Blog Post 41-Parental Anxiety, Depression, and Cognitive Biases (3 of 4)

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

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

If you have not already done so, please read Blog Posts 1 through 5 that describe how sleep is important and beneficial. 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. This is a reference book. Read only the topic of interest to you.

Parental Anxiety, Depression, and Cognitive Biases

(Continued.)

When children are not sleeping well, the cause might be the father, the mother, the baby or any combination.  Even if the root cause or trigger might occur within the father, or the mother, or the baby, as time passes, interactive effects develop between all three.  In order to help solve sleep problems, without judgement, it is important to consider all possible causes (Blog Posts 17 and 18).

Parents may have symptoms of anxiety or depression or habitual thoughts and beliefs that might, or might not, contribute to or cause sleep difficulties in their child.  This topic is confusing because some studies look only at the father’s role and others look only at the mother’s role.  Some research suggests that a colicky baby might trigger these symptoms in the parents.  Interactions between each parent and the baby are important.  Therefore, it is difficult to make firm conclusions about the direction of effect.  Blog Posts 39-42 share studies that describe how parent’s issues might contribute to or cause sleep difficulties in their child.

MOTHERS

A study by Dr. Douglas Teti investigated the relationship between maternal depressive symptoms and their children’s sleep issues. Because these researchers discovered the maternal behavior by which maternal depressive symptoms affect infant sleep, I wish to present this study in detail. The researchers documented what the mother was actually doing and not doing by placing multiple cameras in the home and child’s bedroom:

In the context of infant sleep, mothers who harbor cognitions [habitual thoughts and beliefs] that their infant 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) may be more likely to spend more time with their infants at bedtime and at night and in turn awaken their infant more frequently or keep them awake longer than mothers who do not harbor such cognitions. Mothers reporting higher depressive symptoms [were much more likely to] not have a calming bedtime routine for their infant. Prior to the infants’ bedtime, these mothers had the television on, allowed older children to play rough/make loud noises near the infant, appeared insensitive to the infant’s needs (e.g., hunger), and kept their infants awake after the infant appeared ready for sleep.  [They] were observed responding very quickly to infant vocalizations. For example, a mother of a 12-month-old infant appeared to be hyperattentive to her infant during the night. She responded to nondistressed vocalizations [Blog Post 11] very quickly throughout the night. Two other mothers were observed waking their sleeping infants unexpectedly during the night. Consider the mother of a 1-month-old infant who woke her nondistressed, sleeping infant during the night (i.e., not for the purposes of feeding) and brought the baby to the parents’ bed for the rest of the night. This behavior was only observed among mothers reporting higher symptoms of depression. A final behavior observed included mothers’ inability to set appropriate limits with their children after bedtime and during the night, especially among older children.  The most striking example of this included a mother who appeared unable to structure bedtime for her 24-month-old infant. As the rest of the family went to sleep, this infant remained awake until 2:00 a.m. with a TV that remained on in the bedroom, occasionally wandering out of the bedroom to other areas of the home. This mother eventually brought her infant close to her and held her until she fell asleep.

The researchers concluded:

“Mothers with elevated depressive symptoms and worries about infant nighttime needs were more likely to be hyperresponsive to nondistressed infant vocalizations (i.e., babbling or cooing that did not appear to function as a signal for parental assistance), to pick up and nurse the infants even when it appeared that the infants were not in need of nursing, to go to their soundly sleeping infants and move them from their cribs to the parents’ bed to sleep (and in the process, wake their infant up), and to poorly structure bedtimes that in turn led to prolonged infant wakefulness. We suspect that mothers who worry excessively about their infants’ 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. Among mothers with depressive symptoms, the mothers’ behavior at nighttime was associated with infant night waking because they incorrectly believed (dysfunctional cognition) that they had to attend to their non-distressed infants and feed them even if they had just been fed [emphasis added]”

(To be continued.)

DO I HARM MY CHILD IF I LET HIM CRY AT NIGHT TO LEARN SELF-SOOTHING?           

• Studies show that children are not harmed (Blog Post 24) when extinction or graduated extinction is used. Blog Post 25.

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

WHAT A PARENT CAN DO

• Seek professional help if your child is not sleeping well and you suspect parental anxiety or depression might be present. Blog Posts 39, 40,

• Accept the fact that your friends and relatives may not be aware of why a healthy brain depends on healthy sleep. Blog Post 38.

• Ignore myths such as sleep regressions or that teething or growth spurts disrupt sleep or that late bedtimes are fine because your young child is an “owl”. Blog Posts 36 and 37.

• Focus on timing: The time when drowsy signs (Blog Post 9) begin to appear is the time when you start your soothing to sleep. Blog Posts 2835.

• It may be difficult to begin or choose a sleep solution. Blog Posts 23 and 26.  A Community Sleep Consultant may be helpful. Blog Post 27.

• No television or digital electronic devices in child’s bedroom (Blog Post 21), if possible. Blog Post 22.

• Some babies sleep better than other babies. Develop coping strategies to reduce stress if your baby has extreme fussiness or crying.  Plan to encourage self-soothing skills at 2 to 4 months of age. Blog Post 20.

•  ‘No Cry’ sleep solutions (‘Fading’ and ‘Check and Console’) may solve sleep problems. Blog Post 19

•  Communicate with each other and coordinate nighttime parenting practices.  Consider delaying your response to nondistress sounds your baby makes at night by 5-10 seconds, especially after 3 months of age.  Blog Post 18.

•  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.  Blog Post 17.

•  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, 5, and 38.

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