“Sleep Training: Make the right decision for your family…and no need to judge others” – with Emily Oster

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. All right, Emily, welcome back to the podcast, my favorite guest. How are you doing?
Emily: I’m great. It’s so nice to talk to you. Thanks for having me back.
Dr. Fox: Yeah, we were just saying before, it’s nice to talk, even though we seem to be emailing a lot nowadays.
Emily: It’s good to hear your voice and put a voice to the words in my email.
Dr. Fox: Yeah, you know, when they have, like, the favorites for the phone, you’re my favorites for the email. I just put an E and Emily Oster pops up. So it’s all good. All of my listeners know who you are, but if you don’t, you know, you’re a world-famous economist and professor, and now writer around pregnancy and parenting, and you have a newsletter and you are everywhere. So, you know, you are slowly, slowly taking over the world, which I think is awesome.
Emily: Well, thank you. Yeah, I am having a great time. I’m having a great time doing what I’m doing and so hopefully it is helpful for people.
Dr. Fox: Yeah. And you know, we’re gonna be talking about, you know, sleep training today, which is obviously something related to early parenting, I would say. And, you know, the books that you wrote, I guess paralleled your own experience as a parent. You did “Expecting Better,” which is sort of related to pregnancy, and then “Cribsheets,” which is early parenting, and “Family Firm,” which was I guess later parenting or toddler-type parenting, I would say. I’m curious now that you’ve sort of gone through all three of those stages, and we’re talking about early parenting, which one of the three was the most, I guess, maybe surprising to you when you went into the data on all of them?
Emily: I think for me, the data was most surprising in pregnancy just because it was a lot of stuff I didn’t really know anything about. By the time I got into the early childhood stuff, there’s kind of more information out there in the world, and so I was a little bit more prepared for some of the stuff I was seeing, which doesn’t mean there weren’t pieces that were surprising. But, you know, I think one of the things you come up with a lot when you dig into this data on early parenting is like there are a lot of good choices and the data is often not gonna tell you, you have to do this or you have to do this other thing, and that’s both reassuring and relaxing, but it also limits the surprise, because usually, if the pride comes when you’re like, “Oh, my gosh, someone told me to do this, and it was a terrible idea.” And the reality here is like most things are not a terrible idea. A few things, but most things are not a terrible idea.
Dr. Fox: And I think what also comes to that, which is so fascinating is, you know, there’s…you know, we spoke about this with “Expecting Better,” that there are some things that people really like hotly debate and get very angry about if you say A versus B, or B versus A. And that gets taken to like the major leagues when you talk about raising children. People are very passionate about what’s best with raising your young children. I mean, to the point of like wars. It’s really unbelievable how intense people are with this sometimes.
Emily: I mean, the way I think about this is that people really wanna do a good job with their kids, and they wanna do a good job to such a degree that they want the choices they make to not only be right for them, but be right for everyone else. And so it’s like when I see someone who’s doing something different from me, instead of just thinking, “Well, everyone makes different choices.” What I think is, “That person thinks I’m a bad parent, but I know that they’re the bad parent.” I think that bad dynamic really like causes so much of this conflict that you see, and I absolutely think you’re right. Particularly early parenting, you just get…they’re overwhelming the amount of negative reaction that you can get with almost any choice that you say that you’re making.
Dr. Fox: Right. I mean, I think that, you know, one of the paradigms is obviously for that is with nursing, with breastfeeding, where it’s like literally, I think, you know, countries have gone to war over this. And then sleep training is a big one also. People are very passionate about their sleep training or not sleep training, amazingly.
Emily: Yeah. I mean, you know, we’ll talk all that through stuff that I say, but just when you surface any opinion about this or any kind of argument about this in public, particularly on social media, but even in sort of smaller groups, you really get these very disparate views from, you know, “If you don’t do this, your child will never sleep through the night,” all the way to like, “If you do this even once, you could cause your child to hate you forever, or you could cause them to ruin their vocal cords and need emergency surgery.” I mean, things which are just definitely not true on either side, but it gets very, very, very extreme.
