My disappointment with Ferber's book

WyoGal · September 2010

So, I read Ferber's book last week out of curiosity and as the premier child/sleep doctor in the US I was a little disappointed (some of it was probably not his fault). Most of the science of sleep in his book had already been covered in other books I read so that was nothing new. Beyond that, his progressive waiting (CIO) and setting limits were all parenting advice without any real research or support behind them (at least that he referenced in the book).

His basic premise was sleep is important and necessary for health which I agree with. However, every other sleep book also agrees with that. He uses the analogy that you would teach your child to stay away from a hot stove for safety and you should treat sleep as being just as important. I also agree.

However, how you teach your child to stay away from the stove varies from spanking, to saying no, to redirection, to baby gates, to time-out etc and much like there's no "medically approved" way to teach your baby to stay away from the stove, I never got the feeling that his methods of getting your baby to sleep had any sort of medical/doctor basis to them.

Anyway, this is rambling but I guess I went in reading it expecting he would have some sort of "official" knowledge to support progressive waiting and his methods of limit setting with double baby gates in the doorway etc. but I wasn't convinced that for the first 2-3 chapters it was anything more than a pedi overstepping his medical boundaries and giving parenting advice.

If anyone has come across any of his actual research and papers I'd be interested in reading them. I feel like for the weight his advice is given there should be more research behind it somewhere.

Kestrel84 · September 2010

While I have not come across anything written by Ferber himself, I have read a study that supported his proposed method of sleep training. The study involved almost 2,000 Canadian families. I've copied and pasted the results:

At 5 months of age, almost one quarter of the children were not sleeping six consecutive hours at night. At 17 months, 7% fit this description; at 29 months, 10%. For babies 5 months old, sleeping less than six consecutive hours at night was strongly associated with how parents reacted when the child awoke during the night. Children who were fed when they awakened were 2.6 times more likely to sleep poorly than those who were not fed. Similarly, poor sleeping was 1.7 times greater in children who were rocked to sleep or brought into the parents' bed when they awakened rather than being comforted in their own bed. Children with a "difficult" temperament (as perceived by the mother) also were more likely to be poor sleepers. In addition, breastfeeding and cosleeping (sharing a room or bed with parents or siblings) were strongly associated with sleeping less than six consecutive hours a night at 5 months of age.

This was taken from a study conducted by Michael Burke published in Contemporary Pediatrics in 2005.

So essentially this supports his training method, but obviously this study does not examine any emotional consequences. Nor does it address what should be considered "normal" sleep patterns for infants and children, not what society thinks it should be. While I imagine his method "works" there isn't anything I've found that can convince me that his sleep training method is the right thing to do for a child emotionally.

**sunny** · September 2010

most of his own papers related to this subject have been reviews of the literature published in journals.

you can go to www.pubmed.gov and see:

Neurol Clin. 1996 Aug;14(3):493-511. Childhood sleep disorders. Ferber R. Center for Pediatric Sleep Disorders, Children's Hospital, Harvard Medical
School, Boston, Massachusetts, USA.

Sleep problems in children may differ in various ways from analogous problems in 
the adult. This is less because of neurophysiologic differences between the two
groups than it is because of the child's greater level of dependency. Young
children make few decisions on their own and, as a result, parent-child
interactions become connected intimately to the child's sleep process at bedtime 
and throughout the night. Parental desires and expectations are at least as
important as those of the child in determining the pattern of sleep that follows.
Such interactions are most important when it comes to understanding causes of
sleeplessness in the young child, and only by appreciating these interactions can
the clinician serve a useful role in helping the family to understand and improve a young child's problematic sleep patterns.

-------------------------------------

Pediatrician. 1990;17(1):2-4. Sleep disorders in childhood and adolescence. Introduction. Ferber R.

-----------------------------------------

Psychiatr Clin North Am. 1987 Dec;10(4):641-53. Behavioral "insomnia" in the child. Ferber RA.

Center for Pediatric Sleep Disorders, Children's Hospital, Boston, Massachusetts.

Most of the causes of sleeplessness in the young child after early infancy are
behavioral in nature. These may be primary or they may complicate other
disorders. Typical factors include inappropriate associations to the sleep
transition process, absent and inconsistent limit setting by caretakers, and
various scheduling abnormalities (including unnecessary nighttime feedings). Once
proper diagnosis is made, rapid resolution can be expected through behavioral
intervention. Even partial arousal symptomatology ("night terrors"), often
misdiagnosed at this age, may reflect, and respond to correction of,
inappropriate sleeping schedules.

