When Attachment Parenting is Not Enough (And Why It Still Matters)
Image: young baby crying and in distress. Photo credit Evan Amos, photo in the public domain.
THE ROLE (AND LIMIT) OF ATTACHMENT PARENTING IN HELPING BABIES WITH UNDERLYING SLEEP CHALLENGES
For those who have not read the story of our sleep deprived early days as parents, and one of the reasons I focus my occupational therapy practice largely on baby sleep consulting , you can read it here. In the below article I talk about our personal experiences with sleep early on, the role that attachment approaches played, and why I am so passionate about ensuring there are no “fixable” barriers to sleep that are getting in the way of sleep progressing as it should.
It also highlights how important family-centred practice is to me: I want to hear parents’ stories, I value their perspectives, and I believe we need to work together to create sleep situations that fit for each family. I have always valued these things in my OT practice, but my experiences as a mom of a baby with reflux and gut issues made it really clear to me that this is not always the case.
SLEEP PROBLEM? OR SLEEP DEVELOPMENT?
At the end of the article I suggest a few things that parents can do or think about when they are sorting out sleep issues that need support versus ones that need intervention. It can be tricky to navigate, but there can be some clues.
The reality is that baby sleep challenges take up a lot of time in the minds of most parents. We read a lot about it, we talk a lot about it, and we worry a lot about it.
It is a bit of an obsession!
And no wonder. The messages parents get about sleep are mixed at best and out right contradictory at worst. Some articles normalize disrupted sleep to the point of making it feel like all sleep disruptions are fine, while other articles dismiss even the most disturbed sleep as requiring firm discipline, a schedule, and cry it out.
WHEN “NOT SLEEPING THROUGH THE NIGHT” BECOMES NOT SLEEPING AT ALL:
For us as parents the reading and talking about sleep was no different, though thankfully I caught onto responsive parenting approaches early on.
In hindsight, I was a bit naive in thinking that responsive parenting approaches would get us good sleep early on. It was in the early days of parenting that I discovered what it truly meant to be sleep deprived.
Even after adjusting for “you’ll be exhausted”, my baby still needed more soothing than even the most lenient of books said he'd need. I knew to expect it to be hard, but the difficulty he had falling asleep and staying asleep was beyond anything I had expected.
And yet, as a first time mom I figured that I was ignorant about what to expect, and that anything I was worried about was probably out of sync with what was reasonable. I figured most of my baby’s sleep challenges, outside of any significant acute medical issue that might arise, could likely be put in to the "this too shall pass" pile of parenting woes. Despite this, I simply could not figure out why I couldn’t sooth my baby to sleep better.
Regardless of the level of nurturing we provided, and eventually the bed sharing we did to get a good night’s sleep, and despite responding to him like Dr. Sear's Baby Sleep Book discussed, nothing seemed to “work” to truly soothe him.
At one point I was in tears as I typed a letter to Elizabeth Pantley. The irony of crying while writing to the author of the No Cry Sleep Solution was lost to me at the time. Although bed sharing at 6 months took the edge off the energy needed to respond to a wildly high number of wake ups, and helped me reduce my sleep debt, sleep was still no where near "good".
My baby was a big spitter upper. Literally: he was big and he spit up a lot. And the conventional wisdom was that babies who are growing well and spit up a lot are "happy spitters", not babies with reflux.
Despite telling our family doctor that my son was not sleeping well, little was done: the only solution offered was to sleep train. No questions were asked about what I meant by "not sleeping well" (at this point it was 2 hours to get him down to sleep and frequent 2 hour wake ups in the middle of the night, in addition to frequent wake ups through the night). Nothing was asked about what I had tried. And there was no indication at all that my sense that something was not quite right was worth discussing. At one visit to the doctor, I mentioned that sleep was difficult and the doctor walked out the door without a word of response. Talk about deflating!
This experience, ironically, happened after I finished my Masters studying family centred care. I had literally been studying for two years on the importance of listening and working with families, and of considering them to be the ones who know their babies best, and I was left floored by the lack of acknowledgement that my observations of my baby matters, or that my experiences were valid.
If it was "normal hard" it would have been helpful to have reassurance and guidance.
If it was a health concern, it would have made a big difference to have a knowledgeable advocate to guide me.
To say I felt alone trying to solve the issue is an understatement.
As a first-time mom in particular, it was difficult to distinguish between what was "normal hard" and what was an actual sleep problem that needed intervention. If it was "normal hard" it would have been helpful to have reassurance and guidance around routines and rhythms, what to expect developmentally, and how to prioritize self-care. If there were indeed barriers to sleep development, it would have made a big difference to have a knowledgeable advocate who could guide me in resolving the challenges, and reassuring me that we were on the right track.
Instead, I hacked away at eating dairy free (that lasted three days), removing gluten, and eliminating coffee and spicy foods (I couldn't give up the coffee. It was my daily ritual with a friend who provided more support than she could know).
FINDING INFORMATION THAT “FITS” THE SLEEP PROBLEM
At the time I knew next to nothing about typical sleep development other than the general ranges for hours of sleep and number of daily naps provided by all the typical online pediatric websites and the resource racks at health care offices. When they suggest you shouldn’t use Dr. Google, they forget how hard it is to actually find the information you need elsewhere when none of the information seems to fit, and when the main advice implies that you are causing bad habits and you ought to sleep train!