Dr. Fox: Yeah. So we’re gonna hopefully find that sweet spot, A, in the middle, and B, sort of the brackets around what is fine and what seems to work, and what doesn’t work, and the positives and negatives. And obviously, we’re gonna talk about the data supporting it. And then, you know, we may tell some stories of our own children to embarrass them, you know, for posterity so they have…
Emily: Posterity.
Dr. Fox: Yeah. It’s always good to have it recorded, all the things we wanna say about our children.
Emily: Absolutely. And then they can get back at us in the retirement home.
Dr. Fox: Yeah. My kids are already getting back at me because we went skiing last week and I said, “My family hates me because they dragged me skiing, they know I’m not good at it, and they take me places I shouldn’t be going. And then when I fall and can’t get up, they video it and laugh at me.” So it’s just wonderful. But I love my children so it’s all good. They’re definitely getting back to me now. So let’s start with the basics in case anyone needs to be caught up to speed. What is sleep training?
Emily: So broadly, think of sleep training as any kind of activity that you engage in that tries to encourage a particular sleep schedule for a baby or a small child. In practice, when people talk about sleep training in the kinds of conversations that are very fraught, they’re typically talking about part of that being some kind of…what’s sometimes called cry it out. So some kind of approach in which you allow the baby to cry for some period in order to basically learn to fall asleep. And so the sort of sleep training generally used would be something that said, doing something and letting the baby cry for some period of time until they fall asleep.
Dr. Fox: And there’s different sort of variations on that theme and it’s mostly based on sort of how long you let them cry in general or the first night, whether you do it sort of, you know, just leave them be, or whether like the first day you give them 5 minutes and the next day you give them 10 minutes. And you know, just that’s sort of the biggest variation on this, but the concept is you’re giving them some sort of, like, exposure to crying and trying to fall asleep on their own so that they learn it themselves.
Emily: Yeah. I think there’s sort of two important things to say. So one is that you’re right, there’s kind of three pretty…in the literature at least, three kind of pretty clear differences. There’s one which is just called extinction, where you pretty much just like close the door and don’t go back. There’s a version of this where you go check every once in a while on some timescale, and then there’s a version where you stay in the room but don’t do anything, which we can talk about how that one doesn’t work. So that’s a really interesting thing.
The other point to make is that this is generally part of a broader sleep approach. So it isn’t just like turn the lights off and throw the [inaudible 00:07:34] clothes in the crib. You know, the first thing that people generally establish is kind of bedtime routine. So you give the kid a bath, you, you know, put their pajamas on, you read them a book, you do whatever, and then you put them in the crib, and then that’s the first part, and then there’s this crying part after. So I just think it’s important to sort of put in context that this is part of a broader approach to sort of what we call sleep hygiene that typically starts with a bedtime routine, and then has these other parts potentially after it.
Dr. Fox: So before we get into sort of what are the potential benefits and the potential harms, before we put that out there, what did you do with your own kids?
Emily: So I sleep-trained both of my children, and both of them with basically some version of kind of close the door and don’t come back. I will say, and this is sort of in some ways in a class of what not to do. With my first kid, we just kept trying different things. Like we would do something for a few days, and then something else for a few days, and there was a lot of back and forth. There was sort of no consistency. By the time we got to the second kid, we realized that being consistent was like the most important thing. And so we just adopted one thing and he was super easy. He basically slept through the night after two days and that was it. What about you?
Dr. Fox: So, my first two twins, we were very young parents. They were a little bit early, like a month early, so they weren’t really ready for till about, let’s say three months or something. And my son was always just an easy sleeper, just easy personality, easy sleeper. My daughter, Kira, was not, and she was really causing us a lot of stress and we didn’t know what to do. And it was also so odd because we have two kids, right? They’re both ours, they’re both here and one is so different from the other.
Emily: Why aren’t they the same?
Dr. Fox: Yeah, like, what’s going on? And we were like, “There’s something wrong with this child.” And then our pediatrician is like, “She’s fine, just put her in the crib, close the door and go to sleep.” And literally the first night we did that, she cried for 10, 15 minutes, and then she slept through the night. It was like the easiest thing in the world for her, right? That once we did that, it was done. And then she and her brother, who was already good sleeper, were great sleepers like after that. My third, it’s actually interesting. When she was about seven weeks old, we used to…we’re horrible parents. We used to sleep her on a blanket on the floor in the den because we didn’t… She shared a room with the twins because we were in an apartment of the city because I was a resident and we’re broke. And so everyone’s in like the same room. And so we didn’t want her to get woken up by them…or them to get woken up by her, excuse me. So I slept her on the floor in one…I think it was a Friday night. I was on call in the hospital and my wife had a horrible ear infection, couldn’t hear anything.
