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Angelique Millette, PhD, CLE, CD/PCD - Guest
Angelique Millette is a parent-child coach, pediatric sleep consultant, and family sleep researcher. Angelique’s diverse background includes training in child play, art, and nature therapies, child development and sleep, and work as a child psychologist. Her commitment to children and parents spans twenty-five years and she continues to develop programs to meet families “where they are at.” Her approach allows her to work with diverse communities both nationally and internationally. Angelique has developed The Millette Method™ a multi-disciplinary approach to family sleep and child behavior. The Millette Method™ does not follow one specific sleep or behavioral method, but rather uses a “tool-box” of different methods and approaches and takes into account various factors including child temperament and history, culture, family social support, access to nature/play, parental overwhelm, history of trauma, and parent/child mental health and wellness. Angelique has worked with more than 15,000 families, and presents professional workshops to non-profits, government agencies, Fortune 500 companies, universities, and parents groups across the country and internationally. She also consults with juvenile products manufacturers in their development of innovative sleep and child development designs. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, PsyD: (00:22)
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. Today I'll be speaking with Dr. Angelique Millet, who is a parent, child coach, pediatric sleep consultant, and family sleep researcher. Dr. Millet's. Diverse background includes training in child play, art and nature therapies, child development and sleep, and work as a child psychologist. Her commitment to children and parents spans 25 years, and she continues to develop programs to meet families where they're at. Her approach allows her to work with diverse communities, both nationally and internationally. Angelique has developed the Millet method, a multidisciplinary approach to family sleep and child behavior. The Millet method does not follow one specific sleep or behavioral method, but rather uses a toolbox of different methods and approaches and takes into account various factors including child temperament in history, culture, family, social support, access to nature play, parental overwhelm, history of trauma, and parent-child mental health and wellness. Angelique has worked with more than 15,000 families and presents professional workshops to nonprofits, government agencies, Fortune 500 companies, universities, and parent groups across the country and internationally. Angelique also consults with juvenile products manufacturers in their development of innovative sleep and child development designs. Let's listen to the interview. Well, hi Angelique. Thanks for joining us today.
Angelique Millette, PhD, CLE, CD/PCD: (02:00)
Hey, Keith, thanks so much for having me. It was great to get the invite and I'm pleased to be here today.
Keith Sutton, PsyD: (02:05)
Yeah, definitely. So I've known about your work for some years. When I had my own children and we had little kids, you know, a number of different people used your services. I forgot if we might've gotten some consultation from you at one point - and I ended up kind of getting on your email list. And so I've seen the work that you've been doing over time and I had a couple that I'm working with and they're struggling with their children's sleep. And that's affecting, you know, kind of adding to the difficulties in the relationship. And I was just thinking it would be interesting to have you on.I know there's different perspectives on sleep with children, sleep with infants, and then also sleep issues that come up more generally. Sleep is so important related to health and memory consolidation and all sorts of things. So I just thought it would be a really interesting topic. So I wanna get into all that, but first, I always like to hear about, you know, how you got doing what you're doing. What was kind of your evolution of your thinking to get where you are today?
Angelique Millette, PhD, CLE, CD/PCD: (03:08)
Well, I love answering this question because certainly there were a lot of historical doors that opened to get me here. I started out as a midwife, then worked my way - that was in my early twenties - and then worked my way into a birth doula and postpartum doula. Basically means I was there for families as they were giving birth, and then I would spend time with them postpartum weeks or even months helping them as they made that transition of parenthood. And as I was doing that work - that would be in my early twenties - I like to joke that I did not party in my twenties, I was helping babies sleep at night. I was just deeply fascinated by how families made that transition to parenthood and familyhood. And my field work was sleeping on the floors of these families' homes and the kids' babies' nursery. There were all kinds of families that I worked with, all kinds of babies, all kinds of birth complications, feeding, digestion issues, and the list goes on. I was just a bright eyed, deeply curious, interested 20 year old, who just wanted to understand this area, this space of where insomniac parents, sleep deprivation parents, depression, anxiety, how the couple, if it was a couple or parent navigated all of the particulars around that transition. And then you add in how this little baby develops and bonds, is feeding and how they start to come into their little bodies. So I saw sleep as this lens into this sort of portal to understand a lot of different aspects about that transition. And when I started to look at the research, so that would've been, I'm gonna be 50 this year, so that was almost 30 years ago. So I've been doing this sleep research for roughly 25 years. When I was looking at the research, I was surprised to find that most of the research was rather dated. It was looking at a sleep method called ‘extinction cried out’, which is a method where you put a baby down at bedtime or even a child and you don't return until the morning. And the idea is that you extinguish, which is a very interesting word to use, but you extinguish the cries, extinguish the needs, extinguish the fears. The research was sparse to say the least. It was dated. I was just shocked to find out there was nothing out there that was really answering the questions I was asking. A lot of parents were asking about, well, what's really happening with sleep? So, the interesting thing is, I would try to get out to professional conferences as I was building my interest in the field, I would try to start teaching about what I'm seeing in the field and see if there's other folks doing the same. The response was, well, “Sleep's not important. We're just not getting any interest in sleep.” So this would've been in the nineties. “We're not getting any interest in sleep. There's other topics, but that's not the one - we get no interest in sleep.” Boy, have things changed, right? In 20, 25 years. So I just put my nose in the grindstone and just kept that field work up and developed what I call now the Millet method, which is pulling from all these different disciplines and modalities to understand how a child's temperament, their history, even their birth, early development, their developmental milestones, growth spurts, how they separate from their caregivers, you know, what's historically imprinted that separation? Even looking at aspects of the parents' fertility before they even have this baby. If they have multiple losses. How that informs the parents thinking around separating sleep. It turns out for babies and for kids it’s about separating. It's process of slow separation from the caregiver that takes place not in a straight line, it's not linear, but it's quite new and fluid. So that really started to inform the method I was looking, of course, at demographic, culture, whether the family feels supported by their community, their biological family, their family of origin, so to speak. Are they from another country parenting in this country for the first time? Without outgoing support. What complications have arisen in their lives, medical or events that inform their feelings of safety or security, because that informs how they see their child's wellbeing. And that's just to name a few mental health issues we look at. And then I started to develop this toolbox of different methods because it's not one size fits all. Extinction wasn't going to work. To me, extinction is rather outdated. It looks at sleep as if that's the problem baby, the problem child ,manipulating the parent and the parent's failing and all if they have to just buck up, just get tough and then rise and then they'll be unsuccessful. And I don't think that paradigm is helpful. I’ll close the chapter on that. It's probably how we look to sleep and we're gonna look at it from a really different perspective. The toolbox allows me to use all kinds of different methods and then I can modify the method based on those variables I just shared with you to really fit what the family needs. It's not the problem child or the problem parent, it's that family going through some kind of transition. Getting their needs met as a family and sleep is that portal that gets them to pick up the phone and call me.
Keith Sutton, PsyD: (08:54)
Oh, great. Yeah. And sleep is so important because postpartum depression is so significantly related to lack of sleep. And, you know, particularly I do a lot of work with couples and in emotionally focused couples therapy there's the concept of attachment injury. And oftentimes there's a lot of attachment injuries in the relationship during this time of the birth of the first child. And, you know, the Gottman research on 68% of couples having a significant decrease in their satisfaction relationship. There's all these kinds of things that are happening as well as of course the child's attachment and learning to soothe and so on. It's such an important piece. And I'd be interested in hearing you talk a little bit about what the different kinds of philosophies are? There's the philosophy of ‘cry it out’, but I know there are different philosophies too. There's attachment parenting, things like that. Can you speak a little bit about the range of ways that folks think about it? And then I'd love to hear how you kind of integrate.
Angelique Millette, PhD, CLE, CD/PCD: (09:58)
Oh, yeah. I would like to do that because I think it's so helpful in terms of thinking about how to match a method to a client. I'll say there's not a perfect method for any one person, but there will be a good enough sleep method for this child, for this family etc. So we look at sleep methods based on parent proximity, meaning how close is the parent in proximity to their child as they're doing the method. Crying, is there a range of crying that's gonna take place from say a no/low cry up to say crying? Then of course I look at what I call responsiveness as a variable, which means is the parent doing a lot to jump in or is the parent holding back a little bit, giving that child space. And so we'll chart those basically on a graph to really figure out what's gonna be the best fit for this family. And then we'll take that a step further. And when I say we, I have a team of 10 that I've trained in this work, their masters, PhD level, they're counselors, nurses, lactation consultants who have a real deep love, passion, and focus for this work as well. They see the range of dynamics that I bring to the work and use with their families that they're supporting. So, I would say for babies, we're looking at some approaches that range between very low crying. I think it's clever marketing to say no cry. I know there's books written that's say no cry, but I think that
Keith Sutton, PsyD: (11:23)
Yeah, I think here is kind of a camp out there that, you know, kind of, you're not wanting the baby to cry at all. You're wanting to make sure that they're going to feel abandoned or they're, you know. Is that kind of the perspective or what is the perspective with the no cry approach?
Angelique Millette, PhD, CLE, CD/PCD: (11:38)
I think that came largely out as the antithesis to the Cry it Out program. Because that was really all that was available. So when, I believe it was Elizabeth Pantley that coined the term. Don’t quote me on that, I can double check, but I think Pantley was one of the folks that coined it. It was basically a no cry method, which was: Hey, for those folks that don't wanna do a cry it out program, here's a no cry. My problem with it is that it ends up being that parents take that in and they think that no cry means that they've been successful at parenting. That their entire job is to get their little one to stop crying. And the truth is, babies cry.
Keith Sutton, PsyD: (12:22)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (12:23)
For all unexplained reasons. Talk to a parent that's had a baby with colic or reflux, which is about 35% of parents, a third of the parents just right off the bat, have no powers of predictability. They're just gonna have a baby that cries a lot.
Keith Sutton, PsyD: (12:38)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (12:40)
No matter what they do.
Keith Sutton, PsyD: (12:41)
It's not, it's not necessarily their fault or they're doing something right or wrong, it's sometimes just something that's, that's gonna happen. Particularly with colicky and gassiness and so on. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (12:51)
That's it. That they're just gonna cry a little bit more. So,I think that ‘no cry’ term came out of that. I prefer to say ‘Low Cry’ because I think it delineates between say a sleep training method where we let a baby cry versus a more hands-on jumping in and, and doing some soothing or comforting techniques. So for example, I developed this method over 25 years ago called the Rinse and Repeat method. I'm gonna say it's a pickup and put down and shush path. It isn't a ‘low cry’ method. It's not a sleep training method, meaning the parent stays with their newborn baby. They offer a lot more padding, shush and comforting. Looking at sleep signs. They're capturing these things called sleep windows where the baby has an optimum time to fall asleep. And they have this release of sleep hormones to get to sleep. And if a parent can identify those signs and then facilitate that entry to sleep, the baby's gonna have a little easier time falling asleep. And
Keith Sutton, PsyD: (13:50)
And that actually makes me think too… A lot of the early years are coming back now. My kids are eight right now, but, I think I recall that in the first three or four months, you kind of maybe didn't worry so much about them not sleeping through the night yet because their body weight is a certain weight. But that idea of staying attuned for the sleep signs and noticing and then kind of helping them gradually and then putting them down when they're just about to go to sleep or such. Sometimes I think about it too, even for adults. It's almost like we're walking down the stairs to sleep. Sometimes we need to wind down and read a book or relax a little or, you know, rather than just doing a bunch of work and then getting in bed or something, you kind of have to take those steps down to sleep.
