The crying game
Children's sleep icon Richard Ferber updates his book and explains his method
It can take three or four months for parents to get an appointment with renowned children's sleep specialist Richard Ferber , director of the Center for Pediatric Sleep Disorders at Children's Hospital Boston . When the day finally comes, they're bound to be wasted.
If a youngster has a sleep problem, so do the parents. They're sleep deprived. Walking zombies.
What's more, by now they've likely concluded they're bad parents. After all, they can't get their child to easily achieve that most natural of all states, sleep. And then there's the intimidation factor: He's the only pediatrician in America whose name has seeped into the vernacular as a verb, as in, ``We Ferberized our daughter. How about you?" ``Ferberizing" is commonly understood to mean ``letting a baby cry it out."
With all this hanging in the air, Ferber's very presence is a palpable antidote.
A small, unassuming man of 62 with a nearly white, neatly trimmed beard, he greets the family with a calm, courtly -- some might say curt -- demeanor. A nod of the head, a quick handshake, an equally quick smile, then down to business. You almost want to nudge him: What about that adorable baby?
Warm and fuzzy he's not.
But get this. ``He spent two hours with us. What doctor does that?" says Lynn Grisco of Northborough.
Ferber's revised edition of the best seller ``Solve Your Child's Sleep Problems" (Fireside), is in stores today, and that, too, is an example of how he's atypical. Ferber, who lives in Newtonville, is the man who put pediatric sleep on the map in 1978 with his first-in-the-world pediatric sleep lab, and then, in 1985, with a book that revolutionized pediatric sleep.
What author waits 21 years to update a best seller? Why hasn't he capitalized on his fame and spawned a mini-industry of Ferber-endorsed products, videos , or baby sleep aids?
``I'm not into gimmicks," he says. ``That's not what I went into medicine for."
Is that a swipe at pediatrician Harvey Karp , whose popularity threatens to eclipse Ferber's? Karp's website sells swaddling blankets and white-noise CDs in addition to his books and DVDs, ``The Happiest Baby on the Block" and ``The Happiest Toddler on the Block" (Bantam) .
``I' m not familiar enough with his work to comment," Ferber says.
Ferber likes to be precise. For him, timing and scheduling are the nuts and bolts of pediatric sleep, not swaddling techniques or whether your baby sleeps with you or independently. What's more, timing and schedules vary from child to child and family to family. ``There's no one-size-fits-all strategy," he says.
That's both a caution to parents who might buy into one sleep strategy or another, and a defense of ``Ferberizing," which has come under fire over time. One critic is pediatrician William Sears.
``If you were a baby, would you want to go to sleep alone, crying in a dark room, or drift peacefully off in the arms of your most favorite person in the whole world?" Sears asks in a telephone interview. The press release for his newest book, ``The Baby Sleep Book: The Complete Guide to a Good Night's Rest for the Whole Family" (Little, Brown) co authored with Robert, James , and Martha Sears, reads: ``Dr. [William] Sears has always condemned `Ferberizing,' otherwise known as the `cry it out' method."
Does it bother Ferber that his name is synonymous with letting a baby cry?
``Yes," he says simply. ``It does."
In person, one of the first questions Ferber asks parents is, ``What are you trying to fix?" From that, he works backward to figure out what's broken. ``You can't treat a sleep problem without a diagnosis," he says.
That's his bedrock. To understand that is to recognize that ``crying it out" is a misrepresentation of his strategy. ``Letting a baby cry is a treatment-driven approach. As if crying itself is a good thing," Ferber says. There's a silence. ``It's not," he adds, just to be perfectly clear.
In trying to get to the `` why?" of a sleep problem, Ferber realized that interactions between parents and child could be the cause of a problem. Twenty years ago, that was ground breaking. He explains:
``The baby falls asleep with one set of conditions, being rocked in daddy's arms, and then the parents sneak him into the crib and leave the room. When the youngster wakes up [in the natural course of a sleep pattern], everything feels wrong: `Where am I? What happened?' " Instead of falling back to sleep, the baby is jarred into a more fully awake state. ``Now the parents have to re - create the conditions, and a cycle begins out of the best of intentions."