And lo and behold, that was the night that she slept through the night because probably my wife didn’t hear her. And at seven weeks she slept through the night. Again, she also only took one night, easy kid. My fourth, Mia, was untrainable. Like literally, there’s nobody on earth who was able to sleep-train her. She stayed up all night every night and it was just such a disaster that we eventually just put her crib downstairs on a different floor from us. We were already in the house at that point. But I told her last night, even though she was a disaster as a baby and couldn’t be sleep trained, she’s wonderful now and she’s a great sleeper as a teenager.
Emily: Yeah. I mean I think there’s like two [inaudible 00:10:38]. I think one is that there actually is a lot of variation across kids in how well this works. And so I think sometimes what happens is people try and it doesn’t work. And you know, on average it does. We can talk about the data, but for some people, this doesn’t. And that can be a thing where people are like, “Well, I’m doing it wrong, or I’m bad, or my kid is broken. Like, can I get a less broken one?” And it’s worth saying, you know, this isn’t necessarily going to be for everybody, and isn’t necessarily going to work for everybody, and so there’s a space for a little bit of grace and recognition that, you know, kids are different.
Dr. Fox: Yeah. I mean, we used to advertise that we’re the greatest sleep-training parents of the history of mankind because our first three kids were like, boom, boom, boom. We had amazing sleepers. We knew what we’re doing, we’re such experts. And then this Mia Fox shows up and we’re like, “What the hell is going on here? Like, what happened?” And she’s just different. And again, she was delightful, you know, as a child, but she was a horrible sleeper and it took her a really long time despite everything we tried, and then she became a good sleeper. But it was definitely…she was immune to all of our Jedi mind tricks. She was like Jabba the Hutt, you know. “Your Jedi mind tricks won’t work on me, Dad. I know what you’ve got.”
Emily: “Forget it. I know what’s coming. I learned from the older sibling.”
Dr. Fox: I hope she doesn’t mind I just called her Jabba the Hutt. All right. Well, whatever. So, what are the benefits to sleep training other than your kid sleeps and it’s quiet?
Emily: So when we look at data that evaluates sleep training, actually a lot of the focus is on…the first it’s on whether the kid sleeps and it is true that sleep training improves sleep term for children. It also improves sleep for adults, and as a result, it improves many other aspects of family function. So yes, adult sleep, marital satisfaction, postpartum depression. There’s a bunch of things we see in the randomized trials which appear to be benefits to the family unit. And sometimes these are very big. So there are, you know, small trials when they bring people into a sleep lab who have, you know, kids who are not sleeping well at all. And often these studies are quite old, so it’s been many, many months of tremendous amount of sleep deprivation.
In one of these studies, you know, at intake, like 70% of the women are screening positive for postpartum depression on a screen, and that doesn’t mean that they’re truly depressed, but it means that they’re showing symptoms that would be consistent with needing a further evaluation. They do this sort of sleep training in the lab on the way out, you know, 4 days later, like 10% of them are screening positive. And so, now that doesn’t say that sleep training lowers postpartum depression by 60%, obviously, but it suggests that this added sleep that parent get is just a huge benefit of improvement in infant sleep. And we know that sleep is just really important for functioning and for being happy, and for being able to kind of engage with the world. So I think those are really the big advantages.
Dr. Fox: And I think that really can’t be overstated because as we’ll get to a sort of the theoretical or potential harms, people worry about sort of the bonding, and sort of the psyche of the baby and all this, but all right, even, you know, whether that’s true or not true, we’ll talk about it, but the fact that the mother or the parents are gonna be well slept, and maybe have less postpartum depression or less incidents of it, or less symptoms of it, that also improves bonding, and parenting, and relationships, and, you know, outcomes for the children potentially. And so you can’t take, you know, one aspect of the bonding, so to speak, in isolation from the other. You know, if there’s a parent who’s like, “No, I’m totally fine getting up every two or three hours at night. And my kid’s gonna cry, and I’ll get up and I feel great.” Fine, like, great choice. But if the person is literally a wreck because their kid’s not sleeping, then the benefit’s really great potentially of doing sleep training.
