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An illustration of a baby crying in a crib. Sarah Lawrence for Vox

The exhausting, lucrative world of childhood sleep consulting

Tired parents are desperate to get their kids to sleep. There’s a whole industry designed to help (for a fee).

I remember when I reached my breaking point with my son’s sleep. He had faced big changes to his little life over the previous year: an interstate move, a new house, a new preschool, and the arrival of his baby sister. His routines suffered for it, and his bedtime demands had become increasingly baroque and desperate.

If my husband or I didn’t stay in the room with him until he fell asleep, he would explode with panic. “I’m all alone and I’m only 3 years old!” he wailed through a sheet of tears and mucus. If we left the room, he hurled his body against the door like a moth thumping a porch light.

This particular night, my husband was out of town, leaving me solo with both kids. Hours since I’d gotten him in his jammies, my son was still awake and his protests were threatening to wake the baby. This risk was unacceptable.

I pulled him out of their shared bedroom and into “the big bed” with me. The lights were off but his little overtired body wouldn’t stop twitching and jerking with excitement. As his heels jabbed at my ribs (“I’m just stretching”), I directed my phone’s glow away from his face and fired off a deranged missive via online form. Christine emailed me back the next morning.

“One of the top times that I get emails from tired parents is somewhere between midnight and 2 am,” says Christine Stevens, who owns Sleep Solutions by Christine. Stevens is a certified child and infant sleep consultant, a professional who offers services to families struggling with behavioral childhood sleep problems. She is one of the growing league of such professionals around the globe, a cohort of providers who fill this need for exhausted families.

There are no national or international guidelines on who can be a provider, but a sleep consultant typically receives training through one of several organizations that offers a proprietary sleep curriculum in service of getting parents and children the sleep they need to function and thrive. The Family Sleep Institute, one of these organizations, calls its curriculum comprehensive and evidence-based, covering such topics as “Safe Sleep Environments Preventing SIDS,” “Twins,” and “Working with Families of Children with Special Needs” in their certification program.

Some might associate sleep consulting with “sleep training,” a phrase often used as shorthand for the practice of teaching infants to self-soothe via controlled crying, also called “crying it out.” But childhood sleep concerns are as diverse as each family who seeks help.

One set of parents may be fed up with their 10-month-old still waking every two hours at night like a newborn, and they might feel prepared to grit their teeth through some crying; they just need help getting started. Another family might be trying to keep their 2-year-old from sneaking into their bed at 3 am every night.

Most parents have tried to solve the issues themselves but feel overwhelmed by the abundance of opinions available via internet forums, books, and friends and family. The sleep consultant can offer each family custom assistance from a menu of services, ranging from a one-time phone consult for $50 to a custom sleep plan with coaching via text message, to extended stay in-home consulting, which can cost thousands.

Children have presumably been tormenting their parents with disrupted sleep since we lived in caves, yet sleep consulting is a fairly emergent field. A survey of sleep consultants published in Behavioral Sleep Medicine in 2018 showed that the median length of time a consultant has been in practice is just four years. While childhood sleep problems are common, the supply of board-certified pediatric sleep specialists is low, with few pediatricians certified in sleep medicine or psychologists certified in behavioral sleep medicine.

Though they are not medical providers and may not have a health care background, certified child sleep consultants fill a need for commonsense solutions to everyday sleep hassles. Stevens said that pediatricians often refer families to her, as their caseload does not permit the type of individualized behavioral coaching that a sleep consultant can provide. Families might seek help for a range of problems, from resistance to napping and bedtime delaying, to night wakings and unwanted bed-sharing, to excessively early waking.

Maybe sleep has always plagued new parents, but modern American parents face a particularly trying set of circumstances. In most American families, every adult works. In 2018, according to the Bureau of Labor and Statistics, around 65 percent of mothers with children under age 6 worked. Forty-one percent of mothers in 2017, the latest year with available data, were sole or primary breadwinners for their families.