The remedy, he says, ``is for a child to learn to fall asleep under the same conditions that will exist when he wakes up."
Yes, in the course of changing conditions, a baby will likely cry. The revised edition recommends allowing for shorter crying periods, three minutes instead of five on the first night, 5 instead of 10 on the second night, and 10 instead of 15 on the third. Also new in this book: more than nine pages on co-sleeping, something he says he regrets dismissing in mere paragraphs in the original; a section on naps; and another on twins. He'll discuss these and other topics on the ``Today" show on NBC tomorrow , and on ``American Morning" on CNN and ``The Early Show" on CBS, both on Thursday .
What he most wants parents and critics to understand is that ``crying it out" is not appropriate in all situations, or for all babies ; never, for instance, for a child who is frightened or on an inappropriate schedule.
These days, however, the most common complaint he hears likely will only be solved with tears. Here's the complaint: `` My 3-year-old is tired all day."
More often than not, Ferber finds that the child is not getting the sleep parents think because he falls asleep watching TV in his room. When he awakens during the night, the television is either still on or he turns it on himself and watches until he falls back to sleep, sometimes hours later.
``Try to fix this -- it's an addiction, really -- and you get a lot of tears," Ferber says. ``But that doesn't mean you shouldn't do it," typically by removing the TV from the room.
Other sleep problems happen because parents have unrealistic expectations of how much sleep a child needs, force a nap long after a child needs it, or unwittingly provide inconsistent sleep associations. When Linda and Michael Micciche of Framingham first saw Ferber a few months ago, their son Lucca , now 9 months old, woke up as many as seven times a night. ``As parents go, we were pretty much at a breaking point," says Michael.
Turns out, because Lucca was with three different care givers during the course of a week, including his parents, he was on three different nap schedules. His body clock was confusing day and night.
``All Dr. Ferber did was put us all on the same schedule. If his nap time is 10 a.m., it's fine if he falls asleep at 9:30, but then you wake him after an hour and a half," says Michael.
Lynn Grisco and her husband, Todd, went to Ferber for a second opinion, frightened at the diagnosis -- misdiagnosis as it turned out -- of seizures for their son Blake, now 2. A child who could sleep more than 14 hours in 24, Blake would cry out in his sleep, his eyes would roll back, and he would thrash about. Ferber diagnosed night terrors, and said Blake was getting too much sleep. By creeping his bedtime later and later over a three-week period, his sleep was reduced by two hours a day. The ``seizures" are gone. Things aren't perfect, though. To fall asleep, Blake needs a parent in his room, a habit dating to his premature birth.
``Do you notice that he seems to almost fall asleep and then he opens one eye . . . ?" Ferber asks.
``Yes!" says Lynn.
``. . . to check, `Did you leave yet? Did you leave yet?' He's fighting sleep to see if you're going to sneak out on him."
``So don't sneak," Ferber counsels. ``Tell him, `I'm going to the bathroom; I'll be right back.' At first, he'll wait for you to come back. When you do, you can tell him, `Now I'm going to put on my PJs. I'll be back.' Once he sees that you will return, he'll allow himself to fall asleep while you're out of the room."
``I can do that," says Lynn.
``Of course you can," says Ferber, flashing one of his rare smiles, even to Blake.
Family: Separated, two grown sons, Matthias and Thaddeus
Education: Harvard College, 1965; Harvard Medical School, 1970
Occupation: Founder and director of the Center for Pediatric Sleep Disorders, Children's Hospital Boston
Hobbies: Downhill skiing, in-line skating, listening to classical music
Book he's currently reading: "The Ancestor's Tale" by Richard Dawkins
On whether his children had sleep problems: "Sleep is not a huge issue in our family, but we faced some of the same issues other families face."
On whether he's a good sleeper: "I don't think of sleep as a particular problem."
On what he loves about his work: "It's very gratifying. In general pediatrics, people are always grateful, but they know that if you don't help them, the next doctor will. There are not a lot of areas in medicine where you have the ability to cure problems, not just treat them, do it quickly, and without surgery or medication. If you treat a baby, you are treating the whole family. That's very rewarding."
Barbara Meltz can be reached at firstname.lastname@example.org.