Emily: Yeah, and I think that sometimes when we talk about sort of the advice we give to new parents in this kind of like rosy eye, a totally unconstrained way in which we are not recognizing that you may not be able to do everything. It may not be possible to get up every hour with your baby, and also function with them during the day, and also, you know, drive them places, and also like…it just may literally be impossible to do all these things. Sometimes we’re not good at helping people understand what are the choices that you could make that would be, you know, fine and supported by data, and would make you less constrained in these other ways. So we sort of end up talking about it without any acknowledgement that the kind of parents are people too, and that the family unit has to function, not just one person in the family unit. Because if the parents aren’t functioning, that is not good for the baby either.
Dr. Fox: Yeah, 100%. Parenting is tough, man. It is.
Emily: It’s hard.
Dr. Fox: It is not easy. And those who have a very easy time with it are lucky and are the exception, or they’re just better than the rest of us. I have no idea, but for most people, it’s really hard. Take that newborn home, you have another one, it’s rough, and it’s okay that it’s rough, but we should try to do everything to make it easier. So what are the advertised risks of this that you’re gonna find on the Google and whatnot?
Emily: And so I think the main advertised risk is kind of a loss of attachment. And that’s the thing you see most frequently discussed is that, you know, leaving your baby to cry in the crib is teaching them that you don’t care about them, and that, you know, no one will come if they call. And sometimes you’ll see people say things like, you know, “Would you leave an elderly person lying, crying in their bed?” And no, you wouldn’t do that, and this is in some way sort of similar. And if you sort of look down the line, this is gonna cause your child to have all kind of psychological problem then, you know, lack of attachment and being unable to form adult relationships. And that’s kind of the extreme form of what people will say.
Dr. Fox: And sometimes they’ll quote studies pointing to this like the famed Romanian orphanages.
Emily: Yeah. So it is true that Romanian orphanages were an appalling public policy choice by the Romanian government, and children were left, you know, with more or less no human contacts for years, and that is really, really terrible for emotional development and for all kinds of other stuff. Of course, it’s really not comparable to what we’re talking about in indications of sleep training. And so I think that, you know, that parallel, while people sort of, of course, understand it’s not the same, they’re saying, “Well, if you extrapolate down, kind of similar.” And I think it is in fact not similar. It’s just not similar.
Dr. Fox: Okay. So let’s go into the questions that people typically ask. And the first question is, does it work? Like do children who are undergoing or have undergone sleep training, do they actually sleep better than the other children?
Emily: They do. So on average, these randomized…and again, I think we should be clear, like these data are from randomized experiments. So where they sleep-train some kids, they don’t sleep-train other kids, and they sort of see what happens. Sleep in general is better on average for kids who have been sleep-trained. And so that means sort of longer stretches of sleep, fewer wake-ups at night. One thing that is I think useful for parents to know is that this is not a panacea after which your child will never get up again at night.
Like it can actually seem like quite a miracle, and often for many people, it really does improve sleep a lot, but it isn’t always something where you do this once and then your kids sleep through the night forever. In fact, a lot of the ways we approach sleep training are kind of to help kids fall asleep at the beginning of the night, then maybe they still do eat once in the middle of the night, and then they sleep until the morning. So, we’re kind of trying to improve the sleep. It doesn’t average improve the sleep, it doesn’t immediately turn every child into somebody who sleeps for 12 hours at night, and that’s just, you know, worth recognizing when you evaluate how this is going.
Dr. Fox: Right. And also we talk about averages, which means that in the sleep training group, there’s definitely gonna be kids for whom it doesn’t work like Mia Fox. And in the kids who were not sleep trained, there’s definitely kids who are gonna be great sleepers without being sleep trained. And so we’re just talking about on average. And so this doesn’t have to be individualized in any given family or child, but this is just sort of, does it work on average? Yes, it works on average.
Emily: It works on average, yes.
