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Dr. Paul Smolen has been practicing pediatrics for 32 years as an attending physician at Carolinas Medical Center, an Adjunct Associate Professor at the University of North Carolina School of Medicine-Chapel Hill, and a private practitioner. To learn more about Dr. Smolen, click here

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Our mission is to stimulate and empower parents with interesting conversations about a wide variety of pediatric topics. To read the complete Mission Statement, click here

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Book Review Pedcast; Happiest Baby Guide to Great Sleep, by Harvey Karp, M.D. (Pedcast)

Happiest Baby Guide to Great Sleep, by Harvey Karp MD

Harper Collins Publishers

First Edition/ June 2013

 

Play

Welcome to this special edition of DocSmo.com.  I am your host Dr. Paul Smolen, a general pediatrician with 32 years of practicing experience… so far.  For most of my pediatric career I was too busy trying to keep up with what was new in pediatric medicine to take the time to read the parenting books that my patients were consuming.  Well, I think that was a mistake as I look back on that decision.  After I founded this blog, I decided that knowing which parenting books were accurate, well written, and worth a read by parents might be very useful, so I started a book review section on my blog, dedicated to this purpose. One of the first books that my staff and I reviewed was written by a pediatrician named Dr. Karp that I am sure many of you are familiar with called The Happiest Baby on the Block.  We loved this book and gave it a rave review, so we were very excited to start my evaluation of another of Dr. Karp’s books in which he discusses the important pediatric topic of, sleep; something every pediatrician knows a fair amount about from our day to day experiences.  So, here we go with a review of Dr. Karp’s, Happiest Baby Guide to Great Sleep.

 First, if you have not read one of Dr. Karp’s books, you are in for a treat. His writing is easy to understand, well written, and very interesting as he likes to mix modern scientific sleep medicine with wisdom from ancient cultures. His chapters are well organized and finding useful, practical information is very easy to do. He stresses practical solutions to sleep problems that parents often face. Dr. Karp is also particularly good at giving memorable names to sleep techniques he wants you to remember like “Twinkle interruptus” aimed at getting rid of a child’s paci at night, or “the Owie” geared to convince a child not to breast feed at night when they sleep in the same bed, or “Wake+Sleep” designed to allow children to be rocked and fed to sleep but also learn go to sleep on their own without further help from their parents…  more about that later.

 

Dr. Karp divides his discussion of sleep mostly by age, birth-3 months, 3 months- 12 months, toddler- 5 years, and finally special sleep problems like the those presented by children with ADD or new onset insomnia. His discussions of these topics are well researched and done quite well. Here are some of the big points Dr. Karp wants his readers to get;

-Sleep is an active process with many sleep/wake cycles a night

-Good sleep is essential to good memory and cognitive function

-From birth to 3 months, teaching a child to be independent at night is secondary to them learning to trust and bond with their parents. As Dr. Karp says, “Children need to learn trust then table manners.”

-Older children need a predictable bedtime routine to become good sleepers.

-He argues that for children to become good sleepers, their parents need to use what he calls the “relaxation reflex” that he made famous in his original book that he wrote to teach parents how to sooth a fussy young infant; white noise, comfortable positioning, sucking, and gentle motion. Sleep will follow this reflex.

Now for the problems we see with his advice. Unfortunately, The Happiest Baby Guide to Great Sleep contains a number of inaccuracies, some minor and some not so minor.  Dr. Karp  advocates for parents to use reclining swings for infants.  While this practice undoubtedly helps some children sleep, devices like these are not recommended by the experts at the AAP since they have not been tested for safety and may not be a safe sleep surface”.  ( 1)  Longtime listeners to the DocSmo blog already know this.  Check for yourself on the AAP guidelines. Dr. Karp also advocates pacifier use for older children because he believes and that states that the number of children developing a mal shaped mouth is greater from children who suck their thumbs than those who use a pacifier.  The opposite is actually true.( 2)  Finally, our biggest criticism of Dr. Karp’s advice; he repeatedly talks about the importance of a sleep ritual and self soothing for older infants and children but he won’t quite advocate for one that truly allows a child to become an independent sleeper at night.  Just listen to his major advice like “dream feeds” (waking an older child to feed them at night so they will sleep), or “wake+sleep” (allow your child to fall asleep with their parents rocking or feeding them but briefly wake them and let them fall asleep on their own).  Dr. Karp, the reality is that children can truly learn to sleep through the night, starting at around 4-6 months of age, without their parents feeding or rocking them, if a good sleep ritual is established at that age. Why not just encourage parents in that direction instead of pretending they are independent at night with tricks like “dream feeds” and “wake+sleep”?  The reality is that “dream feeds” teach children to eat at night and “wake +sleep” teach children to need their parents to fall asleep at night instead of being independent.

For those reasons, we feel that, while a valuable edition to anyone’s knowledge about sleep in young children, The Happiest Baby Guide to Great Sleep falls short on the most important advice that parents need who have young children.  We therefore are only giving it a 2.5 out of a possible 5 DocSmo stars.

Thanks for blogging with Doc Smo.  Your comments are always welcome on iTunes or my website www.docsmo.com.  Here’s hoping that your cute little peeps, are always getting a good night sleep.  Until next time.

Smo Notes:

  1. http://www.onondagachildfatalityreview.com/pdf/AAP-guidelines.pdf
  2. http://www.aafp.org/afp/2009/0415/p681.html

Written collaboratively by Angela Solis and Paul Smolen M.D.

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