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Sleep training, cortisol and more: with Professor Wendy Middlemiss

white in blue hat and top baby crying in cot sleep training and communication cues
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Sleep training, cortisol and more: with Professor Wendy Middlemiss

white in blue hat and top baby crying in cot sleep training and communication cues
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Sarah Ockwell Smith interviews Professor Wendy Middlemiss:
white in blue hat and top baby crying in cot sleep training

For those of you unfamiliar with Professor Wendy Middlemiss her work is raising awareness of the potential impact of ‘sleep training’ on babies. You can find a simple summary of her research in the Huffington article ‘Babies Left To Cry Suffer Stress Even After They Have Quietened Down’  and here’s a link to the study abstract for those of you who like a little more science.

Here we ask Wendy about the inspiration behind her research and her vision for change.

Tell us a bit about yourself

Although born and raised in New York, I currently life in Denton, Texas. I moved here about 5 years ago to take a position at the University of North Texas. My position in the Department of Educational Psychology. provided the opportunity to focus on both educational psychology and development and family studies. This is something few positions offer. I have one son who will be turning 16 this year.

What led you to your career

After college and working in New York in publishing, I found a brochure on the subway about a degree program in Educational Psychology. I had loved my psychology class as an undergraduate and thought perhaps this would be great. The brochure made it clear that there were lots of things you could do with a degree in educational psychology. That interested me very much. I think I have pushed the bar a bit in regard to what you do as an educational psychologist.

During my time at Syracuse University, I became very interested in learning more about how we raise our children. Especially whether research truly examined the intricacies of family life and looked with a clear lens into different family choices. It was my sense that research often defined all families using one description. Those families who fitted that description looked good and the others being framed with their beauties and challenges clearly seen.

Since then my work has focused on how to better understand families and provide them with information to help them raise competent children in a family context that fits their own family goals.

You are well known for your research into baby sleep training and cortisol levels, what led to you researching this? Do you have any plans to expand on this with more research?

It is always easy to answer how long have you been doing this research, since the work started with the birth of my son. As a new parent, I had all the requisite nighttime care equipment—crib, bumpers, mobiles, everything! Even a net for the top of the crib to keep out our cat. When I came home with my son, I didn’t feel comfortable putting him in this big space where I could hardly see him. So, I wanted to know the recommendations about nighttime care, where babies sleep, and what I needed to do or not do as a parent.

Given my background, I started reading the research. What I found was very disconcerting and not as strong a body of research as made me comfortable about any choices. With this, I started a literature review, examining the research across the decade or so before my son’s birth. Then I started asking my own questions. First I asked about the role of mothers’ comfort with sleep routines and babies’ outcomes. I found it was mothers’ comfort with a routine, not necessarily her choice of nighttime care, that mattered for children’s later social outcomes.

Then I started looking at questions of stress related to sleep training routines that required having infants cry themselves to sleep. My path in research has always been to clarify an aspect of nighttime care. Then to provide clear information that parents can adapt to their own care routines.

Thinking about the results of your research, why do you think there was an asynchrony between the mothers and babies cortisol levels after three days of sleep training?

Mothers and babies are so well attuned to each other and the communication is so subtle, but so strong. There is research examining microseconds of interaction that show how babies imitate mothers and mothers in return imitate babies. In sound, facial expression, and other ways. The research helps us see the importance of that synchronous interaction.

As infants grow, mothers and babies become more and more attuned when all is working well. Infants communicate in many different ways. However, with distress, their greatest communicating tool is crying—this is infants’ behavioural response to stress. When infants cry, mothers become attentive to their behavioural indication of distress. The crying raises mothers’ stress level—and together mother and infant resolve the distressing event. The mother helps the infants’ physiological distress response [related to cortisol] dissipate.

When babies stopped crying during the sleep training, the mothers’ cue to their distress was eliminated. The mothers’ response to the apparent absence of infants’ distress, was a reduction in their physiological levels of stress. Almost an ‘ahhh, my baby is okay now…. I can be okay.’ You can almost imagine the possible relief a mother might feel when sleep had become such a distressing event.

