How Doctors Can Seem Out of Touch With Sleep Training
Not too long ago, I received an e-mail from a long-term client, now working on her third son’s sleep (second with me by her side) and boy WAS SHE ANGRY! Why? Her doctor told her that her 6 month old “technically” didn’t have to eat at night anymore and she should avoid that “trap” that he had to eat at night. He said that he should be able to go 12 hours without eating (Can you?).
Now, to give this some context, this little baby had already had some feeding and weight-gain issues, so it was even more upsetting to her that he would be so flippant about this piece of advice. Add to that, and his next piece of advice was to let him cry it out. Oh was she steaming at the ears at that! She has been a strong advocate of Attachment Parenting all along. In our experience, a 6 month old breast-fed baby quite often still eats once, if not twice, a night. While many formula-fed babies tend to night-wean around 6 months old (not all), a smaller number of breast-fed babies don’t without a lot of effort.
Think this is just one doctor? Think again.
Yet another client e-mailed us that her doctor recommended giving her 8 month old Benadryl for two weeks in order to stop a rocking to sleep association. My jaw dropped at this piece of news, except I shouldn’t be surprised considering all of the things I’ve heard over the years that doctors have told clients. Medication to change a behavior? I believe we can teach babies to learn how to fall asleep without medication. Of course, I know many of us are tempted to try to drug our babies to sleep at one time or another, but that’s not the answer! 😀
I also remember one doctor told a client that naps were “optional” and it didn’t matter if her baby didn’t take one all day. Woah. I don’t know about you, but I find it extremely hard to concentrate on learning something new when I’m exhausted! Perhaps one day I can muscle through, but day after day? Chronic sleep deprivation is bad news.
Granted, doctors give very sound advice on a variety of topics, so I’m not trying to bash doctors here. I just find their strategies for sleep training sometimes lack depth, depending on the doctor. I can imagine they have a very short amount of time with their patients to get into the ins and outs of their parenting philosophies or the nitty gritty of the true source of the sleep problem. And, another thing. I have had a few pediatricians as clients, ironically, and at least one shared with me that they really don’t get a lot of training in the way of sleep when it comes to their medical training. And, it makes perfect sense, because the advice about sleep and sleep training varies very widely from doctor to doctor! It is for these reasons that we have created sleep resources for healthcare providers, doulas, midwives, and other professionals who come in contact with new parents. We feel like if you have something you can hand your patients, this will help guide them to the information they need that you may not have or have the time to share in detail.
So, what should you do about this if your doctor seems out of touch or is recommending something outside your comfort zone?
When it comes to your baby, you should always know that you know him best. You need to use your instincts and help them guide you to what you do for your baby. Remember that doctors are human and have their own beliefs, too. You may love your doctor for one aspect of child rearing, but disagree with their philosophy on sleep training, for example. And, that’s okay. I know it’s very scary to even consider going against the advice of a doctor or nurse at your pediatrician’s office. After all, they work with babies every day! But, as I say all over The Baby Sleep Site, the strategy you use for your baby’s sleep training will depend on your baby’s temperament, personality, your parenting philosophy, your patience, and your unique situation.
Now, don’t go crazy and think I’m saying you should not listen to your doctor about health concerns. All I’m saying is that it’s okay to get second opinions or find a doctor that is like-minded when it comes to certain philosophies. We interviewed a doctor or two when I was pregnant and we have switched to a new doctor since then (bedside manner is important to me). Keep in mind that Dr. Ferber varies from Dr. Weissbluth and Dr. Weissbluth varies from Dr. Sears, but are all doctors. They, of course, vary very greatly in their approach to sleep training, though. I do believe, however, that they are all very capable doctors. Find a doctor who is right for you…or recognize that it’s okay if they don’t agree with your philosophy about sleep training and night-weaning. When it comes to some things, it’s okay to listen to the advice and modify it to fit your parenting style.
How Has Your Doctor Been In Touch or Out of Touch? Share Your Story!
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Nicole, that is the reason why we have people like you! I remember NEVER got a piece of information about sleep from my pediatritian. Not even in the wellness checkup they asked me a single question about sleep…..so I thought I should not even ask them about the topic and I went and researched…..read books, articles…. until I found your website almost 4 years ago and it was a blessing!! my two boys are terrific sleepers now….it wasn’t easy, but your advise was an important key in this process!
