Sleepinf With Baby, Don’t Think Too Much, Teen Drug Abuse

Parents who sleep with their baby

Erol Reyal for The New York Times

Parents who sleep with their baby: Richard and Christina Harrison with Alyssa.

December 29, 2005
And Baby Makes Three in One Bed
By AMY HARMON

JENNIFER JAKOVICH has spent most of her 5-month-old daughter’s life dodging questions from friends, family and strangers about how and where Chloe sleeps. But since hearing that Dr. Richard Ferber, the country’s most famous infant sleep expert, has relaxed his admonition against parents sleeping with their babies, she has taken a different tack.

"I now mention Ferber’s new view while openly admitting to co-sleeping," said Ms. Jakovich, an engineer in San Diego. She has broken the news to friends that Chloe sleeps in the same bed with her and her husband, John, a computer programmer. "I feel I have now been given the green light, that it’s O.K."

The Jackoviches are part of a growing group of American parents who share a bed with their baby, a common practice in the rest of the world, which had become nearly taboo in this country. A survey by the National Institute of Child Health and Human Development has found that about one-fifth of parents with infants up to eight months old said the baby usually shared a bed with them, more than triple the number of a decade ago.

The trend appears to be driven largely by the increase in breastfeeding working mothers, who say it allows them to connect with their babies and still get some sleep. But given the prevailing cultural distaste, many parents say they have felt compelled to hide their shared sleeping arrangements.

It is a testament to Dr. Ferber’s influence that even the halfhearted nod he has given the practice in interviews has inspired a kind of collective coming-out party among co-sleeping parents. Transcripts of his network news and talk show appearances last month are being circulated on the Internet and recited on the playground.

"Even though I shouldn’t have to defend myself, it is nice to have that," Ms. Jakovich said. Like many other parents, she never intended to sleep with her daughter. "My view was that granola-hippie-type people co-sleep," she added.

But Ms. Jakovich, 30, quickly found that she slept better when she didn’t have to get up in the night to nurse Chloe. To make things more comfortable, the Jakoviches took one side off Chloe’s deluxe crib and pushed it up against their mattress, which they upgraded to a king-size.

The old Dr. Ferber would not have approved. In his best-selling 1985 book, "Solve Your Child’s Sleep Problems," he advised parents to let babies cry for intervals of up to 45 minutes without responding, to train them to sleep on their own. Should the child cry so hard that he throws up, parents are to clean up and leave again. "If you reward him for throwing up by staying with him, he will only learn that this is a good way for him to get what he wants," Dr. Ferber wrote.

Parents who take a baby into their bed instead, the book suggested, damage the child’s development as an individual and are probably only trying to avoid their own intimacy problems. "If you find that you actually prefer to sleep with your infant," it warned, "you should consider your own feelings very carefully."

Practiced by millions of parents and widely promoted by pediatricians, Ferberization and its variations tap into the American desire to imbue children with independence from an early age. Setting babies apart in their own cribs also eases a typically American tendency to see sleeping arrangements as sexual rather than social, some anthropologists say.

Concerns about safety, albeit contested, added to the consensus against bed sharing, so that a baby’s completing a sleep-training regimen has come to be seen as a developmental milestone comparable to crawling or cutting a first tooth.

Now, in a flurry of publicity for a revised version of Dr. Ferber’s book, he has allowed that his technique is not suitable for all babies and that children can develop healthy sleep habits sleeping in their parents’ bed.

A spokeswoman for Dr. Ferber’s publisher, Marcia Burch, the vice president for publicity at Touchstone Fireside, a division of Simon & Schuster, said he had been taken aback by the interest in his position on bed sharing and that Dr. Ferber, the director of the Center for Pediatric Sleep Disorders at Children’s Hospital in Boston, would not comment further until the new edition is published in March.

"He totally underestimated the reaction," Ms. Burch said. "He totally misunderstood that this was going to be really big news."

Still, Dr. Ferber’s shift has sparked celebration among some parents, who have faced criticism for defying the American dictum that babies should learn to sleep alone. And in a child-rearing battle that has become as ideological as it is intimate, others say vindication is in order, not from Dr. Ferber so much as from fellow parents who evangelize his teachings with moral fervor.

