Millions of parents swear he helped get their children to sleep through the night, but Richard Ferber, M.D., isn't sure whether or not to be proud. He's dedicated his life to studying sleep and helping parents survive night wakings, early wake-ups, and nap anarchy (he directs the Center for Pediatric Sleep Disorders at Children's Hospital Boston), but he's not so happy that his name has become synonymous with leaving babies alone to "cry it out." A few years ago, he published a major overhaul of his best-selling book, Solve Your Child's Sleep Problems, to help correct that misconception, but the label still sticks. In an exclusive interview with Babytalk senior editor Patty Onderko, the sleep guru chatted about his ongoing work at the center and the legacy he hopes to leave.
Babytalk: How do you feel about the fact that parents describe their children as "Ferberized"?
Richard Ferber, M.D.: It's flattering that my name is out there, but it suggests a misunderstanding of what I've been teaching for so long that it concerns me. I've always believed that there are many solutions to sleep problems, and that every family and every child is unique. People want one easy solution, but there's no such thing. I never encouraged parents to let their babies cry it out, but one of the many treatment styles I described in my book is gradual extinction, where you delay your response time to your baby's wakings. I went to great pains in the second edition to clarify that that treatment is not appropriate for every sleep issue, of which there are many. So if someone tells me they tried my "method," I know they only read one small part of my book.
BT: But you do believe that self-soothing is an important part of an infant's sleep health, correct?
RF: Yes. One of the most common problems I see is night waking. There's a huge misunderstanding that children should sleep through the night without any waking. All humans wake up a number of times at night to check that all is well, to reposition themselves, and then return to sleep. When babies experience these normal partial arousals, they may whine or fuss, and parents think it's their responsibility to "help" their child go back to sleep. But when you become a part of the process -- by rubbing your baby's back or rocking her -- she might not be able to fall back asleep on her own.
BT: That sounds like you're suggesting letting them cry, though.
RF: Gradual extinction is one way to deal with night waking, if the baby expects a certain intervention such as rocking or back rubbing, but it's not always that simple. There are other reasons babies wake up at night, too: They may be getting too much sleep during the day, they may have gastrointestinal distress, or the child might be anxious. But when your child knows how to self-soothe, you know that when he wakes up crying at night there is probably another reason worth investigating. We have to look at the whole pattern of day and night sleep habits to create a plan that will work.
BT: You and your team at the center are continually studying the science of sleep. What are some of your latest findings?
RF: We've found that infants don't need nearly as much sleep as we once thought. The idea that 4-month-olds can sleep 15 or 16 hours a day is wishful thinking, yet parents believe there's something wrong if their child is sleeping less. Many parents complain that their baby wakes up too early, at 5 a.m., and they want to try letting her cry it out until 7 a.m. But if the child naps for two hours and goes to bed at 7 p.m., that's 12 total hours of sleep. She may not need more than that, so making her stay in the crib another two hours isn't a great idea.
BT: So how much sleep do infants really need?
RF: It varies by age, and we included an updated chart of average sleep amounts in my revised book. (See our Baby Sleep Chart.)
But, in general, your baby will get the amount of sleep she needs on her own. If she sleeps 11 hours a day but wakes up happy each time, it doesn't matter if you want 12.
BT: You've gotten a lot of flack from parents who co-sleep. What's your stance on the practice?
RF: Philosophically, I have no problems with co-sleeping. Emotionally and developmentally, I think kids can thrive no matter where they sleep. People say that co-sleeping is an age-old, cross-cultural practice, and that's true, but sleeping on a modern bed is much different than sleeping together on the floor of a hut or spreading out futons for the whole family to lie on. Kids don't keep their orientation at night like adults do, and their movements are less inhibited than ours, so they roll all over. In a modern bed, that can be unsafe. It can also be disruptive to everyone's sleep. For most of the co-sleeping parents I see, it wasn't a choice. They just felt it was the only way their child would sleep for a period of time, and now they don't know how to stop.
BT: But parents who do choose to co-sleep believe it helps make their babies feel more secure.
RF: And some babies do need that extra security. Taking a child who is frightened and has separation anxiety, often around 9 or 10 months, and putting him in a dark room by himself may not be the best idea. It's not an ideal time to work on self-soothing if you haven't already done so. I encourage parents to choose whatever sleeping arrangement works best for them. But I do think parents who choose to co-sleep need to go into it with a plan. Will you all go to bed at the same time? How and when will you stop co-sleeping? The idea that it will stop naturally on its own is incorrect -- transitioning the child to his or her own bed is a process that takes work. And, of course, I want parents to understand the potential dangers [bed sharing has been linked to a higher risk of sudden infant death syndrome] and take the necessary safety precautions.
BT: If you could tell parents only one thing about their child's sleep habits, what would it be?
RF: That almost all children have the potential to sleep well. Once you understand the causes of your child's sleep problems, you can make the changes necessary to allow a better sleep pattern to emerge.