Angelique Millette, PhD, CLE, CD/PCD: (14:43)
Well. And then of course, the part of that entryway for, especially for new parents, but it could also be for a second, third or fourth time parent. I get plenty of parents that say, “Hey, it's my third time at this, what's going on? I don't, I can't solve this sleep thing.” That every kid is different. Their temperaments are different. And so as a parent, you know, again, powers is predictability. You don't know what kind of baby you're gonna get. That is the juicy part of parenting, you're just on a wild ride.
Keith Sutton, PsyD: (15:08)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (15:10)
Not so juicy when you're missing out on sleeping, going, wait a second, you're very vocal, you cry a lot, you need constant movement to sleep. And maybe that's a second time parent. They said the first one just slept. We thought we were great parents. We just thought, you know…
Keith Sutton, PsyD: (15:26)
“We're amazing at this!”
Angelique Millette, PhD, CLE, CD/PCD: (15:28)
We were judging our friends and kids that sleep saying, “why can't they figure this out?” And then they get the second kid that's like, needs constant movement, needs a lot of shushing dark room, talking, the parents are literally just bouncing for hours going “oh, we're humbled”. So I think part of the work is to teach parents that these little ones have their own temperament and they're quite robust even at birth that temperament is wired in. So that ‘no/low cry’ method I developed, the rinse and repeat, is gonna be about identifying sleep windows and looking at the temperament of the baby. Even looking at their birth history. We've certainly seen this and the research is starting to bear it out that babies that have a lot of complications at birth or a lot of interventions at birth tend to have a lot more to vocalize and say about it later. Not always, but the research is bearing out that they may have some trouble with sleep later. The other thing we're looking at is, like I said, that one third of little ones are gonna have that collic reflex. Looking at how comfortable they are in their bodies. I don't believe in doing any crying related program until they start to develop some settling. Their circadian rhythms aren't even fully developed at birth. The idea that a sleep consultant would come in and sleep-train a two week old, when their circadian rhythm, which is like knowing the difference between day and night, isn’t even fully developed, doesn’t make sense to me. And so we really wanna shift this into thinking about that first three or four months, like what you've just described, that fourth trimester is a time when they're landing. They are developing a circadian rhythm or body clock similar to us where we are awake during the day, we sleep at night. Believe it or not, those newborns are having bowel movements all night long, right? And first time parent will say, “Hey, is this ever gonna stop? Do I just do poopy diapers all night?” Yes, and no (respectively)! Because their circadian rhythms start to match ours. And by two to four months of age, you stop having poopy diapers at night. Nobody is up at night pooping, right? Yeah. It's the same concept. So there's this educational piece with especially the first time parents. Really walking them into understanding, “Hey, this is what your little one's body is doing”.
Keith Sutton, PsyD: (17:37)
Yeah. So some of that psychoeducation around kind of where you are and where you're going.
Angelique Millette, PhD, CLE, CD/PCD: (17:40)
That's exactly right. Identifying the sleep windows that are the signs that your little one gives you that they're starting to fall asleep. And helping parents capture that sleep window so it's easier to get them to sleep. Teaching about swaddling, and then talking a little bit about what we call the five self-soothing signs. These are the signs that little ones develop as they start to work their way towards becoming better at self-regulation. I think the layman's term is self-soothing. I think a good word for it is self-regulation. Every single person that walks this earth over the course of their early life had to learn these inherent self-regulation tools and skills. And they happen on various scales. I won't go into that, but we help parents identify those because they help us know when a baby is moving out of the newborn stage into a baby stage of sleep. And then we can start to introduce the interval method, which is a good method.
Keith Sutton, PsyD: (18:40)
Sure. Wait, I wanna find out what those Self-soothing signs are.
Angelique Millette, PhD, CLE, CD/PCD: (18:44)
Okay. Well let's talk about those. So there's five that I've identified in that work, those 10 years where I didn't sleep in my twenties. I watched all these little ones develop these signs. So the first one would be hands, fingers to mouth. A newborn doesn't have any self-control. The proprioceptive system is that sort of startle reflex. And you just look at them and say “okay, you're helpless” and they just kind of shake, right? Then they start to develop some more fluid self-control and they'll bring their fingers to mouth. And that is a self-regulation piece that's that fetal clock. So that's self soothing sign number one. The second one is that if you're holding a baby that's starting to get tired, they will have a natural reflux that starts to develop at two to four months, where they burrow or bury or burrow into your armpit, chest area. And they're doing this because they're trying to turn away from all the interesting stimuli in their environment that grows the brain, but in order to sleep, if they just kept tracking that they would melt down and become overstimulated.
Keith Sutton, PsyD: (19:47)
Too stimulating.
Angelique Millette, PhD, CLE, CD/PCD: (19:49)
So they start to have this reflex where they wanna get into a dark cocoon-y kind of thing, typically into the caregiver's body. They'll even try to bite or suck on the inner arm or neck. They'll nurse if that's available. And the idea is that they want to turn their attention away, and settle to sleep and self-soothe. So that's our second self-soothing sign. The third is the bringing hands to the midline position. You'll see this in the womb. Where they'll try to hold their little hands in the center of their body. Midline is a self-regulating position. A lot of us will try to sleep in that fetal type position where we have some kind of hand or arm moved into the middle of the body to bring relaxation and calm.
Keith Sutton, PsyD: (20:33)
Oh interesting.
Angelique Millette, PhD, CLE, CD/PCD: (20:33)
Yeah. There's two more signs. One of the two is the self-soothing cry. Newborns meltdown when they're getting tired, and certainly when they're overtired. But these 2, 3, 4 months of age, they start to develop a new cry. It sounds like this, it's really obnoxious when I do it, but nevertheless, here it is. It's this, “uh, uh” it's like a squeaky door fussing. It's not a meltdown cry. Every one of you adults listening to this made that cry when you were a baby. To relax yourselves and sleep. And I encourage parents when I'm teaching these sleep classes, you know, “tonight when you're going to sleep, close your eyes and make that sound”. Even for like 10 seconds. It sounds silly, but you'll feel your body and your nervous system start to just relax.
Keith Sutton, PsyD: (21:25)
Yeah. It's almost like a humming it sounds like.
Angelique Millette, PhD, CLE, CD/PCD: (21:27)
And you're feeling, as I talk about it now, there's this thing that happens with that sound in the baby's body and you, like I said, every one of us did that. That helps the nervous system, helps it discharge, self-regulate, and get ready for sleep.
Keith Sutton, PsyD: (21:40)
Interesting. It's also reminding me of this baby whisperer. They talked about like, you know, how all babies have similar cries in the beginning. I remember, it was like, “nah, nah” means like, hungry or something. And you can kind of begin to, I don't know if there's anything to that.
Angelique Millette, PhD, CLE, CD/PCD: (22:02)
Absolutely. They do make these various intonations and there's this syllable to the cry that can give parents some information about what they need. And this particular cry is happening as they are finishing up a time of play or wake or alertness and their body is getting ready to go to sleep. If we don't pay attention, if we miss the cry, they now go into a meltdown cry, which is, “Hey, I'm over tired, it's too much. Now I really need your help to get me to sleep”. You try it, you know, close your eyes at bedtime tonight, make that sound for like 10, 20 seconds and you will actually feel your body just relax. So they make that sound again, it's starting between two to four months. And then the last of the five self soothing signs is rolling to the side, rolling to the tummy. That one tends to come together closer to 3, 4, 5 months of age. Nevertheless, it's a really important milestone. The literature is clear. Always put a baby on their back for sleeping. And this is because of the very clear research on, on SID sudden infant death. It's a scary topic. Nevertheless, we wanna tell our listeners about it and share that it's always back sleeping. I, I can't say enough that it's, it's demonstrable research and efficacy of back sleeping, being safe. However, it's not a natural position for babies to be in. In fact it's a highly unnatural position for babies to be in. And this is why a lot of parents will say, “my baby fight sleep”. The position that babies are in, in the womb is the C-curve. The uterus holds that baby in that position quite tightly. In fact, that is the body swaddle. C-curve meaning that they're in a C (shape) and their body isn't naturally held in a fetal tuck. That baby feels very safe and secure. Putting a baby on their back to sleep is a very, uh, exposed vulnerable position.
Keith Sutton, PsyD: (23:55)
Yeah. They're like, open.
Angelique Millette, PhD, CLE, CD/PCD: (23:57)
That's it. So this is why we recommend safe swaddling technique to mimic that. What we are calling the fourth trimester rate is essentially mimicking the uterus. The womb. That is now, because they can't control that hands to midline position now, it's happening with the facilitation of the swaddle. And that baby now can feel self-regulated to settle, to sleep, to relax, to sleep. So in effect, once the baby starts to roll or move, it is no longer safe for them to be in the swaddle position, to be swaddled. They need to have their hands free. But quite frankly, they're going to move into a sleep position of their own choosing.
Keith Sutton, PsyD: (24:36)
That's when you go into sleep sacs.
Angelique Millette, PhD, CLE, CD/PCD: (24:39)
That's exactly right. Now a sleep sac means their hands are free so they can safely push off the mattress to find their sleep position of choice, which is very often side or even tummy position. And I'm talking about a classic crib sleeping arrangement. I work with all kinds of demographics, all kinds of families. Families that will also follow safe co-sleeping, which I wanna really talk about if we have time because that is there as well. I'm talking about the classic crib sleeping position and the idea is that the baby's now going to roll into a position of their own choosing, which actually facilitates sleep as well. Because just like us, they wanna be in a position that they wanna be in. That they chosen to get themselves into for sleep.
Keith Sutton, PsyD: (25:22)
Definitely
Angelique Millette, PhD, CLE, CD/PCD: (25:24)
Doesn't affect self cleaning signs.
Keith Sutton, PsyD: (25:25)
Yeah. And I think this is right, I mean, I've conceptualized also. I've got one family right now where the son is now in kindergarten and the mother had always laid with him in bed till he went to sleep and then gotten up. She is transitioning, I think he was sleeping in their room also. So transitioning into his own room and so on. And, the part I was kind of also encouraging as helping with the sleep training is helping to develop that self soothing, you know, those emotional regulation kind of pieces. That self-regulation through that process of kind of helping the kids learning how to sleep on their own, at whatever age that may be, depending on the family's culture, whatever it might be. Because sometimes it is a hard period and it is a transition that brings up a lot of distress in the parents too. So sometimes it's just easier to just lay down with them and go to sleep with them or whatever it might be.
Angelique Millette, PhD, CLE, CD/PCD: (26:24)
That's right. That's right. It begs the question is there a magic time? Is there a preferred time? Have you missed a window if you don't sleep train? And the truth is, there's no researcher data that supports any of that. Anybody that tells a parent, you have to do it by this age, you have to do it by this and the baby is this weight, there's no science at all that supports that. It's totally made up.
