Expert Blog-Marc Weissbluth

Marc Weissbluth, M.D., has been a pediatrician since 1973. A leading researcher on sleep and children, he founded the original Sleep Disorders Center at Children’s Memorial Hospital (now the Ann and Robert H. Lurie Children’s Hospital of Chicago) and is a Professor of Clinical Pediatrics, Emeritus, at the Northwestern University Feinberg School of Medicine. Dr. Weissbluth discovered that sleep is linked to temperament and that sleep problems are related to infant colic, and he coined the now familiar phrase sleep training to describe his method for helping children learn how to fall asleep.

His finding that changing the time a child is put to bed dramatically decreases the number of night awakenings was published in the prestigious journal Sleep in 1982. His landmark seven-year study on the development and disappearance of naps, published in Sleep in 1995, highlighted the importance of daytime sleep. Since its original publication in 1987, Healthy Sleep Habits, Happy Child has sold more than a million copies and, in twelve foreign editions, helped millions of families the world over. Dr. Weissbluth was acknowledged by the American Academy of Pediatrics for his extensive contributions to the chapter “Your Child’s Sleep” in their popular book for parents, Caring for Your Baby and Young Child: Birth to Age 5. Dr. Weissbluth is also the author of Your Fussy Baby and Healthy Sleep Habits, Happy Twins, and the producer of a CD, Sweet Baby: Lullabies to Soothe Your Newborn. Married to his wife, Linda, since 1965, he is the father of four sons and eight grandchildren—and they are all good sleepers. Dr. and Mrs. Weissbluth live in Chicago.

Q: What is the Weissbluth Method?

A: The brain is the only organ in the body that requires sleep.  Parents are responsible to make sure this need is met.  Think of healthy sleep like healthy food in the sense that there is good quality food and junk food.  Just as parents don’t look at just the number of calories consumed, parents should not look at just the number of minutes or hours asleep.

Healthy Sleep for Children is composed of five main elements:

1. Sleep duration: night and day.
2. Sleep consolidation.
3. Sleep schedule, timing of sleep, bedtime.
4. Sleep regularity.
5. Naps.

These five elements interact with each other so parents need to be mindful of all five.

Respecting your babies need for healthy sleep is a core principle.  In practice:

1. Start early to help your baby sleep well.  Practice bedtime routines.
2. Many Naps or Brief intervals of wakefulness which prevent a second wind that interferes with easily falling asleep and staying asleep.
3. Many hands means involve others in soothing to sleep so your baby learns how to self-soothe in different circumstances.
4. Get Dad on Board means that fathers help at night and general support during the day predict better infant sleep.
5. At 6 weeks of age, the brain wants an earlier bedtime.  Respect the night sleep circadian rhythm.
6. At 2-4 months of age, naps become more regular.  Respect the nap circadian rhythm.

At any age, sleeping in synchrony with circadian sleep rhythms produces better quality sleep.  Use your child’s natural sleep rhythm as an aid to help your child sleep well.

A Healthy Child needs a Healthy Brain.
A Healthy Brain needs Healthy Sleep.

Q: How should a new parent be preparing for their baby?

A: Co-parenting is the manner in which parents work together to raise their children.  Within the context of specific family circumstances, to achieve healthy sleep, focus on teamwork.  High positive co-parenting quality elements include:

1. Agreement: “My partner and I have the same goals for our child.”
2. Closeness: “My relationship with my partner is stronger now than before we had a child.”
3. Support: “My partner asks my opinion on issues related to parenting.”
4. Endorsement: “I believe my partner is a good parent.”
5. Division of labor: “My partner does carry his or her fair share of the parenting work.”

When positive co-parent quality is high, parents’ ability to deal with bedtime issues and nighttime awakenings is greater.  This emphasizes the importance of communication and concordance in nighttime parenting practices.

Communicate with each other and coordinate nighttime parenting practices.

Q: What are the signs of baby fatigue?

A: Drowsy signs are the early warning system, signaling that you need to start the soothing process to sleep. Then, sweet sleep is almost guaranteed.  Fatigue signs occur when you were too late and finding sleep might be tough.

Drowsy Signs

Moving into the Sleep Zone.  Moving away from alert, calm and relaxed.

• Decreased activity, less animated, becomes quieter.

• Slower motions, less social, less vocal.

• Less interested in toys or people.

• Sucking is weaker or slower.

• Yawning.

These behaviours are most noticeable when the child is in a quiet and relaxed environment, for example, when being read to.  They might be less apparent in a stimulating environment such as a busy mall or when he is in front of a television or screen-based media device.  Or they might not be noticed because you are distracted by looking at a screen or on a phone call.

Important Point

Try to begin soothing before you notice changes in the eyes.

• Pay close attention to the eyes and eye lids as he transitions from mild to deeper drowsiness to almost a sleep state:

• Eyes become less focused on surroundings, eyes appear glazed over, staring, or not as sparkling.

• He may seem to look “through you” and not socially “at you.”

• Eyelids drooping, eyelids come down slowly, long blinks.

Fatigue Signs

Entering Overtired Zone.  Becoming overtired.  Moving toward irritable and tense.