-------------------------------------------

Pediatr Rev. 1987 Sep;9(3):69-82. Sleeplessness, night awakening, and night crying in the infant to toddler. Ferber R.
---------------------------------------------

Ann Clin Res. 1985;17(5):227-34.

Sleep, sleeplessness, and sleep disruptions in infants and young children.

Ferber R.

WyoGal · September 2010

Kestrel84:
So essentially this supports his training method, but obviously this study does not examine any emotional consequences.

Interesting, thanks for sharing! However, I will disagree and say I still don't think it supports his method of fixing the problems, it supports his statements that sleep associations and co-sleeping can cause sleep "problems" (less than 6 consecutive hrs. of sleep).

Pantley says the same thing about the root of sleep problems but suggests fixing it in a different manner.

WyoGal · September 2010

**sunny**:
most of his own papers related to this subject have been reviews of the literature published in journals.
you can go to www.pubmed.gov and see:

Thanks for this link! I'm sure I'll use it a lot for all my nerdy research endeavors!

Also, the abstracts were interesting and reminded me that I think I did at some point understand Ferber's greater support to his methods which would be the entire psychological field of behaviorism. Which might bring me to my greater philosophical confusion over what the role of behaviorism is in parenting.

EcoBaby · September 2010

Thanks for the review! I still haven't read Ferber, other than reading a few articles and skimming a few chapters.

I was reading an article the other day (link: https://www.timesonline.co.uk/tol/news/uk/article1083020.ece) and the person being interviewed said, "There is absolutely no study saying it is good to let your child cry.? I don't know if that is true or not. In fact, I have read studies that say it is good to let your child cry because it is effective in making them sleep better. I would be interested to know more about the context of her comment - I'm assuming she means that the ends doesn't justify the means, but I'm not sure. I didn't read her book.

I think it all comes back to cultural expectations. As Meredith Small points out in "Our Babies, Ourselves," even adult sleep patterns are cultural. It is not necessarily human nature to sleep 8, 9, 10, etc. hours per night. Some cultures break up their sleep - 5 hours here, 5 hours there. Our culture does not permit that because we are very regulated by the clock, and not our personal needs. Arguably, sleep might not be a medical problem at all. Maybe it is a cultural problem. "Sleep Disorder" is often used to describe a person's condition when they are having trouble sleeping. But depending on the "disorder" - it may actually just be a deviation from the norm and what is expected in our culture.

In one of those abstracts, it says that "unnecessary nighttime feedings" may be causing sleep disorders. Again, who is to say that a nighttime feeding is unnecessary?

I could go on and on, but I'll stop now

sweetkakes419 · September 2010

I'm an actuary, so anytime statistics and studies and numbers are thrown out, the first thing my mind goes to is "what are they NOT saying? and how could they be misinterpreting/misstating the results?" What I thought when I read that BF/cosleep babies don't get 6 consecutive hours of sleep was - who the heck cares? how much TOTAL quality sleep are the mothers and babies getting, whether or not it's necessarily "consecutive"

webMistress0609 · September 2010

DH & I did a ton of research on different sleep training methods & I've read Ferber's book. The majority of the studies that compared graduated extinction & more gentle methods such as scheduled awakenings concluded that graduated extinction works more quickly, but the effectiveness was not greater.

I found helpful info in Ferber's book for scheduling issues & for cutting down on nighttime feeds. We're actually going to do another round of his nightweaning method beginning this weekend - we found it to be the most gentle & effective for Ari. Crying is a big no-no with him at night, he's a tension increaser. I don't care for controlled crying period anyway.

mrsfirefly · September 2010

EcoBaby:
In fact, I have read studies that say it is good to let your child cry because it is effective in making them sleep better.

I've read the same and am currently struggling with a LO whom I just can't put to sleep. DH succeeds at night but during the day, I really struggle. I don't let my LO cry, and this often makes me wonder if I am doing more harm than good. Sleep is so important and my LO is often overtired and fussy. Would she be better off if I let her CIO for a few days?

Regarding the initial post, I didn't find Ferber entirely incompatible with AP. I thought he emphasized that his clinic sought individualized solutions that worked with the parents' philosophy. I found the chapter on naps helpful and, per his advice, am currently tracking DD's sleep habits to try to develop a nap "schedule" that follows her individual circadian rhythms. That seems very child-centered to me.

EcoBaby · September 2010

mrsfirefly:
DH succeeds at night but during the day, I really struggle. I don't let my LO cry, and this often makes me wonder if I am doing more harm than good. Sleep is so important and my LO is often overtired and fussy. Would she be better off if I let her CIO for a few days?