Keith Sutton, PsyD: (26:50)
Yeah. Oh, interesting.
Angelique Millette, PhD, CLE, CD/PCD: (26:52)
No, there's not a single look of research or science to support any of it. I say to parents, it has everything to do with thesort of the path this family is taking in sleep and self care.
Keith Sutton, PsyD: (27:03)
You could speak on that and, and before we get into the interval technique. How do you think about that or how do you know when families are looking for recommendations? I know you're saying based on culture and on family preferences of whether they're gonna co-sleep, whether they're gonna have the bassinet in the bedroom with them? Whether they're going to have the child in a separate room or a crib or such, or whether they'll be sleeping in the bed until they're in elementary school or older.
Angelique Millette, PhD, CLE, CD/PCD: (27:37)
I would say that the answer really lies within the family. Every family will answer that question a little differently. If we're looking at the science,I always, I always like to quote this when I'm teaching classes, there's just as many studies that show that go sleeping leads to super confident independent adults. And then just as many studies that show that it hindered. It's not one of those variables. There's just as many studies that show that co-sleeping, or pardon me, that sleep training rather, - same outcomes. So I say to families, you know, really the answer is, “you're gonna make this choice based on what's gonna work individually for your family”. So that's the first starting point is to start to answer their question. Are the parents getting their needs met with the sleep arrangement? Is the child getting their needs met? And I'm not just talking about good sleep, I'm talking about bonding family connection for the couple. Then we can go through a whole list of those kinds of questions for each family individually. Typically, by the time a family picks up the phone to call me, they're at what I call a crossroads moment. Yeah. Again, I'm working with zero to 10 year olds. They've usually come to a crossroads moment saying, “Hey, this isn't working for us this current way.” And I would say that the new generation of parents are quite savvy. They're using a lot of social media to educate themselves. So they, for example, have seen the research from the American Academy of Pediatrics recommending room sharing with your baby for the first six months at least. And this is really interesting because when I first started doing this, 20, 25 years ago, the recommendation was to get that baby to sleep in the crib in another room. Otherwise you'll never get 'em out of your room. And these sorts of things, you follow that journey of thought. There was no science behind it whatsoever. It was just a recommendation based on a deep emphasis, cultural emphasis here in the US on early independence. Now what we've found, and this is I would say credit to the really interesting work from James McKenna. he's an anthropologist who looks at sleep through that lens. He has sleep labs where parents co-sleep. And he found that, in fact, there were reduced incidents of what we'll call trigger breathing heart rate issues and newborns and young babies when the parents slept in proximity to their baby. Meaning that they were in the same room. Something is happening, we're not sure, but there's some kind of regulation that's taking place in the early mechanisms of breathing and heart rate in that baby when the caregiver is close by. They're literally regulating off the caregivers presence, which is probably the simplest way to describe it.
Keith Sutton, PsyD: (30:34)
So some of that like polyvagal theory, which is the idea that a nervous system is taking in information from other nervous systems around us.
Angelique Millette, PhD, CLE, CD/PCD: (30:43)
You've got it. We're attachment beings. Babies develop and the sleep wasn't any different. It was so important in fact that the American Academy of Pediatrics, the AAP and their newest release of information said, I believe it was even 2015. It's even dated in that way. They said, “let's at least room share”. They're not gonna go out and say anything about co-sleeping, but they're saying let's share, keep that bassinet next to your bed at least for six months and if you can up to 12 months.
Keith Sutton, PsyD: (31:14)
Wow.
Angelique Millette, PhD, CLE, CD/PCD: (31:15)
Which is a profound shift over 25 years of doing this work. A profound shift. And it's a testament to so much great research coming out, looking at all these variables we're talking about today.
Keith Sutton, PsyD: (31:27)
Great. Okay. And then you mentioned there was a comment maybe on safe co-sleeping if the child is sleeping in the bed.
Angelique Millette, PhD, CLE, CD/PCD: (31:36)
That's correct. So when I looked at the research on co-sleeping and of course working with co-sleeping parents, I felt like there was a disconnect between what the AAP was recommending, which is zero tolerance co-sleeping. It doesn’t distinguish between bed sharing versus not bed sharing. With Bed sharing because the baby's in the bed, but the parent SIDS risk, last from zero to 12 months of age and the highest risk of SIDS is between two to four months of age. Which coincidentally happens to be a time when there's a lot of development. And so the deal here is that the research shows that US up to 80% of families will co-sleep bed-share and room-share with their little ones from zero to three years of age. And then given my field work, I've worked with over 10,000 families over these years, what I started to realize is the left hand's not targeting the right hand. I'm not really gonna do my best job of facilitating sleep solutions with families if I go across the board just say, well there's no bed sharing. So then those families are actually gonna continue without reliable safety measures. So there, Kathleen Kendall Tackett, is a fabulous researcher who has put together safe guidelines for co-sleeping. She's also a breastfeeding advocate because the truth is for those breastfeeding wounds, a lot of them will initiate bed sharing. And she's putting out a list of co-sleeping or bed sharing safety guidelines, that I think they're probably quite logical. It's like, don't drink and co-sleep, don't drink and bring your baby to bed.
Keith Sutton, PsyD: (33:19)
Yes, yes.
Angelique Millette, PhD, CLE, CD/PCD: (33:20)
Don't bring your pets to bed if your baby's in bed with you. Don't do drugs. So she started to really tease out in her research the families that were bed sharing, with a lot of know, education, and of course information about how to do it. Versus like an unsafe bed sharing.. You know, it still is controversial in this country, but the truth is there are a lot of families that are bringing babies to bed.
Keith Sutton, PsyD: (33:48)
Yeah, definitely. Okay.
Angelique Millette, PhD, CLE, CD/PCD: (33:50)
And there are a lot of families that aren't bringing babies to bed because they're terrified of doing it and they're putting babies in unsafe sleeping contraptions. And in fact, in my practice of 25 years, the families that have experienced a SIDS loss, unfortunately it's happened, have been families where they've haven't been beding, but the family thought that, okay, if I sleep on the sofa recliner, put them in this special sleep contraption. Yeah. It'll be safe. It'll be safe. Yeah. So my point is, if you're gonna do some bed sharing, go look for Kathleen Kendall Tack. It works. If you've got a family member or friend doing it, make sure they're empowered and educated with safe sleeping strategies for bed sharing.
Keith Sutton, PsyD: (34:29)
Great. Now one of the things that you also mentioned earlier was the responsiveness location and the crying. Can you say more? I don't know if that ties in with the interval kind of approach.
Angelique Millette, PhD, CLE, CD/PCD: (34:44)
So, interval method is the only crying method that I'll use for a baby. I don't do any crying methods, by crying, I mean we're letting them do a little bit of crying. I delay the start of any crying methods until they're at least 16 to 21 weeks of age or older, and they have demonstrated to us they've organized at least four out of five of those self-soothing signs that we talked about. I think that's just the clearest way to start to understand what, what this little baby can do. It also helps us start to tease out a sleep issue versus like the newborn stage of transition where our parents like, I'm not sleeping. We're not, we just don't wanna sleep train newborns because their circadian rhythms are not developed. There's filling up this, what I call bank of attachment, getting their needs met consistently building security resiliency through those first months, their bowels are learning to move bowel movements. So the interval method is a method that works in three to seven nights versus the rinse and repeat method I touched on earlier that I did. That takes about four to six weeks. It's a slow, gradual separation between baby and parent, and that's for a parent that's philosophically opposed to any crying or maybe baby's four months and younger where they're just too young to start a crying program. Maybe they have health issues and a range of other reasons why we might use that method. But for a parent that calls me and says, “Hey, we're really sleep deprived and I'm struggling with some depression because of the sleep loss, or I'm headed back to work, or I'm ignoring literally my family and my own self care, my other kids because it's taking me hours to help my baby sleep”. We might consider this interval method with some caveats, some modifications I've made to it. I'm a breastfeeding educator and there's no research that says you have to extinguish all breastfeeding to be successful with sleep training. Using interval methods, that's just, again, debunking these myths that are perpetuated in the sleep work. You can absolutely be successful at breastfeeding a baby at night and then also getting rem sleep cycles linked up at night. So we'll use this interval method. Well, let's just, for example, say we have a four to six month old, we might identify one or two, maybe even three feeds at night that are what we call good full feeds. You can use the method at bedtime and through the night to link up those sleep cycles outside of the feed. And that method would take three to seven nights so it can resolve that sleep loss in particular for families that are really exhausted fairly quickly. They can implement that method and get pretty good results with minimal crying, I have found, and we do the method side of growth spurts of developmental phases as well. We want to make sure we're not doing it if like the mom is going back to work, we don't start that night.
Keith Sutton, PsyD: (37:29)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (37:30)
We find a period of time where it's opportune for the, in particular for mom and baby, to make that transition or the, the caregiver that's spending the most time. Sometimes we've had the other parent is doing a lot of the feeding at night, so we have to have parent that's
Keith Sutton, PsyD: (37:43)
We're kind of creating a schedule so that the baby is kind of full throughout the night and, and not necessarily having to wake up and cry and then come.
Angelique Millette, PhD, CLE, CD/PCD: (37:51)
It's for sure a schedule, but we're tracking data before he’s started to find that baby's opportune body clock. Let's say that the baby wants to fall asleep at six o'clock, but the parents always heard 7:00 PM was the bedtime. Then we educate them about, “Hey, that's just what your baby needs”. That baby is having five feeds at night. But we determined through a period of assessment, we collect data that the baby's kind of snacking. I just worked with the family and the baby would have 10 feeds at night.
Keith Sutton, PsyD: (38:23)
Wow.
Angelique Millette, PhD, CLE, CD/PCD: (38:24)
But they were on the bottle and we explored further. They were taking one ounce each time. This family was up all night, but they were relegated to this “Hey, well this, this is how this baby likes to eat”. There were no medical issues. What was happening is the baby got habituated. They came to expect every time they woke up, just have a little hit of milk, a pacifier, there's no nutritional (value).
Keith Sutton, PsyD: (38:48)
Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (38:48)
So again, it's just that we wanna track that data ahead of time so I can really understand this baby, this baby's body clock. I work with toddlers too. They're not feeding at night and that's even a whole other conversation about their clocks as well and what their developmental needs are. So we collect that data and then it helps me understand where to set up the feeds at night and where to implement the method. And then, I don't work on naps and nights at the same time. Again, no science that shows that how a little one sleeps during the day has to be identical to how they sleep at night. And that research is so clear just anecdotally. Look across the world: there's little ones sleeping in a daycare program or pram or grandparents' arms and then they sleep alone in their own room in a crib. So again, it's debunking myths, giving parents time to read…
Keith Sutton, PsyD: (39:37)
The thing that I didn't know or learned was that actually the better naps that the child has, oftentimes the better they do at night. Rather than like some people worrying that like, oh, if the baby sleeps during the day, they're not gonna sleep during the night or something like that.
Angelique Millette, PhD, CLE, CD/PCD: (39:50)
Yeah. I would say that parents are largely starting to understand how important daytime sleep. It's the time when babies and toddlers file away the information that they've organized and learned. During the week hours they use sleep time to file it away.
