this might be what is happening, and you'll need to find a way to get your baby to sleep in the cot. Alternatively, you could try co-sleeping.

b) Is your baby about 4 months or older?

While every baby is different, around 4 months babies can and do start developing notions of time, causality, and their role as a causal agent. This means they can start to not only be relaxed by warm baths and baby massages, but start to know that such events lead up to bed time. So it can be helpful to start doing a wind-down routine at this stage.

If you still have lots of night wakings and still don't want to try crying, then yes, you may create certain sleep associations on which your baby becomes dependent, but remember that it's not a problem until it's a problem for you – and your baby can always unlearn these habits if that becomes necessary. See this great article by Nicole Johnson (http://www.babysleepsite.com/baby-sleep-support/baby-wont-sleep-your-fault/).  Some time between 12 months and 5 years, your baby should naturally outgrow these needs, or reach an age where you can teach them a new way to fall asleep by talking, role-playing, and using their pride in being all 'grown up'.

It may help to remember that a baby has growth spurts and developmental leaps. For $2.49 you can get the Wonder Weeks app for an iPhone (http://itunes.apple.com/au/app/the-wonder-weeks/id342152206?mt=8), which helps you appreciate when your baby is likely to be more fussy and difficult and when they will be calmer and easier to settle. If nothing else, this can help remind you that even with the best routines, there are other factors involved.

Do you need more intensive / personalised help?

If so, you can look into sleep schools or consultations.

• Karitane (http://www.karitane.com.au) in NSW offers a sleep school for babies older than 6 months, and settling assistance for babies younger than this and has a phone line for advice: 1300 227 464.
• Tresillian (http://www.tresillian.net/) in NSW offers sleep schools, consultations, and phone advice. Freecall: 1800 637 357
• North Park Sleep School in Melbourne and Pinky McKay offer personalised help that does not involve crying methods.
• Nicole Johnson will do an email consult for $29.95 USD, or unlimited emails for a month for $239 USD.