152: Everything you need to know about sleep training

We've already covered a couple of episodes on sleep, including the cultural issues associated with sleep, then more recently we talked with Dr. Chris Winter about his book The Rested Child where we looked at sleep issues in older children.   But if you have a young child who isn't sleeping well, from the baby stage all the way up to about preschool, this episode is for you!  My guest is Macall Gordon, senior lecturer in the Department of Psychology at Antioch University Seattle, and who has studied young children's sleep for 20 years.  She's particularly interested in the intersection between children's temperament and their sleep, and how parents of the children she calls 'little livewires' can support these children so everyone gets more sleep.   If you have questions about sleep training - particularly when and how to do it - this episode is for you!   And if you're expecting a baby or have one under the age of one (whether this is your first or not!) you might be interested in the Right From The Start course, which is designed to help you get things right for you from the start.  We go in-depth on understanding topics like sleep, feeding, physical, mental, and emotional development, and more - both for baby and for you!   Get all the (research-backed, of course) information you need, plus a supportive community and four group coaching calls during the 8-week course.  Click the banner below to learn more!     Jump to highlights 01:25 Introduction of episode 05:15 Age range of a child to be sleep-trained 16:15 What it's like to be a parent in a sleep training study 17:30 The active ingredient to sleep coaching 29:00 The differences of how babies sleep through the night 37:20 Only one method in sleep training the child 40:21 Limit setting disorder 48:54 Realization on the episode   [accordion] [accordion-item title="Click here to read the full transcript"] Jen Lumanlan  00:02 Hi, I'm Jen and I host the Your Parenting Mojo podcast. We all want our children to lead fulfilling lives, but it can be so   Jenny  00:09 Do you get tired of hearing the same old interest in podcast episodes? I don't really but Jen thinks you might. I'm Jenny, a listener from Los Angeles, testing out a new way for listeners to record the introductions to podcast episodes. There's no other resource out there quite like Your Parenting Mojo, which doesn't just tell you about the latest scientific research on parenting and child development but puts it in context for you as well. So you can decide whether and how to use this new information. I listen because parenting can be scary and it's reassuring to know what the experts think. If you'd like to get new episodes in your inbox, along with a free infographic on 13 reasons your child isn't listening to you and what to do about each one. Sign up at YourParentingMojo.com/subscribe. You can also join the free Facebook group to continue the conversation. Over time you might get sick of hearing me read this intro so come and record one yourself. You can read from a script Jen provided or have some real fun with it and write your own. Just go to YourParentingMojo.com/recordtheintro. I can't wait to hear yours.   Jen Lumanlan  01:26 Hello, and welcome to the Your Parenting Mojo Podcast. Today we are going to be talking about a topic that we have addressed a number of times recently. We're coming back for another go at it from a different angle. We're looking at sleep and specifically this time we're looking at sleep training. Before we do that, I wanted to let you know that I am reopening the course that I ran with Hannah and Kelty from Upbringing in a few weeks and it's called right from the start. And it's really about how to get parenting right for you from the start, rather than that, there is one right way to parent. And so we cover all the essential topics that are really relevant to parenting in baby's first year, from sleeping to feeding to supporting physical, mental and emotional development. But the parents who have taken the course tell us that the part that they really needed that they didn't know they needed was the part that really speaks about "What is my experience as a parent? What are my needs as a parent? And how do I get those met along with meeting my baby's needs as well?" So, the course is designed for both first-time parents as well as those who have a child already and who know that parenting cannot be the same with this child as it has been with previous children because we don't have enough hands to go around. There isn't enough of us to give this child the same experiences our previous children have had. So enrollment for right from the start is open between April 3rd and 13th  and we all start together as a group on Monday, April 18. So, gift certificates are also available, so if a new baby is not in your present or in your future, then you may find that it makes a great gift for somebody if you're going to a shower or potentially an even an early Mother's Day gift for somebody who's important in your life. So if you would like to help somebody in your life to get the right start for them with their baby, then I invite you to go to YourParentingMojo.com/rightfromthestart to learn more. Today I’m here with Macall Gordon, who is the senior lecturer in the Department of Psychology at Antioch University Seattle. And she has been interested in the topic of baby sleep for over 20 years now. And it's a topic that took her back to graduate school in 2001. She's a certified gentle sleep coach at her company, Little Live Wires, as well. And Macall may actually, in addition to obviously being on the same page sartorially with me (we're both here in our navy blue shorts) she may be the best-prepared guest I've ever had on the Your Parenting Mojo podcast. She actually reached out to me and said, "Could I be on the show?" And I said, "Well, I've done a couple of episodes on sleep already. What new angle do you think we could take on this?" and she responded with a long list of topics that really get into the weeds on the research. So if you are the parent of a child who isn't sleeping well and particularly if that child is under a year of age, then do listen up, because today we're going to spend quite a bit of time talking about sleep training, and we'll learn what we know from the research as well as where that research base really lets us down, and what all of that means for struggling parents, particularly parents who have what researchers call a “Difficult Temperament,” but I imagined Macall might call a Little Livewire. So welcome, Macall. It's great to have you here.   