Keith Sutton, PsyD: (40:05)
Yeah. Cause when it's such an important part of sleep neurologically is consolidating memory. Um, right?
Angelique Millette, PhD, CLE, CD/PCD: (40:12)
That's right
Keith Sutton, PsyD: (40:13)
Especially for babies. Yeah. They're, it's almost like they're needing to consolidate every few hours or so.
Angelique Millette, PhD, CLE, CD/PCD: (40:19)
That's right. That's right. The sleep is important. During the day, just as is at night,
Keith Sutton, PsyD: (40:26)
I remember when our kids were little, we had been taught kind of to, you know, kind of soothe them, you know, put them down to bed, not a hundred percent asleep, and then kind of a little less, a little less, and they'd get more used to falling asleep on their own and then maybe kind of coming and checking in, soothing a little bit, stepping out, leaving, letting a little crying happen, coming back. I don't know if that's kind of a particular approach or how that, you know, to give some crying, but not necessarily kind of just, okay, you're done. We're just gonna go outta here and just leave.
Angelique Millette, PhD, CLE, CD/PCD: (40:59)
So that is the interval method you're describing, which is apparent checking at intervals meaning you go in for about a minute, use the minute to check in, but you're not feeding, you're not handling a bunch, it's just a quick check-in and then you leave after a minute no matter what state the baby's in. Yeah. I would, the hardest part of the method the leaving them after that minute. Yeah. It's not easy to do, but what tends to happen is they use the self-soothing that we just described, and by giving them a little space, they actually start to take over the job by getting themselves to sleep.
Keith Sutton, PsyD: (41:29)
Yeah. Remember we used to have to set the timer and like just force ourselves not to go back in. And then oftentimes by the time the timer went off, they would, the, the baby had fallen asleep. But it's hard. It's hard to listen to a baby crying and not wanting to run in and, and just, you know, relieve that suffering. Something that was interesting too, when my children were toddlers, was that I had read Alicia Lieberman's, The Emotional Life of the Toddler. And she talked about how sometimes children have to have their tantrum and go down to the depth of their emotions and come out. Sometimes you can give them a hug or you can soothe them out, but sometimes they just need to go through that process. And that later on learning about exposure therapy and cognitive behavioral therapy, that idea of actually sitting with that discomfort riding that wave, rather than like, “oh no, we have to prevent that discomfort at all costs”. It really starts from the sleeping, you know, and I imagine too in how families are responding to distress in the children.
Angelique Millette, PhD, CLE, CD/PCD: (42:30)
Oh, I, I would agree with you wholeheartedly. A whole area of my focus, especially with toddlers sleep, is really educating parents about that this is a feeling state for your little one. They're having feelings. This is not a reflection of poor parenting. It doesn't mean there's something wrong with your child. They're expressing feelings and then really buffering the parent and helping them with breathing and staying grounded during that cycle. It could last two minutes, it could last 10 minutes. But in fact that it's a healthy extinguish, it's like a healthy release for that one. And in fact it does help them to sleep. I don't know how much time we have to talk about the toddler approach that I use…
Keith Sutton, PsyD: (43:10)
We've got about like eight minutes or so. I would love to hear about that. We use a combination of like little rewards or like, you know, checking in every, “I'll be back in 10 minutes”. Oftentimes they'd fall back asleep before you or even timeouts of not sitting like, “okay, let's go” and then come on back and like resetting. But yeah, how do you do that?
Angelique Millette, PhD, CLE, CD/PCD: (43:30)
Well, so the, the toddler method I developed was largely informed by my work as a child psychologist. And my area of expertise was play therapy, sand tray and art therapy. Which basically means that you use these modalities to help little ones with feelings, events, traumatic events. And what I found was that generally speaking, even really young kiddos, toddlers weren't walled up, like adults were. They could play and they'd sort of work through emotions or their histories that way or their events that were traumatic. And what I did is I developed this two phase approach out of that work because the popular sleep method at that time was to just lock the door. Throw some reward at them, but lock the door and let them really, screen until they sleep. Mind you with a toddler that could get out of bed or climb out of a crib. Which to me, maybe after, you know, 2, 3, 4 hours they slept. But I saw this as a power struggle and I don't think they had learned anything. I was much more interested based on my work and the research, “how do we develop a sleep method that supports a secure attachment between the parent and the child?”. But as we do the method the parent separates still. There's still this limit setting separation piece. Because again, we understand that that's a big part over the arch of childhood, this separation. So a two phase approach. I start using it for little ones as young as eight to 10 months as they start to age out of those baby methods that I use somewhere around eight to 10 months of age. And then we're gonna call that the pre toddler stage into the toddler stage and then the child stage. The first stage of this approach, I teach parents very simple play based in storytelling activities. Because kids learn through play and through language they're primed for it. They're primed to understand their role through play and through language. Activities are very simple, they're easy to teach. I teach parents these little activities. They'll spend about 10 or 15 minutes a day doing them with their pre toddlers, toddlers and young kids. The theme of those activities is separation and sleep. For example, one game we have parents play is hide and seek. Very simple hide and seek seeker peekaboo in the child's room. Which as a parent, we think that's happening as a random act. It's not - your child is practicing separating and reuniting from you when they play that game. They're trying to hold the feeling of you, “oh, you're still there, I can't see you. Where'd you go? You're back! Thank goodness. You're, you're back.” So we have parents play those games. 50% of the children will spontaneously improve their sleep after one week of playing those games with their parents.
Keith Sutton, PsyD: (46:12)
Oh wow. Great.
Angelique Millette, PhD, CLE, CD/PCD: (46:13)
Which is just phenomenal to me. It's really shifting this paradigm again. So parents start to see the kids play as not random but purposeful.
Keith Sutton, PsyD: (46:23)
Yeah. They're building, they're working on skills or they're working through something or
Angelique Millette, PhD, CLE, CD/PCD: (46:27)
It's just integrating separation. Perhaps they've got a fear about the parent leaving. Perhaps something happened to make them scared about the parent leaving. Perhaps they've never slept alone, ever. So we wanna prepare them for that separation and the parent too, who may have a lot of anxiety about the separation for all kinds of reasons.
Keith Sutton, PsyD: (46:43)
Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (46:44)
So we do that 50% of the kids will improve sleep just simply from doing the play and the storytelling with them, which is amazing. And then the other 50% will start phase two. Phase two is a parent presence method called the ‘chair mattress method’. A parent presence methods, remember that parent presence means we're not just having the parent check on them and leave, check on them and leave. That would freak a toddler out. With this method, the parent actually moves into the child's room and sleeps on a mattress by the crib or the child's bed. We give the child what they want, which is the parent. What that does is it creates a positive feedback loop with the child's bed in the room as a safe place to sleep. And now the cortisol levels go down, the child feels safe to learn and safe to sleep. And then over the course of five to 10 nights, we move the parent a little further, a little further away. It's a slow fading of the parent presence in the room. Until parent gets to the doorway, then hallway and then parents back at their room. We're seeing phenomenal results with this. Especially five to 10 year olds who for all kinds of reasons have had sleep issues. They're not having hours long tantrums at bedtime or at night. Now parents can actually separate from them and have a little couple’s time, sleep, and actually get the sleep that they need at night. Those parents will say, “Gosh, I feel like I have a newborn again. My eight-year-old let me leave.” Now those parents can get their sleep, get some couples time and the child can separate and feel safe to separate at sleep time.
Keith Sutton, PsyD: (48:10)
Mm-hmm, great.
Angelique Millette, PhD, CLE, CD/PCD: (48:12)
It's a really dynamic approach. I am very proud of it because it just captures this whole other shift in the work. Stepping out of the paradigm of, again, that toddler that's manipulating the parent. Which I don't believe is true at all. It has much more credence on looking at “What is this little one feeling when they separate?” How do we buffer them in giving them skills to feel safe to separate from the parent that I feel are gonna be skill sets for life? They separate at kindergarten. They separate at play date, they separate when they go to college, they're now separating in a romantic relationship. How do they feel at that separation now?
Keith Sutton, PsyD: (48:49)
Yeah. Are they kind of holding that person still in their heart and feeling, you know, that kinda object, permanency or whatever it might be.
Angelique Millette, PhD, CLE, CD/PCD: (48:56)
That's right. That's right.
Keith Sutton, PsyD: (48:57)
Not experiencing that distress that this person is not there in separation. Also kind of building that muscle to feel that discomfort and kind of having that experience that, that it works out and it's okay. And, and so on
Angelique Millette, PhD, CLE, CD/PCD: (49:11)
A common response when they're doing the activities in phase one, the child might say, “I can't do this, or I scared” or throw the doll that we're doing this play therapy with. Or run out of the the room and I say to the parents not that they're gonna fail at, they're not telling you they are going to fail at sleep changes, they're saying to you, “I have feelings”. That's what we call resistance or emotions coming up. So then it's empowering the parents to say, “Hey, I see you understand what I'm talking about. You're talking about you and I not seeing each other at night.”
Keith Sutton, PsyD: (49:39)
Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (49:40)
Yeah. I hold you in my heart right here and thank you for telling me how you feel about the changes. I'll hold it in my heart for you. I'll be right here to help you make these changes.
Keith Sutton, PsyD: (49:50)
Reminds me of a, what was that book? The Kissing Hand? You know, the toddler and the parent kissing their hand and then kind of being able to, you know, turn to it during the day when the parent's not there.
Angelique Millette, PhD, CLE, CD/PCD: (50:01)
That's it.
Keith Sutton, PsyD: (50:03)
Well this all is so great and interesting. I think it's such an important aspect and I think there's, you know, that that definitely it sounds like you're saying that a lot of people are getting maybe some education on their own beforehand, maybe even before needing to reach out and get the, the help or the consultation when the kind of crisis is happening. Do you have resources that you have of kind of, you know, preempting or is there a book or any trainings or workshops that you do for parents?
Angelique Millette, PhD, CLE, CD/PCD: (50:32)
What we have available are pre-recorded webinars. At a very affordable price. They're under $50. They're an hour long. They'll talk you through the program. Some families will utilize that alone. And they never work with me individually and they get great results. Some families will review that, they try it, but they still have additional questions and then they'll reach out to me for additional consultation and then I can really strategize to figure out where they're getting hung up with the method. The website is www.angeliquemillette.com. We are doing a fabulous website update. We'll roll that out late March and we'll have all sorts of additional resources there for parents to interact with. But for the time being, all those webinars are hanging out on that website and parents can purchase some there and access that information on a range of topics.
Keith Sutton, PsyD: (51:27)
Perfect. Well, I think this will be a great, you know, information for therapists that are helping families and also I think just again, thinking about attachment and kind of development as well as so many therapists are parents and going through this process themselves. So this is really helpful. I really appreciate you taking the time today. Thanks a lot.
Angelique Millette, PhD, CLE, CD/PCD: (51:47)
Oh, Keith, it was my pleasure. You can see I'm passionate about this topic and really like the opportunity to share it with you and other folks out there. Thanks for having me. I really appreciate it.
Keith Sutton, PsyD: (51:57)
Great. Thanks a lot. Take care. Bye-bye.
