Blog Post 17-Fathers and Mothers

Healthy Sleep Habits, Happy Child
by Marc Weissbluth, M.D.

A Healthy Child Needs a Healthy Brain,
A Healthy Brain Needs Healthy Sleep.

“Sleep Readiness” is the title of Chapter 11 of the United States of America Department of the Army field manual (FM 7-22) that prepares young men and women to become soldiers.  It is the official document that describes how all young recruits will acquire necessary skills during the process that is sometimes referred to as basic training or “boot camp.”  Updated in 2020, it is based on empirical data using traditional scientific methods.  Sleep is serious business. 

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial, from the point of view of the United States of America Department of the Army.  I have lightly edited, added emphasis, and condensed Chapter 11 in order to show you how “Sleep Readiness” can also help parents help their child sleep better.

Initially, I posted Chapter 11 (Blog Posts 1 through 5) to emphasize the value of healthy sleep.  Based on the material presented in Chapter 11 of the Army field manual, Blog Posts 6 through 15 show how basic principles of sleep apply, not only to military basic training, but also to parenting.

Going forward, I will post specific information for parents and children based on my book, “Healthy Sleep Habits, Happy Child.” Please do not be put off by my book’s length. For now, only read the single, age-appropriate Chapter for your child.  Later, if you wish, read Chapters on What is Healthy Sleep, Why Healthy Sleep is Important, and Preventing Sleep problems.  Finally, if needed, read the Chapter on Sleep Solutions.

            Let’s go!

FATHERS

            Fathers can help or hinder their child’s healthy sleep.  The studies presented here were published in peer-reviewed medical journals.

STRENGTHS

            A higher involvement of fathers in infant care was associated with fewer infant night-awakenings.  Perhaps because fathers in general may endorse a higher degree of limit-setting approach that encourages infants to self-soothe.

            Separately, “Greater paternal involvement in infant daytime and nighttime caregiving at 3 months significantly predicted more consolidated maternal and infant sleep at 6 months.”  So, Moms get more sleep too!

            Another study of children 1 to 3 years of age showed that sleep problems were solved when fathers took over the management of bedtime routines and night wakings. Fathers can do everything that mothers can do for bedtime routines and soothing except for breast-feeding.

CHALLENGES

            At 3, 6, 12, and 18 months, families were classified into two sleeping arrangement categories:

  1. Persistent solitary sleeping (infants slept in a separate room)
  2. Persistent room-sharers (infants slept in parents’ room)

Among the room-sharers, the mothers had lower objective sleep quality and reported more infant night wakings, had higher levels of maternal separation anxiety and the father’s overall involvement during the day and nighttime involvement in infant caregiving was less compared to solitary sleepers.

            At 6 months, another study showed that mothers of room-sharers had more sleep disruptions and this was associated with mother reports of marital and coparenting distress.

            Australian publicly funded Early Parenting Centers provide a residential program, for mothers and children, offering parenting support and education, commonly for crying and sleep issues.    Fathers whose wives sought care in these Centers exhibited “risky alcohol use (episodic excessive drinking or daily alcohol use).”  Among these fathers, 20% had mental health problems and risky alcohol use occurred in 82%; among the 80% without mental health problems, risky alcohol use occurred in 50%.  Fathers who sought care in these Centers complain more of tension, agitation, and frustration than depression. 

MOTHERS

            Mothers can help or hinder their child’s healthy sleep.  The studies presented here were published in peer-reviewed medical journals.  However, many studies did not include fathers.  Therefore, it would be wrong to assume that challenges that mother’s experience are all within-the-mother problems.  If there is an absent, abusive, alcoholic, or addicted father, and he is not included in the study, a false impression might be created that it is primarily the mother who has a problem.

STRENGTHS

            Emotional availability (EA) of the mother at bedtime is comprised of four items:

                        · Sensitivity: Rated high when the mother detected immediately, interpreted accurately, and responded promptly and appropriately to the infant’s signals by fulfilling the infant’s needs such as feeding, soothing, and diaper changing.

                        · Structuring:  Rated high when the mother engaged with the infant in bedtime routines in a quiet, soothing, and organized manner that gently induced the infant to sleep.

