Monday, March 7, 2011

Weissbluth vs Gethin & Macgregor

I have been doing a little balanced reading.  On the one hand, I have a copy of infamous cry-it-out sleep training advocate Marc Weissbluth's Healthy Sleep Habits, Happy Child.  On the other I have Anni Gethin and Beth Macgregor's Helping Your Baby to Sleep: Why gentle techniques work best.  To some extent these books provide practical suggestions on how to get your baby to sleep, but much more of them is devoted to arguing why crying is either going to save your child from being an obese, delinquent idiot who you hate (Weissbluth), or cause your child to be a traumatised, anxious idiot who hates you (Gethin).  Ok, they don't say that in quite so many words, but that's the distinct impression you get.

Still, reading the two of them together wasn't too bad.  One was kind of the antidote to the other and vice-versa.

Here are some quick book reviews:

Let's start with Weissbluth

The good: 

If you are planning to do a crying method, then this is probably going to be the most comprehensive read into what works and why.  Rather than give you a rigid schedule that you follow by staring at the clock every two seconds, this book explains the biology of sleep and how it evolves over time, so that you can work out a schedule that is appropriately tailored to your baby.

Most of what he says on the biology of sleep is consistent with the research I've read, which is not surprising given that compared to most sleep parenting books, Weissbluth does at least support much of what he says with referenced studies.  The book advocates a range of non-crying methods that he suggests will probably work with about 80% of babies, although there is not enough detail on this and the focus of the book is how to use crying methods for the other 20%.

A little unusually for a CIO proponent, the book advocates breastfeeding (including feeding the baby to sleep) and even co-sleeping (the latter on a 'if it works for you' basis), and talks about how night feeding when co-sleeping does not really fragment sleep for you or your baby because neither wake up properly.  This makes a refreshing change from the 'co-sleeping is a crazy hippy idea' that many mainstream sleep training books seem to have, and shows that he has actually looked at the studies on co-sleeping and how it works.  There's also lots of good advice on how fathers need to take responsibility for parenting babies by being hands on and supporting mum.

The bad: 

The worst part of this book is the constant warnings, boxed and in bold, that infants who 'sleep poorly' (by Weissbluth's standards) are going to sleep poorly when they get older.  In support of this, he cites ONE study that apparently asked the mothers of college students how well their kids slept as infants.  The mothers remembered that the kids were problem sleepers.  There are so many variables this doesn't control for it's ridiculous.  I mean, what was a 'sleep problem'?  According to who?  And even if it were true, it doesn't show that 'sleep training' would have corrected the problem.  For all we know, those mothers did sleep train their kids because they were so difficult, leaving them to scream for hours, and the kids sleep poorly now because they have poor attachment.  Who knows?  This is a very poor basis for trying to scare the bejesus out of vulnerable parents so they will obediently leave their babies to cry.

There a now more comprehensive studies that show that an enormous number of factors influence the sleep of an older child, and how they slept as a baby rarely has anything to do with it.  Anyone who cares to look at the hundreds of posts by parents on internet forums also can see that plenty of poor sleepers turn into good sleepers before 3 years, regardless of what the parents do in terms of 'sleep training'.

The second-worst part of the book is his complete dismissal of attachment theory.  Attachment theory is actually very well established and there are literally thousands of studies that show it does indeed predict behaviour of children as they grow older in many important ways.

He says there is no evidence to suggest that crying it out disrupts attachment, and in fact in the studies that have been done there was improvement in relationships between mum and bub.  Well, I've done my own research on this and you can see (research is under the Factual Info tab) these studies on crying methods gathered very limited data over a short time frame, the alleged improvements occurred mainly in depressed mothers with severe sleep deprivation who must have been at the end of their tether after they were provided with regular supportive meetings as part of implementing the sleep training, and when longitudinal follow-ups were done the improvements to the relationship were only temporary.  So yeah, be skeptical folks.  Weissbluth cites a study done on the babies of schizophrenic mothers who were hospitalised for their disorders, where the babies were observed as they were sleep trained, although this study was small and did not use controls, and I have to say I'd be cautious from generalising about baby behaviour from a study of babies of mothers with schizophrenia so severe they had to be hospitalised and have their babies removed from their care.  There are also studies which show that interventions that focus on developing a more responsive and sensitive response by mum to the baby massively reduce mum's perception of problematic behaviours.