Angelique Millette, PhD, CLE, CD/PCD: (52:00)
Bye now.
Keith Sutton, PsyD: (52:01)
Thank you for joining us. If you're wanting to use this podcast to earn continuing education credits, please go to our website at therapyonthecuttingedge.com. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, providing in-person and remote therapy in the San Francisco Bay Area. IAP provides screening for licensed clinicians through our in-person and online programs, as well as our treatment for children, adolescents, families, couples, and individual adults. For more information, go to sfiap.com or call (415) 617-5932. Also, we really appreciate feedback and if you have something you're interested in, something that's on the cutting edge of the field of therapy and think clinicians should know about it, send us an email or call us. We're always looking for the advancements in the field of psychotherapy to help in creating lasting changes for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. Today I'll be speaking with Dr. Angelique Millet, who is a parent, child coach, pediatric sleep consultant, and family sleep researcher. Dr. Millet's. Diverse background includes training in child play, art and nature therapies, child development and sleep, and work as a child psychologist. Her commitment to children and parents spans 25 years, and she continues to develop programs to meet families where they're at. Her approach allows her to work with diverse communities, both nationally and internationally. Angelique has developed the Millet method, a multidisciplinary approach to family sleep and child behavior. The Millet method does not follow one specific sleep or behavioral method, but rather uses a toolbox of different methods and approaches and takes into account various factors including child temperament in history, culture, family, social support, access to nature play, parental overwhelm, history of trauma, and parent-child mental health and wellness. Angelique has worked with more than 15,000 families and presents professional workshops to nonprofits, government agencies, Fortune 500 companies, universities, and parent groups across the country and internationally. Angelique also consults with juvenile products manufacturers in their development of innovative sleep and child development designs. Let's listen to the interview. Well, hi Angelique. Thanks for joining us today.
Angelique Millette, PhD, CLE, CD/PCD: (02:00)
Hey, Keith, thanks so much for having me. It was great to get the invite and I'm pleased to be here today.
Keith Sutton, PsyD: (02:05)
Yeah, definitely. So I've known about your work for some years. When I had my own children and we had little kids, you know, a number of different people used your services. I forgot if we might've gotten some consultation from you at one point - and I ended up kind of getting on your email list. And so I've seen the work that you've been doing over time and I had a couple that I'm working with and they're struggling with their children's sleep. And that's affecting, you know, kind of adding to the difficulties in the relationship. And I was just thinking it would be interesting to have you on.I know there's different perspectives on sleep with children, sleep with infants, and then also sleep issues that come up more generally. Sleep is so important related to health and memory consolidation and all sorts of things. So I just thought it would be a really interesting topic. So I wanna get into all that, but first, I always like to hear about, you know, how you got doing what you're doing. What was kind of your evolution of your thinking to get where you are today?
Angelique Millette, PhD, CLE, CD/PCD: (03:08)
Well, I love answering this question because certainly there were a lot of historical doors that opened to get me here. I started out as a midwife, then worked my way - that was in my early twenties - and then worked my way into a birth doula and postpartum doula. Basically means I was there for families as they were giving birth, and then I would spend time with them postpartum weeks or even months helping them as they made that transition of parenthood. And as I was doing that work - that would be in my early twenties - I like to joke that I did not party in my twenties, I was helping babies sleep at night. I was just deeply fascinated by how families made that transition to parenthood and familyhood. And my field work was sleeping on the floors of these families' homes and the kids' babies' nursery. There were all kinds of families that I worked with, all kinds of babies, all kinds of birth complications, feeding, digestion issues, and the list goes on. I was just a bright eyed, deeply curious, interested 20 year old, who just wanted to understand this area, this space of where insomniac parents, sleep deprivation parents, depression, anxiety, how the couple, if it was a couple or parent navigated all of the particulars around that transition. And then you add in how this little baby develops and bonds, is feeding and how they start to come into their little bodies. So I saw sleep as this lens into this sort of portal to understand a lot of different aspects about that transition. And when I started to look at the research, so that would've been, I'm gonna be 50 this year, so that was almost 30 years ago. So I've been doing this sleep research for roughly 25 years. When I was looking at the research, I was surprised to find that most of the research was rather dated. It was looking at a sleep method called ‘extinction cried out’, which is a method where you put a baby down at bedtime or even a child and you don't return until the morning. And the idea is that you extinguish, which is a very interesting word to use, but you extinguish the cries, extinguish the needs, extinguish the fears. The research was sparse to say the least. It was dated. I was just shocked to find out there was nothing out there that was really answering the questions I was asking. A lot of parents were asking about, well, what's really happening with sleep? So, the interesting thing is, I would try to get out to professional conferences as I was building my interest in the field, I would try to start teaching about what I'm seeing in the field and see if there's other folks doing the same. The response was, well, “Sleep's not important. We're just not getting any interest in sleep.” So this would've been in the nineties. “We're not getting any interest in sleep. There's other topics, but that's not the one - we get no interest in sleep.” Boy, have things changed, right? In 20, 25 years. So I just put my nose in the grindstone and just kept that field work up and developed what I call now the Millet method, which is pulling from all these different disciplines and modalities to understand how a child's temperament, their history, even their birth, early development, their developmental milestones, growth spurts, how they separate from their caregivers, you know, what's historically imprinted that separation? Even looking at aspects of the parents' fertility before they even have this baby. If they have multiple losses. How that informs the parents thinking around separating sleep. It turns out for babies and for kids it’s about separating. It's process of slow separation from the caregiver that takes place not in a straight line, it's not linear, but it's quite new and fluid. So that really started to inform the method I was looking, of course, at demographic, culture, whether the family feels supported by their community, their biological family, their family of origin, so to speak. Are they from another country parenting in this country for the first time? Without outgoing support. What complications have arisen in their lives, medical or events that inform their feelings of safety or security, because that informs how they see their child's wellbeing. And that's just to name a few mental health issues we look at. And then I started to develop this toolbox of different methods because it's not one size fits all. Extinction wasn't going to work. To me, extinction is rather outdated. It looks at sleep as if that's the problem baby, the problem child ,manipulating the parent and the parent's failing and all if they have to just buck up, just get tough and then rise and then they'll be unsuccessful. And I don't think that paradigm is helpful. I’ll close the chapter on that. It's probably how we look to sleep and we're gonna look at it from a really different perspective. The toolbox allows me to use all kinds of different methods and then I can modify the method based on those variables I just shared with you to really fit what the family needs. It's not the problem child or the problem parent, it's that family going through some kind of transition. Getting their needs met as a family and sleep is that portal that gets them to pick up the phone and call me.
Keith Sutton, PsyD: (08:54)
Oh, great. Yeah. And sleep is so important because postpartum depression is so significantly related to lack of sleep. And, you know, particularly I do a lot of work with couples and in emotionally focused couples therapy there's the concept of attachment injury. And oftentimes there's a lot of attachment injuries in the relationship during this time of the birth of the first child. And, you know, the Gottman research on 68% of couples having a significant decrease in their satisfaction relationship. There's all these kinds of things that are happening as well as of course the child's attachment and learning to soothe and so on. It's such an important piece. And I'd be interested in hearing you talk a little bit about what the different kinds of philosophies are? There's the philosophy of ‘cry it out’, but I know there are different philosophies too. There's attachment parenting, things like that. Can you speak a little bit about the range of ways that folks think about it? And then I'd love to hear how you kind of integrate.
Angelique Millette, PhD, CLE, CD/PCD: (09:58)
Oh, yeah. I would like to do that because I think it's so helpful in terms of thinking about how to match a method to a client. I'll say there's not a perfect method for any one person, but there will be a good enough sleep method for this child, for this family etc. So we look at sleep methods based on parent proximity, meaning how close is the parent in proximity to their child as they're doing the method. Crying, is there a range of crying that's gonna take place from say a no/low cry up to say crying? Then of course I look at what I call responsiveness as a variable, which means is the parent doing a lot to jump in or is the parent holding back a little bit, giving that child space. And so we'll chart those basically on a graph to really figure out what's gonna be the best fit for this family. And then we'll take that a step further. And when I say we, I have a team of 10 that I've trained in this work, their masters, PhD level, they're counselors, nurses, lactation consultants who have a real deep love, passion, and focus for this work as well. They see the range of dynamics that I bring to the work and use with their families that they're supporting. So, I would say for babies, we're looking at some approaches that range between very low crying. I think it's clever marketing to say no cry. I know there's books written that's say no cry, but I think that
Keith Sutton, PsyD: (11:23)
Yeah, I think here is kind of a camp out there that, you know, kind of, you're not wanting the baby to cry at all. You're wanting to make sure that they're going to feel abandoned or they're, you know. Is that kind of the perspective or what is the perspective with the no cry approach?
Angelique Millette, PhD, CLE, CD/PCD: (11:38)
I think that came largely out as the antithesis to the Cry it Out program. Because that was really all that was available. So when, I believe it was Elizabeth Pantley that coined the term. Don’t quote me on that, I can double check, but I think Pantley was one of the folks that coined it. It was basically a no cry method, which was: Hey, for those folks that don't wanna do a cry it out program, here's a no cry. My problem with it is that it ends up being that parents take that in and they think that no cry means that they've been successful at parenting. That their entire job is to get their little one to stop crying. And the truth is, babies cry.
Keith Sutton, PsyD: (12:22)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (12:23)
For all unexplained reasons. Talk to a parent that's had a baby with colic or reflux, which is about 35% of parents, a third of the parents just right off the bat, have no powers of predictability. They're just gonna have a baby that cries a lot.
Keith Sutton, PsyD: (12:38)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (12:40)
No matter what they do.
Keith Sutton, PsyD: (12:41)
It's not, it's not necessarily their fault or they're doing something right or wrong, it's sometimes just something that's, that's gonna happen. Particularly with colicky and gassiness and so on. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (12:51)
That's it. That they're just gonna cry a little bit more. So,I think that ‘no cry’ term came out of that. I prefer to say ‘Low Cry’ because I think it delineates between say a sleep training method where we let a baby cry versus a more hands-on jumping in and, and doing some soothing or comforting techniques. So for example, I developed this method over 25 years ago called the Rinse and Repeat method. I'm gonna say it's a pickup and put down and shush path. It isn't a ‘low cry’ method. It's not a sleep training method, meaning the parent stays with their newborn baby. They offer a lot more padding, shush and comforting. Looking at sleep signs. They're capturing these things called sleep windows where the baby has an optimum time to fall asleep. And they have this release of sleep hormones to get to sleep. And if a parent can identify those signs and then facilitate that entry to sleep, the baby's gonna have a little easier time falling asleep. And
Keith Sutton, PsyD: (13:50)
And that actually makes me think too… A lot of the early years are coming back now. My kids are eight right now, but, I think I recall that in the first three or four months, you kind of maybe didn't worry so much about them not sleeping through the night yet because their body weight is a certain weight. But that idea of staying attuned for the sleep signs and noticing and then kind of helping them gradually and then putting them down when they're just about to go to sleep or such. Sometimes I think about it too, even for adults. It's almost like we're walking down the stairs to sleep. Sometimes we need to wind down and read a book or relax a little or, you know, rather than just doing a bunch of work and then getting in bed or something, you kind of have to take those steps down to sleep.