Man no wonder so many people react so strongly against CiO. Our doc suggested it, but it was in no way phrased as: “You SHOULD do this” just as worth trying to help with sleep issues. If my son’s pediatrician were this absolutist about sleep or feeding, I’d be furious and feel betrayed.
I agree that doctors pretending to be experts when they really know very little is a huge problem, I didn’t mean to imply that all the responsibility is on the parent in terms of knowing what and what not to trust. With non-medical issues our pediatricians have always been very good about sounding like experienced adults giving advice, not experts giving directives!
The pediatricians in the practice we go to all act as experts in sleep and feeding issues. They’ve been giving me advice since I was in the hospital from my son’s birth, and much of it has not been helpful. For example, I was told to have someone give my son formula at night so I could sleep, and this was while I was in the hospital and before breastfeeding was well established. I was also told at the 4-month checkup to stop feeding my son at night and that I should put him to bed and let him cry it out all night without going in to check on him, because he no longer needed to eat that much and “should” be able to sleep just fine for 10-12 hours. I tried it and it was a complete failure, upsetting both me and my baby very much. I can say with certainty that he was not ready for that. I’ve never been very comfortable with crying it out, but our pediatricians act as if that’s the only way. Now I don’t want to talk to them about sleep issues at all, I’ll just say everything’s fine.
I am towards the Attachment parenting end of the spectrum and a physician myself, though not a pediatrician. My husband is a much stronger proponent of CIO, which I could not stomach. We have 3 year old twins. It would be scary and frustrating for me to go to the well child visits, when the children were younger, knowing that the pediatrician would invariably give the “they are old enough to sleep on their own” and “you should let them cry it out…it won’t hurt them” speech, when I knew that I could not do that, and that this advice would just add fuel to the fire of my husband’s and my differing philosophies. As others have commented, there is minimal training on sleep and other issues in medical school, and often the pediatrician’s advice is 1) personal opinion or 2) based on some sort of written statement by the pediatrician group (as ours was) that does not take into account the vast variation in beliefs and practice. Physicians as a whole would be better off being more open about what they know about and what they don’t know about, as well as areas in which the research in non conclusive.
I agree with this article, and appreciate that you have put it out there.
My trust in doctors has decreased from hearing what my pediatrician, friends’ pediatricians, and the pediatrician in my family say about sleep.
They just say CIO, or “he shouldn’t be waking up so much” without any direction. They should rule out medical issues, then realize and tell patients they don’t know much about sleep. Even if they are parents, they may have had “easy” sleepers or a bigger personal tolerance for CIO. At least we’ve learned that doctors are humans, and that their expertise probably (hopefully) lies with MAJOR medical problems.
Thank you again for putting this out there.
@A You are very welcome and thank you for commenting and sharing your experience!
@K Thank you so much for commenting as a physician! I appreciate your perspective on the matter.
@SW Oh no! I’m so sorry for all you went through! 🙁 Thank you for sharing your experience with us.
@Cristina Awww! That is so wonderful to hear and thank you so much for being such a loyal reader! I love hearing that! 🙂
We had an experience of this early on, when our son (now 7mths) was not napping AT ALL (!!!) during the day and would roughly sleep a maximum of 5hrs at night. Yes, a total of 5hrs in a 24hr period! Any napping he would do was in a sling or on me for 10 minutes or so at a time. Needless to say the three of us were very sleep deprived and it was an awful, awful time. Our doctor at the time gave us the ‘naps were optional’ speech and said some babies just dont need sleep! After finding a new doctor that would take us (and my obsessively written sleep and behaviour journal) seriously, Carter was diagnosed with severe reflux and a dairy allergy. He now naps (in his own cot too!) and 90% of the time sleeps through the night.
Although I agree that doctors aren’t sleep experts, they should definitely be more willing to acknowledge that fact and refer you to someone else who does.
@Amy Wow!! Your poor baby was hardly sleeping at all! I’m so glad you followed your gut and went to another doctor! Thank you for sharing your experience!
We have a VERY good pediatrician, – knowledgeable, matter-of-factly, with a great sense of humor that fits ours – and we really like her and trust her. But when at the 4- or 6-month checkup for my son (who’s 5.5 years old now) we told her that we just couldn’t get him to sleep during the day, she said that it was ok, he didn’t need to as long as he was getting his 12 hours of sleep at night, and yes he’ll be cranky in the afternoon, so what, not a big deal. I was very dubious, but hey! that was coming from THE DOCTOR – she must KNOW!!! At the same time, just around then information about the importance of sleep and the dangers of sleep depravation in ADULTS was starting to make the headlines. Why did she think it was ok for a baby to not sleep, if it was a problem for adults???