Their families’ financial security depends on their earnings, and yet American parents don’t have access to a single hour of paid leave provided at a federal level following childbirth or the adoption of a child. The best we have is the Family and Medical Leave Act (FMLA), which provides no paid leave but protects one’s job for up to 12 weeks.

Even so, FMLA doesn’t apply to all employers, nor does it apply to all workers. For those who haven’t been employed for a full year when they give birth, the employer has no obligation to furnish a period of leave, even unpaid leave. A worker’s best bet may be eligibility for short-term disability (six weeks for vaginal delivery, eight weeks for a C-section). If a person returns to work after this period in order to prevent the financial ruin of further income loss or job termination, their body might very well still be bleeding.

A parent in this position is unlikely to have the multigenerational support at home that previous generations did, and it’s biologically typical for their baby to wake two to three times during the night. American women are mostly working outside the home, frequently outearning their partners but still performing more of the unpaid household labor, including caring for children, than men in similar demographic categories. Parents, and especially mothers, are exhausted.

What’s a worn-out parent to do? It’s not that there isn’t enough information out there about baby sleep. Most of us turn first to the internet for advice on, well, everything, an information landscape too saturated, contradictory, inaccessible, or general on this topic to translate helpfully into much concrete action.

There are the parent message boards, terrifying and dense minefields of extreme opinions and war stories. Asking for help on social media usually solicits the type of advice that shows up on the first page of Google, an acquaintance with no children who used to be a nanny and says, “try swaddling!”

Then there are the hundreds of books by experts, with titles like Happiest Baby on the Block and On Becoming Babywise growing so popular that entire brands, complete with product lines, have sprung up around them. (If you ever see The No-Cry Sleep Solution on a new parent’s coffee table, you have my encouragement to gently hug them; they’re really going through something.)

Yet even these books, with their case studies and distinct ideological permissions and prohibitions, can still feel too overwhelming and general for a desperate parent. Even Cara Dumaplin, whose baby sleep company Taking Cara Babies has 704,000 Instagram followers, does not provide individualized sleep coaching. She offers short phone consults for a fee, but only for those who have already purchased and enrolled in her online classes.

Sleep deprivation makes for good retail, as parents determined to cut through the information cacophony may turn hopefully to stuff. Dr. Harvey Karp, the renowned professional behind Happiest Baby on the Block, sells products on his website that support his sleeping precepts, from tight swaddling sacks to constrain the baby’s startle reflex to a $1,300 bassinet, the Snoo, that safely rocks and soothes baby for better nighttime sleep.

The harrowing online reviews of this product answered my questions about who would buy such an expensive bassinet: people who feel they have no choice. One five-star review reads: “I did not want to buy this. ... In her first 6 weeks, I could count on one hand the number of times I got any more than 1.5 hours of sleep. Then one night at 3 a.m. I started getting worried about what life would be like when I had to go back to work at 11 weeks. I have a one-hour commute each way and I work in patient care and got more and more nervous about the potential of getting in a car accident or making a terrible mistake at work because of sleep deprivation.”

Parents of early-rising toddlers may feel tempted by the range of children’s clocks that give time cues, perhaps the best known being the Ok to Wake! clock. The Ok to Wake! clock is an alarm clock and nightlight shaped like a chubby little alien. Parents determine the morning hour when toddlers are allowed to leave their bed, and program the clock accordingly. At the correct hour (in our home, it’s 7 am) the clock glows green, creating a visual cue for preliterate children. This can change lives — or it can be an expensive nightstand decoration, depending on the temperament of the child.

Often, parents who seek out sleep consultants have tried everything, or they’re just too wiped out to try anything. “I ask [parents], ‘Have you read the books? What have you tried?’ And they say, ‘I’ve bought the books, but I don’t have time to read them, I’m too tired.’” Stevens said.