Angelique Millette, PhD, CLE, CD/PCD: (14:43)
Well. And then of course, the part of that entryway for, especially for new parents, but it could also be for a second, third or fourth time parent. I get plenty of parents that say, “Hey, it's my third time at this, what's going on? I don't, I can't solve this sleep thing.” That every kid is different. Their temperaments are different. And so as a parent, you know, again, powers is predictability. You don't know what kind of baby you're gonna get. That is the juicy part of parenting, you're just on a wild ride.
Keith Sutton, PsyD: (15:08)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (15:10)
Not so juicy when you're missing out on sleeping, going, wait a second, you're very vocal, you cry a lot, you need constant movement to sleep. And maybe that's a second time parent. They said the first one just slept. We thought we were great parents. We just thought, you know…
Keith Sutton, PsyD: (15:26)
“We're amazing at this!”
Angelique Millette, PhD, CLE, CD/PCD: (15:28)
We were judging our friends and kids that sleep saying, “why can't they figure this out?” And then they get the second kid that's like, needs constant movement, needs a lot of shushing dark room, talking, the parents are literally just bouncing for hours going “oh, we're humbled”. So I think part of the work is to teach parents that these little ones have their own temperament and they're quite robust even at birth that temperament is wired in. So that ‘no/low cry’ method I developed, the rinse and repeat, is gonna be about identifying sleep windows and looking at the temperament of the baby. Even looking at their birth history. We've certainly seen this and the research is starting to bear it out that babies that have a lot of complications at birth or a lot of interventions at birth tend to have a lot more to vocalize and say about it later. Not always, but the research is bearing out that they may have some trouble with sleep later. The other thing we're looking at is, like I said, that one third of little ones are gonna have that collic reflex. Looking at how comfortable they are in their bodies. I don't believe in doing any crying related program until they start to develop some settling. Their circadian rhythms aren't even fully developed at birth. The idea that a sleep consultant would come in and sleep-train a two week old, when their circadian rhythm, which is like knowing the difference between day and night, isn’t even fully developed, doesn’t make sense to me. And so we really wanna shift this into thinking about that first three or four months, like what you've just described, that fourth trimester is a time when they're landing. They are developing a circadian rhythm or body clock similar to us where we are awake during the day, we sleep at night. Believe it or not, those newborns are having bowel movements all night long, right? And first time parent will say, “Hey, is this ever gonna stop? Do I just do poopy diapers all night?” Yes, and no (respectively)! Because their circadian rhythms start to match ours. And by two to four months of age, you stop having poopy diapers at night. Nobody is up at night pooping, right? Yeah. It's the same concept. So there's this educational piece with especially the first time parents. Really walking them into understanding, “Hey, this is what your little one's body is doing”.
Keith Sutton, PsyD: (17:37)
Yeah. So some of that psychoeducation around kind of where you are and where you're going.
Angelique Millette, PhD, CLE, CD/PCD: (17:40)
That's exactly right. Identifying the sleep windows that are the signs that your little one gives you that they're starting to fall asleep. And helping parents capture that sleep window so it's easier to get them to sleep. Teaching about swaddling, and then talking a little bit about what we call the five self-soothing signs. These are the signs that little ones develop as they start to work their way towards becoming better at self-regulation. I think the layman's term is self-soothing. I think a good word for it is self-regulation. Every single person that walks this earth over the course of their early life had to learn these inherent self-regulation tools and skills. And they happen on various scales. I won't go into that, but we help parents identify those because they help us know when a baby is moving out of the newborn stage into a baby stage of sleep. And then we can start to introduce the interval method, which is a good method.
Keith Sutton, PsyD: (18:40)
Sure. Wait, I wanna find out what those Self-soothing signs are.
Angelique Millette, PhD, CLE, CD/PCD: (18:44)
Okay. Well let's talk about those. So there's five that I've identified in that work, those 10 years where I didn't sleep in my twenties. I watched all these little ones develop these signs. So the first one would be hands, fingers to mouth. A newborn doesn't have any self-control. The proprioceptive system is that sort of startle reflex. And you just look at them and say “okay, you're helpless” and they just kind of shake, right? Then they start to develop some more fluid self-control and they'll bring their fingers to mouth. And that is a self-regulation piece that's that fetal clock. So that's self soothing sign number one. The second one is that if you're holding a baby that's starting to get tired, they will have a natural reflux that starts to develop at two to four months, where they burrow or bury or burrow into your armpit, chest area. And they're doing this because they're trying to turn away from all the interesting stimuli in their environment that grows the brain, but in order to sleep, if they just kept tracking that they would melt down and become overstimulated.
Keith Sutton, PsyD: (19:47)
Too stimulating.
Angelique Millette, PhD, CLE, CD/PCD: (19:49)
So they start to have this reflex where they wanna get into a dark cocoon-y kind of thing, typically into the caregiver's body. They'll even try to bite or suck on the inner arm or neck. They'll nurse if that's available. And the idea is that they want to turn their attention away, and settle to sleep and self-soothe. So that's our second self-soothing sign. The third is the bringing hands to the midline position. You'll see this in the womb. Where they'll try to hold their little hands in the center of their body. Midline is a self-regulating position. A lot of us will try to sleep in that fetal type position where we have some kind of hand or arm moved into the middle of the body to bring relaxation and calm.
Keith Sutton, PsyD: (20:33)
Oh interesting.
Angelique Millette, PhD, CLE, CD/PCD: (20:33)
Yeah. There's two more signs. One of the two is the self-soothing cry. Newborns meltdown when they're getting tired, and certainly when they're overtired. But these 2, 3, 4 months of age, they start to develop a new cry. It sounds like this, it's really obnoxious when I do it, but nevertheless, here it is. It's this, “uh, uh” it's like a squeaky door fussing. It's not a meltdown cry. Every one of you adults listening to this made that cry when you were a baby. To relax yourselves and sleep. And I encourage parents when I'm teaching these sleep classes, you know, “tonight when you're going to sleep, close your eyes and make that sound”. Even for like 10 seconds. It sounds silly, but you'll feel your body and your nervous system start to just relax.
Keith Sutton, PsyD: (21:25)
Yeah. It's almost like a humming it sounds like.
Angelique Millette, PhD, CLE, CD/PCD: (21:27)
And you're feeling, as I talk about it now, there's this thing that happens with that sound in the baby's body and you, like I said, every one of us did that. That helps the nervous system, helps it discharge, self-regulate, and get ready for sleep.
Keith Sutton, PsyD: (21:40)
Interesting. It's also reminding me of this baby whisperer. They talked about like, you know, how all babies have similar cries in the beginning. I remember, it was like, “nah, nah” means like, hungry or something. And you can kind of begin to, I don't know if there's anything to that.
Angelique Millette, PhD, CLE, CD/PCD: (22:02)
Absolutely. They do make these various intonations and there's this syllable to the cry that can give parents some information about what they need. And this particular cry is happening as they are finishing up a time of play or wake or alertness and their body is getting ready to go to sleep. If we don't pay attention, if we miss the cry, they now go into a meltdown cry, which is, “Hey, I'm over tired, it's too much. Now I really need your help to get me to sleep”. You try it, you know, close your eyes at bedtime tonight, make that sound for like 10, 20 seconds and you will actually feel your body just relax. So they make that sound again, it's starting between two to four months. And then the last of the five self soothing signs is rolling to the side, rolling to the tummy. That one tends to come together closer to 3, 4, 5 months of age. Nevertheless, it's a really important milestone. The literature is clear. Always put a baby on their back for sleeping. And this is because of the very clear research on, on SID sudden infant death. It's a scary topic. Nevertheless, we wanna tell our listeners about it and share that it's always back sleeping. I, I can't say enough that it's, it's demonstrable research and efficacy of back sleeping, being safe. However, it's not a natural position for babies to be in. In fact it's a highly unnatural position for babies to be in. And this is why a lot of parents will say, “my baby fight sleep”. The position that babies are in, in the womb is the C-curve. The uterus holds that baby in that position quite tightly. In fact, that is the body swaddle. C-curve meaning that they're in a C (shape) and their body isn't naturally held in a fetal tuck. That baby feels very safe and secure. Putting a baby on their back to sleep is a very, uh, exposed vulnerable position.
Keith Sutton, PsyD: (23:55)
Yeah. They're like, open.
Angelique Millette, PhD, CLE, CD/PCD: (23:57)
That's it. So this is why we recommend safe swaddling technique to mimic that. What we are calling the fourth trimester rate is essentially mimicking the uterus. The womb. That is now, because they can't control that hands to midline position now, it's happening with the facilitation of the swaddle. And that baby now can feel self-regulated to settle, to sleep, to relax, to sleep. So in effect, once the baby starts to roll or move, it is no longer safe for them to be in the swaddle position, to be swaddled. They need to have their hands free. But quite frankly, they're going to move into a sleep position of their own choosing.
Keith Sutton, PsyD: (24:36)
That's when you go into sleep sacs.
Angelique Millette, PhD, CLE, CD/PCD: (24:39)
That's exactly right. Now a sleep sac means their hands are free so they can safely push off the mattress to find their sleep position of choice, which is very often side or even tummy position. And I'm talking about a classic crib sleeping arrangement. I work with all kinds of demographics, all kinds of families. Families that will also follow safe co-sleeping, which I wanna really talk about if we have time because that is there as well. I'm talking about the classic crib sleeping position and the idea is that the baby's now going to roll into a position of their own choosing, which actually facilitates sleep as well. Because just like us, they wanna be in a position that they wanna be in. That they chosen to get themselves into for sleep.
Keith Sutton, PsyD: (25:22)
Definitely
Angelique Millette, PhD, CLE, CD/PCD: (25:24)
Doesn't affect self cleaning signs.
Keith Sutton, PsyD: (25:25)
Yeah. And I think this is right, I mean, I've conceptualized also. I've got one family right now where the son is now in kindergarten and the mother had always laid with him in bed till he went to sleep and then gotten up. She is transitioning, I think he was sleeping in their room also. So transitioning into his own room and so on. And, the part I was kind of also encouraging as helping with the sleep training is helping to develop that self soothing, you know, those emotional regulation kind of pieces. That self-regulation through that process of kind of helping the kids learning how to sleep on their own, at whatever age that may be, depending on the family's culture, whatever it might be. Because sometimes it is a hard period and it is a transition that brings up a lot of distress in the parents too. So sometimes it's just easier to just lay down with them and go to sleep with them or whatever it might be.
Angelique Millette, PhD, CLE, CD/PCD: (26:24)
That's right. That's right. It begs the question is there a magic time? Is there a preferred time? Have you missed a window if you don't sleep train? And the truth is, there's no researcher data that supports any of that. Anybody that tells a parent, you have to do it by this age, you have to do it by this and the baby is this weight, there's no science at all that supports that. It's totally made up.
Keith Sutton, PsyD: (26:50)
Yeah. Oh, interesting.
Angelique Millette, PhD, CLE, CD/PCD: (26:52)
No, there's not a single look of research or science to support any of it. I say to parents, it has everything to do with thesort of the path this family is taking in sleep and self care.