                        · Nonintrusiveness:  Rated high when the mother did not initiate arousing activities with the baby or other family members.

                        · Nonhostility:  Rated high when the mother did not display covert or overt impatience, frustration, or anger at bedtime.

When mothers were more emotionally available, the infants slept more throughout the night.  Mothers who were ranked high on EA had infants with lower bedtime and nighttime cortisol (indicating less stress) compared to infants whose mothers ranked low on EA. 

Separate from the concept of EA is the notion of “Parenting Practice” at bedtime.  Parenting Practice at bedtime means whether or not, after soothing and the child being put down:

                        · The parent stays in the room until the child falls asleep.

                        · How long the parent is in contact with the child, such as for feeding or cosleeping.

High maternal EA in combination with less close contact at bedtime after the child is put down was associated with more infant sleep at night.  However, high EA had a strong effect on infants rated high in “surgency” defined as an enthusiastic positive affect (more expressive and warmer in interpersonal interactions, more smiles and laughter) and a weak effect on infants rated low in surgency (Differential Susceptibility, Blog Post 14).                                   

CHALLENGES

            Some mothers have eveningness preference; they are “owls” and prefer to go to bed later, wake up later, and feel better in the evening.  Compared to “larks”, the children of mothers with eveningness preference require more time to fall asleep and have more sleep difficulties.

            Over a 12-month survey, 19% of adults had anxiety disorders (past year prevalence), but it was 23% for females and 14% for males.  Between 2013 and 2019, moderate to severe anxiety rose from 18% to 34% and severe depression increased from 9% to 21%.  During pregnancy, for young mothers (19-24 years), depression has increased from 17% to 25% between 1991 to 2014.  Maternal anxiety or depression might cause sleep problems in the child.  Mothers with depressive symptoms appear to feed their child upon awakening, even when the child was not hungry and to stay present until the child falls into a deep sleep and both behaviors predict frequent night waking when older. 

Other mothers, without necessarily having symptoms of anxiety or depression, habitually think and believe that “their child will feel abandoned if they are not by the infant’s side during the night or that their infant will go hungry if not fed (even when the infant is not distressed), are more likely to spend more time with their infants at bedtime, and at night, awaken their infant more frequently or keep them awake longer than mothers who do not harbor such habitual thoughts.  We suspect that mothers who worry excessively about their infant’s well-being at night may be motivated to seek out and intervene with their infants, regardless of whether the infants require intervention or not, in order to alleviate mothers’ anxieties about whether their infants are hungry, thirsty, uncomfortable, and so on.  We suspect that mothers with elevated depressive symptoms may be motivated to spend time with their infant at night in order to satisfy mothers’ emotional needs.”

IT IS NOT NECESSARY TO MAKE YOUR CHILD CRY TO HAVE A GOOD NIGHT’S SLEEP

WHAT A PARENT CAN DO

·  Encourage partner to help care for baby daytime and nighttime.  Be emotionally available at bedtime.  Seek help if your child is not sleeping well and there are symptoms of anxiety or depression for yourself or partner.

•  Encourage self-soothing; the earlier the better.  Consider leaving the room after putting your child down to sleep. Provide opportunity for naps based on drowsy signs.  Encourage partner to help care for the baby daytime and nighttime. Blog Post 16.

•  Plan for healthy sleep by focusing on sleep quality, not just sleep quantity. Provide opportunities for naps. Blog Post 15

•  Make a sleep plan that you are comfortable with; be flexible and tolerant.  Blog Post 14.

·  Become more aware of the difference between how you feel when well-rested versus mildly sleepy. Blog Post 13.

·  Try to maintain a regular sleep schedule.  Blog Post 12.

·  Try to not respond immediately to every quiet sound your baby makes at night.  Blog Post 11.  

·  Practice soothing to sleep and bedtime routines, every night, if possible. Blog Post 10.

·  Watch for drowsy signs. Blog Post 9.

·  Respect your child’s natural sleep rhythms.  Blog Post 8.

·  Encourage an early or earlier bedtime (even a slightly earlier bedtime may produce better sleep.  Blog Post 6) especially at 6 weeks.  Blog Post 7.

∙ Recognize that a healthy brain requires healthy sleep. Blog Posts 1, 2, 3, 4, and 5.

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