At the age of your LO, I think CIO is more harm than good, so I think you are doing it right. Sleep is still going to be all over the place at that age.

mrsfirefly · September 2010

EcoBaby:
mrsfirefly:
DH succeeds at night but during the day, I really struggle. I don't let my LO cry, and this often makes me wonder if I am doing more harm than good. Sleep is so important and my LO is often overtired and fussy. Would she be better off if I let her CIO for a few days?
At the age of your LO, I think CIO is more harm than good, so I think you are doing it right. Sleep is still going to be all over the place at that age.

Thank you for the reassurance!

WyoGal · September 2010

webMistress0609:
DH & I did a ton of research on different sleep training methods & I've read Ferber's book. The majority of the studies that compared graduated extinction & more gentle methods such as scheduled awakenings concluded that graduated extinction works more quickly, but the effectiveness was not greater.

Interesting. That's always what I wonder about his method. He mentions to just keep re-doing it when you have a hiccup so LO can re-learn, but if teething, illness, travel and visitors all cause hiccups, heck, we spent most of 4 mos. to now hiccuping anyway :-)

And I agree that his method of decreasing night feedings was gentle, as were his methods for confusion arousals and even naps to some extent (let your child use the TV to nap if that's what works?!?!?!). I have mixed feelings on controlled crying in general because I'm not so certain where the line exists (for me at least) between controlled crying and allowing your LO to tantrum and if bedtime is much different.

I do think the overall tone of his book has a lot of moments of being gentle and responsive to your LOs individual needs but I find his tone to be very erratic and seems to go from help your LO however works to every child should be doing this at this time and it's problem if yours is not.

WyoGal · September 2010

Eco, I definitely think you have a good point and every time you bring up that book I keep meaning to grab it so I just put it on hold at the library :-)

Regarding that article, that's intriguing but as with most parenting statements I worry it's painting broad strokes with miniscule facts. However, with Ferber, Babywise and many other sleep books, each book is being "updated" to be gentler so I think the general trend is toward gentle sleep habits. Unfortunately, our cultural drive for busy-ness, productivity and making the most out of every hour doesn't really jive with natural sleep patterns but maybe a middle ground is in the process of emerging.

WyoGal · September 2010

mrsfirefly:
Regarding the initial post, I didn't find Ferber entirely incompatible with AP. I thought he emphasized that his clinic sought individualized solutions that worked with the parents' philosophy.

I agree with reservation only because every time he repeated "every healthy 6 month old should be able to sleep through the night" I was incredulous. Also, I found the tone and solution of the setting limits chapter very anti-AP in his solutions (not the idea of setting limits).

Quazel · September 2010

EcoBaby:

Thanks for the review! I still haven't read Ferber, other than reading a few articles and skimming a few chapters.

I was reading an article the other day (link: https://www.timesonline.co.uk/tol/news/uk/article1083020.ece) and the person being interviewed said, "There is absolutely no study saying it is good to let your child cry.? I don't know if that is true or not. In fact, I have read studies that say it is good to let your child cry because it is effective in making them sleep better. I would be interested to know more about the context of her comment - I'm assuming she means that the ends doesn't justify the means, but I'm not sure. I didn't read her book.

I think it all comes back to cultural expectations. As Meredith Small points out in "Our Babies, Ourselves," even adult sleep patterns are cultural. It is not necessarily human nature to sleep 8, 9, 10, etc. hours per night. Some cultures break up their sleep - 5 hours here, 5 hours there. Our culture does not permit that because we are very regulated by the clock, and not our personal needs. Arguably, sleep might not be a medical problem at all. Maybe it is a cultural problem. "Sleep Disorder" is often used to describe a person's condition when they are having trouble sleeping. But depending on the "disorder" - it may actually just be a deviation from the norm and what is expected in our culture.

In one of those abstracts, it says that "unnecessary nighttime feedings" may be causing sleep disorders. Again, who is to say that a nighttime feeding is unnecessary?

I could go on and on, but I'll stop now

I agree with everything here. I loved OBOS and found the different cultures' sleep habits fascinating. While I understand daylight kid of regulates our body systems, that isn't true of all. I love your comment about some sleep disorders possibly being just different from what we expect.

I had planned to read Ferber this summer but didn't get to. I was hoping to read exactly what the OP says wasn't there, back up for his method. However, I tend to think there is still a lot of good information not pertaining to CIO in there based on other reviews so I really need to get it.

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