Perhaps the most important part of that research was the finding that infants had been able to dissociate their behavioural response to stress: crying; from their physiological experience of stress. It wasn’t clear that infants had the ability to do that. However, that was what happened. Infants stopped crying, but their physiological distress remained. Without communicating this distress to mothers, mothers didn’t “see” the indicator of their distress. It seems that in this way, without this behaviour cue, mothers and infants had a different response to the sleep training.

What advice would you give to an exhausted parent with a baby who wakes frequently throughout the night who is desperate for more sleep?

Find a way to find relief through greater support at night. Change the sleeping context so that there is more opportunity to sleep when the baby is sleeping. Find someone who can help with night wakings. It is a hard question without knowing what options each parent has and what each parent is comfortable to do. Babies will eventually sleep much better, however, for many infants that will be months away.

black baby in mother's arms

Exhaustion is a real and taxing state of being. It is important not to dismiss the parents’ needs out of hand to alleviate the situation. Equally important is not to dismiss the infants’ needs. My advice would be to see what they can change to make things easier, without expecting the infants’ sleeping habits to change. Sleeping is important for both parent and baby.

There are so many things in the care environment that are essential; safety, warmth, breastfeeding, responsiveness. I would advise parents identify what is essential for care and adapt what they can to make things manageable.

I wish there were a simple answer. Perhaps it is also helpful is for parents to know that sleep training isn’t necessarily an easier answer. Sleep of all sorts is normal, and this will pass. This information has been found to be very helpful for parents.

If you could give a new parent just one piece of advice, what would it be? 

Love your child, for who they are and who they will be. Provide them the love and comfort that will give them the security to grow to be the best they can be. Your child is a beautiful, lovely new being who needs your love, comfort, and care. Let them be who they are and guide them to who they can be, accepting their needs and characteristics. Be responsive in providing them with the tools they will need to be strong and successful. I would assure them that the first tool is being responsive and respectful.

What support do you think new parents need? How could society change to offer this?

Parents need information about how important is their role in supporting and nurturing their child. We need to be honest in acknowledging that what infants and children need is not just restrictions but responsiveness and care. We need to provide families with the resources [information, financial, time] that provide them the opportunity to be parents.

What do you think about the current craze of ‘baby sleep experts’?

Whenever information tells someone exactly how to do something or precisely what needs to be done and when, then likely that information is only helpful to those who want to engage in that parenting. Our babies, no matter their age, are our babies. We protect them by trying to give them what is best. If we give information without telling parents why something is helpful, we do a great disservice more often than we provide helpful support. “Experts” who aren’t willing to be “novices” in each family’s network, runs the risk of being unhelpful in the suggestions they offer.

Are there any experts in the parenting industry or other scientists in the field whose work you do admire?

I admire the work of those who keep trying to bring information to the fore. Helpful, well-couched information that focuses on why something is needed and why it helps. Whether it is researchers, family practitioners, parent educators, that tells parents they are important to their children. Some of the people whose work I admire are strong, well-known researchers, such as Dr. McKenna or Shonkoff. Some are people who have taken up a battle but may not be well known, such as Dr. McManus, in Milwaukee.

Others I admire are those who have taken the challenge of providing information and work tirelessly toward that end. Such as Lauren Porter, Liz Lightfoot and Celeste Pon, all in New Zealand. People who, in the case of Lauren, have established centres to continue to bring the message of how important is parents’ responsiveness to children. Liz and Celeste work so tirelessly with parents. I greatly admire the work and energy of Stephanie Cowan, director of Change for Our Children. She is a wonderful combination of innovation and caution; a woman who does.

I also admire the passion, if not the perspective, of those with whom I strongly disagree theoretically. Those whose work I work tirelessly to put in a different light for parents. These researchers and policy makers have the same passion and often the same goal; the health and wellbeing of our infants, children, and parents. I hope we find those common, essential elements that will bring our work together to provide clear information to parents. Information that will protect our children.

If you would like to know more about infant sleep then visit the Baby sleep section of our knowledge hub.

Recommend0 recommendationsPublished in Babies, Baby sleep, Being a parent, Calmer relationships, Crying
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