March 28, 2015

It doesn’t take “guts” to “sleep-train” an 8-week-old

When doctors openly advocate neglect

Parenting Wellness
CIO Sad Baby File Art /for PhillyVoice

MRI study finds babies feel pain 'like adults.'

The staff at Regents Heights Nursing Home is tired. This is particularly true for those who work the overnight shift. The elderly residents keep buzzing for their attention. One resident is thirsty. One is lonely. One senile elderly woman just wants someone to hold her hand while she cries. The bald and blind 90-year-old man at the end of the hallway consistently needs help going pee. It’s beyond annoying. The staff is tired. They can’t get a break. 

Imagine their relief when care protocols suddenly change. As mandated by management, a radical reordering of care strategies is to take effect immediately. The staff no longer will spend their time relentlessly responding to the midnight “superfluous needs” of residents. No longer will they be “manipulated” by a 3 a.m. cry for attention. Why? A new geriatrician has written a book inspiring waves of reform across the country with regard to the care of America’s elderly.

According to Dr. Edwin Beely, author of “Caring for The Aged,” all of an elderly person’s needs can be adequately met in daylight hours. Care during the evening/nighttime hours is optional. In fact, it’s to everyone’s benefit that it be discontinued. 

The evening staff is now advised to do the following. Make sure each elderly resident is placed in a properly sized, crib-like bed that ensures no one can move around at night on his or her own. Dress each resident in an adult diaper should they need to urinate or defecate. Properly feed and hydrate each resident by 7 p.m. Say a polite and firm “Good night.”  Promptly turn off all room lights by 7:30 p.m. 

Unless a resident is actually ill, the staff at Regents Nursing Home is to ignore every buzz, every cry for help, and every call for attention between 7 p.m and 7 a.m. After all, the residents aren’t really hungry during these hours. Physiologically, they safely can wait to hydrate when the lights come back on. The residents need their sleep, a solid 12 hours. In fact, they must learn to sleep.  

The overnight staff is strictly advised to do nothing. They can now, finally, rest. 

Fiction or Real Life? 

The preceding account is fictional. 

There is no Regents Heights Nursing Home. Dr. Edwin Beely doesn’t exist. “Caring for the Aged” is not a real book. Certainly, any geriatrician who publically advocated the above “advice” would lose her or his medical license. We can rest assured that the most vulnerable amongst us are not routinely or purposefully ignored for 12-hour shifts. We can rest assured that they are treated with basic dignity. 

Or are they? 

In her recent New York Times blog post “Sleep Training at 8 weeks: ‘Do You Have the Guts?” Aimee Molloy describes a routine pediatric visit that took an ugly turn. Rather than affirm her maternal instincts to respond to the healthy and normal physiological needs of her 8-week-old daughter, Molloy was told that her little one should be sleeping 12-hours straight, alone, without any human contact. 

Molloy was told not to feed, change, or touch her daughter as part of the training. The lights should be turned off and all cries for attention should be ignored. Molloy should shut the door to her daughter’s nursery and not open it again for a full 12-hours. Like the elderly residents in the Regents Heights Nursing Home, this little 8-week-old girl must learn to sleep.  

It’s hard to imagine what it would be like to walk the nighttime hallways of such a cruelly run nursing home. Can you imagine the cries of our abandoned elderly? Can you imagine the harsh and righteous judgments that would be levied against a selfish and indulgent staff? 

Even healthy adults in midlife often don’t sleep undisturbed for 12-hours straight. We wake to pee, drink water, and reach out to hold a loved one. We cherish the freedom of responding to our own physiological and emotional needs. The vulnerable amongst us are unable to do this. They depend on us. They depend on us to wisely use our freedom to kindly nourish, nurture, and love them. 

Molloy’s post created quite a stir. Lactation consultants, psychologists, birth professionals, parents, and pediatricians weighed in to condemn the proposed sleep training of such a young baby. 

A breastfeeding mother expressed her concern: “There appears to be no consideration given to the fact that when you're nursing every 4-5 hours during the day, going without nursing for 12 hours can leave you engorged and uncomfortable. How does the body adjust to a 12-hour break?” 

One social worker wrote: “If it was reported that an infant was left unattended for 12 hours, I (or any other mandated reporter) would have made the call to the Child Abuse Registry. The practice that is advocated in the above article is developmentally unsound and downright dangerous.” 

Personally, I was sickened by Molloy’s account. Having devoted many hours to researching the effects of various sleep-training methods on babies and toddlers, I advocate for gentle sleep training techniques and condemn both the modified and unmodified forms of cry-it-out (CIO). In my work, I’ve heard from parents who have lost their babies because they practiced CIO. How is this possible? When abandoned for hours, it’s not uncommon for babies to vomit out of duress. If they can’t turn over, they are at serious risk of aspirating on their own throw up.

I can’t image what it would be like to close the door to a child’s nursery, purposefully ignore her cries, sleep soundly in the silence, and then wake to find a dead baby. The haunting grief would have no end. 

A Question of Guts 

“Do you have the guts to do what I’m suggesting?” asks Molloy’s doctor, tossing forth a dare. His name is Dr. Michel Cohen. 

Cohen – founder of Tribeca Pediatrics and author of “The New Basics: A-to-Z Baby and Child Care for the Modern Parent,” is a real-life Dr. Beely. Yet, instead of profiteering off of advocating the nocturnal neglect of our elderly, his focus is babies. 

“Do you have the guts?” 

Let me be unequivocally clear. 

To follow through with Cohen’s “advice” doesn’t require “guts.” Sleep training an 8-week-old doesn't require "guts." The instinct to respond to a baby's cries is empathetic, wise, and vitally important to the healthy development of future generations.

What requires "guts" is seeking out a new pediatrician when one's current doctor advocates medically sanctioned abuse and neglect. It takes "guts" to change our federal maternity leave system and finally catch up with the ethical and family-friendly legislation that characterizes the modern world. It takes "guts" to be present and respond to a baby who isn't physiologically wired to "sleep through the night." It's healthy for babies (and toddlers) to wake and breastfeed and connect. It's normal.

It takes courage to respond to our most vulnerable with compassion, connection, and evidenced-based clarity in America today. We stand together in opposing the neglectful abuse of our elderly. Authorities would shut down any nursing home that practiced the neglect described in the opening of this piece. It’s time we stand firm in opposing the purposeful nighttime neglect of our children.