Dr. Fox: And then we discussed this before, but the benefits in terms of the sleeping, and then also for the parenting and the depression, that’s also been shown in these randomized studies. That it’s not just sort of like a possibility, it has been shown to be true.
Emily: It has been shown to be true. Yeah.
Dr. Fox: Yeah. So what about the harms? Have any of these studies shown any of the harms that people are afraid of in terms of whether it’s attachment or whether it’s sort of emotional stability, or, you know, whatever it might be that you’re concerned about as these kids get older?
Emily: No. So sort of both of these trials have sort of significant follow-ups. So there you can see both in the immediate term after sleep training, there’s kind of no difference in child mood or parental perceived attachment. Actually, if anything, parents perceive their kids to be happier and more attached in the immediate aftermath. Although my interpretation of that, it’s that the parents are happier. But then when you look five, six years, you know, at the age of sort of five or six, you don’t see any difference in emotional regulation, in attachment, any of these kind of metrics. You also at that point don’t really see any differences in sleep. So ultimately, you know, both groups of kids end up sleeping, some kids sleep well, some kids sleep less well. So really, the kids just look the same on all of these dimensions. So you’re kind of buying with sleep training better sleep in these early years in the sort of infancy and early childhood, and then later all the kids looked the same.
Dr. Fox: Right. So basically, there’s short-term benefit and there’s not long-term harm?
Emily: Exactly.
Dr. Fox: Perfect. All right. So that’s a plus. Now, what about looking at one method versus another? You know, you mentioned the sort of parental presence, which is sort of the parents stay in the room versus the sort of extinction, which is the parents are totally out of the room versus this modified where they, you know, come and go. What do we know about those three possible ways of doing this?
Emily: So in general [inaudible 00:20:45]we haven’t known very much about this. Yeah, recently, there’s at least one study that has sort of come out where a [inaudible 00:20:53]. It’s a study that takes advantage of data from a sleep monitor. So one of the like things that you have in the room that monitors can read, some new technology camera I think. And so what they did is they sort of have this like objective amounts of sleep data from the camera, and then they have the parent report of what they did in terms of sleep training. And they make a distinction, which is common in literature between the kind of close the door and don’t come back, the close the door and come back, you know, like 5 minutes to 10 minutes to 20 minutes, these like sort of checks. And then, you know, stay in the room.
And what they see is that the first two look very similar. Maybe close the door and don’t come back is a like a little bit more quickly successful, but you know, they can’t really statistically distinguish those. The stay in the room, it takes a much longer time to show actual impacts on kids and on the sort of quality of sleep. I also did a less scientific survey of people in which I asked them about sort of their satisfaction basically with these different options that there you see again this sort of burst like just close the door and the close the door with checking looked very similar. People report much less happiness, much less success with the stay in the room.
You know, I think part of that is that probably a lot of what this requires is consistency. Is the ability to sort of say, “I’m gonna do this every single time for, you know, some period until it kind of starts to work. It typically takes a few days. That it may be much harder to be consistent when you’re in the room typically. I mean, you perhaps remember this like, it’s hard often just train your kids, like they’re crying, people don’t like hearing their kids cry. Being right in the room with them may make that more difficult to follow through on [inaudible 00:22:41]
Dr. Fox: They’ll look you in the eyes and they give you that look like, “Why are you not picking me up? Like, what’s wrong with you?”
Emily: Yeah.
Dr. Fox: And also, what I thought was interesting was the study that you referenced from sort of the commercial company, and the one that you did pretty similar sort of incidents of sleep training. It’s a give or take, two-thirds of people reported that they do it and the other third reported that they don’t. I don’t know if that’s reflective of the worlds or just, you know, people who read your stuff or get those cameras. There’s probably difference in different communities, but, you know, in case people are curious amongst the listeners here, about two-thirds of people at least said that they tried to do it.
Emily: Yeah. And then, you know, it’s hard to know. I think it’s probably a tremendous amount of demographic variation in kind of how common this is.
Dr. Fox: Yeah. And then when do people tend to start it and does it seem to matter? Meaning, should you start it two weeks, two months, two years, like what typically happens and what seems to work?
Emily: So the modal time that people start is kind of four to five months. I think that that is because if you look on the internet, it will say like you should start sleep training around four months.