Keith Sutton, PsyD: (27:03)
You could speak on that and, and before we get into the interval technique. How do you think about that or how do you know when families are looking for recommendations? I know you're saying based on culture and on family preferences of whether they're gonna co-sleep, whether they're gonna have the bassinet in the bedroom with them? Whether they're going to have the child in a separate room or a crib or such, or whether they'll be sleeping in the bed until they're in elementary school or older.
Angelique Millette, PhD, CLE, CD/PCD: (27:37)
I would say that the answer really lies within the family. Every family will answer that question a little differently. If we're looking at the science,I always, I always like to quote this when I'm teaching classes, there's just as many studies that show that go sleeping leads to super confident independent adults. And then just as many studies that show that it hindered. It's not one of those variables. There's just as many studies that show that co-sleeping, or pardon me, that sleep training rather, - same outcomes. So I say to families, you know, really the answer is, “you're gonna make this choice based on what's gonna work individually for your family”. So that's the first starting point is to start to answer their question. Are the parents getting their needs met with the sleep arrangement? Is the child getting their needs met? And I'm not just talking about good sleep, I'm talking about bonding family connection for the couple. Then we can go through a whole list of those kinds of questions for each family individually. Typically, by the time a family picks up the phone to call me, they're at what I call a crossroads moment. Yeah. Again, I'm working with zero to 10 year olds. They've usually come to a crossroads moment saying, “Hey, this isn't working for us this current way.” And I would say that the new generation of parents are quite savvy. They're using a lot of social media to educate themselves. So they, for example, have seen the research from the American Academy of Pediatrics recommending room sharing with your baby for the first six months at least. And this is really interesting because when I first started doing this, 20, 25 years ago, the recommendation was to get that baby to sleep in the crib in another room. Otherwise you'll never get 'em out of your room. And these sorts of things, you follow that journey of thought. There was no science behind it whatsoever. It was just a recommendation based on a deep emphasis, cultural emphasis here in the US on early independence. Now what we've found, and this is I would say credit to the really interesting work from James McKenna. he's an anthropologist who looks at sleep through that lens. He has sleep labs where parents co-sleep. And he found that, in fact, there were reduced incidents of what we'll call trigger breathing heart rate issues and newborns and young babies when the parents slept in proximity to their baby. Meaning that they were in the same room. Something is happening, we're not sure, but there's some kind of regulation that's taking place in the early mechanisms of breathing and heart rate in that baby when the caregiver is close by. They're literally regulating off the caregivers presence, which is probably the simplest way to describe it.
Keith Sutton, PsyD: (30:34)
So some of that like polyvagal theory, which is the idea that a nervous system is taking in information from other nervous systems around us.
Angelique Millette, PhD, CLE, CD/PCD: (30:43)
You've got it. We're attachment beings. Babies develop and the sleep wasn't any different. It was so important in fact that the American Academy of Pediatrics, the AAP and their newest release of information said, I believe it was even 2015. It's even dated in that way. They said, “let's at least room share”. They're not gonna go out and say anything about co-sleeping, but they're saying let's share, keep that bassinet next to your bed at least for six months and if you can up to 12 months.
Keith Sutton, PsyD: (31:14)
Wow.
Angelique Millette, PhD, CLE, CD/PCD: (31:15)
Which is a profound shift over 25 years of doing this work. A profound shift. And it's a testament to so much great research coming out, looking at all these variables we're talking about today.
Keith Sutton, PsyD: (31:27)
Great. Okay. And then you mentioned there was a comment maybe on safe co-sleeping if the child is sleeping in the bed.
Angelique Millette, PhD, CLE, CD/PCD: (31:36)
That's correct. So when I looked at the research on co-sleeping and of course working with co-sleeping parents, I felt like there was a disconnect between what the AAP was recommending, which is zero tolerance co-sleeping. It doesn’t distinguish between bed sharing versus not bed sharing. With Bed sharing because the baby's in the bed, but the parent SIDS risk, last from zero to 12 months of age and the highest risk of SIDS is between two to four months of age. Which coincidentally happens to be a time when there's a lot of development. And so the deal here is that the research shows that US up to 80% of families will co-sleep bed-share and room-share with their little ones from zero to three years of age. And then given my field work, I've worked with over 10,000 families over these years, what I started to realize is the left hand's not targeting the right hand. I'm not really gonna do my best job of facilitating sleep solutions with families if I go across the board just say, well there's no bed sharing. So then those families are actually gonna continue without reliable safety measures. So there, Kathleen Kendall Tackett, is a fabulous researcher who has put together safe guidelines for co-sleeping. She's also a breastfeeding advocate because the truth is for those breastfeeding wounds, a lot of them will initiate bed sharing. And she's putting out a list of co-sleeping or bed sharing safety guidelines, that I think they're probably quite logical. It's like, don't drink and co-sleep, don't drink and bring your baby to bed.
Keith Sutton, PsyD: (33:19)
Yes, yes.
Angelique Millette, PhD, CLE, CD/PCD: (33:20)
Don't bring your pets to bed if your baby's in bed with you. Don't do drugs. So she started to really tease out in her research the families that were bed sharing, with a lot of know, education, and of course information about how to do it. Versus like an unsafe bed sharing.. You know, it still is controversial in this country, but the truth is there are a lot of families that are bringing babies to bed.
Keith Sutton, PsyD: (33:48)
Yeah, definitely. Okay.
Angelique Millette, PhD, CLE, CD/PCD: (33:50)
And there are a lot of families that aren't bringing babies to bed because they're terrified of doing it and they're putting babies in unsafe sleeping contraptions. And in fact, in my practice of 25 years, the families that have experienced a SIDS loss, unfortunately it's happened, have been families where they've haven't been beding, but the family thought that, okay, if I sleep on the sofa recliner, put them in this special sleep contraption. Yeah. It'll be safe. It'll be safe. Yeah. So my point is, if you're gonna do some bed sharing, go look for Kathleen Kendall Tack. It works. If you've got a family member or friend doing it, make sure they're empowered and educated with safe sleeping strategies for bed sharing.
Keith Sutton, PsyD: (34:29)
Great. Now one of the things that you also mentioned earlier was the responsiveness location and the crying. Can you say more? I don't know if that ties in with the interval kind of approach.
Angelique Millette, PhD, CLE, CD/PCD: (34:44)
So, interval method is the only crying method that I'll use for a baby. I don't do any crying methods, by crying, I mean we're letting them do a little bit of crying. I delay the start of any crying methods until they're at least 16 to 21 weeks of age or older, and they have demonstrated to us they've organized at least four out of five of those self-soothing signs that we talked about. I think that's just the clearest way to start to understand what, what this little baby can do. It also helps us start to tease out a sleep issue versus like the newborn stage of transition where our parents like, I'm not sleeping. We're not, we just don't wanna sleep train newborns because their circadian rhythms are not developed. There's filling up this, what I call bank of attachment, getting their needs met consistently building security resiliency through those first months, their bowels are learning to move bowel movements. So the interval method is a method that works in three to seven nights versus the rinse and repeat method I touched on earlier that I did. That takes about four to six weeks. It's a slow, gradual separation between baby and parent, and that's for a parent that's philosophically opposed to any crying or maybe baby's four months and younger where they're just too young to start a crying program. Maybe they have health issues and a range of other reasons why we might use that method. But for a parent that calls me and says, “Hey, we're really sleep deprived and I'm struggling with some depression because of the sleep loss, or I'm headed back to work, or I'm ignoring literally my family and my own self care, my other kids because it's taking me hours to help my baby sleep”. We might consider this interval method with some caveats, some modifications I've made to it. I'm a breastfeeding educator and there's no research that says you have to extinguish all breastfeeding to be successful with sleep training. Using interval methods, that's just, again, debunking these myths that are perpetuated in the sleep work. You can absolutely be successful at breastfeeding a baby at night and then also getting rem sleep cycles linked up at night. So we'll use this interval method. Well, let's just, for example, say we have a four to six month old, we might identify one or two, maybe even three feeds at night that are what we call good full feeds. You can use the method at bedtime and through the night to link up those sleep cycles outside of the feed. And that method would take three to seven nights so it can resolve that sleep loss in particular for families that are really exhausted fairly quickly. They can implement that method and get pretty good results with minimal crying, I have found, and we do the method side of growth spurts of developmental phases as well. We want to make sure we're not doing it if like the mom is going back to work, we don't start that night.
Keith Sutton, PsyD: (37:29)
Yeah. Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (37:30)
We find a period of time where it's opportune for the, in particular for mom and baby, to make that transition or the, the caregiver that's spending the most time. Sometimes we've had the other parent is doing a lot of the feeding at night, so we have to have parent that's
Keith Sutton, PsyD: (37:43)
We're kind of creating a schedule so that the baby is kind of full throughout the night and, and not necessarily having to wake up and cry and then come.
Angelique Millette, PhD, CLE, CD/PCD: (37:51)
It's for sure a schedule, but we're tracking data before he’s started to find that baby's opportune body clock. Let's say that the baby wants to fall asleep at six o'clock, but the parents always heard 7:00 PM was the bedtime. Then we educate them about, “Hey, that's just what your baby needs”. That baby is having five feeds at night. But we determined through a period of assessment, we collect data that the baby's kind of snacking. I just worked with the family and the baby would have 10 feeds at night.
Keith Sutton, PsyD: (38:23)
Wow.
Angelique Millette, PhD, CLE, CD/PCD: (38:24)
But they were on the bottle and we explored further. They were taking one ounce each time. This family was up all night, but they were relegated to this “Hey, well this, this is how this baby likes to eat”. There were no medical issues. What was happening is the baby got habituated. They came to expect every time they woke up, just have a little hit of milk, a pacifier, there's no nutritional (value).
Keith Sutton, PsyD: (38:48)
Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (38:48)
So again, it's just that we wanna track that data ahead of time so I can really understand this baby, this baby's body clock. I work with toddlers too. They're not feeding at night and that's even a whole other conversation about their clocks as well and what their developmental needs are. So we collect that data and then it helps me understand where to set up the feeds at night and where to implement the method. And then, I don't work on naps and nights at the same time. Again, no science that shows that how a little one sleeps during the day has to be identical to how they sleep at night. And that research is so clear just anecdotally. Look across the world: there's little ones sleeping in a daycare program or pram or grandparents' arms and then they sleep alone in their own room in a crib. So again, it's debunking myths, giving parents time to read…
Keith Sutton, PsyD: (39:37)
The thing that I didn't know or learned was that actually the better naps that the child has, oftentimes the better they do at night. Rather than like some people worrying that like, oh, if the baby sleeps during the day, they're not gonna sleep during the night or something like that.
Angelique Millette, PhD, CLE, CD/PCD: (39:50)
Yeah. I would say that parents are largely starting to understand how important daytime sleep. It's the time when babies and toddlers file away the information that they've organized and learned. During the week hours they use sleep time to file it away.
Keith Sutton, PsyD: (40:05)
Yeah. Cause when it's such an important part of sleep neurologically is consolidating memory. Um, right?