"It is at her next doctor’s appointment, her 12-month checkup," Christina Harrison said of her daughter, Alyssa, "that I relish the chance to bring it up the most." Ms. Harrison, 29, let Alyssa cry until her voice was hoarse at her pediatrician’s urging. "It was horrible."

Ms. Harrison has resolved to sleep with Alyssa until she is happier about being in her own bed.

Stephanie Lazure, 31, hopes to show a clip of the ABC News interview with Dr. Ferber to her husband’s boss, who bought the couple Dr. Ferber’s book as a baby present. "She comes over and shakes her finger in the baby’s face and says, ‘You have to learn to self-soothe,’ " Ms. Lazure said. "It’s not that I feel criticized. It’s that I feel my baby is being criticized for not sleeping."

Pressure not to co-sleep isn’t coming only from relatives and other parents. Many pediatricians discourage the practice because they worry about parents rolling over and smothering the baby. But the question of how co-sleeping affects the risk of sudden infant death syndrome, known as SIDS, is contested. Last month the American Academy of Pediatrics SIDS task force released a statement discouraging parents from sharing beds with their babies.

But the academy’s own section on breastfeeding argues that bed sharing is safe in many circumstances and can benefit babies by facilitating breastfeeding. And an epidemiological study published in the fall in the journal Pediatricsfound no higher sudden infant death risk for infants older than 11 weeks unless the mother smokes.

"Some of the opponents of bed sharing persist in their beliefs in spite of the scientific evidence," said Dr. Martin Lahr, who is an author of the paper on bed sharing.

Co-sleeping has long been embraced by devotees of Dr. William Sears and his philosophy of "attachment parenting," who dismiss Dr. Ferber’s earlier methods as cruel. Ferber fans have in turn derided co-sleepers as sacrificing themselves and their romantic relationships in the name of spoiling a baby who needs parents to set limits.

But many of the new co-sleepers appear to base their sleeping arrangements on a blend of pragmatism and pleasure, rather than on a particular approach to parenthood. Some push together queen mattresses with twin mattresses, others snuggle closer together or improvise each night. Cribs, Pack ‘N Plays and bassinets become useful repositories for toys and laundry.

Rita Hunt Smith, 39, a children’s librarian in Hershey, Pa., began co-sleeping with her first son, Ezra, after spending an agonizing night listening to him cry in the crib down the hall. Then she came to treasure the closeness it forged among Ezra, her and her husband, Kurt, a graphic artist.

Now 3½, Ezra spends most nights in his own bed, while the Smiths’ 14-month-old son, Fletcher, sleeps with them. Perhaps because her husband has an older son from a previous marriage, Ms. Smith said, he has been supportive, even though he would like more room for his 6-foot-3 frame.

"He knows the day is coming when they won’t even want to be in the same room with us, so let’s soak it up now," Ms. Smith said. Upon waking, Fletcher, who has just begun to talk, greets his parents with "hiya."

Ms. Smith said she used to be highly secretive about their co-sleeping, but has begun talking more about it during baby story-time sessions she runs. Her mother, though, "continues to think I’m ruining my sons’ sleep habits forever," she said.

Child development experts have said that Dr. Ferber was likely to be reacting to accumulated research since his earlier edition that supports the notion that babies have different temperaments and that their development is best served when parents are able to adapt to their individual needs.

"It is clear that children of differing temperaments need different things at night, just as they do during the day," said Sara Harkness, the director of the Center for the Study of Culture, Health and Human Development at the University of Connecticut.

Dr. Harkness, who has conducted cross-cultural research on infant sleep habits in several countries, said no studies have borne out the connection originally drawn by Dr. Ferber and others between teaching babies to sleep alone and their ability to develop autonomy.

"It’s an American myth," Dr. Harkness said. "It’s fine to think about training children to be independent, but there has been this misguided effort to extend it to an area where it’s really not developmentally appropriate."

Some co-sleeping parents say they do not need advice from experts to decide where their baby should sleep.

"With no intended disrespect to Dr. Ferber, I do not need his opinion to validate my view that co-sleeping is the healthiest, safest and most natural sleep situation for my child," Kristi Buxton, 29, a microbiology researcher in Portland, Ore., wrote in an e-mail message. "The individual who has most influenced (and radically changed) my beliefs about co-sleeping is my child."

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Don’t Think Twice, It’s All Right

Jon Krause

December 29, 2005
Op-Ed Contributor
Don’t Think Twice, It’s All Right
By TIMOTHY D. WILSON
Charlottesville, Va.