Dr. Fox: Which is based on nothing.
Emily: Which is like, basically based on nothing. The reported success that people have seems pretty unrelated to when they start. You know, it is much different to do this with a two-year-old. But if you sort of think about within like the first year or so, how successful people say they are seems to [inaudible 00:24:05] to do with when they start. So people will say…you know, some people will start some kind of sleep training as early as, you know, 8, 10 weeks. One thing that is worth noting and this… So the book we used for this, the sort of resource we used was the Marc Weissbluth’s “Healthy Sleep, Happy Child.” And he talks like pretty explicitly in a very helpful way I thought about what you’re trying to accomplish at different ages. So some, but most…some babies [inaudible 00:24:33] but most babies at sort of 8 or 9 weeks are actually not in a position to sleep for 12 hours at night. They often need to eat in the middle of the night.
If you were going to do some sleep training with a sort of 8 or 10-week-old baby or 10 or 12-week-old baby even, you’re almost certainly trying to encourage them to fall asleep alone at the beginning of the night. And then there’s some point at which, you know, okay, then we will let them eat. And in our house, we had this like very elaborate schedule of like, no one will go in before midnight, and then it will be like this amount of time between eating and whatever. If you have a seven-month-old, you know, probably they can just sleep through the night, they do not need to eat in the middle of the night. So it sort of varies a little bit. I always tell people you should write it down.
Dr. Fox: I have a hard time believing that you guys had a very elaborate schedule.
Emily: Yeah, that’s what everybody… Would you be shocked to know it was written in a Google Docs theme?
Dr. Fox: I’m surprised it wasn’t on the wall with the whole thing with rules and procedures and whatnot. It’s, you know…
Emily: Different punishments if one parent like, you know…
Dr. Fox: Yes, consequences. Yeah.
Emily: Consequences.
Dr. Fox: Whoever goes in the room gets a kid the next two nights. Yeah, I mean, our pediatrician, he was great and he was just very sort of like sensical, I would say, you know, not a lot of rules. And he just said, you know, sort of at the point where it’s…you know, there’s usually a point when these kids, you know, they wake up every three hours and eat, and they wake up every three hours. And then there’s one night where suddenly like boom, they don’t wake up and it’s like five, six hours. You’re like, “Oh, hey, like what just happened?” And he goes, “That’s usually the point where they can sleep five or six hours.” And so if you’re gonna do sleep training, that’s usually your goal, right? Get them to fall asleep and, you know, make it through that six hours. And as they get bigger, that time’s gonna increase, and yeah, it’s a little different for every kid, and sometimes they’ll go by weight. Say, okay, they’re probably ready to sleep 6 hours when they’re 10 or 11 pounds.
But again, these are really averages because some kids are born at 10 pounds and aren’t ready to sleep through the night. And so, you sort of get a sense of who your kid is. But I think that there is, at least what the data shows and a lot of experience shows is that, as you said, you can start it early and it does seem to work if you started early, but your goal is a little different when they are 2 months versus when they are 6 months in terms of you can’t expect a 2-month-old to sleep 12 hours. If they do, that’s great, but it’s pretty unusual. But if they sleep seven or eight hours, that’s a difference between a normal night’s sleep for the parents and an abnormal night’s sleep for the parents. It really just six or seven hours is what you need.
Emily: Yeah. No, I agree. I mean, I think sometimes your kid really like…like with our second kid, it was incredibly clear. We had this period where he was taking like an hour and a half to fall asleep at the beginning of the night when we were in with him. We were like holding him and rocking him and [vocalization] just like a whole thing, and it was just like, he doesn’t want us here. Like so obvious. Like I never seen like a, you know, like three months old. It was just like crystal clear. He was like, “Get out of my effing room because I’m trying to do…fall asleep and you just keep like bugging me.” And then Justin was like, “I think he’s ready. We kind of made a plan, we put him in the first sight, he cried for like 15 minutes, and that was it.” And it was like a week before that of 90 minutes every night of sort of hysterical crying while we were like trying to do stuff. And then as soon as we left him alone… So, I don’t know. Sometimes your baby’s like…some babies are easier than others.