A few months after that someone recommended Dr. Weissbluth’s book to me, and then I was horrified both at what we were doing to our son by not helping him sleep more and by our pediatrician’s advice. My son still has sleep issues (he has completely refused naps when he was 2.5 or 3, though he frequently STILL needs them; we periodically still struggle about the bedtime, and he’s had some behavioral issues that I believe were a result of not enough sleep). Bud now, looking back, I realize that he is wired that way: when they did heart monitoring in the last days of my pregnancy, his heart rate was so high and erratic, and for so long, that they sent me to the emergency room; and when a few days later I was being induced (he was 10 days overdue), the nurse who was checking his heart rate for several hours commented that she’d never seen such a baby – all that time he did not sleep at all! We know now that he needs extra help getting the sleep he needs, that he is extra sensitive to sleep deprivation, and sleep is always the highest priority in our schedules.
Our 2nd baby just turned one. This time, instead of asking our pediatrician for sleep advice, I directed her to this site and asked her to recommend it to all those parents who, like we did 5 years ago, come to her desperate to get their babies to sleep and to get some sleep themselves. Hurray to babysleepsite! 🙂
A shout-out to a great doctor – I really appreciate our pediatrician. Mostly because he has four kids of his own, he’s a pretty laid-back guy, and at our first visit his advice to us was “Just don’t drop him on his head too much, and he’ll turn out just fine.” Now, that wasn’t literal – he was just saying that we shouldn’t sweat the small stuff and that our little man was going to be just fine. And, at subsequent visits, it’s pretty much been the same attitude: things going well? Great. Keep doing what you’re doing! Even when it was clear I wasn’t producing enough milk to breastfeed adequately (medical issues), and this doctor was very pro-breastfeeding, he gently said “In this case, I think he needs formula. And this does NOT mean you’re a bad mother. Alright?” So there are some great doctors out there!
Having said that, I think we expect a LOT, in current society, from babies. He isn’t sleeping through the night at 3 months? What??? (Never mind that he’s not “sleeping through the night” at 7 months. Ha!) But while I would LOVE more sleep, my husband and I have accepted that our little guy is a very high-touch person – even when he’s playing, especially if it’s later in the day, he just needs to have a foot on you or be within touching distance. It’s his personality.
All of that is to say that we listen to ourselves, get to know our babies, and, in the words of Dr. Sears, if it’s working for your family, it’s fine. If it’s not working, then work on changing it!
I completely agree with all the above comments! Doctors are not sleep experts or nutritionists. My daughter’s ped told me to stop night-feeding her at 6 mos and to let her CIO. My daughter was at 1%tile for weight. The doc also told me that b/c I was breastfeeding her so much it was causing her to burn too many calories and that’s why she wasn’t gaining weight! I went home crying that day b/c I thought I was a horrible mother. But then remembered “hey, I’m an actual dietitian and probably know more about breastfeeding than this woman. Plus, I definitely know more about what my baby needs!” I got rid of that doctor soon after.
…and don’t start me on doctors who give horrible breastfeeding advice, but that’s besides the point. If only doctors could restrain themselves to the subjects where they actually know what they’re talking about.
“I think maybe part of the problem is expecting too much from doctors. They aren’t sleep experts”: problem is, many doctors go out of their realm and give unsolicited parenting advice. When my son was waking up every hour at 4 months, I mentioned it to his doctor to make extra sure he didn’t have a problem such as an ear infection or reflux. He lectured me for something like a good half hour about how I had to let him CIO and night-wean, even though I made it clear from the start that it was not happening. He even wrote down the reference of a Ferber book. Again, I was not asking for parenting advice.
So true!! at my 4 month old well visit, the pediatrician told us that I should be putting my twin boys to sleep later, around 8:30, and to let them CIO if they woke up in the middle of the night. She also advised me that they wouldn’t wake each other up! When I contradicted her with my actual experience (sometimes they do wake each other up!) she flat out said they would sleep through it. well, we almost went at it right there in the office! VERY out of touch. At that point, I was putting them to bed around 6-6:30, dreamfeeding at 11 and feeding them again around 3-4. I didn’t change a thing! Soon after that visit, they dropped one feeding and now they eat around 1am and sleep until 6-7am – and they did this all on their own because we’ve been establishing good sleep habits early on. I understand parents are desperate for sleep – I have TWINS – I am very desperate, but you still have to be realistic about a baby’s needs. It certainly made me angry that a doctor was giving such ludicrous advice. Thankfully, there are many options out there for parents to figure out what works best for their little one(s).