Macall  04:16 Thank you. I'm so happy to be here.   Jen Lumanlan  04:18 All right. And so you have been at this for a while now. This is a long time to be interested in baby's sleep. What was it that really drew you to this topic?   Macall  04:28 That's such a good question. I started on this journey back with my first child that I had right at the very start of the internet so it was so early that all the websites that were on the web could fit in a book. It was actually a telephone directory of the internet, so we relied very heavily on books and then all these parenting magazines that you'd see in the pediatricians' offices and the magazines I was noticing that this was the era of critical periods of brain development, right? It's a big deal about the first three years, so important for brain development. And so, they were talking about the importance of responsiveness for brain development and attachment, and everything. And then, literally on the next page, they were saying, but for sleep, you gotta let your baby cry it out. And what I noticed was that the age to start was getting younger and younger. When I first started looking at was six months, and then it was five months, and then it was four months, and I thought, "Boy, this just doesn't totally make sense to me." There must be research to show that this is safe and a good idea. And back then I didn't really have a lot of resources to dig into the research but as the Internet became more and more available, I started poking around. And once I figured out, first of all, what researchers called "crying it out," which was a whole project by itself, once I kind of unlocked the research base, honestly, the more I looked, the less I found. And I kept thinking, "Okay, I'm just not finding it." It's out there. I just haven't found it yet. And even when I went to my very first conference to present my lit review, I was standing there quaking in my boots because I thought there's going to be some massive researcher who's going to come along and just look at me and shake their head and pity, and say, "Oh, honey, didn't you know about the whatever study?" That I had missed some huge piece, but really, what I found is that there wasn't a lot there, and in the ensuing 10 or 15 years, still not much more on this particular question, so many levels we're still in the same boat as we were even 20 years ago.   Jen Lumanlan  06:44 Yeah, and on that issue of the age at which to start sleep training. When I looked at one of your conference posters, and it has the bars showing the age at which the resource or the book or the study recommends sleep training, and the vast majority of them, they're doing a study on children who are aged between six months on the very young end, but usually around 12 months, and like 50 months, right? parents in the real world. Yes, there are a small fraction whose children are not sleeping through the night by then and they need help, but who are most of the parents who are searching for information on sleep training?   Macall  07:19 Right. They are parents of young babies. Yes, that's perhaps one of the most startling findings to me was that the research that we often use to support the need and effectiveness of sleep training in young infants was not even done on infants, but we know very little about how any infants in those studies experienced the intervention for being, you know, so big on precision, sometimes research really misses the boat on development so I think you probably saw, there's one study that had the sample was 4 to 52 months. If you do that math, 52 months is a four-and-a-half-year-old. You can't possibly tell me that a four-and-a-half-year-old experienced that intervention the same way a four-month-old baby did. But the results of that study didn't even parcel things out by age at all. They just reported it for the sample. That's what I knew when we started poking at it and saying, "Okay, what do we really know, in a nuanced, developmentally aware way about sleep training?" It really is a bit of the emperor's new clothes, right? I've consistently gone, why is no one else seeing this? No one else is seeing what I'm seeing here.   Jen Lumanlan  08:32 And so I think that's super important to understand for this topic and for other topics as well. I mean, this is not uncommon in the literature, right? To study a sample that is convenient to you. Maybe those were the babies that the researcher had easy access to, for whatever reason, and they didn't know how to go about analyzing the data, or it wasn't convenient for them to analyze the data in multiple cohorts, maybe there was only one four-month-old and all the rest of us are much older, and they would have had to throw that one child out and then report a much older dataset, and they didn't want to do that. These concerns exist throughout the literature and it's a pervasive problem. What other kinds of disconnects did you find as you're digging into this research?   Macall  09:08 Oh, goodness, well, what we're really talking about is the difference between how researchers characterize effectiveness and then what happens to those findings when they're reported in the real world and the problem is that the findings from research have been expanded to such a level that when you really start looking for nuanced, developmentally appropriate information, it's just not there, so, for example, that study the four to 52 months, some of these don't even say how many infants were in the sample, and then they just say "extinction," which is really what we're talking about here. Extinction is the main focus of, I would say, 99% of the research on sleep interventions. Extinction is basically the idea that whatever you don't pay attention to will go away. The old behavior modification behaviorist idea that what you pay attention to persists and what you ignore goes away, so essentially, crying it out, there are at least a couple of forms of crying it out extinction. There's pure extinction, which has been researched, which is you just close the door and you don't go back until morning, some people call that cold turkey and there are books who recommend doing that. The second one is the graduated extinction, which we think of as Ferber, so you leave for progressively longer periods of