Dr Gillian Riley

here was an interesting article in the conversation yesterday on infant sleep. Alongside an infographic that appeared on Instagram.

I’m not going to link to it because I think it’s a little skewed, and then the comments on it are also, angry. But you can go looking for it if you choose.

In the article the author calls the sleep interventions “sleep strategies” however the two “strategies” mentioned are controlled crying and camping out. Which are both generally referred to as sleep training in most mediums.

I need to be very clear when I write this. I am training in the NDC method. However I do not, and will never explicitly endorse ANY specific form of method for how you look after your babies. YOU are the expert in your baby. Parents are generally living in an absolute minefield of information, some of it flat out telling them that if they do or do not do something they will hurt their baby (sometimes including suggestions they will cause brain damage or severing of psychological attachment). They’re usually experimenting all the time, and coming up with unique solutions that fit their social context and their unique environment. Babies have their own ideas about how things are going to work thanks, and they are going to win.

This means I am never going to tell you there is a right or wrong way to approach sleep with your baby (or feeding for that matter). There’s one very wrong way to raise a baby, and that’s to neglect them and hurt them, but if you love your baby and you’re doing your best then it’s likely you’re not going to harm them. At all. Our job together is to find the right path forward. I give you suggestions, you experiment and find what works. No judgement.

I do think, however, that it is disingenuous to explicitly label something as a “strategy” when it already has a label. To try and redirect parents from realising what they are reading.

I am also concerned that with this particular article it talks about the sleep intervention as being the reason that there was a reduction in harm with these babies and mothers.

The actual intervention with these mothers and babies was that they had contact with MACH nurses, over several structured appointments. Those on the control arm had no contact.

At the age of five there was no difference between the control group and the group that had MACH follow up in terms of differences in child sleep, child emotional behaviour, parenting style or parent mental health but during the study period – parents reported better mental health at the 12 month and 2 year follow up. Crucially baby sleep was only better at the 12 month follow up and there was no difference at the 2 year follow up.

We know from the evidence, and I have my NDC hat on here, but I also say this as a mother of one baby who slept and another who just wouldn’t. That infant sleep is physiological. We tell parents you can teach infants to sleep. Really? It’s physiogically normal for some infants to wake every few hours. Around the clock. In some cases until they’re toddlers.

This means that the babies who respond to sleep training were the babies that were ready to sleep.

For those babies that aren’t- we leave parents often in a position where we are telling them what they “should” be doing and what their baby “should” be doing. But isn’t. In a society where there is no village. Not really. And without the evidence and the science and the support to understand that it’s a variation of normal. And that there are things we can do to help and adjust and survive. (Move the body clock, look at sleep pressures, lots of sensory input, cry on my shoulder).

I would argue that the confounder in this study is not the sleep training – it’s the MACH nurse. It’s that support. The authors do acknowledge this in the journal article (which is paywalled) – but not in the conversation article.

Is it comforting to know that sleep training likely doesn’t harm babies? Yes. But to be honest I think we probably knew that anyway. And I think that also needs to be clearly acknowledged in some of the social media rhetoric I have also seen today. It isn’t helpful to tell desperate tired parents who are experimenting that they have hurt their child if they have tried training. Your baby will be ok. They will. You have not condemned to a lifetime of mental health issues, I promise. Forgive yourself. This is a really hard.

And at the risk of being completely cancelled – sometimes it’s the right and needed thing to do in the context of that family. And that’s ok.

My worry is and always continues to be that this then gets tied up and presented as the answer, when sometimes there isn’t one. Because this approach isn’t one size fits all. Because you might not want to do it. Because human beings are more complex than a single method. And because babies don’t read the text books. And I truly wish we could find some nuance in this . That’s all.

I looked for a photo of one of my kids sleeping . And then I laughed and laughed. Anyway. Here’s a meme.