• Mild fussiness, irritability, cranky, moodiness, pulling ears, drooping head, rubbing eyes.

• Easily upset, clinging, peevish, easily frustrated, short-fused, rough around the edges.

• Whining, whingeing, mewling, crying, slightly “wired”, less cooperative, less able to entertain himself.

The most common mistake made by parents is mistaking fatigue signs, which come late, with drowsy signs which appear early and signal the rising of the sleep wave.

Q: What is your top tip to help get the baby to sleep?

A: The single most important word is timing.  You are using your child’s natural sleep rhythm as an aid to help her sleep well.  You watch for drowsy signs and when they appear, you begin your soothing to sleep efforts and bedtime routines.  Good timing prevents a second wind.  What happens when you skip a nap or the interval between naps is too long or the bedtime is too late?

When you are short on sleep, your body reacts in a predictable way. You get keyed up because your body produces stimulating chemicals such as cortisol, adrenaline, and noradrenaline to fight the fatigue. This results in a burst of energy commonly known as a second wind. When you catch your second wind, you are in a state of higher neurological arousal. You might feel more wired, turned on, or full of nervous energy.

The higher state of neurological arousal makes it more difficult to fall asleep or stay asleep or both.  Understanding how sleep deprivation causes a second wind that makes it more difficult to easily fall asleep and stay asleep also leads to a deeper appreciation of the opposite situation: being well-rested allows your child to more easily fall asleep and stay asleep.

It’s a virtuous circle: sleep begets sleep.
It’s also a vicious circle: sleeplessness begets sleeplessness.

Q: At what age should you start the Weissbluth Method?

A: It is never too early to start to help your child sleep better.  Start with your newborn, or as early as possible to help your child sleep well because:

1. Keeping the intervals of wakefulness between naps brief and protecting early bedtimes avoids the overtired state which makes it easier for your child to fall asleep and stay asleep. Your soothing efforts and bedtime routines help your baby transition from wakefulness to sleep.  As time passes, because your child is well-rested, your child is more able to learn self-soothing and develop healthy sleep habits.  Learning good habits early is easier than breaking bad habits later.  The benefits of healthy sleep accrue and sleep problems are prevented.
2. Healthy sleep may enhance neurodevelopment of the brain just as healthy foods build strong bones. Brain development is extremely rapid during infancy and the first few years of life.  Starting early with healthy sleep optimizes healthy brain development and may prevent adverse outcomes.

It is never too late to start to help your child sleep better because:

1. Brain development continues during the first two decades.
2. A small number of extra minutes of sleep, even only 10-20 minutes, over time, make a big difference. Perhaps, just move the bedtime a little earlier.

Q: How does daytime sleep differ from night sleep?

A: Naps are not little bits of night sleep randomly intruding upon children’s waking hours.  Naps have their own rhythms and specific purposes.

Why Naps are Beneficial:

1. Naps reduce stress: During a nap, levels of cortisol dramatically decrease.
2. Naps enhance emotional- and self-regulation: After a nap, children show more joy and pride; less worry/anxiety.
3. Naps modulate temperament: Napping is associated with more positive mood, more adaptability, and longer persistence.
4. Naps consolidate memories: Naps following learning enhance the memory of what was learned.
5. Naps enhance executive function:  Naps improve attention in the presence of conflicting information.
6. Naps contain REM sleep and REM sleep helps direct the course of brain maturation.
7. Naps and night sleep interact with each other:  When children nap well, they remain at a lower level of neurological activation that produces a virtuous circle of healthy sleep during the day and healthy sleep during the night.  When children do not nap well, they are at a higher level of neurological arousal resulting in bedtime resistance, night wakings, and short night sleep durations.  Subsequently, waking up short of sleep, naps become more problematic: a vicious circle.

Q: Does the Weissbluth Method work for all age groups?

A: Yes.

For children of every age, the brain naturally alternates between wake and sleep outputs.  This is an automatic process over which we have no control.  If you try to fight this circadian rhythm, you will lose because the ancient and powerful force behind this biological process is the rotation of the earth on its axis creating day and night.  As the earth rotates, dawn and dusk separate day and night.  Dawn and dusk are twilight, or in-between states. Not fully day and not fully night.

The brain automatically shifts into the drowsy state which  is also an in-between state: not fully awake and not fully asleep.  As your baby starts to become drowsy, begin to soothe your child to sleep.  Healthy sleep occurs when the sleep period is in synchrony with the occurrence of the brain’s output for sleep both during the day and night.

When you put your well-rested child to sleep at the beginning of the drowsy period, because the baby’s brain is naturally drifting into a sleep state:

· It is easier for your baby to fall asleep and stay asleep.
· No crying occurs before your child falls asleep.

Although some adults have an eveningness preference (owls) while others have a morningness preference (larks), research in children shows that between birth and 8 years of age, evening types (owls) occurs in less than 2 percent of children at every age.  In separate research, using objective measures of sleep and salivary melatonin, at 30-36 months of age, the number of definite evening types was zero.

So, the vast majority of babies and young children are larks (become drowsy early in the evening and wake up early in the morning) and thus benefit from early bedtimes.

More information is available at: Marcweissbluthmd.blog or Healthy Sleep Habits, Happy Child

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