Dr. Fox: Yeah. I mean, which is actually important because at least in that other study, for most or parents of the average time was more than a week till it really got better. Meaning that this idea that’s gonna work in one night that sort of you had an I had is actually unusual. It does take several days typically for this to really have an effect. So, which is part of the reason you said people have to be persistent with this.
Emily: Yeah. And I think it’s also like, you know, I think it’s worth acknowledging like we’re talking about this in a kind of like, you do it, and like it’s a good idea and it works. In part, I think that that kind of…the lifeness about this experience of having your baby cry is like delivered by the fact that our kids are big, and that when you are the parent, even of a, you know, 7-year-old and 11-year-old, which is how old my kids are, this seems like a very distant memory and it doesn’t, but at the time, it’s very challenging and it is hard to listen to your kid cry. And it is worth remembering that there actually are some reasons to do this. Your own mental health, but also the sleep hygiene of your kid. Kids do need sleep. This can help them sleep better. But it is hard. It’s like many things you will try to experience with your kid where they will be very upset, and you will be saying, you know, “We’re doing this because this is good for you or it’s good for the family, or it’s good for our functioning,” but they’re very unhappy about it and that happens, you know, that’s sort of a broad description of most of the parenting actually.
Dr. Fox: Yeah. No, 100%. And it’s also why there isn’t one right answer. You know, like we said, if you’re a parent or, you know, parents and fine, you’re like totally cool getting up every three hours with your kid and, you know, feeding him or her and going back to sleep and you’re functioning great, and you really have no desire to let your kid cry. In the long run, it probably doesn’t matter. But if you’re a parent who really needs sleep and this is severely affecting your ability to function, your ability to work, your ability to have a relationship with your partner, or it’s getting it to the point of like real mental health, you know, postpartum depression, anxiety, then the stakes are higher and it’s sort of more relevant and probably more helpful for you. And that’s a very individualized decision, which is why there really…you know, this isn’t the place to sort of judge people for doing it or not doing it, it’s just if someone is really suffering, it’s good to know that there is an option that might be helpful to you, or if you just want it, you want your kid to be a better sleeper.
Emily: [crosstalk 00:30:05]
Dr. Fox: Yeah. Which for us, I don’t think we had mental health issues in our family, at least, you know, none more than baseline from our kids. It was just, it really made a huge difference. And again, like my twins are born, I was a med student, my wife is in school, and getting six hours of sleep at night for each of us was critical to be able to function during the day and do everything we had to do. And it was really important and it worked, and thank God it worked for us. And if it had not worked, it could have really gotten ugly, I would say.
Emily: But I think it’s an example of a place where, again, the pendulum sort of moves in these things in different, you know, social groups. I think there was a time in which, you know, there was a lot of judgment if people did sleep train, and over time as evidence is kind of accrued in the direction that like, well, it seems like this is not damaging. We’ve almost sort of pushed back in the direction of people feeling like they’re told they have to sleep train. And then you get the pushback in the other direction. I think again, it would be sort of nice to be in the middle and say, you know, this is an option that can work really well for some people for a variety of different reasons. It’s not an option that everybody wants and is not an option we should force on people. It is something that, you know, we should have people look at the evidence and decide what works for them, with the combination of the data, and also just like what their family preferences are, and what their family constraints are. And we’re just not very good when we come to parenting decisions. We’re not very good at letting people make the ones that work for them.
Dr. Fox: Yeah. No, I think it’s true for this, it’s true for parenting, it’s true for life. You know, make good decisions for you and your family and don’t judge everybody else, just let them do their thing. And everyone will be a lot better off if we all sort of adhere to that in a sense.
Emily: It’s so true. So we’re not gonna adhere to that.
Dr. Fox: Well, we’re working on it, so we’ll…
Emily: It’s a lofty goal. It’s a lofty goal that we can work toward.
Dr. Fox: We will start with sleep training and then go all the way to politics. It’ll be great.
Emily: Exactly. It’ll be great.
Dr. Fox: Awesome. Emily, thank you so much for coming on the podcast. I really appreciate talking to you, getting your opinion on this. It’s a great topic and a lot of parents have a lot of questions on it, and your perspective and knowledge is much appreciated.
Emily: Thank you for having me.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.