In the end, all my knowledge of attachment theory did little to address the reflux, food sensitivities and gut issues that my son had. Intense work with a naturopath, as well as exploring osteopathy and chiropractics, and a biomedical approach to gut health and reducing toxicants and chemicals at home made a difference.
Blending attachment theory with a biomedical approach more fully ensures a family’s experience is captured and appropriate support is given.
It is what has led me to work to blend the attachment-based strategies that are so imperative to healthy development with thorough exploration of underlying causes or barriers to sleep development. For most attachment-oriented parents, the challenge is to confident in meeting the need, while also distinguishing between the circumstances when sleep truly is disrupted by a changeable health or environmental factor.
Does this mean a focus on attachment did nothing to support our goal to nurture our son?
Hardly.
Although it was crucial to address the health issues my son had, attachment-based approaches provided the foundation for a safe and secure environment for him. Without leaning into meeting the need, and soothing him when he was upset (and at times in physical pain), the foundation would not have been set for a secure attachment.
ATTACHMENT THEORY AT THE CORE OF SLEEP SUPPORT
Attachment theory forms the basis of my work with families. Regardless of the concern --sleep, development, mealtimes, discipline, play, reflux, or prematurity -- the principles of attachment are front and centre in figuring out, and working to improve, challenges. However, there is a limit.
Attachment parenting "buys" time to figure out underlying problems**. It allows babies to continue to feel as safe and as secure as they can be while simultaneously experiencing pain, discomfort, or simply feeling not "right in the world". It means the trajectory for good emotional health is set, and that when medical and health issues that interfere with sleep are resolved, attachment practices will already have been working their magic in supporting secure attachment, and mitigating the influence of health issues on secure attachment.
**Addendum, August 2023. I’d like to reword this thought. Attachment parenting does more than “buy” time. I believe it sets development and solving health problems on an entirely better path. I believe it allows parents to SEE the impact of treating underlying health concerns without trying strategies that would further alarm their baby.
ATTACHMENT PARENTING AND IDENTIFYING UNDERLYING SLEEP PROBLEMS ARE NOT MUTUALLY EXCLUSIVE.
What if there are no underlying health or developmental concerns?
Then attachment parenting provides just as much in terms of giving babies what nature intends: caring, responsive parents day and night who have met their baby’s biological and emotional needs in order to support a gradual and natural emergence of independence and self-confidence.
In the end, attachment theory and a biomedical approach are NOT mutually exclusive. They work together to smooth the way for independently sleeping through the night when your baby is ready —emotionally and physically.
WHAT CAN PARENTS DO TO SORT OUT “NORMAL SLEEP” FROM SLEEP THAT NEEDS INTERVENTION?
Understand normal sleep. This can be by reading sleep books and blogs that are based on a biological and developmental perspective and that use research evidence of norms for sleeping. Some recommended articles include my own (here and here) as well as www.evolutionaryparenting.com. It is also the role of a good sleep consultant to share knowledge on what is normal so that parents do not spend time trying to “fix” something that is not broken.
Trust your instincts. The uncertainty of early parenting can make it hard to listen to instinct. It can also make it easy to dismiss as “I’m a first time mom, so I worry needlessly about everything”. The truth is that you are on a huge learning curve, not just in terms of how you are nurturing and caring for your baby, but also how you will uncover the roots of your instincts. They are there. And they are valuable.
Speak up. When you are worried something is not quite right, speak up. And if practitioners don’t listen, say it again, and again, or look for someone else. Speaking up can be easiest if you come with really clear points about what you are observing and explain the impact it is having on your family. Be specific. Be “objective” (he woke up 5 to 8 times each night this week, and had night time wake periods of 2 hours twice). Your feelings matter, but the facts will get you action.
Keep Track. When solving underlying sleep issues and sleep disorders, the sleuthing process can take time. Is it tummy troubles? Or pet allergies? Is it sleep apnea? Or reflux? Each of these will take a different set of solutions, but figuring it all out may take some time. Keep track of the ideas you have about what may be going on. What ideas are not worth pursuing now may end up being the most sensible path later on.
Keep Nurturing. Through any sleep challenge, and all the ups and downs it brings, your nurturing, responsive parenting will continue to lay the foundation of trust, and a strong bond. When sleep issues are resolved, sleep development may hit the ground running because of the nurturing you did. And regardless of how long it takes to solve, your parenting is establishing an environment that will nurture your child’s growth and development long after they are sleeping through the night.
For more on attachment-based approaches to parenting, sleep development, health barriers to sleep, and family-centred care see:
Heather Boyd (August 5, 2019). Sleepless in Niagara. The Voice of Pelham Newspaper. Available at https://thevoiceofpelham.ca/2019/08/05/sleepless-in-niagara/ and
Jennifer Harrell (July 23, 2013). Guest-post: Living with a Baby with Reflux. Available at http://evolutionaryparenting.com/guest-post-living-with-a-reflux-baby/
Tracy Cassels (2013). When Your Infant’s Sleep Isn’t Normal. Available at http://evolutionaryparenting.com/when-your-infants-sleep-isnt-normal/
Heather Boyd (November 16, 2018). Normal Sleep From 6 to 12 Months. https://www.heatherboyd.org/blog/2018/11/16/normal-sleep-from-6-to-12-months
CanChild Centre for Childhood Disability. Family Centred Service in Ontario a Best Practice for Children with Disabilities and their Families. Available at: https://www.canchild.ca/en/resources/175-family-centred-service-in-ontario-a-best-practice-approach-for-children-with-disabilities-and-their-families