IT’S navel gazing time again, that stretch of the year when many of us turn our attention inward and think about how we can improve the way we live our lives. But as we embark on this annual ritual of introspection, we would do well to ask ourselves a simple question: Does it really do any good?

The poet Theodore Roethke had some insight into the matter: "Self-contemplation is a curse / That makes an old confusion worse." As a psychologist who conducts research on self-knowledge and happiness, I think Roethke had a point, one that’s supported by a growing body of controlled psychological studies.

Not sure how you feel about a special person in your life? Analyzing the pluses and minuses of the relationship might not be the answer.

In a study I conducted with Dolores Kraft, a clinical psychologist at the University of Texas Southwestern Medical Center, and Dana Dunn, a social psychologist at Moravian Collegein Pennsylvania, people in one group were asked to list the reasons their relationship with a romantic partner was going the way it was, and then rate how satisfied they were with the relationship. People in another group were asked to rate their satisfaction without any analysis; they just gave their gut reactions.

It might seem that the people who thought about the specifics would be best at figuring out how they really felt, and that their satisfaction ratings would thus do the best job of predicting the outcome of their relationships.

In fact, we found the reverse. It was the people in the "gut feeling" group whose ratings predicted whether they were still dating their partner several months later. As for the navel gazers, their satisfaction ratings did not predict the outcome of their relationships at all. Our conclusion? Too much analysis can confuse people about how they really feel. There are severe limits to what we can discover through self-reflection, and trying to explain the unexplainable does not lead to a sudden parting of the seas with our hidden thoughts and feelings revealed like flopping fish.

Self-reflection is especially problematic when we are feeling down. Research by Susan Nolen-Hoeksema, a clinical psychologist at Yale University, shows that when people are depressed, ruminating on their problems makes things worse.

In one study, mildly depressed college students were asked to spend eight minutes thinking about themselves or to spend the same amount of time thinking about mundane topics like "clouds forming in the sky."

People in the first group focused on the negative things in their lives and sunk into a worse mood. People in the other group actually felt better afterward, possibly because their negative self-focus was "turned off" by the distraction task.

What about people like police officers and firefighters who witness terrible events? Is it helpful for them to reflect on their experiences?

For years it was believed that emergency workers should undergo a debriefing process to focus on and relive their experiences; the idea was that this would make them feel better and prevent mental health problems down the road. After 9/11, for example, well-meaning counselors flocked to New York to help police officers, firefighters and rescue workers deal with the trauma of what they had seen.

But did it do any good? In an extensive review of the research, a team led by Richard McNally, a clinical psychologist at Harvard, concluded that debriefing procedures have little benefit and might even hurt by interrupting the normal healing process. People often distract themselves from thinking about painful events right after they occur, and this may be better than mentally reliving the events.

What can we do to improve ourselves and feel happier? Numerous social psychological studies have confirmed Aristotle’s observation that "We become just by the practice of just actions, self-controlled by exercising self-control, and courageous by performing acts of courage." If we are dissatisfied with some aspect of our lives, one of the best approaches is to act more like the person we want to be, rather than sitting around analyzing ourselves.

Social psychologist Daniel Batson and colleagues at the University of Kansas found that participants who were given an opportunity to do a favor for another person ended up viewing themselves as kind, considerate people – unless, that is, they were asked to reflect on why they had done the favor. People in that group tended in the end to not view themselves as being especially kind.

The trick is to go out of our way to be kind to others without thinking too much about why we’re doing it. As a bonus, our kindnesses will make us happier.

A study by University of California, Riverside, social psychologist Sonja Lyubomirsky and colleagues found that college students instructed to do a few acts of kindness one day a week ended up being happier than a control group of students who received no special instructions.

As the new year begins, then, reach out and help others. If that sounds suspiciously like an old Motown song or like simplistic advice from one of those do-gooder college professors, well, it is. But the fact is that being good to others will ultimately make us kinder, happier people – just so long as we don’t think too much about it.

Timothy D. Wilson, a professor of psychology at the University of Virginia, is the author of "Strangers to Ourselves: Discovering the Adaptive Unconscious."