He is critical of Sears for ignoring that children may have real biological sleep needs that are very important, and that parents may not cope with attachment parenting methods if the child is not cooperative.  This is a fair criticism, I think.  But then it is apparent that Weissbluth is just as judgmental about parents who prioritise attachment-style parenting, and uninformed about the literature on attachment.  For example, he labels any upset behaviour (including boredom, whinging, or displaying displeasure) as a sign of tiredness, which he calls being a 'brat'.  Apparently, in Weissbluth's opinion, babies do not have frustrations, boredom, or reason to be upset unless they are tired.  If they try to legitimately express their feelings, he labels them pejoratively - and although he doesn't blame the children, he blames the parents for 'indulging' their own feelings and 'allowing' a 'bratty child'.  Instead, these children should be promptly put to bed and if they scream, ignored.  Expecting constant pleasant, happy, and 'charming' behaviour (used by Weissbluth to describe a well-slept child at one point) is such an unhealthy, unrealistic attitude for parents to have.  In real life this will have parents constantly doubting themselves, overreacting to normal childhood emotions, and leading parents to set standards that are impossible for the children to live up to (or that the children can live up to only by suppressing/ignoring their own sense of self).

It is a travesty, I think, that Weissbluth has dug up one child psychiatrist to write a postscript to parents about how leaving a child to cry is healthy limit-setting.  Firstly, psychiatrists are not psychologists or psychoanalysts and are not experts in attachment.  They take a medicalised approach and are experts in prescribing drugs.  Karen Pierce M.D. writes in the postscript, "Being a child psychiatrist had taught me about nurturing and reducing frustration, but not about parenting.  Thus, believing the standard theories learned during my training, I feared I would 'damage' my child.  I was unable to let him cry initially."  She goes on to say she let him cry and they all got over it and everything was fine.  This is all she has to say about attachment, and apparently all she knows.

As to the healthy limit-setting, the stories here keep relating to two year olds and older.  You wouldn't give in if your two year old wanted a second helping of ice-cream, they write, so how is it different letting your baby know you won't give in to comforting him when he helps sleep?  This seems a very strange argument to me - there is a huge difference between the maturity of a baby's brain and the brain of a two year old, in both its physiological response to stress and in the child's capacity to interpret events rationally.  Weissbluth / Pierce also say that as your child gets older they will experience pain and frustration and get over it, so what's wrong with a bit of pain and frustration as a baby?  Again, I don't really follow this argument.  So my five year old might scream when she falls off her bike on the bitumen and skins her knee.  It does not follow that it is of any benefit to put my baby on a bike and let her fall off onto the bitumen so that she can learn about pain and frustration.  I think my baby is thoroughly frustrated many times a day by all the things she cannot do.  She is in pain every time she falls and hits her head, or gets a cold, or a mozzie bite, or an immunisation or... the list goes on.  I don't think I deliberately need to add to the list to 'teach her' about frustration or pain.

The verdict: 

I would not give this book to a parent unless and until sleep problems actually manifest.  While there is some gentle, reassuring advice in there for the first three months, the book is overall filled with so much scare-mongering that you would interpret even the smallest expression of discomfort from your baby when awake as a 'problem' and 'treat it' by leaving them to scream elsewhere.  However for those parents who are not coping with how the baby is sleeping, and who are turning to a crying method, this is an informative read that offers a lot of flexibility in how to do a crying method effectively.  And after all, if you're going to do it, you don't want anyone to be miserable for longer than they have to be.