time. There are some variations of that, were ones called like time checks, where you go in at regular intervals. Then there's this funny one called "camping out," which is a little bit blurry because it can mean what they call "extinction with parental presence," meaning you do pure extinction but you stay in the room, so the parent stays there and pretends they're asleep, while the baby or child is freaking out. It can also mean what we refer to as parental fading, which means that you start giving a lot of support at first and then you fade that out. Those two things are lumped together under the same title, which I don't personally fully understand so that one's a little bit unclear, but for sure, pure and graduated extinction are the big ones, and because they're the big ones, we have to think about the business of research, right? because it's an industry. It's business. What happens with research is that once there's a finding and people start building on or replicating those findings, it becomes a thing, right? That you just keep, you know, not really regurgitating, but definitely recycling, adding, reciting, and suddenly it becomes a mountain and then A it becomes evidence-based and B no one wants to question it, right? It's really becomes like this juggernaut that no one can sail because there's this mountain of evidence but there's also a mountain of evidence because people keep asking that same question, right? There's a reason there's a mountain of evidence. It's not because it's the best, it's just because most people are researching it because they want to build on an existing body of literature, so that's definitely where we're at right now. I continue to be surprised at the number of studies that just ask and answer, "Does extinction work? Does it work?" We need to start asking other questions like, "Who does it work for?" Who does it not work for? At what age is it maybe not recommended? How much crying is too much? At what ages? " So more of a dose-response, rather than just this global, it works for everyone at all times, in all situations, across all amounts of crime. I really think we need to really start deconstructing it, really taking it apart and looking at each piece more carefully, which is kind of the focus of my work, I would say.   Jen Lumanlan  13:01 I'm 100% agree. And just on that sort of mountains of evidence point, I mean, I see that over and over and over again, where whatever study I'm looking at, it was just released, cites a study from a couple of years before, and what they're citing is not necessarily the findings of that study, but just a comment that the person in that study who was doing that study made, which was then citing a previous study, which was about a comment that person in that study may not their actual results. And so you build on this series of comments that people have made that aren't actually even related to their results, and then you get finally back to the beginning of the evidence chain and you'll find that what was described in the original research is nothing like what you ended up, it's like that game of whispers, right, where you're whispering one to the next, and it gets changed throughout the way that it's cited, and it's built on as if at each stage, it still represents the truth, right?   Macall  13:52 There's some new work now called I just dipped my toe into it, but it's about what's called citation networks. It's very much this. It's about how people citing and reciting certain pieces of evidence builds a kind of belief system that then gets sort of entrenched, right? And then you have review articles that summarize the things that people have already said again and again, and then meta-analyses that re-review, and then you have levels of evidence, right? We have this chambliss criteria of evidence-based practices, and you start really looking at it, and then I, of course, compare it to what the books are saying, because then this information gets funneled into more popular consumable information, then I do a comparison of like, well, the book said this, what is the research say? It is like whispers, right? It is like, I think we call it "rumors" or something, yeah, where things get altered in the translation, so, that's very much true. I always have to do a disclaimer that this work is not about slamming extinction as an intervention. It's not at all. It definitely works for some families and lots of babies and lots of children. It totally works without a lot of stress and drama. However, it does not work for everyone and I don't think parents get that message really. As far as parents are concerned, this is literally the only option and that is very much not true, so it's more a call for the idea that we need to know more about the ins and outs of using extinction and what the alternatives are because they're out there. They just don't get depressed. And also, it's gotten so polarized to pro and anti-crying it out and I really think that's leaving out a lot of struggling people in the middle, so this is also a call. And also, the people on either side of that debate, whatever they are lobbying for worked for them, then I say, there's all these people in the middle for whom neither option worked, right? And they are really struggling and so I think that by giving parents options, we can defuse some of the sleep war piece and we can give struggling parents a little bit better information, I think.   Jen Lumanlan  16:11 I totally agree. Okay, so another thing that I want to be really clear about is that when we're talking about doing a study on a method of supporting children's sleep, the way the researchers are doing that study is very different from the way a parent at home, who is struggling and right in the thick of this and has a sleepless baby in one hand and their sleep book in the other hand, and these are two very different experiences, right? Can you talk a little bit more about what it's like to be a parent in a sleep training study?   Macall  16:40 Oh, boy, that's such a big, great question. In research, we call that transportability, right. Does what we find in the lab translate into real-world experience? In studies, they rarely just hand the parent a pamphlet or a book and say, "Let us know how that goes." Almost all the time, someone meets with the family and then does a whole intake history. Often, they craft a plan with that family and then there is a follow-up for questions even if that...