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When Teenagers Abuse Prescription Drugs

Ian Kelte

December 27, 2005
Essay

When Teenagers Abuse Prescription Drugs, the Fault May Be the Doctor’s
By HOWARD MARKEL, M.D.
Every Thursday evening, I counsel a group of teenagers with serious substance abuse problems. None of the youngsters elected to see me. Typically, they were caught using drugs, or worse, by their parents or a police officer and were then referred to my clinic.

To be sure, all the usual intoxicants – alcohol, marijuana, amphetamines, LSD and cocaine – are involved. But a new type of addiction has crept into the mix, controlled prescription drugs, including potent opiate painkillers, tranquilizers and stimulants used to treat attention deficit disorders.

This is hardly unique to my clinic. Several studies report that since 1992, the number of 12- to 17 -year-olds abusing controlled prescription drugs has tripled.

In fact, dabbling with some of the pharmaceutical industry’s finest psychoactive compounds constitutes the fastest growing type of drug abuse in the United States, outpacing marijuana abuse by a factor of two. One of my patients, Mary, illustrates this trend all too well. A voracious reader and a talented musician in her high school orchestra, Mary at 16 is also a "garbage head," meaning that she will ingest anything she thinks will give her a high.

Last December, she was taken to the hospital for an overdose of hallucinogenic mushrooms, alcohol, and ketamine, a chemical cousin of angel dust that doctors sometimes use to anesthetize patients and that, more commonly, veterinarians use to sedate large animals.

Lately, she has been playing with one of the strongest opiates and potentially addictive painkillers ever created, Oxycontin. She downs a few with a single shot of vodka and calls the combination "the sorority girl’s diet cocktail," because it simultaneously allows for a stronger kick of inebriation and far fewer calories than mere alcohol alone.

The most recent Monitoring the Future report, the continuing study of teenage drug use conducted by the University of Michigan and the National Institutes of Drug Abuse since 1975, found that 5.5 percent of all high school seniors abused Oxycontin, up from 4 percent in 2002. Oxycontin abuse has increased 26 percent since 2002 among 8th, 9th and 12th graders.

A listing of  Food and Drug Administration -approved uses for Oxycontin shows that it is specifically for patients in moderate to severe round-the-clock pain like that in advanced stages of cancer.

So where does this physically robust teenager obtain her pills? Weeks earlier, she had a tonsillectomy, a minor though uncomfortable procedure by any standards. The surgeon wrote a prescription for 80 tablets. Mary spent the next week in a narcotized and medically sanctioned bliss, until her mother confiscated the last 20 tablets.

At medical conferences, I hear colleagues fault parents who abuse and obtain these controlled substances but leave them easily accessible in their unlocked medicine chests where teenagers can help themselves. Other experts fault the Internet, where almost anyone can obtain controlled prescription drugs from offshore pharmacies with a few clicks on a home computer.

The favorite scapegoat is deceptive: addicted patients who, the argument goes, "doctor shop" and manipulate the physicians into prescribing the medications, alter the prescriptions themselves or buy them from drug dealers at exorbitant prices.

None of these targets come close to the real root of the problem. Many doctors are too quick to write prescriptions for these powerful drugs.

The National Center for Addiction and Substance Abuse recently reported that 43.3 percent of all American doctors did not even ask patients about prescription drug abuse when taking histories; 33 percent did not regularly call or obtain records from a patient’s previous doctor or from other physicians before writing such prescriptions; 47.1 percent said their patients pressured them into prescribing these drugs; and only 39.1 percent had had any training in recognizing prescription drug abuse and addiction.

Yet from 1992 to 2002, prescriptions written for controlled substances increased more than 150 percent, three times the increase in prescriptions for all other drugs.

The morning after hearing about Mary’s Oxycontin holiday, I called her surgeon and asked him whether he had read her medical chart detailing an extensive history of substance abuse. "Why did you prescribe this narcotic bazooka when a BB gun of a painkiller such as acetaminophen might have done the trick?" I asked.

Sheepishly, the surgeon replied, "Well, I guess I wasn’t thinking."

No one in pain – physical or psychic – should suffer. But the fact remains that we doctors still do the bulk of prescribing of the substances. The search for root causes of the epidemic with controlled substance abuse has to include doctors as active participants. A big part of the solution depends on reserving prescriptions for those who need, rather than desire, them.

Dr. Howard Markel, a professor of pediatrics at the University of Michigan, is the author of "When Germs Travel."

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