Gethin & Macgregor

The good:

This book sets out in plain English the brain science and attachment psychology that suggests there are risks to crying options.  It is much plainer, for example, that my posts on this blog on the topic.  It has cartoons and anecdotes and 'key points' to make it easy for sleep-deprived parents to read.  Sleep training does not always even 'work', and the book makes parents aware of this beforehand.

The bad:

In the same way that Weissbluth knows nothing about attachment but presumes to judge, Gethin and Macgregor have either never dealt with or ignore the situation of parents who cannot cope with the night-waking or whose babies don't respond to gentle methods.  They refer frequently to the No Sleep Solution (which I think is a great book) but they imply that these methods will always work, or that parents always manage them.  They very much gloss over the fact that different babies have different degrees of demandingness, or just how difficult a truly bad sleeper can be for a parent to deal with.  The suggestions are useful but they won't work for some people, and this book will leave you feeling like you are a horrible, abusive parent if you cannot handle being supermum to a difficult baby.

Most concerningly, they fail to appreciate the potential risks to attachment by a mum who is so tired that she gets PND, cranky with her baby etc.  Attachment does not just occur at sleep time.  If you are withdrawn, unresponsive, or angry at your baby because you are not coping with sleep deprivation or prolonged settling through the day and night, how well equipped are you to be responsive to your baby's needs?  At the end of the day, it's responsiveness overall, not just at daytime or nighttime that is the issue here.  Some mums and bubs end up more distressed by sleep training, but some do not.  For some families it is a genuine quick solution to a real problem.  This is not acknowledged.

The verdict:

I would suggest this book to a parent whose baby sleeps reasonably well (say, one-two night wakings and less than an hour of settling) who is considering sleep training, not because they need it, but because they've told they ought to do it (or they'll create a rod for their own back etc), or because someone's given them what may be unrealistic expectations (all babies sleep through the night by six, seven, eight months etc if you train them - all it takes is a couple of days of crying).  It might also be a good book for parents who find sleep training is not working for them, although something like Pinky McKay or Elizabeth Pantley would be more practical.


  1. I totally agree with you in that most books regarding sleep, or parenting in general regardless from the perspective they are written, make the assumption that every child is the same and will respond to things in the same way, and that therefore the solutions they offer will work for EVERYONE. It is just not true. Nobody knows their own baby better than the parents and nobody knows their own limits more than oneself, and everyone really needs to find something that works in there own situation. Often this can be a combination of things from different "experts" rather than following any one person's advice religiously. I am not a fan of "theories", I am a fan of what is practical in real life and not in the pages of a book. Although I do enjoy reading and knowing about the theories, they are all meaningless if you can't apply them within the context of real life in a way that works for you and your family.

  2. I read the Gethin & Macgregor book while waiting for SOS from the library, pre-sleep school. I thought it was pretty patronising and like you say, didn't really offer a solution. It did help make my mind up that I wasn't going to do CC, which I really already knew but it was nice to have some back up reasoning other than "I just don't want to"! I'm currently reading No Cry Sleep Solutions, and i'm going to give some of it a try, so will see if it really is the panacea they say!

    For the record I thought SOS was awful - there's no way I'm sticking to that kind of routine WITHOUT a baby, never mind with one!

  3. Fantastic reviews. I read Gethin & Macgregor and agree it doesn't really offer any detailed information when it comes to 'how to' or factual information about their sleep needs at different ages. I did love some of the graphics and reading the stories from other mums. Especially the daughter's one about her dad telling her that noses are for pulling at any hour of the night, no matter what the problem/issue. I love the concept of creating openness and a non judgmental environment - that for me was a major insight.

    SOS is ridiculous and torture to read. Anything that is so prescriptive just makes me nervous and adds unnecessary head noise.

    I really admire your openness and detailed account of your sleep journey with Bethany - it's precious to have access to such personal thought processes and ones I'm sure many of us can also relate to.

    Have you read Buddhism for Mothers? I think you may love it :)