I think maybe part of the problem is expecting too much from doctors. They aren’t sleep experts. They’re not nutritionists. They’re not any number of things. They’ve gone through long years of medical schools, and most of them picked up special interests WITHIN MEDICINE along the way, but medical school is grueling. When did they have time to learn all the extras? When you ask a doctor a non medical question, you need to realize that the answer is not a medical opinion- its advice from someone who knows a lot about kids, and probably has about as much credence as anything your day care provider might suggest. (Suggesting benydril for an 8 month old is still horrible.)
If I went to MY doctor with sleeping issues she would do one of three things: prescribe a sleeping pill, refer me to a specialist, or commiserate. What she would almost certainly NOT do is examine my problem in any depth. Because she doesn’t know how.
When my first son was a month old I was placed in a new mums group and we had six weeks of ‘lessons’ delivered by the nurse. One of those lessons was about sleep. We should never hold our child while they slept, feed or rock our child to sleep, babies should always be put into the cot ‘drowsey but awake’ and from three months ‘controlled comforting’ (read controlled crying) was an acceptable tool. I don’t doubt that it’s good advice to new parents to try and avoid creating sleep associations and that controlled crying works in some (but not all) families very effectively. The problem for me (and a lot of other mums I’ve talked to) is that it wasn’t given as one of many options, it was given as the only right way and when it didn’t work for you or fit with your parenting approach then you were really on your own.
When my son was six months and still feeding every three hours over night my doctor told me that there was no reason to attend to him over night, to shut the door and let him cry. After three nights, he said, he’d be sleeping through. Again this advice didn’t fit well with my own thoughts of parenting and was really difficult to do with my PND.
Now I have two beautiful boys and I try to remember that health care professionals are trained in many things but they’re not specifically trained in sleep behaviours. A lot of the advice they give is based on their own experiences, how they parented their own children and the guidelines they’re given by their employing health department (in the case of the nurses here).
There’s a wealth of information out there for parents on everything from nappies, to sleep, to food. We need to be discerning in what we take on board as parents and we need to stay true to our own philosophies. Gone are the days of drs being the fount of all knowledge, now we know that they are falliable.
@Wendy Thank you for sharing your experience and giving other mums more confidence! I know when we new mums we are the most nervous. 🙂
@Meagan I believe most people think their pediatricians do know a lot about sleep and probably consider feeding and sleep as being “medical.” I definitely hear what you’re saying, but it certainly SEEMS like doctors would know a good amount about sleep and feeding that you’d be able to trust what they say. I don’t think most people would expect a doctor not to know the proper number of times to breastfeed an infant, for example. But, a few weeks ago we had a parent tell us that the doctor said her 6 month old baby only had to breastfeed 3 times during the day and NONE at night. According to our sources, babies need to breastfeed at least 5-6 times in a 24 hour period at that age (which we shared and shared with this mom numerous times to really show her the expectations were far too high for a 6 month old). I do agree that we expect a lot from our doctors, but they aren’t exactly saying “That’s not my specialty.” either. That would probably make it easier for some people to think about reaching out to other sources, at least. But, many doctors will give advice like it’s THE only way to do it. That’s what’s hard for new parents, especially, in our experience. Thank you for your comment!
@Dialma Some twins will sleep through their sibling’s crying, but we definitely know not all do!! Amazing your doctor tried to discount your actual experience! I’m so glad you found what worked for your twins. It sounds like they are doing awesome! 🙂
@Marie Wow! A 30 minute lecture? Oh boy. I’m glad you stuck to your guns. Thank you for sharing!
@JB Awww! I’m sorry you had to go through that and feel that feeling of failure and guilt! 🙁 That is so hard when something like that happens. I’m glad you were able to turn those feelings around and realize you knew your baby best! Thank you for sharing!
@Kristine I agree that our expectations are very high, on the whole! Both my boys nursed once a night for their first year. It was exhausting, but going 12 hours isn’t easy for some adults, let alone my boys with fast metabolisms (and to this day, my eldest still eats roughly every 2 1/2 to 3 hours during the day and starves while at school, since he can’t there!). Thank you for your comment!
@Anna What a great story to share with others! Thank you so much for your support and referring your doctor to the site. I hope she refers others! 🙂 It sounds like you have done a wonderful job with your two children! 🙂 Thank you for your comment!