Baby Sleep Refusal and the Airline Oxygen Mask

4/9/2008

A long time parent in my practice came in today with a very cute eight month old baby for a routine well visit. Her major issue was that the baby was refusing to sleep for more than one and a half hours straight. Mom or dad spends much of the night rocking her back to sleep only to be reawakened shortly after. There are three older siblings at home who cater to the babies every whim all the time. Mom and dad are in dispute about how to cope with this very cute but manipulative baby.

I always voice my concerns about sleep refusal to well meaning parents by using the airplane oxygen analogy. When flying on commercial airliners, travelers are always advised “in the event of a change in cabin pressure put the oxygen mask on yourself first and after that on your baby”.  Why is that the sequence? Clearly a baby has a lower reserve for low oxygen tolerance, so why the baby last? The answer lies in what happens normally.

If a parent is hypoxic (in a state of low oxygen), they will become confused and weakened. Under those conditions they will not be able to care for their child, thus the advice to take care of you first and then the baby. The same goes for parenting and specifically sleep battles. A fatigued mom will not be a very happy or effective mom as the nights take their toll. Babies rarely happily negotiate a sleep truce. A stubborn baby will wear down a conscientious parent every time. There is no problem with enforcing longer periods of sleep in an eight month old. I advised mom to go in on occasion to check on baby but without turning the interaction into a long cuddling episode. Reassurance, a calm and gentle few words and back to bed. This is a battle of wills and parents must win in order to get the sleep they need to be effective parents. Parenting and childhood is a partnership. When one partner consistently caves into the other, it is not healthy.

The other factor here is the difference of opinion between mom and dad. Babies will work this conflict to the point of crisis. Smart parents recognize the ability of a baby to work this breach like a crack in a levy. Parents must come to agreement before dealing with this issue. If they are tugging at each other over this or other issues, kids will recognize it and use it to their advantage. Older siblings typically make this type of situation harder as they typically enjoy allowing behaviors that mom or dad might not yield on. Part of normal babyhood is gaining a certain confidence and independence under typical situations. Being catered to frequently by older siblings albeit well intended, is not helpful to this cute but tough cookie.

      

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