Angelique Millette, PhD, CLE, CD/PCD: (40:12)
That's right
Keith Sutton, PsyD: (40:13)
Especially for babies. Yeah. They're, it's almost like they're needing to consolidate every few hours or so.
Angelique Millette, PhD, CLE, CD/PCD: (40:19)
That's right. That's right. The sleep is important. During the day, just as is at night,
Keith Sutton, PsyD: (40:26)
I remember when our kids were little, we had been taught kind of to, you know, kind of soothe them, you know, put them down to bed, not a hundred percent asleep, and then kind of a little less, a little less, and they'd get more used to falling asleep on their own and then maybe kind of coming and checking in, soothing a little bit, stepping out, leaving, letting a little crying happen, coming back. I don't know if that's kind of a particular approach or how that, you know, to give some crying, but not necessarily kind of just, okay, you're done. We're just gonna go outta here and just leave.
Angelique Millette, PhD, CLE, CD/PCD: (40:59)
So that is the interval method you're describing, which is apparent checking at intervals meaning you go in for about a minute, use the minute to check in, but you're not feeding, you're not handling a bunch, it's just a quick check-in and then you leave after a minute no matter what state the baby's in. Yeah. I would, the hardest part of the method the leaving them after that minute. Yeah. It's not easy to do, but what tends to happen is they use the self-soothing that we just described, and by giving them a little space, they actually start to take over the job by getting themselves to sleep.
Keith Sutton, PsyD: (41:29)
Yeah. Remember we used to have to set the timer and like just force ourselves not to go back in. And then oftentimes by the time the timer went off, they would, the, the baby had fallen asleep. But it's hard. It's hard to listen to a baby crying and not wanting to run in and, and just, you know, relieve that suffering. Something that was interesting too, when my children were toddlers, was that I had read Alicia Lieberman's, The Emotional Life of the Toddler. And she talked about how sometimes children have to have their tantrum and go down to the depth of their emotions and come out. Sometimes you can give them a hug or you can soothe them out, but sometimes they just need to go through that process. And that later on learning about exposure therapy and cognitive behavioral therapy, that idea of actually sitting with that discomfort riding that wave, rather than like, “oh no, we have to prevent that discomfort at all costs”. It really starts from the sleeping, you know, and I imagine too in how families are responding to distress in the children.
Angelique Millette, PhD, CLE, CD/PCD: (42:30)
Oh, I, I would agree with you wholeheartedly. A whole area of my focus, especially with toddlers sleep, is really educating parents about that this is a feeling state for your little one. They're having feelings. This is not a reflection of poor parenting. It doesn't mean there's something wrong with your child. They're expressing feelings and then really buffering the parent and helping them with breathing and staying grounded during that cycle. It could last two minutes, it could last 10 minutes. But in fact that it's a healthy extinguish, it's like a healthy release for that one. And in fact it does help them to sleep. I don't know how much time we have to talk about the toddler approach that I use…
Keith Sutton, PsyD: (43:10)
We've got about like eight minutes or so. I would love to hear about that. We use a combination of like little rewards or like, you know, checking in every, “I'll be back in 10 minutes”. Oftentimes they'd fall back asleep before you or even timeouts of not sitting like, “okay, let's go” and then come on back and like resetting. But yeah, how do you do that?
Angelique Millette, PhD, CLE, CD/PCD: (43:30)
Well, so the, the toddler method I developed was largely informed by my work as a child psychologist. And my area of expertise was play therapy, sand tray and art therapy. Which basically means that you use these modalities to help little ones with feelings, events, traumatic events. And what I found was that generally speaking, even really young kiddos, toddlers weren't walled up, like adults were. They could play and they'd sort of work through emotions or their histories that way or their events that were traumatic. And what I did is I developed this two phase approach out of that work because the popular sleep method at that time was to just lock the door. Throw some reward at them, but lock the door and let them really, screen until they sleep. Mind you with a toddler that could get out of bed or climb out of a crib. Which to me, maybe after, you know, 2, 3, 4 hours they slept. But I saw this as a power struggle and I don't think they had learned anything. I was much more interested based on my work and the research, “how do we develop a sleep method that supports a secure attachment between the parent and the child?”. But as we do the method the parent separates still. There's still this limit setting separation piece. Because again, we understand that that's a big part over the arch of childhood, this separation. So a two phase approach. I start using it for little ones as young as eight to 10 months as they start to age out of those baby methods that I use somewhere around eight to 10 months of age. And then we're gonna call that the pre toddler stage into the toddler stage and then the child stage. The first stage of this approach, I teach parents very simple play based in storytelling activities. Because kids learn through play and through language they're primed for it. They're primed to understand their role through play and through language. Activities are very simple, they're easy to teach. I teach parents these little activities. They'll spend about 10 or 15 minutes a day doing them with their pre toddlers, toddlers and young kids. The theme of those activities is separation and sleep. For example, one game we have parents play is hide and seek. Very simple hide and seek seeker peekaboo in the child's room. Which as a parent, we think that's happening as a random act. It's not - your child is practicing separating and reuniting from you when they play that game. They're trying to hold the feeling of you, “oh, you're still there, I can't see you. Where'd you go? You're back! Thank goodness. You're, you're back.” So we have parents play those games. 50% of the children will spontaneously improve their sleep after one week of playing those games with their parents.
Keith Sutton, PsyD: (46:12)
Oh wow. Great.
Angelique Millette, PhD, CLE, CD/PCD: (46:13)
Which is just phenomenal to me. It's really shifting this paradigm again. So parents start to see the kids play as not random but purposeful.
Keith Sutton, PsyD: (46:23)
Yeah. They're building, they're working on skills or they're working through something or
Angelique Millette, PhD, CLE, CD/PCD: (46:27)
It's just integrating separation. Perhaps they've got a fear about the parent leaving. Perhaps something happened to make them scared about the parent leaving. Perhaps they've never slept alone, ever. So we wanna prepare them for that separation and the parent too, who may have a lot of anxiety about the separation for all kinds of reasons.
Keith Sutton, PsyD: (46:43)
Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (46:44)
So we do that 50% of the kids will improve sleep just simply from doing the play and the storytelling with them, which is amazing. And then the other 50% will start phase two. Phase two is a parent presence method called the ‘chair mattress method’. A parent presence methods, remember that parent presence means we're not just having the parent check on them and leave, check on them and leave. That would freak a toddler out. With this method, the parent actually moves into the child's room and sleeps on a mattress by the crib or the child's bed. We give the child what they want, which is the parent. What that does is it creates a positive feedback loop with the child's bed in the room as a safe place to sleep. And now the cortisol levels go down, the child feels safe to learn and safe to sleep. And then over the course of five to 10 nights, we move the parent a little further, a little further away. It's a slow fading of the parent presence in the room. Until parent gets to the doorway, then hallway and then parents back at their room. We're seeing phenomenal results with this. Especially five to 10 year olds who for all kinds of reasons have had sleep issues. They're not having hours long tantrums at bedtime or at night. Now parents can actually separate from them and have a little couple’s time, sleep, and actually get the sleep that they need at night. Those parents will say, “Gosh, I feel like I have a newborn again. My eight-year-old let me leave.” Now those parents can get their sleep, get some couples time and the child can separate and feel safe to separate at sleep time.
Keith Sutton, PsyD: (48:10)
Mm-hmm, great.
Angelique Millette, PhD, CLE, CD/PCD: (48:12)
It's a really dynamic approach. I am very proud of it because it just captures this whole other shift in the work. Stepping out of the paradigm of, again, that toddler that's manipulating the parent. Which I don't believe is true at all. It has much more credence on looking at “What is this little one feeling when they separate?” How do we buffer them in giving them skills to feel safe to separate from the parent that I feel are gonna be skill sets for life? They separate at kindergarten. They separate at play date, they separate when they go to college, they're now separating in a romantic relationship. How do they feel at that separation now?
Keith Sutton, PsyD: (48:49)
Yeah. Are they kind of holding that person still in their heart and feeling, you know, that kinda object, permanency or whatever it might be.
Angelique Millette, PhD, CLE, CD/PCD: (48:56)
That's right. That's right.
Keith Sutton, PsyD: (48:57)
Not experiencing that distress that this person is not there in separation. Also kind of building that muscle to feel that discomfort and kind of having that experience that, that it works out and it's okay. And, and so on
Angelique Millette, PhD, CLE, CD/PCD: (49:11)
A common response when they're doing the activities in phase one, the child might say, “I can't do this, or I scared” or throw the doll that we're doing this play therapy with. Or run out of the the room and I say to the parents not that they're gonna fail at, they're not telling you they are going to fail at sleep changes, they're saying to you, “I have feelings”. That's what we call resistance or emotions coming up. So then it's empowering the parents to say, “Hey, I see you understand what I'm talking about. You're talking about you and I not seeing each other at night.”
Keith Sutton, PsyD: (49:39)
Yeah.
Angelique Millette, PhD, CLE, CD/PCD: (49:40)
Yeah. I hold you in my heart right here and thank you for telling me how you feel about the changes. I'll hold it in my heart for you. I'll be right here to help you make these changes.
Keith Sutton, PsyD: (49:50)
Reminds me of a, what was that book? The Kissing Hand? You know, the toddler and the parent kissing their hand and then kind of being able to, you know, turn to it during the day when the parent's not there.
Angelique Millette, PhD, CLE, CD/PCD: (50:01)
That's it.
Keith Sutton, PsyD: (50:03)
Well this all is so great and interesting. I think it's such an important aspect and I think there's, you know, that that definitely it sounds like you're saying that a lot of people are getting maybe some education on their own beforehand, maybe even before needing to reach out and get the, the help or the consultation when the kind of crisis is happening. Do you have resources that you have of kind of, you know, preempting or is there a book or any trainings or workshops that you do for parents?
Angelique Millette, PhD, CLE, CD/PCD: (50:32)
What we have available are pre-recorded webinars. At a very affordable price. They're under $50. They're an hour long. They'll talk you through the program. Some families will utilize that alone. And they never work with me individually and they get great results. Some families will review that, they try it, but they still have additional questions and then they'll reach out to me for additional consultation and then I can really strategize to figure out where they're getting hung up with the method. The website is www.angeliquemillette.com. We are doing a fabulous website update. We'll roll that out late March and we'll have all sorts of additional resources there for parents to interact with. But for the time being, all those webinars are hanging out on that website and parents can purchase some there and access that information on a range of topics.
Keith Sutton, PsyD: (51:27)
Perfect. Well, I think this will be a great, you know, information for therapists that are helping families and also I think just again, thinking about attachment and kind of development as well as so many therapists are parents and going through this process themselves. So this is really helpful. I really appreciate you taking the time today. Thanks a lot.
Angelique Millette, PhD, CLE, CD/PCD: (51:47)
Oh, Keith, it was my pleasure. You can see I'm passionate about this topic and really like the opportunity to share it with you and other folks out there. Thanks for having me. I really appreciate it.
Keith Sutton, PsyD: (51:57)
Great. Thanks a lot. Take care. Bye-bye.
Angelique Millette, PhD, CLE, CD/PCD: (52:00)
Bye now.
Keith Sutton, PsyD: (52:01)
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