It’s hard to overstate the hopelessness of indefinite sleep deprivation. We just want someone to tell us what to do and when to do it. Dr. Benjamin Spock, in his Common Sense Book of Baby and Child Care, made waves in the postwar era with his gentle and intuitive approach when he counseled parents to trust themselves: “You know more than you think you do.” What about those of us who feel they know absolutely nothing?

Sleep consultants can lift this hopelessness. When I had my initial phone consult with Christine, the most comforting words I heard were that she could help, and that within days I could be walking out of my son’s bedroom by 8 pm and waking up with just my husband beside me in bed. When friends heard that I’d hired a sleep consultant, they were eager to glean secret knowledge or “hacks” from which they could benefit. I had to break it to them that there’s no magic, just a structure informed by sleep education and the built-in accountability to keep to that structure. Sleep consultants do not train babies, after all, they train parents.

Leanne, 40, first hired a sleep consultant when her oldest son was eight months old. Her pediatrician’s office had hosted an open house where a local sleep consultant was offering free consults, and Leanne hired her after the consult for more hands-on help. Her son was not sleeping, day or night. He only ever slept in very short chunks, and had to be in someone’s arms or in motion in a swing device or stroller.

“I felt dumb, honestly,” Leanne said of the crisis with her son’s sleep. She and her wife were both working full-time. “The solution [provided] was so simple, but I couldn’t think.” When he was a toddler, they hired the same consultant again for a reset, when new sleep concerns had emerged.

It’s important to bear in mind that sleep problems that appear behavioral may have underlying medical concerns, which families should address with their primary care provider. “If parents are seeking help for their child’s sleep problems then they should know that person’s qualifications to best determine if they can help with the specific sleep problem,” says Maile Moore, pediatric nurse practitioner (PNP) at the Center for Pediatric Sleep Disorders at Boston Children’s Hospital.

“A sleep coach/consultant is a general term for someone who provides advice, education, and support to help improve a child’s sleep,” she continued. “However, the criteria for who can call themselves ‘sleep coaches’ can be quite variable and does not guarantee any specific training or certification.”

What prevents parents from seeking specialized help? Maybe they don’t know they have options, or maybe they think parenthood is supposed to feel this way. Exhaustion is often worn as a cultural badge of honor, proof that we’ve ground ourselves to a paste at the altar of self-sacrifice. Maybe, like me, they feel like a millennial dipshit for needing to outsource a difficult stumbling block on their parenting journey.

By far the largest practical barrier to accessing services provided by sleep consultants is cost. Prices, depending on the services provided and area of the country, can range from less than $100 to thousands of dollars. In most cases, the service is coded as an “alternative therapy” not covered by health insurance.

Those who have access to health savings accounts or flexible spending accounts may be able to use that pre-tax income to defray the costs. Yet considering most Americans wouldn’t be able to cover a $1,000 emergency, hiring a professional remains chiefly out of reach.

One option is to seek treatment at a pediatric sleep center through one of their sleep coaches, typically a registered nurse, nurse practitioner, or physician with sleep medicine training. Like any other medical specialty referral, this would typically be covered by medical insurance or Medicaid. The locations of these centers track closely to population density, so those living in rural areas and those who have mobility barriers may have limited access.

Telemedicine could improve access to these professionals; after all, many non-clinical sleep consultants provide all their services remotely. I never once met our sleep consultant in person, but the confidence she brought to my parenting, via a behavioral plan and scheduled phone check-ins, felt very personal.

The well-being I’ve enjoyed on the other side of no-drama child sleep is something all parents, regardless of income level, deserve to experience. As I worked late at night recently, my son burst through my bedroom door crying about a bad dream. “In my dream, it was April already but it was still cold!” he explained through tears. A nightmare, to be sure. He asked if he could sleep in bed with me and I said yes, rather than walk him right back to his room the way I’ve been professionally coached to do. I was on deadline, and I didn’t know how much time I’d have the next day to write.

An hour later, I closed my laptop and carried my son’s small sleeping form back to his bed, thinking of Dr. Spock’s words: You know more than you think you do. Not perfect, but for this family, it was pretty good.

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